As part of our efforts to share information and help support the elimination of restraints and seclusions, we want to shine a spotlight on individuals and organizations driving change. In this post, we are speaking with Veronica Federiconi, CEO of Autism Services, the only agency in Western New York that solely serves people with Autism. Veronica was also a featured speaker on our recent webinar, “On the Front Lines: How Comfort vs. Control Works in Practice.”
When did you start working in the Autism field?
I have always been interested in analyzing the underlying causes of behavior in children and adults with autism. I began working with children and adults with all abilities in the 1970s. I first encountered autism in children affected by the rubella epidemic, who also faced other challenges, in an institutional setting. They were non-sighted, non-hearing, were diagnosed at the severe end of the spectrum and exhibited extreme self-injurious behaviors and aggression. That was the start of my career in Autism and I have never left.
How has training changed over the years?
In my early years working in institutions, because it was run by psychiatrists and with a medical model, I received training in the administration of medication and use of camisoles. As time went on, the state required us to learn other, less restrictive approaches, and we were introduced to crisis management curriculums.
In addition to the proactive part of the curriculum, which helped us to identify the early signs of extreme behaviors, there was also a physical part of intervention. That was extremely difficult for me. It never felt right to put my hands on anyone. But, at the time, that was all that we were taught and certified to use.
Can you describe your personal experience, as a caregiver, in using restraint and seclusion?
The first time I had to physically intervene with someone, it was a very emotional experience. Afterward, I contacted the instructor, explaining that I did not feel okay with it. He said, “That is exactly how you should feel. You should never want to put your hands on anyone. You should always try to recognize early signs and be proactive.”
Since that time, I have been working to understand the impact the environment has on the behavior, learning, and comfort of individuals with Autism. My focus for the last 26 years has been building an environment that is engaging, supportive and comfortable. My mission and vision is serving this population without having to physically intervene.
What was your introduction to Ukeru?
I heard Kim Sanders speak at an Autism Society of America workshop several years ago. She was not speaking about Ukeru at that time, but rather how her organization was moving toward a culture of hands off, no restraints, no seclusion. My immediate reaction was: This is exactly what I want to happen. I want people to understand that it is never okay to put your hands on someone else. I want people with Autism to be more supported, comfortable and learn to be more in control of their own behavior.
I immediately talked with my team about what I had heard. We consulted with Kim and developed our own blocking curriculum called API, Alternatives to Personal Interventions, a term used for holds and restraints in managing behaviors.
Over time, I saw staff injuries, turnover and workers compensation steadily increasing. I decided to reach out once again to Kim and Grafton to see if she was experiencing the same challenges. She confirmed that they were and the result was the development of Ukeru.
How did you implement this program?
In July 2016, we invited Ukeru to present its “Train-the-Trainer” program in so that our staff could become certified. We then embarked on a complete Ukeru training program for every person and program in the agency. When we informed the state that we were embarking on this effort, they were very supportive. Now, everybody has been trained on and is using Ukeru.
Can you share an example of success?
We started the program with one of our most challenging adult gentleman; someone who was in a four person, supine hold for four out of a six hour day. We knew that if Ukeru could work for this person, we would be able to make it work for anyone.
We began by determining the environments and activities that were of most interest to him and the staff whom he preferred. We had to be very patient and very consistent. There were intermittent bursts, but over time he realized that, not only could he get attention and physical sensory input in other ways, he could also have control over his life. Now, restraints are no longer necessary for him.
How has the staff responded to the implementation of Ukeru?
The feedback is very positive. At every training, we solicit feedback and, in response, hear how easy staff find the Ukeru blocking materials to use. Additionally, they appreciate that we are introducing the materials to our children and adults in a respectful, non-threatening manner.
How do you respond to those who say that eliminating restraints entirely puts caregivers and others at increased risk?
I would let the data speak for itself. Since we introduced this initiative, staff injuries are down considerably as are our workers compensation claims. We are using more Ukeru techniques and less physical restraints.
I would also point to the achievements of those served by our agency: People who, in the past, could not move from one room to the next without challenges are now out in the community, working and engaging in meaningful activities of interest. People who used to require several staff for assistance at all times are now walking around with little to no risk of harm to themselves or others, with minimal staff supports.
At Autism Services, we are so grateful for Ukeru’s trauma-informed care training. It fits perfectly with where we are progressing as an organization. We hope to someday create an environment where our children and adults move about freely.
