Page 26 - Reduction of coercive measures

Summary and general discussion
General conclusion
The dissertation contributes to the realization of the right to self- determination for people with intellectual disabilities in daily care practice. By means of a systematic registration more understanding has been gained on the use of coercive measures in residential care for people with intellectual disabilities and its main predictors. Also, the effect of a multi-component approach on the reduction of coercive measures were demonstrated. Thereby, the study led to both an important contribution to scientific knowledge and a direct change in healthcare practice.
The broad interpretation of coercive measures was converted into an overview of standardized measures. Findings concerning reliability of daily registration showed a subset of coercive measures that were recorded with reasonable reliability, and that could provide the basis for routine registration of the use of coercive measures. This registration can be used to improve care and protect the rights of persons with intellectual disabilities, which is in accordance with the objectives of the upcoming Care and Coercion Act. Experts reflected on the criteria set by the regulator and emphasized the importance of a clear definition and criteria on the statutory registration obligation. Subsequently, due to this systematic obtained information on coercive measures concerning a large sample it was possible to determine a comprehensive and integrated overview of a set of resident and support staff related factors and the overall use of coercive measures as defined in its broadest way, and divided into measures that serve a protective function against direct and indirect danger. A low level of communication determined the overall use of coercive measures. Challenging behavior was found to predict the use of coercive measures which are applied to prevent from direct, unforeseen, high risk danger and measures used to prevent from indirect, not acute, danger. Finally, a multidisciplinary intervention program can accelerate the reduction of coercive measures at care units of residential care for people with intellectual disabilities.
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