Page 108 - Reduction of coercive measures
P. 108

                                Chapter 5
(2), behavioral therapist (2), physicians (2), physical therapists (2), occupational therapists (1), video feedback trainers (4), manager (1), resident representative (1) and a coordinator (1). Type and number of experts were determined on the basis of the research literature on reduction of coercive measures (see Introduction) and interviews with candidate members. All experts were employed at the organization in which the study was conducted.
Consultation plan
The work plan of the multidisciplinary expert team included making an inventory of the coercive measures and their possible causes, and developing a treatment plan for reduction. Both the inventory of coercive measures and the treatment plan were included in the consultation plan.
The inventory of coercive measures was based on the information from the registration system for coercive measures, the residents’ digital personal file, and in several cases additional information from support staff or professionals. The overview of coercive measures was set up by a member of the multidisciplinary expert team. For each coercive measure, hypothesized causes (such as antecedent and consequent conditions) were listed. The treatment plans were based on these hypotheses, following principles of evidence based practice where plans were informed by research evidence on effective practices, experts’ experiences and insights, and preferences of residents, family member, and care staff. For example, a treatment plan could be developed based on the evidence based method of Applied Behaviour Analysis. Its goals would be to assess and modify risky or harmful behavior of the resident within the care context. Another example relates to attachment-based interventions. The stress-attachment model of challenging behavior (Schuengel & Janssen, 2006) points towards the important role of the attachment behavioral system to regulate stress, and therefore points towards relationship-focused interventions, such as video-feedback to promote adaptive regulation of perceived stressors (Schuengel, De Schipper, Sterkenburg, & Kef, 2013). Other elements of consultation plans derived from best practice experience gained by members
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