Page 108 - Demo

Chapter 4106To pursue Coherence, EPOC%u2019s implementation intervention Consensus Processes (CP) was used frequently. CP targeted 3 sub-constructs of Coherence: Communal Specification, Individual Specification and Internalization. Professionals involved in implementing MDET built a shared understanding of the aims and expected benefits of MDET, they explored their collective and individual tasks and responsibilities and they added value to the method by connecting it to their clients%u2019 needs. ClientRelated Interventions (CRI) in the form of analysed recordings of restrictive measures in client files was also an intervention to pursue Coherence. CRI added value and importance to the MDET method from a client%u2019s perspective (Internalization). Pursuing Coherence was also observed in the small circle of support staff around one specific client. Educational Outreach-Treatment interventions (EO-T) with step-by-step advices on how to reduce restrictive measures helped caregivers to understand their specific tasks (Individual Specification) and the benefits and purpose of MDET (Internalization).Within the social mechanism Collective Action seven of EPOC%u2019s implementation interventions were mapped on the interactional work that people do with each other to operationalise the MDET method in practice (Interactional workability): support staff discussed restrictive measures of residents in team meetings to seek consensus (CP) about which measures should be phased out first and in what way this should be operationalised (EO-T). To inform their decisions, they relied on the client%u2019s perspective (CRI), formulated by personal caregivers (LOL), but also on general knowledge about common background problems of people with intellectual disabilities (EO-G, DEM, EM). This general knowledge provided through Educational Outreach-General (EO-G) and Educational Meetings (EM) helped to build accountability and confidence in MDET and among support staff teams who were collectively in action to reduce restrictive measures (Relational integration). Cognitive Participation was initiated by EPOC%u2019s implementation interventions Consensus processes (CP) and Local Opinion Leaders (LOL). These interventions were used to drive the method forward (Initiation) and stay involved (Activation). Support staff teams needed to (re)-organise themselves and others to be able to build communal engagement