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Implementing MDET: Evaluating adaptations and effectiveness1696However, alternative explanations could also account for the differences in effectiveness between the study by Schippers (2019) and the current study, due to the limitations we encountered. These limitations include variations in socio-political context, such as the Covid-19 pandemic and the differences between the old Special Admission Act and the new Care and Coercion Act, organisational limitations and limitations in the study design.Socio-political and organisational limitationsThe Covid-19 pandemic was detrimental in implementing MDET. The initial response of participating care organisations was to cancel or suspend MDET, because the government restrictions to prevent infection risk made it difficult to implement the method. Moreover, some care professionals became ill, making organisations reluctant to put extra burden on the care team by implementing MDET. However, care organisations also realised the advantages of this time period to enhance attention to the adverse effects of involuntary care and restrictive measures on clients%u2019 well-being, now that everyone experienced these. Therefore, all organisations chose to proceed with the implementation of MDET. However, they avoided elements that could potentially lead to resistance among care professionals, such as insisting on updating involuntary care recordings and monitoring this. Another limitation may lie in the socio-political and organisational differences between the time periods of the previous and current study. During the study by Schippers (2015-2018) the old Special Admission Act was still in effect, which obligated care professionals to record all forms of restrictive measures even when clients consented. Moreover, in this time period the Board of directors of the organisation in which MDET was developed and tested felt an urgent need to change involuntary care and restrictive practices as they envisioned that people with complex care needs should have the freedom to self-determine their care and support. This vision created a fruitful context for change, which was strengthened by the preparations for the upcoming CCA, for which care professionals (including care staff, physicians, and psychologists) needed to transition to a new definition of involuntary care and a new way of evaluating care practices (Bij de Weg et al., 2021). Within this socio-political and organisational context MDET was developed and proven effective in reducing involuntary care. During the time period of the present study (2021-2023) this effect of transitioning may have been extinguished.