Page 172 - Demo

Chapter 6170Multidisciplinary consultation in extreme cases of restrictive and coercive measures was also conducted under the old Special Admission Act. With the introduction of the CCA in 2020, multidisciplinary consultation has become a part of a step-by-step plan inserted within the CCA, also applied to minor cases of involuntary care. Although the MDET method is more thorough than the CCA step-by-step plan in detecting involuntary care and providing a broad range of advice including team interventions, both emphasise consultation of independent experts. The implementation of the CCA in 2020 (Bakkum et al., 2023) may have led to such a large reduction in involuntary care that, for the current study, there was a floor effect, resulting in fewer opportunities to reduce involuntary care compared to the time period of the study by Schippers (2019).Study limitations Covid-19 not only had consequences for the organisations performing MDET but also for the design of the study. At the start of the pandemic, the original randomised controlled stepped wedge design needed to be changed to a less robust quasi-experimental interrupted time-series design. Although both designs can offer valuable insights in evaluating interventions, the new design interfered with making a clear comparison between implementation and control groups especially when compared to the randomised controlled study by Schippers (2019). Care homes could decide if and when they were going to participate in implementing MDET, which resulted in an implementation group with various MDET implementation start dates and a mixed control group of care homes that had refused to participate in MDET and care homes to whom MDET had not been submitted for participation.The limited monitoring of recordings of involuntary care during the implementation of MDET was another limitation to this study. In the interviews, all MDET coordinators mentioned their uncertainty about whether recordings of involuntary care were updated at the beginning and end of the MDET. Because this was pointed out as a core component of the MDET method by its developers (Schippers et al., 2018) and the data for the current study depended on these recordings, this was a major limitation.