Page 189 - Demo

General discussion1877These MDET results stand in contrast with the effect that Schippers (2019) found in the randomised controlled trail for MDET. The adaptations to MDET may be a possible explanation for the differences in results. Although it is known that the plasticity of innovations could contribute to the ease of implementing these innovations in care organisations (May et al., 2016), the results of the study described in Chapter 6 might mean that when care organisations are free to adapt methods while implementing these, actual changes in daily practice may not occur. With less required change in work routines, also referred to as low elasticity (May et al., 2016), there may be concomitant weaker change in practices around involuntary care. However, another possible explanation for these differences in results might relate to timing. The Special Admission Act (BOPZ, 1994) was in effect during Schippers%u2019 RCT, and the new CCA (Staatsblad, 2018) was in effect during the current trial. The introduction of the CCA drew considerable attention to reducing restrictive measures and involuntary care. Because the definition of involuntary care changed, also the recordings of involuntary care in care plans changed. In addition, the CCA incorporated a step-by-step plan for care professionals to follow to minimise involuntary care, including mandatory multi-disciplinary consultations. As a result, the difference between care in the MDET condition and care as usual might have been smaller than in the earlier trial of Schippers (2019).Limitations and implications for future researchSeveral limitations should be taken into account when interpreting the results of the five studies within this dissertation. Concerning the study in Chapter 2 it must first be noted that the administrative data of involuntary care recordings were collected in only one care organisation, which limits the generalisability of the findings. Other organisations might have introduced the CCA with alternative internal policy advices, which could have led to different results. Second, a limitation of this study is that only the total number of involuntary care recordings were examined, which made it impossible to draw conclusions about which forms of involuntary care were reduced. The initial decrease of involuntary care recordings could be caused by clients%u2019 consent to use specific measures, which could