Page 21 - Demo

General introduction 191From the mid-1960s onward, there was a shift towards psychological and pedagogical professionalisation in care for people with intellectual disabilities, with an emphasis on learning theories and behaviour modification (Illeris, 2018; Wissink et al., 2019). Within this normalisation paradigm the aim was to teach people with intellectual disabilities and challenging behaviour in restrictive care settings to behave according to normal standards before they could move on to a less restrictive environment (Van Gennep, 1997). Within these care institutions, strict discipline by care staff was deemed acceptable. To maintain order, challenging behaviour of clients was not tolerated. For safety reasons and derived from the idea that punishment would lead to a decrease in undesirable behaviour, care staff resorted to coercive measures and physical interventions when clients displayed challenging behaviour. Unfortunately, these interventions often escalated into excessive physical and psychological violence against clients. This violent behaviour of care staff appeared to stem primarily from feelings of powerlessness, lack of experience and knowledge, understaffing, and an inability to effectively manage challenging situations (Wissink et al., 2019). In response to the dissatisfaction with the normalisation paradigm, in the 1980s and early 1990s intellectual disability care moved towards a more inclusive vision in which people with intellectual disabilities, just like anybody else, have the right to engage in communities (Van Gennep, 1997). In the late 1990s and 2000s this resulted in the shared citizenship paradigm (Luckasson et al., 2023; Schalock et al., 2022). Dutch care organisations were searching for more appropriate and effective care strategies to manage challenging behaviour, which led to the development of various regulations and legal frameworks, including the Special Admission Act in 1994 (BOPZ, 1994). This Act aimed to provide clarity on what was permissible in terms of coercive treatment and the use of restrictive measures. However, these attempts to establish clear rules often fell short due to inadequate support for implementation, and a lack of concrete practical guidance, leaving care staff and institutions struggling with the ethical and practical complexities of managing challenging behaviour effectively while respecting the rights and dignity of their clients. Moreover, care staff were initially trained in %u201chow to%u201d correctly apply coercive and restrictive measures instead of reducing these measures (Wissink et al., 2019).