Page 22 - Demo

Chapter 120As the field progressed, physicians specialised in treatment of clients with intellectual disabilities and behavioural specialists with a background in psychology and pedagogical studies1 were increasingly asked to guide and advise care staff on how to manage challenging behaviour, and to decrease the application of coercive and restrictive measures. Studies revealed negative and even dangerous consequences of coercion and restrictive measures for clients not only in the field of intellectual disability (Saloviita et al., 2016; Sturmey, 2009) but also in psychiatry and mental health care (Bonner et al., 2002). These developments contributed to increased awareness among care professionals concerning the use of coercion, restrictive measures, and physical or psychological punishment. However, these developments also led care staff to feel that %u201cnothing was allowed anymore%u201d, creating a sense of frustration as they believed that certain measures were sometimes adequate and necessary. First, measures may be needed to manage dangerous situations caused by challenging behaviour, to calm a client or to protect them from adverse influences from outside (Do%u0308renberg et al., 2018; Van der Meulen et al., 2018a; Wissink et al., 2019). Second, such measures may be needed to reduce care staff%u2019s own feelings of anxiety and distress when working with clients with severe challenging behaviour (Lambrechts et al., 2009).In 2006, the United Nations Convention on the Rights of Persons with Disabilities (CRPD) envisioned the importance of full participation of people with intellectual disabilities as equal, respected, valued, participating and contributing members of society (Luckasson et al., 2023; Nations, 2006; Schalock et al., 2022). The CRPD reflected a broader social and cultural transformation from collectivism to individualism in which the importance of being able to make decisions about one%u2019s own life became increasingly prominent (Santos et al., 2017). In care for people with intellectual disabilities, %u201dperson-centred care%u201d became the underpinning culture of organisations and care teams (McCormack et al., 2011). Nonetheless, the balance between maintaining safety and avoiding excessive use of restrictive measures 1%u2003 The behaviour specialists included not only psychologists focusing on treating clients%u2019 problem behaviour, but also %u201corthopedagogen%u201d with a background in family and educational studies, focusing on contextual determinants such as group dynamics in care homes and parenting and educational contexts that may contribute to the challenging behaviour in question and should be treated for that reason.