Page 50 - Demo

Chapter 248and behavioural problems. For this study, we included and combined data of clients who were granted intensive or very intensive support, care and behavioural regulation (the codes of ZZP 6 and 7 in the Dutch care allocation system), which is indicated for people with complex care needs, including intellectual disabilities and challenging behaviour. Intensive and very intensive forms of care are provided in groups of four to eight clients in specialised 24/7 sheltered care settings. The study protocol was approved by the ethical review board of the Vrije Universiteit Amsterdam (VCWE-2021-200).Data itemsDirect care staff and behavioural consultants involved in daily care and support for clients at %u2018s Heeren Loo are required to record involuntary care in a registration module. An earlier reliability study on these recordings within the same care organisation as in the current study found adequate reliability agreement (i.e. Cohen%u2019s kappa >.50) between support staff and trained observers concerning registration for 25 for the most common forms of involuntary care (out of 57 forms) (Schippers et al., 2018). The registration records the starting date and the form of the measure, for example, restriction on freedom of movement, administration of medication and restriction of visits or use of the telephone. For the purpose of this study, all forms of recordings were combined. Researchers and other interested parties may submit a request for accessing data from the Client Data Bank to the board of %u2018s Heeren Loo. After approval for the present study the data manager provided the data in the form of Excel tables with number of clients in care and counts of restrictive measures (before 2020) and recordings of involuntary care (since 2020) that were in place within each week based on the registrations for those clients. The time period included in this study covered 5 years: from week 1 of 2017 until week 52 of 2021. At the start of the reported period, the organisation had 3,086 clients in care, which gradually increased to 3,534 clients at the end of the study period.Statistical procedureWe conducted an interrupted time series analysis in R version 4.0.5 (R Core Team, 2021). In the first step, the data were prepared for analysis using