Page 103 - Reduction of coercive measures

Multidisciplinary reduction of coercive measures
Introduction
Coercive measures in long-term care for people with intellectual disabilities (ID) are widely seen as undesirable (United Nations, 2006). The systematic elimination and reduction of coercive measures are accepted as a standard for good care in many countries (Deveau & McDonell, 2009; Frederiks, Schippers, Huijs, & Steen, 2017; Chapter 3 of this dissertation, Schreiner, Crafton, & Sevin 2014; Singh et al., 2009). Little is known about the effects of actions that care organizations may take to reduce coercive measures towards their residents (Williams, 2010; Williams & Grosset, 2011). Given the multi-determined nature of coercive care, a multidisciplinary approach would be most likely to succeed. This study tested the effect of a multidisciplinary expert team for supporting staff in residential care units to reduce coercive measures for people with ID.
Definitions of coercive measures vary with context and historical period. In the Netherlands, restraints are currently broadly defined as every measure in a specific situation that is restrictive, which is reflected within regulations set by the Dutch Health Care Inspectorate and the upcoming Care and Coercive Act within the Netherlands (Frederiks et al., 2017). Definitional differences therefore need to be held in mind when comparing and evaluating methods to reduce coercive measures and their effects. The knowledge base on methods to reduce coercive measures has coalesced around three approaches.
The first approach strives to replace coercive measures using Applied Behavior Analysis (ABA) (Williams, 2010). ABA is based on the assumption that behavior serves specific functions bound to individuals and their contexts. ABA reveals antecedent and consequent conditions that cause and maintain particular behavior, such as harmful risk behavior. Studies using ABA have revealed that coercive measures may in themselves reinforce the target behavior, leading to chronic and recurrent risk behavior and coercion (Matson & Boisjoli, 2009). Behavior modification trains low risk alternatives for high risk behavior while removing reinforcement of high risk behavior by coercive measures. While a review of research showed positive results (Williams, 2010), sample sizes have been small and results
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