Page 104 - Reduction of coercive measures

Chapter 5
from single case experiments have unknown generalizability. It is difficult to know how often interventions fail to deliver the predicted results (as these may not have been published; Kilgus, Riley-Tillman, & Kratochwill, 2016), which factors may be important for success, and how stable intervention results are (Luiselli, 2009).
The second approach involves training support staff (Williams, 2010). Sanders (2009) combined staff training in alternative methods to prevent danger and injuries with direct support of team management. He reported a reduction of 99% in the use of physical restraints. Deveau and Leitch (2015) reported a reduction of 32% in restrictive physical interventions after holding restraint reduction meetings on physical restraint use in children residential services. While promising, the lack of experimental control means that it is uncertain whether the training changed the rate of reduction beyond attention to the subject or external factors (Williams, 2010).
The third approach involves multicomponent interventions aimed at residents, staff, and management. Schreiner et al. (2004) studied this approach in an inpatient unit treating adolescents with developmental delays and severe psychiatric disturbances. The intervention included thorough assessment of coercive measures used and comprehensive assessment of initiating and maintaining factors. Informed by these assessments, interventions focused on staff education, treatment interventions, and instigating collaboration between a multidisciplinary advisory committee and an interdisciplinary treatment team. During the intervention phase the use of seclusion declined with 35% and the use of mechanical restraints with 43%. Williams and Grosset (2011) studied implementation of a behavior management-based plan for organization wide reduction of mechanical restraint in a residential setting for people with ID. Direct instruction was used to implement obligatory deployment of behavior interventions plans and positive or corrective feedback to psychologist and support staff was given by the management coordination team. After 17 months a reduction of 80% and a doubling of behavior interventions plans were found. Neither study compared a behavior intervention group aimed at reduction to a control group in a randomized study, however.
102