Page 116 - Reduction of coercive measures

Chapter 5
organization-wide changes might have had underscores the potential of an integrative approach. Empirical testing of synergetic effects of program components at different levels would require trials involve multiple care organizations.
During the intervention period, more coercive measures were recorded in the experimental group than in the control group. The intervention effect might thus be partly due to increased awareness and registration of the coercive measures that were actually used registered prior to and during the intervention period. This would be in line with findings of a study on explanation of an increase in registration after the implementations of a new law and regulations in Norway (Sondenaa, Dragsten, & Whittington, 2015). In order to separate the effects of the program through awareness raising and through altering care practices, the current study additionally tested the experimental effect on coercive measures that were already registered before consultation by the multidisciplinary expert team commenced. The program effectiveness was also statistically significant for this subset of coercive measures.
Several limitations should be mentioned. First, although the multidisciplinary approach had been developed prior to the study and the multi-disciplinary team had a sufficient number of complementary experts, running the multidisciplinary team required coordination, partly provided by the first author. Program effectiveness evaluation was therefore not independent from program implementation. Second, quantitative data on duration and frequency of application were missing from the registration. Because phasing out of coercive measures can also be done by reducing duration and frequency of their application, intervention effects might be underestimated. Third, the broad definition of coercive measures can lead to different interpretations of forms of measures. Despite close involvement of the expert team in registering coercive measures, this may still have affected the registration.
The present study demonstrated the effectiveness of a multidisciplinary approach for reducing coercive measures. These promising effects await replication across as well as within care organizations. Although the program was protocol-based and
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