Page 125 - Reduction of coercive measures

The main purpose of this dissertation was to contribute to a better understanding of how coercive measures are used in the care for people with intellectual disabilities. Previous work has suggested that coercive measures are regularly used in professional care (Fitton & Jones, 2018; Romijn & Frederiks, 2012;). However, systematic evidence on how often coercive measures are used is scarce (Fitton & Jones, 2018). Evidence for the effectiveness of interventions at the level of care organizations to reduce the use of coercive measures is scarcer still (Schreiner, Crafton, & Sevin, 2004; Williams, 2011). The studies in this dissertation addressed these gaps by recording how often coercive measures were used in daily practice, by testing how using these coercive measures was associated with characteristics of residents, professional carers, and settings, and by conducting an effectiveness trial of a multidisciplinary program for reducing coercive measures in residential care for people with intellectual disabilities. The studies were conducted in the Netherlands and took place in parallel with a social and political debate concerning the right of self-determination of people with intellectual disabilities. In the dissertation features of the Dutch legal framework for the use of coercive measures have been highlighted, specifically with regard to the criteria for the daily registration of coercive measures.
The studies in this dissertation used a broad definition of coercive measures as any measure that is restrictive for the resident in a specific situation (Dörenberg et al., 2018; Romijn & Frederiks, 2012). This broad definition covers a wide range of practices, including but not limited to practices defined in the current and future Dutch laws. The upcoming law focuses on ‘resistance’ to care by the person with the intellectual disability or his or her legal representative (Steen, De Schipper, & Frederiks, 2016). Chapter two showed that a reliable registration of coercive measures under a broad definition is only partly feasible. Chapter three discussed the importance of a clear definition and standard formulated measures as part of the mandatory registration in the legal framework. Chapter four reported on a negative association that was found between the resident related factor level of communicative and social functioning and coercive measures. Aggressive and destructive behaviour as well as self-
General discussion
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