Page 127 - Reduction of coercive measures

Summary of main findings
Reliability and feasibility of full registration of coercive measures applied in daily care for people with intellectual disabilities. Quantitative data on the use of coercive measures within care organizations provide starting points for reducing coercive measures use (Huckshorn, 2004; Romijn & Frederiks, 2012). Data provide insight into usage patterns of coercive measures and risk factors, helping to design interventions for reduction (Huckshorn, 2004). However, the field of practice uses a wide variety of often incompatible instruments that operationalize diverging and sometimes unclear definitions (Romijn & Frederiks, 2012). Standardized lists and criteria could lead to reliable and comprehensive registration of the use of coercive measures (Huckshorn, 2004; Matson & Boisjoli, 2009; Webber, McVilly, & Chan, 2011).
Chapter two examined whether registration of the use of coercive measures can be standardized and leads to reliable data, taking into account the context and purpose of the potential coercive measure. Reliability of daily registrations of support staff members was tested against registrations of independent observers and informants and results were validated by a panel of stakeholders. Using a flexible research design (Dellinger & Leech, 2007), the study aimed towards optimization of a registration system that was both reliable and meaningful and would therefore have the greatest chance of successful implementation. Reliability was tested comparing routine registration by care staff to registration on selected days by trained observers as well as other members of the care staff team. The success of implementation of the routine registration system was tested by comparing registration of coercive measures to file records of residents.
Results show reliable registrations for 25 out of 57 types of coercieve measures. The study made clear that despite standardized definitions for each coercive measure (Matson & Boisjoli, 2009; Williams, 2010), registration that covers the broad definition of coercive measures is due to yield unreliable and variable prevalence outcomes. Reflections of stakeholders on unreliable outcomes yielded
General discussion
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