Page 16 - Reduction of coercive measures

Chapter 1
Reliable registration of coercive measures opens up opportunities to study associated factors. In combination, incidence rates and associated factors can guide efforts towards reduction (Huckshorn, 2004) and help to set priorities. Coercive measures are often applied to avert dangerous situations arising from challenging behavior by residents (Heyvaert, Saenen, Maes, & Onghena, 2015). However, associations between challenging behavior and coercive measures are inconsistent (Lundström, Antonsson, Karlsson, & Graneheim, 2011; Scheirs et al., 2012). This may be explained by some studies choosing to focus only to those restraints used for responding to challenging behavior (McGill, Murphy, & Kelly-Pike, 2009; Scheir, Blok, Tolhoek, Aouat, & Glimmerveen, 2012) while others take a broader approach. In addition to challenging behavior, other resident related factors, such as an autistic spectrum disorder, gender, age, and speech impairments (Lundström et al., 2011; McGill et al., 2009) are also associated with the application of coercive measures. In addition to these static factors, complex dynamic interactions between support staff members and residents are also bound to determine application of coercive measures. Therefore, the application, and also the reduction, of coercive measures depend on an interactive set of factors at different levels. Not only challenging or otherwise risky behavior will lead to coercive measures, but also the care context with direct care staff and other managing and specialist staff are bound to be important.
Rights and law and regulations
The right to self-determination is codified in the UN Convention on the Rights of Persons with Disabilities (United Nations, 2006), which indicates that the ultimate outcome of support is autonomy and independence. Autonomy refers to making one’s own choices and shaping one’s own life. However, the convention indicates that there is a close relationship between autonomy and support. Autonomy is determined by the capabilities of the person with a disability and can only be achieved if a person has an unreserved right to good care (Frederiks, 2007). It turns out that in several countries this right is guaranteed in legislation by means of the ultimum remedium principle (Deveau & McDonell, 2009; Romijn & Frederiks, 2012), meaning
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