Page 19 - Reduction of coercive measures

In addition to best practice examples, some evidence-based knowledge is available. The body of scientific knowledge can be subdivided into roughly three approaches. The first approach finds solutions for individual residents for the reduction of coercive measures, the second approach is aimed at teaching the team of support staff members to deal with risky and challenging behavior without using coercive measures, and the third approach is an organization-wide approach in which interventions are made within the various organizational units in order to structurally and systematically reduce coercive measures.
In the first approach, risky challenging behavior is often addressed by means of a behavioral interventions, for example by using behavior modification techniques (Williams, 2010). An overview of studies (Williams, 2010) shows positive results in which residents are taught behaviors as an alternative to risky behaviors, eliminating the need for coercive measures. It is also known that coercive measures themselves can provoke and reinforce risky behavior (Matson & Boisjoli, 2009). By means of training alternative behavior and planned reduction of coercive measures, the vicious cycle of behavior and coercive measures can be broken. The results are encouraging (Williams, 2010), even though, however, the sample sizes have been small and it is therefore unclear to what extent results are generalizable. It is difficult to know how often interventions do not deliver the expected results (these may not have been published; Kilgus, Riley-Tillman, & Kratochwill, 2016), what factors contribute to the success of the intervention, and how long the result will last (Luiselli, 2009).
In addition, methods are used to intervene at the level of support staff. These are often varied training courses in which, for example, the team is taught about psychopathology that underlies certain behavior or about dealing with problem behavior by means of techniques in which they reflect on their own behavior (Williams, 2010). Training support staff is common practice in healthcare organizations. Studies (Schreiner et al.,2004; Williams, 2010; Williams & Grosset, 2011) show encouraging results. However, studies often were limited as there was no control group, and possible success factors
General introduction
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