Page 20 - Reduction of coercive measures

Chapter 1
were not identified (Williams, 2010). Some approaches combine the above methods with an intervention focusing on the organization (Schreiner et al., 2004; Williams, 2010; Williams & Grosset, 2011). Within these multicomponent approach structural interventions focuses on multiple levels simultaneously. Interventions at the level of residents involve individual treatment, interventions at the level of the teams which provide direct care includes training of professionals, and interventions at the level of organizations are characterized by policies and regulations on the reduction of coercive measures (Schreiner et al., 2004; Williams & Grosset, 2011). Results from studies of the effects of these interventions are promising. However, sample sizes were small and studies were mostly conducted using an A-B design, showing weak control for internal validity.
Despite these encouraging initiatives and results, clients and support staff members continue to be confronted regularly with coercive measures (Fitton & Jones, 2018; Heyvaert et al., 2015). To change care practices, researchers have recommended to intervene at multiple interlocking systems levels (Huckshorn 2004; Luiselli, 2009; Schreiner et al., 2004; Williams & Grosset, 2011). It is unclear how feasible it is to modify ingrained patterns, which include or lead to the use of coercive measures, in professional care for people with disabilities. From the perspective of Normalization Process Theory (May, Johnson, & Finch, 2016), the patterns that need to be changed involve several interrelated practices of people working together, such as support staff, residents and professionals. Patterns of action are formed, are reinforced, and continue to exist within these interactions. It is as yet unclear to what extent effects of interventions focused on single interactions or problems can be extended to a complex of interactions involving multiple residents and units. To be effective a multidisciplinary approach is needed which intervenes at multiple levels, including changing the policy and management of the healthcare organization, training support staff, and intervening with individual residents. This study focuses on the use and reduction of coercive measures in residential care within a Dutch health care organization with national coverage, using a multilevel systems approach.
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