Page 21 - Reduction of coercive measures

Dissertation outline
The dissertation describes in the different chapters the use of and reduction of coercive measures in one large care organization for people with intellectual disabilities.
The second chapter describes to what extent a comprehensive daily registration of coercive measures being applied is reliable and feasible. Reliability of registrations of a standardized list of coercive measures of 269 residents living in 55 units was tested against trained observers and informants. Results were validated by a panel of stakeholders. In addition, the implementation of a mandatory routine registration system was investigated by comparing registration of coercive measures to residents’ care records.
Within the framework of the new Dutch Care and Coercion Act that enters into force in 2020 and that emphasizes, among other things, the registration of coercive measures by care organizations, the third chapter sets out a qualitative study into the registration of coercive measures on the basis of legal requirements of the Care and Coercion Act. Reflections from experts and the field of practice regarding correctness, feasibility, and significance for the legal protection of people with intellectual disabilities are described.
With data on the use of coercive measures resulting from the registrations by support staff, the fourth chapter examines if the factors challenging behavior, communicative adaptive behavior, attachment behavior, support staff’s attributions, and self-efficacy were associated with the use of coercive measures concerning 209 residents living in 41 units.
Finally, the available information on the use of coercive measures provided input for an efficacy study described in the fifth chapter. The efficacy of a multi component program on the reduction of coercive measures applied to 107 residents living in 41 units was studied. The program focused on increasing awareness and registration at the organizational level, multidisciplinary consulting at the residential care unit level, and multidisciplinary intervention at the resident level.
General introduction
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