Page 26 - Reduction of coercive measures

Chapter 2
Introduction
The use of coercive measures in care for people with Intellectual Disabilities (ID) has come under intensified scrutiny. Not only is the effectiveness of coercive measures against risky behavior called into question (Harris, 1996), their use also runs counter to important values, such as respect for self-determination and human rights (Chan, LeBel, & Webber, 2012; Heyvaert, Saenen, Maes, & Onghena, 2014). An important expression of consensus about this is the UN convention of human rights for people with disabilities, which prescribes and elaborates respect for self-determination (United Nations, 2006). Policies in several countries now emphasize the use of coercive measures only as a last resort to prevent persons with ID harming themselves or others. Romijn and Frederiks (2012) have pointed at gaps between policy and practice. Given that policies in several countries still allow coercive measures use in care for people with ID (Gaskin, McVilly, & McGillivray, 2013; Matson & Boisjoli, 2009), describing the prevalence may help to identify the areas and settings that would require more support in finding alternatives (Huckshorn, 2004; Romijn & Frederiks, 2012). However, prevalence estimates vary widely (Romijn & Frederiks, 2012), probably due to practical and definitional issues (Frederiks, Schippers, Huijs, & Steen, 2017; Chapter 3 of this dissertation). The effects of changes in policy and practice are therefore hard to assess and it is difficult to know how practice can be supported better (Huckshorn, 2004).
In the Netherlands the Health Care Inspectorate (Dutch Health Care Inspectorate, 2008) insists on full registration of coercive measures, in their broadest definition of every measure that is restrictive in a specific situation (Frederiks et al., 2017). The proposal for the upcoming Care and Coercion Act (Staatsblad, 2018, 36) makes such registration obligatory. In the absence of evidence based national guidelines for reliable registrations, the field employs a wide variety of often incomparable instruments that operationalize the broad definitions in laws and regulations. Research on reliability and feasibility of a full registration of coercive measures use in 24-hour care by support staff members and professionals might therefore
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