Page 76 - Reduction of coercive measures

Chapter 4
Introduction
Coercive measures are common in care for people with intellectual disabilities (ID) (Fitton & Jones, 2018). Health care organizations are expected to resort to coercive measures only temporarily and only when risk is unacceptable and other means to avert this risk are exhausted (Deveau & Leitch, 2015; Romijn & Frederiks, 2012). Disproportionate and routine usage, when encountered, should therefore be actively reduced. Insight into the use of coercive measures is needed to make structural adjustments to the operation of health care providers and to formulate policies, laws, and regulations that prevent and reduce coercive measures (Romijn & Frederiks, 2012; Frederiks, Schippers, Huijs, & Steen, 2017; Chapter 3 of this dissertation). Such insight may include knowing the characteristics of persons with a disability who are confronted with coercive measures and characteristics of the situations in which these are applied (Emerson et al., 2000; Merineua- Côté & Morin, 2014; Sturmey, Lott, Laud, & Matson, 2005).
Currently, no comprehensive and integrated overview of the use of coercive measures and factors in long term care organizations exists (Lundström, Antonsson, Karlsson, & Graneheim, 2011; Merineua- Côté & Morin, 2014; Scheirs, Blok, Tolhoek, Aouat, & Glimmerveen, 2012; Sturmey, 2009; Webber, McVilly, & Chan, 2011). Information is limited because studies each focused on different subsets of coercive measures and factors (Matson & Boisjoli, 2009; Merineua-Côté & Morin, 2014; Webber, Richardson, & Lambrick, 2014). Also, definitions of coercive measures, and consequently recording of care practices as restrictive, may vary by setting and even by informant. Schippers, Frederiks, Van Nieuwenhuijzen, and Schuengel (2018; Chapter 2 of this dissertation) reported that only a subset of coercive measures could be recorded in routine care with sufficient reliability. Factors that have been found associated with coercive measures in single studies have seldom been replicated across studies. Moreover, their unique effects relative to factors found in other studies have not been tested, impeding the development of an integrative approach to coercive measures that takes into account factors at the level of individual residents and context.
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