Page 78 - Reduction of coercive measures

Chapter 4
Another resident-related factor is the level of communicative and social functioning, which are almost by definition impaired in people with lower adaptive functioning (Emerson 2000; Lundström et al., 2011; Scheirs et al., 2012). Several studies (Knotter, Wissink, Moonen, Stams, & Jansen, 2013; Lundström et al., 2011) suggest that misunderstanding of residents’ behaviors by staff might lead to responses that thwart residents’ intentions and wishes. Given the power differential between residents and staff, such misunderstandings may lead to practices that are coercive from the perspective of the resident. A study by Scheirs et al. (2012) confirms this suggestion by showing a significant association between the use of coercive measures and the combination of social withdrawal and maladaptive behavior. In addition, other studies (Chan, Webber, & Hayward, 2013; McGill et al., 2009; Rosenberg et al., 2010) showed that persons with ID and autistic spectrum disorder (ASD) were more likely to be exposed to coercive measures than other persons with ID. For example, challenging behavior may be more often responded to with communication rather than coercion. Studying the highly interrelated CB and social and communicative adaptive functioning alongside each other may offer insight in the potential for compensatory effects.
Underlying both challenging behaviors and social and communicative functioning may be the regulation of stress that is afforded by the relationships between residents and caregivers. The attachment system, in which seeking security or help in another person is understood as a way of handling stress, may not be adapted to an unstable context with many professional caregivers and high turnover (Janssen, Schuengel, & Stolk, 2002). De Schipper and Schuengel (2010) found that young persons who presented more attachment behavior towards support staff showed less irritable, lethargic, and stereotyped behavior than persons who presented less attachment behavior. The association between attachment and the use of coercive measures emerged in a study on a two-phased therapy. A reduction of the use of arm restraints was found during the attachment based phase of a therapy on a person with a severe ID, visual impairment and CB (Sterkenburg, Janssen, & Schuengel 2008). Attachment behavior facilitates the social regulation of stress
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