Page 92 - Reduction of coercive measures

Chapter 4
Conclusion and discussion
Overall, previously identified predictors at resident and staff level offered scant explanation of coercive measures applied in residential care. Only challenging behavior was found associated with coercive measures to prevent from direct danger and social adaptive functioning and staff attribution with regard to the stability of challenging behaviour was associated with the total of coercive measures applied. The resident factors remained uniquely predictive when accounting for other resident factors. In addition, staff’s attribution regarding stability of challenging behavior was not predictive when accounting for other staff factors. Overall, 61 different types of coercive measures were recorded among the 209 residents, with residents on average experiencing 3.23 coercive measures at any given point. The findings underline expectations in the field that coercive measures are widely used (e.g., Romijn & Frederiks, 2012).
While findings for challenging behavior and social adaptive functioning were in line with previous reports (Fitton & Jones, 2018; Knotter et al., 2013, Lundström et al., 2012), the results for the other factors stand in contrast. Variation of the use of coercive measures across units was only partly explained by characteristics such as attributions by staff on the causes of CB and self-efficacy in handling CB of support staff, in contrast to earlier findings (Hastings & Brown, 2002; Knotter et al 2013; Meehan et al., 2000; Mérineau-Côté & Morin, 2014). Zijlmans et al. (2012) suggested that support staff behavior is best seen as a response to a complicated and constantly changing context. The effect for attribution with regard to the stability of the cause of challenging behavior, uncorrected for other factors, is therefore unlikely to reflect the full extent of staff factors in coercive care. Therefore, longitudinal and intervention studies may be needed to uncover the circumstances under which staff characteristics do and do not play a role. Also, Willner and Smith (2008) in their review showed inconsistent results of studies on Weiner’s attribution theory and helping behavior of support staff. Given the weak associations between challenging behavior and coercive measures, perhaps more complex models are needed to describe the role that attributions and
90