1
|
Bakkum L, Bisschops EH, Lagerweij S, Schuengel C. Impact of the Care and Coercion Act on recorded involuntary care in intellectual disability care: a time-series analysis. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:1216-1226. [PMID: 36404437 DOI: 10.1111/jir.12991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/22/2022] [Accepted: 10/30/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND On 1 January 2020, the Care and Coercion Act came into effect in the Netherlands, subjecting involuntary care to more strict regulations and monitoring. This study tested changes in recordings of involuntary care during the transitional year of 2020 and after full implementation in 2021, which coincided with the first severe test of the new regulations, when COVID-19 lockdown measures were taken on 16 March 2020. METHODS Data consisted of weekly counts of involuntary care from 1 January 2017 to 31 December 2021, taken from the care data of more than 3000 clients with intellectual disabilities and challenging behaviour of 's Heeren Loo, a large long-term care organisation in the Netherlands. An interrupted time series design was used to compare the period under the former law with the period under the new law and to the period during and after implementation, taking into account the impact of the COVID-19 lockdown measures on recordings of involuntary care. RESULTS Under the new act in Week 1 of 2020, a statistically significant drop occurred in involuntary care counts, after which these counts gradually decreased. The start of 2021, the year in which the act was fully implemented, showed an initial increase in counts of involuntary care, followed by a decrease (all Ps < .001). The introduction of the COVID-19 lockdown measures did not statistically affect the weekly counts of involuntary care. CONCLUSIONS The decrease in registered involuntary care after the Care and Coercion Act came into effect is a first indication of the efficacy of this new law that requires careful multidisciplinary consultations around the right of clients to respect their self-determination. Follow-up research should examine whether the impact of the new law aligns with clients' experiences of self-determination.
Collapse
Affiliation(s)
- L Bakkum
- Department of Educational and Family Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - E H Bisschops
- Department of Educational and Family Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - S Lagerweij
- Department of Educational and Family Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - C Schuengel
- Department of Educational and Family Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
2
|
Tournier T. "Connectedness" between people with intellectual disabilities and challenging behaviour and support staff: Perceptions of psychologists and support staff. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023; 27:121-137. [PMID: 35086364 PMCID: PMC9941799 DOI: 10.1177/17446295211056820] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 06/14/2023]
Abstract
The tacit practical knowledge of psychologists and support staff to foster a real connection between support staff and people with intellectual disabilities and challenging behaviour was explored. Therefore, six dyads comprising individuals with intellectual disabilities and challenging behaviour and their support staff were video recorded during joint engagement in an activity. To tap into the implicit knowledge of professionals about when staff have 'a real connection' with a person with an intellectual disability, 10 psychologists and 10 support staff were asked to pinpoint these moments in the pre-recorded video compilation. They also shared their interpretations about what they considered to be a real connection. The results displayed that participants designated real connections as occurring when they noticed concrete interactions taking place. Based on thematic analysis of the data, four themes were identified that encapsulated what professionals deemed to be a real connection. In conclusion: joint engagement in an activity appears to be a context that fosters opportunities for real connection. Furthermore, support staff should adopt a sensitive attitude and create a safe atmosphere, to establish real connections.
Collapse
Affiliation(s)
- T Tournier
- T Tournier, Tranzo, Tilburg School of
Social and Behavioral Sciences, Tilburg University, P.O. Box 90153, Tilburg 5000
LE, The Netherlands.
| |
Collapse
|
3
|
Leif ES, Fox RA, Subban P, Sharma U. 'Stakeholders are almost always resistant': Australian behaviour support practitioners' perceptions of the barriers and enablers to reducing restrictive practices. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2023; 69:66-82. [PMID: 36743316 PMCID: PMC9897749 DOI: 10.1080/20473869.2022.2116908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/19/2022] [Accepted: 08/21/2022] [Indexed: 06/18/2023]
Abstract
A restrictive practice (RP) is defined as a practice or intervention that has the effect of restricting the rights or freedom of movement of a person, and includes physical, mechanical, and chemical restraint, and seclusion. If misused or overused, RPs may present serious human rights infringements. In Australia, behaviour support practitioners who deliver behaviour support funded by the National Disability Insurance Scheme are responsible for developing positive behaviour support plans that aim to reduce and eliminate the use of RPs. At present, little is known about the barriers that behaviour support practitioners experience when attempting to reduce and eliminate the use of RPs and, conversely, what helps (or enables) them to reduce and eliminate RPs. To learn more, we conducted an online survey consisting of two open-ended questions with 109 Australian behaviour support practitioners to identify barriers and enablers. We found that fear and reluctance on the part of stakeholders were often barriers to reducing the use of RPs. However, we found that having time, funding, and resources for training, supervision, other implementation activities, care team collaboration, and data-based decision-making helped overcome barriers. We provide specific recommendations for addressing identified barriers for individual behaviour support practitioners, service provider organisations, and government and regulatory agencies.
Collapse
Affiliation(s)
- Erin S. Leif
- Faculty of Education, Monash University, Clayton, VIC, Australia
| | - Russell A. Fox
- Faculty of Education, Monash University, Clayton, VIC, Australia
| | - Pearl Subban
- Faculty of Education, Monash University, Clayton, VIC, Australia
| | - Umesh Sharma
- Faculty of Education, Monash University, Clayton, VIC, Australia
| |
Collapse
|
4
|
Royston R, Naughton S, Hassiotis A, Jahoda A, Ali A, Chauhan U, Cooper SA, Kouroupa A, Steed L, Strydom A, Taggart L, Rapaport P. Complex interventions for aggressive challenging behaviour in adults with intellectual disability: A rapid realist review informed by multiple populations. PLoS One 2023; 18:e0285590. [PMID: 37200247 DOI: 10.1371/journal.pone.0285590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/27/2023] [Indexed: 05/20/2023] Open
Abstract
OBJECTIVES Approximately 10% of people with intellectual disability display aggressive challenging behaviour, usually due to unmet needs. There are a variety of interventions available, yet a scarcity of understanding about what mechanisms contribute to successful interventions. We explored how complex interventions for aggressive challenging behaviour work in practice and what works for whom by developing programme theories through contexts-mechanism-outcome configurations. METHODS This review followed modified rapid realist review methodology and RAMESES-II standards. Eligible papers reported on a range of population groups (intellectual disability, mental health, dementia, young people and adults) and settings (community and inpatient) to broaden the scope and available data for review. RESULTS Five databases and grey literature were searched and a total of 59 studies were included. We developed three overarching domains comprising of 11 contexts-mechanism-outcome configurations; 1. Working with the person displaying aggressive challenging behaviour, 2. Relationships and team focused approaches and 3. Sustaining and embedding facilitating factors at team and systems levels. Mechanisms underlying the successful application of interventions included improving understanding, addressing unmet need, developing positive skills, enhancing carer compassion, and boosting staff self-efficacy and motivation. CONCLUSION The review emphasises how interventions for aggressive challenging behaviour should be personalised and tailored to suit individual needs. Effective communication and trusting relationships between service users, carers, professionals, and within staff teams is essential to facilitate effective intervention delivery. Carer inclusion and service level buy-in supports the attainment of desired outcomes. Implications for policy, clinical practice and future directions are discussed. PROSPERO REGISTRATION NUMBER CRD42020203055.
Collapse
Affiliation(s)
- Rachel Royston
- Division of Psychiatry, University College London, London, United Kingdom
| | - Stephen Naughton
- Division of Psychiatry, University College London, London, United Kingdom
| | - Angela Hassiotis
- Division of Psychiatry, University College London, London, United Kingdom
| | - Andrew Jahoda
- School of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Afia Ali
- Division of Psychiatry, University College London, London, United Kingdom
| | - Umesh Chauhan
- School of Medicine, University of Central Lancashire, Lancashire, United Kingdom
| | - Sally-Ann Cooper
- School of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Athanasia Kouroupa
- Division of Psychiatry, University College London, London, United Kingdom
| | - Liz Steed
- Wolfson Institute of Population Health, Queen Mary, University of London, London, United Kingdom
| | - Andre Strydom
- Forensic & Neurodevelopmental Sciences, King's College London, London, United Kingdom
| | - Laurence Taggart
- School of Nursing and Paramedic Science, Ulster University, Northern Ireland, United Kingdom
| | - Penny Rapaport
- Division of Psychiatry, University College London, London, United Kingdom
| |
Collapse
|
5
|
Lokman S, van Oorsouw WMWJ, Didden R, Embregts PJCM. Setting up a new team of support staff for people with mild intellectual disability or borderline intellectual functioning and severe challenging behaviour: A concept mapping study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 35:1348-1359. [PMID: 35789034 PMCID: PMC9795899 DOI: 10.1111/jar.13023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 06/05/2022] [Accepted: 06/09/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Studies about teams of staff supporting people with intellectual disability have focused on team performance of existing teams. This study aimed to examine important factors in the process of setting up a new team of support staff. Specifically, we considered the process for a team that supports service users with mild intellectual disability or borderline intellectual functioning who display severe challenging behaviour from the orthopedagogical perspective (i.e., with a focus on contextual factors). METHOD Three participant groups (service users, support staff, and professionals supporting a team) participated in a concept mapping procedure, including generating statements in interviews and focus groups, sorting, and rating. An expert group interpreted the results. RESULTS Important factors to one or more groups were: service users and support staff getting acquainted early, team safety, social support, a shared vision, and a positive reputation of the new home. CONCLUSIONS Four core outcomes were addressed that may help service organisations to provide an environment matching the needs of service users who show severe challenging behaviour from the start.
Collapse
Affiliation(s)
- Suzanne Lokman
- Tranzo, Tilburg School of Social and Behavorial SciencesTilburg UniversityTilburgThe Netherlands
| | | | - Robert Didden
- Radboud UniversityBehavioural Science InstituteNijmegenThe Netherlands,TrajectumZwolleThe Netherlands
| | - Petri J. C. M. Embregts
- Tranzo, Tilburg School of Social and Behavorial SciencesTilburg UniversityTilburgThe Netherlands
| |
Collapse
|
6
|
An Exploratory Study among Intellectual Disability Physicians on the Care and Coercion Act and the Use of Psychotropic Drugs for Challenging Behaviour. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910240. [PMID: 34639540 PMCID: PMC8547136 DOI: 10.3390/ijerph181910240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/19/2021] [Accepted: 09/22/2021] [Indexed: 11/17/2022]
Abstract
The new Dutch Care and Coercion Act aims to better regulate the use of psychotropic drugs for challenging behaviour in people with an intellectual disability. This study explores experiences of intellectual disability physicians (IDPs) in prescribing psychotropic drugs and investigates how the Act and the new multidisciplinary guideline on challenging behaviour affects their practice. A qualitative study was conducted, consisting of nine semi-structured in-depth interviews with IDPs, followed by a thematic analysis. It was found that IDPs experienced the new Act and guideline as supportive of their work as guardians of the appropriate use of psychotropic drugs. The multidisciplinary character of the guideline was experienced positively. However, IDPs are faced with organisational barriers and time constraints, as such, they question the feasibility of implementing the Act. Based on these findings, it can be concluded that the Care and Coercion Act may support the existing shift towards the appropriate use of psychotropic drugs if required conditions can be met.
Collapse
|
7
|
Olivier‐Pijpers VC, Cramm JM, Landman W, Nieboer AP. A multiple case study investigating changes in organizations serving residents with intellectual disabilities and challenging behaviours. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:190-199. [PMID: 32939925 PMCID: PMC7821192 DOI: 10.1111/jar.12797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 08/06/2020] [Accepted: 08/12/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND the present authors examined changes made in disability service organizations supporting residents with intellectual disabilities and challenging behaviours, because these changes may influence residents' support and subsequently their challenging behaviours. METHOD In this multiple case study, the present authors collected and qualitatively analysed data (organizational documents, meetings records and focus group reports) on organizational changes made in two specialized Dutch disability service organizations, using ecological theory as a sensitizing framework and the constant comparative method. RESULTS Themes describing organizational changes in this context were as follows: a messy start to the transition; staff, professionals and managers remain at a distance; staff members' ability to change; clear boundaries between formal and informal caregivers; and staff's feelings of being unheard. CONCLUSIONS Organizational changes can enhance, but also limit, the quality of residential support services provided to people with intellectual disabilities and challenging behaviours. The change process and impact of organizational changes on residents must be examined closely.
Collapse
Affiliation(s)
- Vanessa Charissa Olivier‐Pijpers
- Centre for Consultation and ExpertiseUtrechtThe Netherlands
- Erasmus School of Health Policy and ManagementErasmus University RotterdamThe Netherlands
| | - Jane Murray Cramm
- Erasmus School of Health Policy and ManagementErasmus University RotterdamThe Netherlands
| | | | - Anna Petra Nieboer
- Erasmus School of Health Policy and ManagementErasmus University RotterdamThe Netherlands
| |
Collapse
|