Successful Reduction of Involuntary Care Requires Attention to Implementation
Behavioral scientist Esther Bisschops, affiliated with ’s Heeren Loo and Vrije Universiteit Amsterdam, investigated the implementation of a law aimed at reducing involuntary care in residential facilities for clients with challenging behavior. She also examined the application of two existing methods designed to minimize involuntary care. Her research found that the number of involuntary care registrations decreased following the introduction of the law and identified factors that hinder implementation as well as strategies to support it.
The Law on Care and Coercion (2020) mandates the reduction of involuntary care in supporting individuals with intellectual disabilities, except in cases of severe risks, such as danger. Involuntary care refers to interventions resisted by the client, such as seclusion, restraint, or supervision.
Bisschops’ research focused on the implementation of this law in residential facilities for clients with challenging behavior. “After the implementation of the Law on Care and Coercion, registrations of involuntary care decreased in residential facilities. This indicates successful implementation of the law,” explains Bisschops.
Bisschops also studied the implementation of two specific methods aimed at reducing involuntary care:
- The Decision Framework (Wegingskader): An e-tool that incorporates the client’s perspective in decisions regarding involuntary care.
- The Multidisciplinary Expertise Team (MDET): A method where care teams receive guidance on reducing involuntary care.
Bisschops identified several challenges to implementing these methods:
- Caregiver concerns: Fear, dilemmas regarding quality of care, and feelings of overload and stress.
- Organizational issues: Lack of clear implementation plans and uncertainty in selecting appropriate methods.
The study highlighted strategies that can facilitate implementation, including:
- Consensus-building processes.
- Leadership by opinion leaders.
- Client-focused interventions.
Collaborating in Communities of Practice (CoPs) also showed promise. In CoPs, policymakers, behavioral scientists, managers, experts by experience, and caregivers exchange knowledge and experiences about the methods and their implementation. “Collaborating in a Community of Practice to develop implementation plans for the Decision Framework was appreciated, but it did not guarantee successful implementation,” says Bisschops.
Bisschops observed that care organizations modified the MDET method during implementation to better fit their contexts. However, these adjustments often reduced the method’s effectiveness.
The research underscores the importance of thorough planning, design, and execution in the implementation of the Decision Framework and MDET to achieve the intended reduction in involuntary care.
“Organizations must consider barriers at both the caregiver and organizational levels,” Bisschops emphasizes. Communities of Practice can help organizations develop effective implementation plans and provide insights into suitable strategies. Active involvement of caregivers and clients appears to be particularly effective in implementation processes.
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