Applying Restrictive Measures in the Care of Adolescents With Mild Intellectual Disabilities: Attitudes of Support Staff and Policy Implications

Abstract

Research suggests that restrictive measures are widely used on adolescents with mild intellectual disabilities. In the Netherlands, restrictive measures are defined as all measures that limit the freedom of a person. In most countries, legislation and policies that seek to reduce the use of restrictive measures focus on seclusion and mechanical and physical restraints. The study aimed to investigate the extent to which restrictive practices are used in the care of adolescents with mild intellectual disabilities while also exploring the attitudes of support staff toward these interventions. A survey study was done among a nationally representative Dutch research sample consisting of support staff. A structured questionnaire was completed by 195 staff members (response of 68.7%) working in settings providing care for people with intellectual disabilities. The measures generally used by staff members who work with adolescents with mild intellectual disabilities involved restricting the freedom of movement and so‐called social restrictions (such as limiting the use of mobile phones). Nearly all respondents considered restrictive measures to be justified in the case of danger, physical aggression, or sexually abusive behavior (87.8–96.8%). Frequently mentioned reasons for using restrictive measures were averting or avoiding danger (90.4 and 83.0%, respectively) and calming the adolescent (63.8%). Although seclusion and mechanical and physical restraints were generally considered most intrusive, staff members were aware that social restrictions could also be instrusive. The fact that current policies do not address these measures makes support staff question the lawfulness of their actions. As well as staff training to reduce the use of restrictive measures, rules, and legislation are also needed to clarify the options and limits to using such measures in the professional care of adolescents with mild intellectual disabilities.

Reliability and Feasibility of Systematic Registration of Coercive Measures in Care for People With Intellectual Disabilities

“…Therefore, a list of 57 coercive measures was developed, based on studies on coercive measures (Dörenberg et al, ; Matson & Boisjoli, ; Williams, ), reports of the Inspectie voor de Gezondheidszorg () and input from the coercive measure committees of the health care organization, who monitor and improve quality of care concerning the use of coercive measures. Coercive measure was defined as every measure that is restrictive in a specific situation, which was in accordance with the Dutch Healthcare Inspectorate and the Care and Coercion Act (2013).…”

Restraint interventions in people with moderate to profound intellectual disabilities: Perspectives of support staff and family members

“…Some insightful studies have addressed the way individuals with ID experience RIs (e.g., Brown & Beail, ; Fish & Culshaw, ; Jones & Stenfert Kroese, ). In general, people with ID (mostly people with mild ID) receiving RIs experience these interventions negatively (Dörenberg et al., ; Heyvaert, Saenen, Maes, & Onghena, ). When confronted with RIs, they report, among other things, negative emotions such as fear, stress, anger, anxiety, sadness, a lack of respect towards staff members (e.g., Fish & Culshaw, ; Hawkins, Allen, & Jenkins, ; Jones & Stenfert Kroese, ; Lunsky & Gracey, ; Sequeira & Halstead, ), and negative physical reactions such as pain and exhaustion (Fish & Culshaw, ; Griffith, Hutchinson, & Hastings, ; Hawkins et al., ; Sequeira & Halstead, ).…”

Passing laws is not enough to change staff practice: The case of legally mandated “incident” reporting in Sweden

“…The presence of challenging behaviours contributes to the use of coercive practices in services for people with ID (Fitton & Jones, 2018;McGill et al, 2009;Sturmey, 2018;Webber et al, 2019) including seclusion, denied access to personal belongings, physical and chemical restraints (Dörenberg et al, 2018). The use of such practices might put the person at great risk.…”