The Use of Restrictive Measures in Community Services for People With Intellectual Disabilities in Sweden

Petra Björne,Peter Mcgill,Lena Nylander,Roy Deveau

doi:10.1111/jppi.12399

Abstract

AbstractBackgroundCommunity services for Swedish people with intellectual disability (ID) are intended to support self‐determination and integrity. Legislation does not allow the use of restrictive or coercive measures.AimThe aim of this study is to identify the extent of, rationale for, and strategies staff believe would reduce the use of restrictive measures in group homes and daily activities services for people with ID.MethodA survey was sent to all staff in group homes and daily activities in one large Swedish municipality. The survey comprised four Likert style questions and one free text question, addressing the type of and reasons for restrictive measures, and how much staff value their replacement. A total of 250 surveys were completed.ResultsA third of staff reported that some restrictive measures were used daily or weekly, primarily to protect and support service users. Adequate numbers of staff, better service design, and training were considered necessary for change.ConclusionStaff report structural reasons, such as staffing, resources time, lack of training, and supervision for using restrictive measures. Staff see reducing the use of restrictive measures as requiring structural changes with engagement from the whole organization.

Highlights

In services for people with intellectual disability (ID), the use of restrictive measures, including coercion and restraints, is prevalent, especially when behaviors are perceived as challenging (Mérineau-Côté & Morin, 2013; Webber, McVilly, & Chan, 2011)
Leadership focused upon providing good quality care and reducing restrictions is required at all levels in an organization, including strategic senior levels (Deveau, Gore, & McGill, 2020) and frontline practice leadership (Deveau & Leitch, 2020; Deveau & McGill, 2016)
The research was conducted in a large Swedish municipality that manages all group homes and daily activity centers for people with ID

Summary

Introduction

In services for people with ID, the use of restrictive measures, including coercion and restraints, is prevalent, especially when behaviors are perceived as challenging (Mérineau-Côté & Morin, 2013; Webber, McVilly, & Chan, 2011). Reducing the use of restrictive measures is a human rights issue (Karim, 2014). Good leadership within organizations and services appears to be associated with less use of restrictive measures (Stubbs et al, 2009). Aim: The aim of this study is to identify the extent of, rationale for, and strategies staff believe would reduce the use of restrictive measures in group homes and daily activities services for people with ID. Results: A third of staff reported that some restrictive measures were used daily or weekly, primarily to protect and support service users. Conclusion: Staff report structural reasons, such as staffing, resources time, lack of training, and supervision for using restrictive measures. Staff see reducing the use of restrictive measures as requiring structural changes with engagement from the whole organization

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Conclusion