Implementing methods to reduce involuntary care: Studying normalisation processes in long-term care for people with an intellectual disability

The Care and Coercion Act (CCA) (2020) enhances the rights of people with intellectual disabilities to self-determine their care. Care that clients willingly consent to is voluntary care. In situations with a serious risk of harm to the client or their immediate environment care professionals may need to provide care against client’s will, which is involuntary care. Although care organisations acknowledge the impact of involuntary care on their clients, reducing it appears to be a challenge due to insufficient awareness among care professionals and lack of knowledge on interventions to phase out involuntary care. To support care organisations in this endeavour, two methods were developed: 1. Needs Assessment Framework (NAF): An online tool to help care professionals consider the perspectives of clients with intellectual disabilities when deciding on involuntary care. 2. Multi-Disciplinary Expertise Team (MDET)-method: Aimed at reducing involuntary care by providing multi-level interventions. Effectively implementing methods into everyday care practices poses a significant challenge for care organisations, especially concerning methods that reduce involuntary care. To better understand these challenges, this dissertation aims explore implementation processes through the lens of Normalisation Process Theory (NPT). Communities of Practice (CoPs), which are networks of professionals with shared interests that facilitate working, learning, and thinking together by exchanging knowledge, could be helpful in designing implementation processes. The value and effectiveness of CoPs for implementation in intellectual disability care are still uncertain, making it an area worth for further study. This dissertation aimed to (1) examine the impact of the CCA in the Netherlands, on the recording of involuntary care incidents for clients with challenging behaviour. (2) To explore implementation processes in intellectual disability care by identifying key themes and concerns from the perspectives of care professionals. (3) To examine implementation processes through the lens of Normalisation Process Theory. (4) To evaluate the value of collaboration within Communities of Practice for designing implementation plans. (5) To evaluate adaptations made by organisations to tailor the MDET method to their organisational structure and to test effectiveness of the adapted versions. The findings in this dissertation revealed that the Care and Coercion Act (CCA), which came into effect in 2020, can be effectively implemented in care organisations. Furthermore, the results in this dissertation highlighted various determinants that may hinder or facilitate implementing methods that reduce involuntary care. Implementation interventions tailored to the needs of care teams and care professionals might initiate social mechanisms described by Normalisation Process Theory in implementation processes to improve outcomes. A strategy to organise collaboration in implementation processes is a Communities of Practice (CoP). This dissertation showed that participants of CoPs appreciated working together concerning implementation of methods that reduce involuntary care. However, effectiveness of collaboration in a CoP for implementation of the Needs Assessment Framework was not found. When implementing methods that reduce involuntary care, such as MDET, in various care organisations, components of these methods might be adapted to improve its fit within these contexts. For MDET some major adaptations were made such. The results in this dissertation show that adapting methods might lead to less effective outcomes in reducing involuntary care. To conclude, care organisations are constantly striving to reduce involuntary care. The Care and Coercion Act can be effectively implemented in long-term care for clients with intellectual disabilities and challenging behaviour, despite all its difficulties. Although effectiveness of The Needs Assessment Framework for considering clients’ perspectives on involuntary care and the MDET-method for reducing involuntary care were not demonstrated, working together with multiple care professionals from various organisations in Communities of Practice seemed to be valuable in exchanging knowledge concerning the implementation of such methods and developing implementation plans.