Implementing a Multi-Disciplinary Expertise Team method to reduce restrictive measures in care for people with intellectual disabilities: Content of implementation interventions

Introduction: Reducing restrictive measures in long-term-care is known to be a challenge for support staff teams due to risks caused by aggressive behaviour of residents with intellectual disabilities. A randomized controlled trial tested the effect of implementing a Multi-disciplinary Expert Team (MDET) to reduce restrictive measures (RM). Despite the risks, accelerated reduction of RM was observed in units randomized to receive MDET. Following these results we retrospectively explored, through the theoretical lens of Normalization Process Theory, implementation interventions that might have helped professionals adopt MDET. The research question was: Which professional implementation interventions have been used to implement the MDET method in long term care for people with intellectual disabilities and what social mechanisms are manifest in interactions with staff? Methods: MDET was implemented in 19 residential units. The process notes and the MDET plans for each unit were coded both deductively (using EPOC framework for professional implementation interventions) and inductively, to identify and adapt (the meaning of) used interventions in the 6 consecutive phases of the MDET method. The NPT-EPOC professional intervention coding framework (Johnson & May, 2015) was applied to identify the social mechanisms of the implementation process of MDET. Results: A range of actions could be reconstructed and identified as implementation interventions described by EPOC. Additional implementation interventions and subcategories were identified that may be specific to long term care for people with ID. Descriptions of implementation interventions were adjusted to this care setting. The added and adapted interventions were mapped to NPT constructs, resulting in an adapted NPT-EPOC framework. Educational Outreach-treatment interventions, Patient-Related Interventions and Local Consensus Processes were most widely used during implementation of MDET. Implications: In long-term care, where support staff are at risk due to aggression from residents, equal interaction and cooperation is essential for the implementation of methods that reduce RM. Content analysis suggests adjustments to EPOC professional implementation interventions to meet the needs of this care setting. Adjusted interventions vary in how they relate to constructs of Normalization Process Theory, resulting in an adapted NPT-EPOC framework to understand the social mechanisms in implementing MDET or methods that aim to reduce restrictive measures in long term care.