Development of a dataset on coercion in Flemish care.

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Development of a dataset on coercion in
youth (mental health) care:
First experiences in Flanders
25/10/2019
Lillestrøm
P Cosemans1, EO Noorthoorn1,2 B Thomas3 & Y Voskes4
1. ICOBA
2. Ggnet mental health centre
3. UZ Gent
4. VUMC Amsterdam

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Inspection of use of coercion in Flemish (mental)
care for children and adolescents 2016 - 2018
Mental
health
care
Care for
disabled
children
Youth care
25/10/2019Developmentofadatasetoncoercioninyouth
(mentalhealth)care):Firstexperiences.

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Report on use of coercion in Flemish (mental) care
for children and adolescents
Flemish Inspectorate (2016 – 2018)
- Use of coercion in care facility’s is common practice;
- Not always in accordance with international standards;
- Not always safe, not always as little as possible, not always as short as
possible.
- No valid framework available for the use of coercion;
- No uniform definitions available on the use of coercion
- Lack of data
- No indicators available
which counters
which denominators
- Lack of public transparency
25/10/2019Developmentofadatasetoncoercioninyouth
(mentalhealth)care):Firstexperiences.

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transparency: social necessity
25/10/2019Developmentofadatasetoncoercioninyouth
(mentalhealth)care):Firstexperiences.

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Action plan of Flemish government on the use of
coercion
Development of a
guideline for the
use of coercion
Funding for infra-
structural
measures
Development of
uniform definition
regarding coercion
Training and
education on the
use of coercion.
Supporting
organisations in
developing a
supportive
environment
Development of a
reliable dataset on
the use of
coercion in
Flemish care
organisations
25/10/2019Developmentofadatasetoncoercioninyouth
(mentalhealth)care):Firstexperiences.

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Developing dataset on coercion in Flemish (mental
health) care for children and adolescents.
What
How
Why
• Uniform, Valid & Reliable
registration of the use of
coercion in Flemish (mental
health) care.
• In co- creation with relevant
stakeholders (professionals,
organisations, Flemish
Government, federations)
• Creating incentives for quality
improvement on the use of
coercion.
• Creating transparency
25/10/2019Developmentofadatasetoncoercioninyouth
(mentalhealth)care):Firstexperiences.

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• Individualized feedback on
the use of coercion
• Feedback and discussion
about the experiences of the
participating organisations.
• 2nd registration of the use of
coercion in care for adults (2020)
• Implementation of data set
• Developing indicators of the
use of coercion
• Setting up a Flemish database
• Implementation in electronic
patient records
• Kick off meeting participating
organisations
• Frequency on the use of
coercion.
• Clarification of the definitions
in the organizations.
• During one month registration
of all coercive measures on
paper
• Draft version of registration
• Ethical approval
• Clarification of the definition on
the use of coercion
• Selection of the participation
organizations
• Youth care
• Mental healthcare
for children
Preparation &
selection
Kick-off &
registration
Feedback roundImplementation

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Participating organisations
Organisation Number of wards
Forensic psychiatric service 1
Community Institute 1
Psychiatric ward for children and adolescents 4
Welcome, observation and orientation youth Centre 1
So called ‘experimental garden ‘ Institute 1
VAPH - Institutes for ID and physical handicap 9
Eindtotaal 17
25/10/2019Developmentofadatasetoncoercioninyouth
(mentalhealth)care):Firstexperiences.

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Kick off meeting
• New Flemish definitions on coercion
– What is coercion?
– What is seclusion?
– What is a seclusion room?
– What is restraint?
– What is consent?
• Quantitative approach on the use of coercion
– Does the new definition need a clarification?
– How are coercive measures at this moment registered?
– How is the registration used for quality improvement?
25/10/2019Developmentofadatasetoncoercioninyouth
(mentalhealth)care):Firstexperiences.

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How does the new registration look like?
25/10/2019Developmentofadatasetoncoercioninyouth
(mentalhealth)care):Firstexperiences.

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What did we learn so far?
• Great commitment of the participants to have a uniform
registration on the use of coercive measures (urgency shared)
– 17 organisations participated in the try-out
• Clarification on the definitions
– structural coercive measures, which are mentioned in a treatment plan
– Use of coercive measures depending on a situation ( aggression, violence)
– Clarification on the use of restraint
– Clarification on the term “consent”
• Experience of first registration
– Registration is easy to use
– Only once registration
25/10/2019Developmentofadatasetoncoercioninyouth
(mentalhealth)care):Firstexperiences.

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Feedback of participants
Clear goal
meaningfull
Time efficient
25/10/2019Developmentofadatasetoncoercioninyouth
(mentalhealth)care):Firstexperiences.

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What findings say adjacent to what interviews
suggested
Structural
measures
Fixed not only in
case of agression
Higher number of
measures
Mainly in care for
disabled children
and youth
Situational
measures
Depending on
situation (e.g.
agression) and
preserving safety
Lower number of
measures,
shorter duration
Mainly in mental
health care
25/10/2019Developmentofadatasetoncoercioninyouth
(mentalhealth)care):Firstexperiences.

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The next step
• Repeating this study for the target group adults (mental health
care and care) in 2020
• Implementing measurement in daily practice
– organizing systematic data collection taking GDPR into account
• Organising a sympsosium in 2020 about coercion in Flemish
care organisations. Present general conclusions and
recommondations from these two studies
25/10/2019Developmentofadatasetoncoercioninyouth
(mentalhealth)care):Firstexperiences.

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Conclusions
• A uniform register of coercion makes it possible to have a well
founded insight on coercion for (health) care organisations and
other stakeholders (patients, clients, society);
• It is possible to find an agreement in registration on coercion in
different types of (health)care organisations;
• Small differences in different types of organizations are present
– Definitions of coercion
– Registration of coercion
25/10/2019Developmentofadatasetoncoercioninyouth
(mentalhealth)care):Firstexperiences.

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Thank you!
Any questions?
Peter_cosemans
Peter.cosemans@vivosocialprofit.org
25/10/2019
Lillestrøm