Implementing the Multi-Disciplinary Expertise Team method to reduce involuntary care in intellectual disability care: multi-methods study evaluating adaptation and effectiveness.

Abstract

Involuntary care in intellectual disability care may be reduced by deployment of multidisciplinary consultation. The Multi-Disciplinary Expertise Team (MDET) method proved effective in a previous trial on increasing involuntary care reduction. The current study aimed to examine how four organizations adapted MDET during implementation, and tested whether these versions were also effective. Semi-structured interviews with MDET-coordinators were analyzed using the Framework Reporting Adaptions and Modifications-Expanded. A quasi-experimental interrupted time-series design tested change in weekly counts of involuntary care recordings from before to during MDET implementation, in care homes that implemented MDET (n = 24) compared to care homes providing care-as-usual (CAU). Adaptations to MDET varied. These included implementing MDET without an independent MDET-team and loosening recordings of involuntary care. No differential changes in recordings were found between the implementation- and CAU-groups. Scaling-out MDET to other organizations led to adaptations that may have undermined its effects on reducing involuntary care.