What makes CALM work?

A robust value base grounded in compassion and respect for human rights must provide the foundations for every service.

This must, however, be complemented by an explicit practice model that offers a blueprint for how this should translate the organisation’s values and aspirations for the people it supports into a reality on the ground. Especially when their distress may present as behaviour that challenges.  The model must be comprehensive, coherent, robust and applicable across the diverse populations whom the organisation serves. It must also be evidence-based.

The CALM model is integrative.

We subscribe to the behaviourist observation that ‘all behaviour is communication’. But we think that what the behaviour is communicating must always be understood to reflect both short-term and long-term needs. These long-term needs are often about a lack of safety, a lack of meaningful connections in the person’s life, a lack of joy, a lack of purpose and sometimes a lack of hope. Such needs are, of course, fundamental and must be acknowledged, identified, and addressed if we are to support the whole person and not just their behaviour. The needs of individuals will always be unique and the efforts and achievements of families to get such needs met are sometimes heroic. We do, however, need to recognise that for some children and adult services, we are dealing with two legacies. The first stemming from what should have happened to the individual – in terms of safety, secure attachment, nurture and protection from toxic stress – but didn’t. The second from what should not have happened to the individual but did. This includes neglect abuse and trauma at an individual, familial and societal level.

A focus on attachment and trauma and behaviour enables us to develop an understanding of the whole the person and their story – not only their behaviour.

This moves us away from our tendency to victim blame and away from labels and diagnosis. Instead, it prompts us to think about what this person needs now in order to thrive. It also reminds us to think about what organisations, teams and individual staff need in order to be able to do the same.

Training in such an approach is a critical need. But if it is to be effective, it must form part of a whole-organisation strategy that ensures the presence of the necessary infrastructure. This includes the values, governance arrangements, leadership, human and other resources. It needs to be based on robust risk assessment and based upon an understanding of the root causes of behaviour that challenges in the settings in which it is delivered. It has to reflect the results of a detailed training needs analysis and be embedded in a training framework. This has to identify and address the diverse training needs across every workforce from the CEO to the direct care worker. One size does not fit all.

CALM work in partnership with organisations to develop resilient infrastructures.

We work with you to design and deliver smart training solutions tailored to fit the unique needs of your organisation and staff profile. Our approach is grounded in the protection and promotion of the human rights of both service users and staff and in the public health approach to prevention whose application CALM first pioneered.[1]

The public health approach starts from the perspective that health is not merely the absence of disease but a state of complete physical, mental and social well-being.

In seeking to promote this, the model breaks prevention down into four components – briefly summarised below.

 

  • Primary Prevention strategies that seek to identify and address the root causes of behaviour that challenges at the level of the individual child or adult, team and the organisation through a focus on wellbeing and multi-component individualised interventions based on integrative functional assessment.

 

  • Secondary Prevention strategies that seek to identify and respond to early indicators of distress through interventions that aim to de-escalate an impending behavioural crisis.

 

  • Tertiary Prevention strategies that seek to provide a hierarchy of non-physical and in some instances, physical responses to situations where the behaviour of concern poses a significant risk. These provide options where the risk of serious harm to the person or cannot be managed in any other way.

 

  • Recovery strategies that seek to enable the child or adult (and staff) to regain emotional and behavioural regulation, to re-establish the relationships and connections and routines that create felt safety and to promote learning that can inform future prevention.

 

CALM and Restrictive Practice

CALM work tirelessly with every service we support to avoid, reduce or eliminate restrictive practices. However, we also know that there are some times and situations where services cannot adequately protect vulnerable people without the option of physical intervention as a last resort. When that happens, services must be able to demonstrate that the procedures and techniques that they approve minimise the risk of injury to vulnerable children and adults when used. The CALM PI curriculum offers precisely that. It is non-aversive and always has been. It is hierarchal – comprising one, two, and three-person interventions. It is successfully used in a range of settings from primary education to secure services with the curriculum individualised for environment and service users.

Critically, the independent comparative research consistently suggests the CALM PI curriculum delivers greater safety during a crisis in comparison to other PI programs.

The results of both the largest study into the impact of training ever undertaken the multi-site multiyear multimillion-dollar Child Welfare League of America[2] and an evaluation of the impact of training conducted by the National Children’s Bureau.[3] (See Figure 1 below) both concluded that CALM procedures were significantly less likely to result in an injury to a child when restraint was used than the alternatives.

 

Figure 1

Conclusion

CALM was the first organisation in the UK to draw attention to the problem of restraint related injuries and deaths and to call for restrictive intervention reduction to become a priority.[4] CALM was the first organisation in the UK to advocate the use of whole-organisation and public health-based approaches to address behaviours of concern proactively. CALM was the first organisation in the UK to raise concerns regarding the misuse of restraint and seclusion in schools and call for improved guidance and robust regulation. CALM was the first organisation in the UK to stress the need to explicitly engage with the emotional impact upon staff of their exposure to behaviour that challenges. We have recently been amongst the first to warn of the rising dangers posed by compassion fatigue to the wellbeing of the health, education and social care workforces and our efforts to reduce the use of restrictive interventions.

Our achievements in research, publication and campaigning are therefore unparalleled.  Our 25-year track record in working collaboratively with organisations to reduce behaviours of concern, increase safety and improve the quality of life of everyone is though also quite remarkable. Come and talk to us about what we can do in partnership with you.

 

REFERENCES

[1] Paterson B. Leadbetter D., Crichton J., and Miller G., (2008). – Adopting a  Public Health Model to Reduce Violence and Restraints In Children’s  Residential Care Facilities In M. A. Nunno, L. B. Bullard & D. M. Day (Eds.),  For our own safety: Examining the safety of high-risk interventions for  children and young people. Washington, DC: Child Welfare League of  America

[2] Child Welfare League of America (2004) – Achieving Better Outcomes for Children and Families – Reducing Restraint and Seclusion, CWL, Washington DC

[3] Hart, D, Howell, S (2004) – Report to the Youth Justice Board on the use of Physical Intervention within the Juvenile Secure Estate, National Children’s Bureau

[4] Paterson, B., Bradley, P., Stark, C., Saddler, D, Leadbetter, D., Allen, D (2003) – Deaths Associated with Restraint Use in Health and Social Care in the United Kingdom. The Results of a preliminary survey, Journal of Psychiatric and Mental Health Nursing, 10(1): 3-15

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