3.4.2 CALM Policy

RELEVANT LEGISLATION

Sections 22 and 23, Children Act 1989

Care Planning, Placement and Case Review (England) Regulations 2010 Regulation 17, Children’s Homes Regulations 2001, as amended by the Children’s Homes (Amendment) Regulations 2011

Standard 3, National Minimum Standards for Children’s Homes 2011

AMENDMENTS

These legislative references were updated in September 2011.

SCOPE AND RELATED CHAPTER

This chapter applies only to children placed at Clare Lodge and New Horizons and should be read in the context of the chapter: Behaviour Management and Sanctions Procedure.

The CALM Approach
Risk Assessments
The use of Physical Intervention
Use of CALM Techniques
Staff Support
Training
Recording
Monitoring

1. The CALM Approach

1.1	For children placed at Clare Lodge and New Horizons, Peterborough contracts to a methodology known as CALM® (Crisis, Aggression, Limitation Management) which does not rely on causing pain to achieve control, is BILD accredited, and independently bio-mechanically evaluated by a Chartered Physiotherapist.
1.2	The underpinning principle of all CALM® interventions is to: - Intervene at an appropriately early point Use the minimum level of intervention possible to achieve effective management of the particular crisis
1.3	The approach has inbuilt quality control mechanisms and through independent study has been shown to result in fewer injuries to those intervening, or being held than the many alternative approaches used elsewhere.
1.4	It is important the approach taken by the service is “transparent” to the children, parents, and placing local authorities.
1.5	Information about the techniques and underpinning philosophy of the CALM ® is available to all staff in residential care directly managed by Peterborough Children’s Services.
1.6	Residential staff should expect to undertake training and, when necessary, work together to ensure the safety of all – see Section 6, Training.
1.7	It is essential that professional responsibilities are clear and that clear written procedures exist in all children’s homes in relation to all intervention strategies likely to be used.

2. Risk Assessments

2.1	Effective incident management requires all staff to ensure they are aware of individual CALM® risk assessments which are prepared by key workers and detail the likelihood of the need for physical holding, trigger and behaviour patterns, medical factors (where appropriate), and the suitability/unsuitability of specific techniques.
2.2	Risk assessments should be reviewed and updated regularly and signed/agreed by one of the accredited CALM® Instructors available on site.

3. The use of Physical Intervention

3.1	Before physical intervention is used, each situation must satisfy clear legal criteria if it is to be lawful.
3.2	In all instances the child must: - Be endangering him or herself; and/or Be endangering others; and/or Causing serious damage to the fabric of the building. Physical intervention on any other basis is not lawful and may constitute an assault.
3.3	De-escalation is the primary objective. Action should therefore only be taken as a last resort where all other alternatives have been exhausted or would be likely to fail, and then only using the minimum force necessary for the minimum amount of time.
3.4	All physical interventions are potentially dangerous both for children and staff. Early intervention coupled with effective talk down techniques will greatly reduce the need for the physical holding of children. Staff/carers are therefore expected to work within a culture where the application of de-escalatory techniques is the norm. All interventions must be lawful, enhance safety, and take account of the physical, emotional and medical needs of each child.
3.5	The meeting of the legal criteria for the use of physical intervention does not of itself justify physical holding as it is not a substitute for other types of intervention which should as far as possible be attempted first.
3.6	Any physical intervention used will be assertive and designed to minimise overt use of physical force by the application of techniques specified by CALM® and informed by risk assessment information.
3.7	Only holds approved by CALM® and taught at Peterborough Children’s Services may be used.
3.8	Specifically, prone (the holding of a child face down usually on the floor) must not to be used under any circumstances as it has caused a number of deaths through positional asphyxiation.
3.9	For insurance and personal liability purposes, staff members are covered provided they act within the scope of their employment, this policy, and use techniques approved by CALM®, Peterborough Children’s Services and the specific residential home.
3.10	The competence of staff in the application of the techniques will be maintained and developed through formal training, annual accreditation, and the provision of qualified instructors on site. Similarly the level of, and fitness (Children’s Homes Regulations 2001 Section 26, 1(a), and 3(c)) of the staff resource will be kept under review to ensure safe responses when interventions are required.

4. Use of CALM Techniques

4.1	The use of CALM® techniques are subject to the following conditions:- The techniques may only be employed in situations which adhere to the conditions of use as specified within Section 3, Use of Physical Intervention All techniques are taught and demonstrated by CALM® Accredited Instructors. All operational difficulties with the techniques are reported via an Accredited Instructor to CALM Training Services Ltd. A report is prepared annually for CALM Training Services Ltd. which details the use and outcomes made of the methodology including incidence of children / staff injury. The individual competence of staff is maintained through periodic practice and annual re-accreditation.
4.2	The CALM® approach is based on a control hierarchy ranging from simple adult presence to high contact physical intervention: - Adult presence Non verbal signal Assertion (e.g. a request for compliance or limit) De-escalation (e.g. talking down or disengaging) Low contact physical intervention CALM® - Levels 1 to 3, and high contact physical intervention CALM® - Levels 4 and 5
4.3	Whichever intervention is employed, staff should maintain a positive attitude, adopt a relaxed posture, and focus on their training and skills as practitioners. Staff must also remain aware of their own feelings of anger, fear and arousal.
4.4	The concept of minimising space and controlling aggressive behaviour is central to CALM® - principles of physical control whereby movement is minimised by staying as close as possible to the child.
4.5	As the structure of the CALM® approach is based on the lowest level of effective intervention, the person leading the intervention should match their response to the behaviour of the child.
4.6	CALM® physical intervention techniques are divided into five levels: Levels 1 to 3 requires one person Level 4 requires 2 people Level 5 requires 3 people
4.7	Lower level interventions such as “holding” and “steering” can discourage but may not prevent a child from attempting to cause harm or damage.
4.8	Progression from one level to the next level is required only when a technique which has already been employed is met with significant resistance which in the judgement of the adult leading the intervention is likely to result in the subject breaking free or inflicting damage.
4.9	Throughout, staff must reinforce positive behaviour through constant dialogue and discussion including providing the opportunity for the child to reassert self control.
4.10	The expectation that staff will need to exercise judgement and discretion when responding to children applies to all situations – the CALM® framework of techniques being no exception. Often the presenting circumstances will be difficult and require speedy action on the part of staff to prevent harm and damage. Nevertheless the decision to intervene physically must comply with the legal criteria – see Section 3, Use of Physical Intervention and use the approved techniques.
4.11	The intervention should take account of: - The significance of physical contact for the child taking account of his or her previous history and experience The age, gender, maturity, physical size, dangerousness, and health of the child Cultural or religious factors The wishes of the child as far as they can be reasonably ascertained The physical environment, proximity of others, staffing levels, gender of staff and experience The nature and duration of the relationship between the member of staff and the child The need as far as possible to remove other children from the situation as soon as possible.
4.12	Physical intervention should only be attempted when there is a reasonable anticipation of success, and then only using the minimum force necessary for the minimum amount of time.
4.13	Staff should remember the resumption of effective communication is the main aim when embarking upon any form of physical control in order to attempt to establish a psychological verbal contract of compliance with the child.
4.14	Immediately following the intervention, the child should be given time to calm before any form of counselling / follow up commences to allow levels of adrenaline to normalise.
4.15	The child’s social worker, parent/s (where appropriate) and duty manager should be informed about each physical intervention. In cases which result in serious injury to a child, the Service Manager must be notified and s/he must notify the Regulatory Authority.
4.16	Wherever possible, the adults involved in any physical intervention should have an established relationship with the child.
4.17	Holding or touching must be parental and never sexual in intention or expectation. In all interventions great care must be taken to avoid contact with breasts or genitals, and to protect and maintain the privacy of the child. If there is any indication of sexual arousal either in the child or the staff member the action should cease immediately and be discussed with supervisors.

5. Staff Support

5.1

Following “critical” incidents, a meeting may be called by staff trained in de-brief techniques to ensure those involved have the opportunity to express and explore their emotional response to what has occurred. These meetings are followed up through supervision to ensure staff are coping with any residual stress such incidents can cause. In exceptional circumstances arrangements can also be made for onward referral to the Occupational Health Specialists.

5.2

Learning lessons from a physical intervention is a different process which may necessitate a meeting / discussion between those involved in the intervention is designed to concentrate on the process / technical issues.

6. Training

6.1	The Health and Safety at Work Act 1974 places a duty upon employers to provide staff with the appropriate information, instruction and training to undertake their work activities safely.
6.2	Related health and safety regulations require risk assessments to be undertaken of work activities identifying hazards associated with activity at work together with control measures to minimise those risks.
6.3	In the case of critical incidents one of the control measures identified is the provision of compulsory training for staff at Team Manager level and below for those who have direct contact with children in de-escalation theory and physical intervention techniques within the CALM® methodology.
6.4	Staff should be aware of the need to maintain basic levels of fitness to undertake the training/gain accreditation in order to be able to apply the methodology in a way that ensures their own, and the safety of their colleagues, and the children.
6.5	Although CALM® Instructors will ask all training participants to complete a medical questionnaire, they do not conduct medical assessments. These will be referred to an Occupational Health Specialist for assessment.

7. Recording

7.1	The recording requirements are the same as set out in Section 5 of Behaviour Management and Sanctions.

8. Monitoring

8.1	Records of all physical interventions are analysed on a monthly basis by an accredited CALM® Instructor to ensure they are lawful, appropriate, and timely. The analysis links directly back into the training / refresher training, staff meetings, and individually as appropriate to staff.

End