CALM - Crisis, Aggression, Limitation and Management
The absence of valid, published evaluations on many training models remains a theme of concern in successive offical reports in the UK and USA. Additionally the literature identifies negative outcomes in relation to traditional, skills based Violence and Aggression training generally, as well as negaitive outcomes in relation to some specific training models. Therefore, the availability of valid injury rate data remains crucial to issues of safety, confidence and liability protection.
Evidence on the CALM model includes:-
1. Independent, published, national level studies;
There are 4 main Government funded studies on restraint injury rates:-
a) USA, Child Welfare League of America (2004) - Achieving Better Outcomes for Children & Families - Reducing Restraint & Seclusion
This federally funded study was effectively the largest training evaluation project ever undertaken. It comprised the US Congress's response to the publication of the Hartford Courant data base (Weiss 1998) which exposed the very high rate of restraint fatalities in US child care services. It involved a 3 year, 5 site evaluation of the impact of training and restraint reduction strategies. CALM was the only non US domestic training model involved in the project and obtained the lowest injury rate.
"Site E (MCH/CALM Training UK) was the most successful at reducing and maintaining low rates of child injury..." (CWLA 2004;13)
b) UK - Carlile Report (2006)
This report outlined problems of restraint use in the English secure children's estate in the wake of the restraint death of Gareth Myatt. It reported injury rates in other training models of up to 25%. Although not formally included in the report, the annual audit submitted by the single CALM using Youth Justice Board (YJB) registered unit returned an injury rate of 0% for the same period.
c) UK Government report - Independent Review of Restraint in Juvenile Secure Settings (Smallbridge & Williamson 2008)
Considered CALM to be one of only three contenders to become a national restraint system.
d) National Children's Bureau Report - Restrictive Physical Intervention in Secure Children's Homes (Di Hart, 2008)
Again a formal report commissioned in response to restraint related deaths in English Secure Children's Services. CALM was confirmed as achieving the lowest injury rates (Hart, D 2008:36) Viz:- see NCB Table
2. CALM Annual Agency Audits
CALM has recognised the need for valid safety audits and transparency from the outset. In a commercial market place training providers making claims on behalf of their products carry an obligation to ensure valid monitoring and publication of injury rates.
This obligation is recognised in the requirement imposed in Scottish guidance for training providers to:- "Collect and organise relevant information on incident and injurt rates across all user agencies. These should be published and publically available" (Holding Safely Sect 9d6). We understand that we remain the only training provider to honour this obligation. We invite other training providers to publish their data, as the only valid approach to comparative safety.
The obligation to submit annual reports and to report CALM related injuries is a contractual obligation on all CALM using agencies. We now have 7 years of audit data on the CALM system, arguably a greater volume of data than any other system. This includes no fatalities and no litigation. Our injury rate has remained consistently below 0.4%.
Although the literature contains little comparable data, published injury rates on other systems range from 6% > 27%. We recognise the problems in ensuring that submitted data is valid and uniform. However, we remain committed to transparent, evidence based practice. The longitudinal constancy of submitted injury data tends to suggest its general validity.
3. Published Evaluation (Perkins & Leadbetter 2002)
Study on the use of CALM in a Special Education School, undertaken by an independent educational psychologist. The study reported:-
82% of staff reported increased confidence
Reduction of major incidents, post training
50% of staff reported reduction in personal stress levels
Increased use of verbal de-escalation at 6 month follow up
Reduction in reliance on crisis intervention by senior management
4. Edinburgh Recommendation 55 Inquiry (Lindsey & Hosey 2000)
This independent report conducted by the then Centre for Residential Child Care (subsequently Scottish Institute for Residential Child Care) was commissioned as one of the responses to the Marshall Inquiry. An independent and unrelated report on the sexual abuse of children in the care of Edinburgh City Council. During the Marshall investigation Council staff expressed a number of concerns to the inquiry team, one of which centered on the Councils approach to Care and Control. Essentially the Recommendation 55 Report centered on the question “Does CALM Work”?
The report provides an excellent discussion of the complexity of the issues shaping effective care and control in children's services. It highlights a range of conclusions confirmed by subsequent research and the dangers of "Reductionism" (i.e. over simplification of complex problems) and of “Panacea Thinking” (i.e. the belief that training as a stand alone intervention can produce positive outcomes). Contrary to popular belief, conflict management training must compliment, but cannot replace, effective agency strategies. Consequently an integrated “whole organisation approach" and close liaison between training commissioners and suppliers must be an essential element of care and control training strategies.
Recommendations from the Report:
| A. The Scottish Executive should
establish a national standing
committee on Physical intervention
techniques, with multi disciplinary
Accepted - Director to inform Scottish
B. There should be a national reporting
system of physical restraints.
C.There should be continuing research
Note: - As of July 2009 the first 2 recommendations have not been implemented. Research funding (i.e. no 3) remains problematic.
The independent Edinburgh Inquiry into the use of CALM came to the view that is was "not apparent that there is any system on the market that is clearly better than CALM at present " (2000:91)
We belive that this remains the case and that CALM is in fact the safest and most effective training system available in human services. We remain committed to transparency and accountability.