What is CALMER?

Cortex, Amygdala, Limbic, Memory & Emotional Regulation

The CALMER Approach( 6) utilises knowledge translation (7) to synthesize neuroscience (1, 8-11) and behavioural approaches (2,5,12-13) to understand the relationship between emotional regulation and behaviour (1,9). CALMER has specific interest in the influences of:  Cortex (thinking brain), Amygdala (assessing safety and danger), Limbic (emotional brain), Memory (emotions and experiences) and Emotional Regulation (the ability to cope with stress) (1, 8-11), or CALMER (6).

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CALMER is about integrating a variety of theoretical approaches such as Capable Environment, Positive Behaviour Support, Person Centered Active Support, Neuroscience, Polyvagal Theory with the CALMER approach tools. The tools are applied with the person and key stakeholders working together to co-design a capable environment for delivering therapeutic services, improving quality of life and narrowing the gap between theory and practice.

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CALMER is an evolving process and not an end point.

Why don't we use "Assessment" in CALMER?

CALMER approach understands that knowing what something is and understanding what it means are two different things. Therefore, CALMER takes each situation as unique, and seeks to include everyone’s perspective. In CALMER, this process is not called an “assessment” rather it is “Finding Shared Meaning”. A practitioner facilitates this process, which supports the person and those around them to share their goals and have ownership of the plan and outcomes.

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An empathetic approach is adopted in understanding the person from their lived experience, current daily living and goals for the future. Blending neuroscience concepts like polyvagal theory add depth to understanding and ability to respond. One of the key components is to look at the person's ability to feel safe (Limbic system) and their ability to emotionally regulate (Cortex) in response to triggers.

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The process is guided by collaborative gathering of information, including detailed qualitative and observational data. Quantitative data is collated where required. The key people around the person form part of the assessment, as well as environmental triggers. The process occurs in the natural environments for the person, and the person is an integral part (co-design). ​The co-designed process explores where the person might be at emotionally and cognitively at the time of interactions (behaviours).  

​Within this process, unsafe interactions are critically analysed to consider whether the person’s interactions are the problem, or a consequence of a problem. This differs from a traditional assessment question to understand what is the ‘function’ of a behaviour.

CALMER chooses alternate terminology to reflect that all humans interact with one another and their environment. While behaviour belongs to a person, interactions take into account the complex role of others and the environment. By seeking only for a ‘function’, we perhaps make the assumption that all human behaviour is deliberate and intentional. Neuroscience highlights that we function differently and interact differently under different stress circumstances.

CALMER seeks to support the creation of empathetic, therapeutic and supportive environments for everyone. In creating “Shared Meaning” all are invited to engage in new understanding and new perspectives of interactions.

Co-Planning and Plan Activation

CALMER Approach can form the basis for support at all levels, ensuring the person and others feel safe. Therapeutic strategies are co-designed and co-planned based on individuals needs and circumstances to ensure feeling safe from a nervous system perspective.

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CALMER Approach focuses on supporting the goals of the person, so plans are targeted to be both practical and functional, fitting in with their life and priorities, not diagnostic boxes. The information can be developed into formal reporting (Behaviour Support Plans) as well as person centered training and practical advice tailored to each setting.

One of the key features of the CALMER approach is co-regulation support strategies. This is training for the person and those who support the person to understand the regulation needs and enable the person to regulate their emotions and interactions/behaviours.

References

1. Porges, S. W. (2001). The polyvagal theory: phylogenetic substrates of a social nervous system. International journal of psychophysiology, 42(2), 123-146.

2. Gore, N. J., McGill, P., Toogood, S., Allen, D., Hughes, J. C., Baker, P., ... & Denne, L. D. (2013). Definition and scope for positive behavioural support. International Journal of Positive Behavioural Support, 3(2), 14-23.

3. LaVigna, G. W., & Donnellan, A. M. (1986). Alternatives to punishment: Solving behavior problems with non-aversive strategies. Ardent Media.

4. McGill, P., Bradshaw, J., Smyth, G., Hurman, M., & Roy, A. (2020). Capable environments. Tizard Learning Disability Review.

5. Beadle‐Brown, J., Hutchinson, A., & Whelton, B. (2012). Person‐centred active support–increasing choice, promoting independence and reducing challenging behaviour. Journal of Applied Research in Intellectual Disabilities, 25(4), 291-307.

6. de Paula, F. (2022). Towards an active capable environment: Closing the gap between theory and practice. Conference paper presented at National Disability Services (NDS) Conference 06/04/2022, Australia.

7. Straus, S. E., Tetroe, J., & Graham, I. (2009). Defining knowledge translation. Cmaj, 181(3-4), 165-168.

8. Perry, B. D. (2005). Self-regulation: The second core strength. Online: http://teacher. scholastic. com/professional/bruceperry/self_regulation. htm.

9. Shanker, S. (2013). Self-regulation. What is it and why is it important for learning. Published by Commissioner for Children and Young People Western Australia. Accessed online 14/02/2022 from https://www.ccyp.wa.gov.au/media/1769/report-2012-thinker-in-residence-stuart-shanker-june-2012.pdf

10. Siegel, E. D., & Bryson, T. P. (2011). The whole brain child: 12 revolutionary strategies to nurture your child's development mind.

11. Van der Kolk, B. (2014). The body keeps the score: Mind, brain and body in the transformation of trauma. penguin UK.

12. Greene, R. W., Ablon, J. S., & Martin, A. (2006). Use of collaborative problem solving to reduce seclusion and restraint in child and adolescent inpatient units. Psychiatric Services, 57(5), 610-612.

13. Rogers, C. R. (1959). A theory of therapy, personality, and interpersonal relationships: As developed in the client-centered framework (Vol. 3, pp. 184-256). New York: McGraw-Hill.

14. Watkins, J. M., & Cooperrider, D. (2000). Appreciative inquiry: A transformative paradigm. OD practitioner, 32(1), 6-12.

15. People with Disabilities Western Australia. Co-design Guide Co-design for organisations working with people with disability. Published by Government of Western Australia. Accessed 8/04/2022 from https://www.pwdwa.org/documents/connect_with_me/co-design-guide/files/co%20design%20guide.pdf