Safewards intervention refresher: 
Calm down methods

Background and aims
Background
Pro re nata (PRN) medication has been used as an effective strategy to calm people down, but perhaps we reach for it too easily and too quickly. At times it is effective to use the patient’s own strengths and usual coping mechanisms to help them calm down. 
Aims
•	Early de-escalation
•	Divert and prevent
•	Build self-knowledge
•	Build self-management skills for patients
•	Increase people’s sense of empowerment and self-control
Early signs of distress/agitation
Potential changes in:
•	facial expression
•	tone of voice
•	quick response to a normal reminder
•	restlessness
•	breathing patterns
•	body language
•	eye contact (or lack thereof) 
•	movement around the ward

PRN medication is an effective strategy for calming people down, however, calm down methods can:
•	empower people to draw on their own strengths and coping mechanisms to calm down
•	offer alternatives to medication

Task: Calm down methods on your ward
•	What are some of the popular items?
•	What has been effective?
•	What existing processes can support this intervention?
•	When have you offered this intervention first over PRN? 
Task: Using the calm down items
Which of the items do you prefer?
Do you have any suggestions for new items?

Calm down methods – long-term implementation
•	Equipment will need permanent care, a robust storage strategy, and a budget for replacements will be needed
•	Review will be necessary to remove items that may prove to be problematic and to consider and approve replacements and substitutions
•	Alternative titles for this intervention are also proving popular, including 'box of calm', 'chillout box', etc.
Calm down methods fidelity

•	A  box of things that gathers dust in the office or gets dragged to a group
•	A store of equipment for diversional or recreational activities for patients to do on request
Calm down methods adjustments
CAMHS	Safety and supervision review, choice of items different
Forensic 	Safety and supervision review, choice of items different
Older people	Safety and supervision review, choice of items different