THE AIM PROJECT

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THE AIM PROJECT

• What does it take to improve practice?
• Julie Henniker
• London Safeguarding Boards
• 25 July 2007

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Order of Presentation

• Historical Context
• An overview of the AIM project
• Setting up services
• Lessons learnt on the journey
• The way forward for Greater London discussion

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THE AIM PROJECT

• An inter-agency project working across the 10
  local authorities and key agencies in Greater
  Manchester to develop services to children, young
  people and their families where sexually harmful
  behaviour has been an issue

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NCH Report 1992

• Conflict over definitions of juvenile sexual
  abuse
• Absence of policy, practice and ethical guidance
• No co-ordinated management structure
• Lack of inter agency co-ordination agencies
  intervene without reference to others
• Clashes in philosophy especially between juvenile
  justice and child protection approaches
• Inadequate data about the nature, scope and
  effects of the problem
• Lack of clarity about assessment and intervention
  models
• Absence of services/placements for young abusers
• Inadequate training and supervision for
  practitioners

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Government guidance

• Working Together (DoH,1991) clearly identified
  young people who sexually abuse as a child
  protection issue and stated that official
  responses and interventions should take place
  within child protection procedures
• It recommended that ACPCs should co-ordinate the
  development of a strategic plan for dealing with
  this group, bring them into the child protection
  system, and devote a section of their annual
  report to outlining progress

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Cont

• Subsequent Working Together pointed to the need
  for the appropriate child protection procedures
  to be followed in respect of the abuser as well
  as the victim. This is to ensure that such
  behaviour is treated seriously and is always
  subject to a referral to child protection
  agencies
• It then indicates that a child protection
  conference in relation to the abuser should be
  held to consider the current knowledge held about
  the abuser and their family circumstances and the
  need for further work
• It should consider arrangements around
  accommodation, education and supervision in the
  short term, pending the outcome of an assessment
• Evidence Hackett et al. (2003) states the extent
  to which this guidance has been implemented is
  variable significant minority of geographical
  areas not yet developed any guidance, significant
  number of respondents expressed disquiet about
  local guidance

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A backdrop of conflict and confusion

• The DoH and the YJB had clearly not communicated
  in developing their materials. As such lead
  responsibility was given to ACPCs and YOTs by
  different branches of government
• They also developed different assessment models
  independent of each other that are not compatible
  or congruent
• By leaving responsibilities unclear and
  duplicated, services have formulated their own
  eligibility criteria and screen cases according
  to resource availability rather than identified
  need. Thus there is potential for many cases to
  fall outside various systems, leaving the path
  for escalating abuse open to some young abusers
• Reports and fine words were clearly not enough to
  produce a common, effective framework of response
  to children and young people who display sexually
  harmful behaviour. The outcome has been a
  fragmented and ad hoc system

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Lovell 2002 (NSPCC)

• Ten years on from the NCH report (1992) many of
  the policy calls from the committee have not been
  acted upon and others lack funding and
  monitoring. Recent legislation and guidance are
  not adequate and in some cases contradictory.
  They do not provide a coherent strategy. The
  result is an ad hoc system in which there is a
  lack of consistent response to these young
  people agencies do not work together and
  children and young people frequently do not
  receive appropriate treatment and support

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The Greater Manchester Picture

• 1998 Audit of Services
• 1999 Application to the YJB for funding to
  develop services across the 10 local authorities
  and key agencies in Greater Manchester
• January (2000) The AIM (Assessment Intervention
  Moving on) project established
• Pooled funding (2003) 10 LAs, 10 YOTs, NSPCC
• 2004 Charitable status

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Original Aims and Objectives of the Project

• Develop policies and procedures
• A common framework of response
• Develop initial assessment models
• Develop a range of interventions
• Provide training and support mechanisms
• De-mystify this area of work
• Research remit

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Aims and Objectives of the Project

• Maintain developments to date
• Group work provision
• Develop and integrate a response to victims of
  sexual abuse
• Develop a restorative/family group meetings model
  with specific focus on sibling abuse
• Revise initial assessment models in the light of
  evaluation and ongoing research

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Crucial need for a common initial assessment model

• 2 track system operating
• CJ Route ASSET (2000) helpful in assessing
  criminogenic factors, weak in assessing family
  and developmental factors related to the
  maintenance of sex offending
• Child Welfare Approach DoH (2000) helpful in
  identifying need, weak on identifying offence
  specific factors

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and

• Over a quarter of YP charged with a sexual
  offence in GM (2000) did not have an assessment
• In respect of those young people who did have an
  assessment over half of YOT workers did not feel
  their assessment was adequate
• Nationally, Hackett et al. (2003) 39 inadequate
  availability to assessment services 39,
  inadequate quality of assessment 18

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Evaluation AIM Model (Helen Griffin and
Professor. A. Beech)

• Main Findings
• Provided a clear framework
• Training and dissemination of the model promoted
  consistent and effective inter-agency working
• 72 completed all stages of the assessment
• All assessments were co-worked
• Practitioners reported a high level of confidence
  in the model
• High concern element accurately identified 4
  cases where follow-up indicated ongoing concerns

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4 Assessment Domains

• Developmental
• Health issues
• Quality of the young persons early life
  experiences
• Experiences of physical / sexual / emotional
  abuse or neglect
• History of behaviour problems
• Resilience factors
• Social skills and interests
• Sexual development and interests
• Environment
• Young persons access to vulnerable others
• Opportunity for further offending
• Community attitudes to young person and family
• Wider supervisory and support network

• Offence Specific
• Nature of index sexual offence
• Young man and familys attitudes
• Young mans offending history
• Thoughts and feelings about offence
• Motivation to engage with professionals
• Family / Carers
• Level of functioning
• Attitudes and beliefs
• Sexual boundaries
• Parental competence

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and AIM2

• It is not an actuarial instrument designed purely
  to detect risk. Low rates of re-offending make
  actuarial risk models difficult to produce. In
  the absence of such a tool practitioners have had
  to rely on professional judgement. The AIM2 model
  seeks to structure decision making using
  available research, clinical knowledge and
  research
• Makes deliberate use of the terms strength and
  concern
• Considers both static and dynamic factors
• Takes into consideration the strengths and
  weaknesses of existing models, making it a user
  friendly model Helps identify individual/familial
  strengths, needs, concerns
• Helps to formulate further recommendations for
  intervention leading to co-ordinated management
  plans
• Provides a consistent and structured basis for
  expressing opinions

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Referral received
Inter-agency liaison
Allocation to Assessors
Information collection
First stage scoring of AIM2
Identification of knowledge gaps
Interviews with relevant persons
Stage 2
Second stage scoring of AIM2
Analysis of level of supervision and intervention
required
Stage 3
Producing Initial Assessment report
Multi-agency strategy meeting
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Inter agency Safeguarding Inspection 2000

• All agencies working with children and families
  take all reasonable measures to ensure that the
  risks of harm to children is minimised
• Where there are concerns about children /YPs
  welfare all agencies take appropriate actions to
  address those concerns working to agreed local
  policies and procedures in full partnership with
  other agencies

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Changing Children's Services

• Longer term process
• Anxiety/risk triggers retreat into silos
• Structural change whilst underlying silos persist
  is a challenge
• Local leadership is a major lever
• Cultural and attitude change is key

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Setting up services

• Review local situation Identify action areas and
  time frames
• Numbers, nature, scope and impact of the problem
  over the last 12 months
• Service Mapping what is currently available, gaps
  in service
• Changes built on pilots, providing evidence of
  effectiveness are more adoptable than all or
  nothing ventures. AIM is a tried and trusted
  model
• Management and inter-agency infra structure
  (generally and with specific reference to this
  group)
• Include practitioner perspectives what's
  happening on the ground

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Cont

• Identify drivers/assets and barriers/constraint
  s to moving things forward at all levels
• Share the results
• Establish a multi-agency steering group with a
  mandate from the LSB to drive through
  developments in their respective agencies
• Partnership working and pooled funding, will
  result in shared ownership. Ensuring that
  partnership objectives meet some or all of
  individual agencys legislative and ethos
  requirements. In the current climate of public
  sector change, survival concerns and issues
  around gate keeping it is important to realise
  you are not being asked to take on something
  separate but address an issue that compliments
  existing agendas this is CP

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Cont

• Then plan service development in a rational not
  reactive manner based on analysis of information
  this will reduce over/under estimation of the
  problem
• Co-ordinator
• Do not over look the under 10s, females, those
  with a learning difficulty a balance approach is
  required
• Produce a multi- agency protocol/procedures that
  are written into the Child Protection procedures,
  to be followed by all agencies
• Adopt common assessment tool's to include
  consideration of individual agencies e.g.
  guidelines for schools, residential units, foster
  carers

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Cont

• Multi agency briefings to launch the work
• Establish commitment and leadership but engage
  with frontline staff, or its unlikely to succeed
• Produce a training plan and develop peer
  supervision and consultation support/arrangements
• Agree evaluation/research/maintenance plans at
  the outset
• A viable and realistic critical pathway needs to
  be created with clear timescales, staging posts
  and accountabilities. A few quick wins can
  usually be achieved but most complex changes take
  at least 3 yrs. Plans should be realistic and
  flexible enough to learn from the experience,
  re-evaluate and re-direct effort.

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Potential challenges

• This group are not a problem
• This is a Criminal Justice problem
• This work can only be undertaken by highly
  experienced specialists
• Establishing services will increase demand, we
  cannot meet
• It will not be cost effective
• Not another assessment tool

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Features that will assist change

• Establish a sense of urgency (build on today's
  momentum) and dont wait for everything to be in
  place, this is a process. Agree a rationale for
  change
• Establish a powerful core coalition and strong
  leadership
• Create a vision (blue sky thinking something to
  sell to others) to direct/sustain change.
  Establish a viable change plan
• Over communicate the vision
• Model the new ideas (pilot)
• Avoid premature declaration of success evolution
  v revouloution
• Anchor changes in inter-agency culture and
  identify gains and losses
• Establish a funding stream

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Some reasons why change will fail

• Change provokes anxiety, defence, unconscious
  behaviour
• Competing and conflicting priorities
• People issues are unaddressed
• Takes more time and effort than anticipated
• Problems arise during the change process (give
  up). Crisis de-rail strategies
• Ineffective co-ordination of activities
  capabilities of staff insufficient
• Inadequate support and training provided

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Lessons learnt along our journey pitfalls to
avoid!

• Short term funding, this work has to have a
  longer term funding strategy
• Developing therapeutic services ahead of ensuring
  inter-agency co-ordination of referral,
  investigation, initial assessment and planning
  are agreed. Criminal Justice and Child Protection
  agencies must work together
• Over reliance on a small group of enthusiastic
  workers
• Lack of engagement with senior management
  stakeholders
• Creating expectations that assessment/protocols
  will make possible exact quantification of risk
  prediction
• Failure to integrate work with parents/carers
  from the outset as a core component. This is not
  an add on factor

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Cont

• Inappropriate use of specialist services to
  colonise rather than catalyse services. Avoid
  specialists taking/being pushed into the role of
  anxiety bearer for the systems
• Over focus on young people in the Criminal
  Justice and reduced focus on other young people
  displaying the same behaviours
• Risk dominated offence discreet approaches
  which fail to address strengths and needs
• Inappropriate use of models based on work with
  adult sex offenders
• Lack of attention to unresolved
  trauma/rejection/loss in the young person a
  holistic approach

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10.
Evaluate learning for future use
Relapse Prevention
Monitor and review change
9.
Maintenance
Consolidate, integrate and maintain changes
8.
Establish new organisational infra-structure
policy, services,
7.
Action
Formulate a critical pathway for change
6.
Identify how best to make the changes
5.
Contemplation
4.
Identify what changes are needed
3.
Audit current strengths and weaknesses
2.
Establish agency ownership of change agenda
Acknowledgement of need for change
1.
Precontemplation Denial of need to change Fig 3
Organisational Model for Change adapted
ProtchaskA and DiClimenti (1982)
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The London Picture

• AIM has a partnership with NSPCC Freshstart who
  have a commitment to develop work in this area
  within London
• AIM is talking to the YJB Regional Manager and
  London YOT managers regarding implementation
  across London YOTS
• Role of the Safe Guarding Boards?
• Role of other key agencies? Police, CAMHs etc