Harmful Sexual Behaviour:

3 misunderstandings about AIM2 assessments...

Sexual abuse remains a prevalent issue in the news.

Rotherham and the start of the historical child abuse enquiry, have followed quickly on the heals of the Jimmy Savile scandal.

Studies now generally accept that around a third of such abuse is carried out by other children or young people.

Image courtesy of ©iStockPhoto/olm26250 (adapted)

Image courtesy of ©iStockPhoto/olm26250 (adapted)

So agencies are rightly looking for ways to ensure that harmful sexual behaviour (HSB) in children and young people is properly handled.

Pitfalls of non-specialist HSB work…

Cuts to Local Authority spending have meant the withdrawal of funding to specialist HSB services in some areas. One of the “alternatives” being practiced increasingly widely, is buying into the AIM2 assessment.

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I’ve lost count now how many times I’ve heard managers and practitioners justify the withdrawal from or failure to commission specialist services with phrases like:

  • “We used to buy into such-and-such a service, but now we have staff trained in AIM2”
  • “We’re AIM trained so we’ve brought all the HSB work in-house”
  • “It’s OK, we’ve got AIM2 now”

Firstly, a bit about AIM…

Here’s what the guidance itself says about the AIM2 assessment tool:

“The Model is designed to assist in early stage assessment of young men of mainstream educational ability, aged between 12 and 18, who are known to have exhibited harmful sexual behaviour or one or more occasions.” (AIM2 Guidance, Section 2, page 19)
Image courtesy of ©AIM Project

Image courtesy of ©AIM Project

In my view, the AIM2 assessment has great merit. It has real worth in helping practitioners and agencies to make such judgments as are necessary for making decisions about the level of supervision required to ensure their safeguarding obligations are met.

As such, schools, social workers, foster carers, youth offending team officers, CAMHS workers, etc. can glean useful – even crucial – insight into how best to manage HSB in young people. That’s its purpose. And it does it well. Here’s a bit more from the guidance:

“AIM2 is … able to offer an initial, brief, evidence-based tool that can be used to begin to consider the level of supervision that is required for an individual, together with their developmental and intervention needs.” (AIM2 Guidance, Section 2, page 20)

Note the tentative language about the brevity and early stage application of AIM.

Where services are going wrong…

I want to be really clear: I like the AIM2 assessment tool. My problem is not with AIM, but with its use and the assumptions made about what it offers. These include:

  • Seeing AIM2 as a panacea – the language used by non-specialist HSB professionals suggests that embracing this assessment tool covers them for HSB. It doesn’t. It’s a good start, but that’s all.  It establishes an initial estimate of the level of supervision required to manage risk. But it does not ameliorate the causes of that risk. Nor does it give sufficient information to call itself a comprehensive assessment.
  • Believing an AIM assessment is enough – there is the assumption, now prevalent in my experience, of agencies believing that an AIM2 assessment is enough in itself. As I’ve said, it’s a good start, but much more is required. It does not absolve agencies from their responsibility to ensure that children with HSB get the best possible service. It does not bestow the ability to generate properly tailored treatment plans or tell the practitioner how to do this work safely. It doesn’t give them the underlying knowledge they need either.
  • Training in AIM2 as a certification of competence to assess – the AIM2 brand is strong. It is increasingly recognised as a quality practice tool. I agree that it is. But that reputation does not translate to the worker undertaking the assessment on a particular young person. Non-specialist staff have numerous other duties and therefore are likely undertake so few assessments that their skill base has no real opportunity to fully develop. Like all other such tools, the AIM2 is only as good as the person using it…

There isn’t room here to cover the other limitations (for example not being validated for younger children, internet offenders, girls and young people with learning difficulties – which covers a pretty large proportion of the kids with these problems).

Workers at risk…

One of the greatest issues – in my view – surrounding the over-emphasising and misuse of the AIM2 model, is the exposure being felt by staff using it.

Non-specialist staff using AIM in social services teams and in youth justice often say to me that they do the assessment and are then left asking, “…now what?…

More than that, many are worried that they now have a much better idea about the level of risk they are dealing with in a young person (AIM is good at this), but have no more idea about how to address it. Those who may know what to do, don’t have the time or agency remit to do it.

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So what else do we need?…

Here’s where the issue is really clear – that AIM2 is NOT the problem, but rather its use.

This occurs where agencies ask staff to use the tool, or any tool, without appropriate supports and without the necessary checks and balances in place. These include:

  • Staff care – the process of assessing and treating harmful sexual behaviour is a complex one and can be burdensome for staff. This is all the more the case where staff are inexperienced and/or unsupported. Self-care is one thing, agencies putting the right kind of backup in place is another. The latter, in my experience, is often lacking (see clinical supervision below).
  • Specialised ongoing training – being shown how to use a particular tool is fine. But there is a huge body of knowledge sitting behind both its development and its use. Staff need not only to be well versed in using the tool itself, but kept informed about broader research developments and practice innovations. Agencies must commit to this if staff are to practice safely.
  • Journal access – in line with the above, access to resources – particularly the key journals – will help give staff the opportunities to remain current in their knowledge. The two obvious ones are the NOTA journal and the ATSA journal. They are not expensive and add real value. Having these available to staff undertaking assessments is a bit of a no-brainer.
  • Clinical supervision – I’ve written about this before, but the availability of a third party expert for practitioners to consult with is crucial. Apart from helping to mediate for a lack of experience or clinical expertise, having a consultant around makes for a reflective practice culture. This is really important. Dealing with trauma, maltreatment, attachment issues, abuse, etc. mean we must be reflective in order to be safe. You can’t be truly reflective on your own.

I wish dealing with HSB in children and young people were as easy as taking a short training course and doing AIM assessments. Sadly, it isn’t.

Kids with harmful sexual behaviour problems need help. Help to alleviate risk and help to recover and get on with their lives. Here’s why we should let the experts take over where the AIM or any other kind of assessment leaves off:

What specialist services can offer that a stand alone AIM assessment can’t:

  • Access to experienced professionals who have years of experience in working with HSB
  • Top flight clinical consultation with colleagues and others
  • Clinical supervision for assessors and therapists to facilitate reflection and safe practice
  • Psychometric testing to ensure a thorough assessment of psychological and other variables – drilling deeper than any single tool
  • Expertise in following up assessment with specific, bespoke treatment that alleviates risk and aids recovery

AIM2 is a very good assessment tool. It has a part to play in dealing with HSB. But it is not good enough all on its own.

It’s time for agencies to resist the temptation to save money by buying in tools, and put safe practice cultures in place to ensure that children get the best possible deal.

Your thoughts…

  • Do you use AIM? What do you think of it?
  • How can AIM be used to its maximum potential within a wider structure of focussed HSB work?

Leave your thoughts in the comments section below or just click here.

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© Jonny Matthew 2015

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