Purpose

To explain what Key Problems are, as we define them in the AIM, and how we use these to clarify our Formulation and Treatment Aims.

Definition

"Key Problems" refers to one of the scoring options in the AIM, which not only asks for a numerical scoring for the severity of problems in each item,but also offers the option to mark a particular problem as a "Key Problem". Addressing each of these should be covered in your Care Plan, and there is further advice on this in Active Planning.

Key Problems must be amenable to CHANGE: problems that are NOT AMENABLE TO CHANGE should NOT be selected as Key Problems, for instance:

• Learning Disability
• Physical Disability

ICR

If you are using this manual in its most interactive form (ICR), go to "KeyProblems" and look in the Show references and info panel of that Tiddler, to find a list of all the problems that are tagged as Key Problems by the AIM.

Collaboration with client

You will need to clarify and agree what are the Key Problems with the client; it is important that Key Problems have meaning to the young person/their family. However, we accept that certain problems (for instance, a psychotic illness about which the young person has no insight, or an addiction that the young person is denying) will need to be negotiated, and ultimately the AIM is a practitioner-completed questionnaire. Try to highlight any major differences of opinion about what is or is not seen as a Key Problem.

Limit number of Key Problems

When filling in the AIM, you must limit the number of Key problems to 6 or less, otherwise they lose their value as markers of the MOST pressing issues to address.

1. Criteria for labelling a problem as a KEY PROBLEM:

• Key problems are those that are agreed to be the most important ones to change within the proposed treatment period, in order to allow meaningful improvements in this young person's life trajectory to occur.

2. Consultation

The AIM, where Key Problems are first defined, is a Clinician/Practitioner-rated scale, but the Key Problems should preferably be agreed in consultation with:

• Young Person
• Family members
• Other parts of the Professional Network (see Working with other professionals)
• The SupervisoryStructures that are in place.

3. Compromises

As a practitioner-completed assessment the KeyWorker and their SupervisoryStructures are ultimately responsible for making the decision about the assessment. However, in negotiating these, some COMPROMISE may have to be agreed, for instance:

• A young person may deny that Drug use is a Key Problem, whilst family and others all say it is...
• In this case the Formulation and Treatment Aims and Care Plan would need to address these DIFFERENT stances, and the young person's presumed lack of insight into this problem.
• A parent may deny that their own mental health problem is a Key Problem for the young person...
• In this case the Formulation and Treatment Aims and Care Plan would have to address parental lack of insight.