First steps

1. Go to Active Planning - this describes how to go about developing a rational and safe plan for how to approach a young person and their family's complex difficulties.

2. There is a helpful checklist at Starting a NEW CASE - CheckLists which lays out all the necessary tasks for you to go through.

3. If you have completed an AIM assessment, then look at AIM suggested interventions, which is designed to give you a variety of ways of sorting, ranking and sequencing the different Specific interventions that you might select.

Still need help?

1. I am lost!

You may find support in I'm stuck: what next? or KeepingYourBearings.

The KeyWorker in AMBIT offers great flexibility - the ability to shift from one intervention to another very quickly, so as to maintain a sense of momentum. For instance, it is not necessary to wait for the arrival of the Family Therapist before some family work can take place if that is what is called for here today. This is about providing Contingent care. However, working with so many options immediately at hand requires a systematic approach to sequencing interventions, and structures to assist the keyworker in KeepingYourBearings.

2. Consider Hierarchy of Need

Placing the Formulation and Treatment Aims within a hierarchy/sequence may also be helped by using a modified version of Maslow's HierarchyOfNeed. the most basic needs MUST be supplied BEFORE trying to work on higher order needs. (If a child is not safe then no amount of perfectly-delivered and sophisticated psychotherapy will deliver what he or she needs.

3. Maintaining engagement

This is ALWAYS a Treatment Aim.

Included in the generation of Formulation and Treatment Aims should be the identification of some achievable "QuickWins" which, although they may not feed into the sequence of interventions directed at major treatment aims, are nonetheless effective as a tool for assisting Engagement, or to instil optimism if work in other areas appears to be "stalling".

Recognise the need for parallel planning and the capacity to switch flexibly between different tasks. It is very important to keep a sense of momentum.

4. A Balancing act:

Sensitivity & Chaos Vs A "Clear Steer" & Rigidity

The KeyWorker always tries respond with sensitivity to ServiceUserFeedback in choosing what tasks to focus on, and when. However, an important balance must be struck, because alongside the valued capacity to provide:

Contingent Care - i.e. to be guided by, and responsive to, a young persons' demands..

...there is often also the need to provide:

Clear and authoritative guidance; a "clear steer" for a young person and family in crisis.

Responding to the latter requirement avoids the KeyWorker being carried along by the chaos that may characterise the young person's life.

5. Using the team

The use of the team SupervisoryStructures assists in this latter task, harnessing the reflective meta-position of team members/supervisors to help to provide a reflective stance and to avoid the pitfall of the KeyWorker becoming paralysed (for instance by the quite understandable avoidant tendencies within the family and young person as regards very challenging psychological work.)

5. Direct and Systemic work

There is a balance to be found between Face-to-face work Vs. Liaison/networking.

The KeyWorker will bear in mind the need to balance face-to-face contact with the need to be Working with other professionals. One of the earliest of the Treatment Aims (seeFormulation and Treatment Aims) will be the development of a strong therapeutic alliance (attachment security) with the young person and family, and this will necessarily require more direct (face-to-face) contact time in the early stages. However, the keyworker may calculate an advantage in the opportunity of gaining one of the identified QuickWins if an external agency can be rapidly recruited to provide (for instance) benefits assistance.