One of the Core Features of AMBIT is Working with your NETWORKS, and the practitioner's AMBIT stance element of Taking Responsibility for integration makes clear that seeing it as my business to do something helpful about Dis-integration in my professional networks is very central to what it means to work in an an AMBIT-influenced team.

Flowing from this principle is the specific application of this towards the wider the network that surrounds the young person and their family. Addressing Dis-integration is thus the application of this stance in day-to-day practice.

"We are an outreach team working closely with other organisations (Social Services, Schools, Police etc) with high potential for dis-integration. Current cuts to services make maintaining a mentalizing stance all the more important - yet simultaneously harder to do"

AMBIT-influenced team, 2014

Addressing Disintegration Videos

This is a video taken from a training for AMBIT Local Trainers in 2014 (DickonBevington):

In 40 mins by Peter Fuggle: Part 1

Part 2

Large networks

Because of the pervasiveness of the problems of this group (and, frequently, associated risks) the ‘nominal’ number of different professionals involved in these cases tends to multiply. However, clinical experience suggests that this ‘team around the child’ may experience difficulties in working together with this hard-to-reach group. Why?

Different explanatory models

There is the potential that, implicitly or explicitly, each different worker addresses the young person’s problem set through the ‘lens’ of a specific professional training. Each worker references different explanatory models that have largely grown up within, and may be seen as being “owned by”, specific professional groups (social-ecological, legal-criminological, biological-genetic, psychodynamic, systemic, educational, etc). From each of these explanatory frameworks is derived one or more of the different modalities of intervention accepted as being more or less evidence-based. The dilemma for the young person and their family is that, at a time of great fragmentation (‘dis-integration’), they may be expected to integrate what can appear to be both disconnected, and even contradictory interventions from different agencies - this is referred to as the Tower of Babel effect.

Different explicit priorities

Workers from different agencies will have explicit responsibilities for different aspects of the young person's difficulties. For example, the Youth Offending service worker will focus on the young person compliance with the Court Order and avoidance of further offending. The Educational Welfare Officer will prioritise school attendance, while the drugs worker will prioritise reduced substance misuse.

These priorities (that are inevitably required by organisations set up and funded with specific remits) may have different impacts upon the young person's psychological well-being, but if the person gains the sense that they are in opposition to each other this can be damaging.

Anticipating misunderstanding and conflict

A fundamental assumption is that network differences and conflicts should be anticipated as inevitable and not be seen as an indication that people in the network around the young person are somehow "getting it wrong". This is crucial as it moves towards a more mentalized understanding of the complexities of multi-professional and multi-agency working, and away from the attribution of blame and shame (demonstrating, if you like, forgiveness - one of the Strengths in RELATIONSHIPS that are Features of Successful Mentalizing.)

Because of this, the AMBIT practitioner is expected to pay close attention to (and proactively to Mentalize) the wider network around the young person and the family. For this population of young people, the network around the young person may consist of agencies who (even more than in other areas of CAMHS) all see themselves as primary in relation to the young person.

This may include the police, the local Youth Offending Service, the young person’s school or college, the Local Authority, and the local CAMHS (Child and Adolescent Mental Health Service.)

With this typical array of agencies, AMBIT adopts a position that actively anticipates the likelihood of conflict and contradiction between agencies or professionals, and promotes the explicit view that this is understandable, as an inevitable aspect of our best efforts to provide services for the young person. In contrast to much of the literature on integrated practice (which tends to assume a commonality of purpose between different agencies), AMBIT proposes that a context of ‘dis-integration’ is extremely likely with this population of young people.

What to do? The Dis-integration grid

This position may appear to suggest a general negativity about the capacity of other public services to deliver what they promise. This would be entirely incorrect; the nature of such negativity is that it tends to be supported by negative attributions about the competencies of individual workers in other agencies. In contrast AMBIT adopts an entirely different position. The point is to move away from blame and shame and towards practical measures to address and minimise the impact of this state of affairs. AMBIT proposes a series of simple practices drawn from SystemsTheory and Cognitive Behavioural theory, and theories of Mentalization which:

1. Actively address the likelihood of inter-agency and inter-professional differences (see the Dis-integration grid, which is part of the basic Multi-Domain Assessment that every new client receives)
2. Works to reduce the negative impact of this on desired outcomes.

Using notions underpinning the Dis-integration grid, or that exercise itself, is a core part of the AMBIT intervention with the family and wider care network.

Learning, Training and Practising this

There is a page on Learning about Addressing Dis-integration that describes the core didactic teaching from the AMBIT training. There are Training exercises that we include here that explicitly encourage workers to try to practice mentalizing the network (for instance the Dis-integration Grid EXERCISE) or to practice mentalizing each other, and to consider the sensitivities required in this (for instance The 'What's it like to be...' exercise.)

Why?

The purpose of paying close attention to the wider network is partly to improve the effectiveness of interventions, but also is consistent with the overall mentalizing stance of AMBIT. One of the core aims of the keyworker is to help the family make sense of the various professionals' behaviours - by encouraging the family to adopt a mentalizing stance to their work. In our view, Mentalization provides a crucial technique in trying to facilitate an authentic integration of different aspects of multi-agency provision.

AMBIT may sometimes prefer to "wrap around" and assertively consult to and scaffold an existing worker who is identified as having a good relationship, rather than insisting that this relationship is jeopardised by insistence on forming a new relationship. This is in keeping with the AMBIT notion of the "Team around a Worker":

Team around the Worker

Where actively supporting the mentalizing of colleagues is a CORE task for all workers: