AMBIT: an overview

29th March 2018

What is AMBIT?

AMBIT FAQs answer some of the most frequently asked questions arising at the AMBIT trainings. There is also a single page AMBIT in a nutshell that tries to describe AMBIT in the most general terms, but here is a bit more detail:

AMBIT is, by design, changing and adapting in relation to learning, so it is not a "thing", though it is not nothing. This is why it has been developed and described from its very beginnings in a flexible, adaptable online Wiki format, rather than in unchangeable printed text. (That said, there are numerous peer reviewed publications, and in 2017, a 'book of the wiki' was published by Oxford University Press - find these at Academic references).

AMBIT's name changed recently: from Adolescent Mentalization Based Integrative Treatment to ADAPTIVE Mentalization Based Integrative Treatment, because many of the clients that teams using this approach are working with now fall outside the category of adolescence.

Here are three (ranging from the very brief indeed, to longer and more detailed!) video introductions to AMBIT by four AMBIT trainers (there are more detailed Videos below, and many more dotted throughout this manual):

AMBIT is:-

A Mentalization based approach.
An approach for young people with severe and complex problems including mental health problems (see Multi-Domain Assessment).
An approach for young people who may have a very poor or negative Relationship to help.
An outreach approach, but one which can be adapted for other types of service delivery (see Working with your TEAM).
An intervention with a strong emphasis on initial engagement (see Phases of AMBIT work)
An approach that emphasises relationship building and uses ideas from attachment theory (see Attachment theory).
A team approach rather than an individual therapy.
A manualized framework with a strong emphasis on supporting local adaptations and further development of the basic method (see Manualization).

Many of the ideas in this manual will already be familiar to experienced staff working with this client group. In addition it provides manualized instructions on a wide range of Specific interventions that are drawn from evidence-based practice.

The intention is to help workers become more confident in managing complex behaviour by young people. It also aims to enable staff to be able effectively to help their colleagues when they become stressed by their work. it is designed to be highly practical, adaptable, and to build upon a set of collaborative relationships:

Not only between worker, young person, and their existing network
But also between the worker and team members
And between the team and external sources of evidence and advice that the core of this manual represents.
Finally, it promotes a Community of Practice between other teams developing their own practice and building upon AMBIT. Ideally teams practising AMBIT co-construct their own localised version of the AMBIT manual, building in their own local expertise alongside evidence-based or evidence-oriented practice.

A 30 minute overview of AMBIT & its Core Features

Part 1

Part 2

A 40 minute lecture covering mentalization and AMBIT

This was shot at the MAP conference in Norwich 30th Novemebr 2012.

AMBIT is NOT:-

a "one-size-fits-all" rigidly-determined "tick-box" approach to therapy.
a new form of individual therapy
a template for team structure and organisational arrangements
an approach for specific psychiatric disorders
an approach that can only be delivered by statutory services

The Core Features of AMBIT

For the practitioner the most important thing is the Core Features of AMBIT, which are the highly practical "grab-rails" - defining a STANCE - and core features of PRACTICE, that are designed to help a practitioner stay 'on track' - especially at those times of high stress or anxiety that are common in this work. You'll find them summarised in a 'click-able' diagram at AMBIT Wheel, or here:

AMBIT emphasises the importance of local expertise.

AMBIT is designed to support the development of local expertise that provides care that is contingent to the needs of the local setting. There are many different Specific interventions included within the core AMBIT manual and few teams would claim to use all of these, and many teams would include additional interventions that they have expertise in. AMBIT interventions are predominantly delivered by a keyworker working together with the family, engaging with the local and community network, and utilising input from service users. Occasionally an AMBIT may wrap around an existing worker to scaffold that relationship, rather than trying to replace it.

AMBIT is a team intervention

In spite of the emphasis on interventions being delivered by a single keyworker, AMBIT is essentially a team based approach, with a strong emphasis on mentalization as a core concept of team working. In AMBIT, whilst there is emphasis on using different ways to help support and repair Mentalization in the young person and family, there is an equal emphasis on the organisational aspects of instilling within team members the day-to-day duty of mentalizing each other accurately and sensitively, and supporting each others' capacity to mentalize (in what are often hostile or invalidating environments.) There is a focus on developing and sustaining a team culture (see Rituals and Disciplines) that maintains this, and one way to understand this is a deliberate shift from the "Team around a child" approach, towards the "Team around a Worker" - so that the wider team focuses on supporting a secure therapeutic Attachment relationship between the young person and worker:

AMBIT has web based manual

This manual provides information about AMBIT, and aims to be an aid to workers working with young people who manage (often with great ingenuity and fortitude) multiple problems.
Who is this manual for? gives a more detailed discussion of who this manual is really "aimed at". The manual includes all our AMBIT training materials, so it can act as an aid to teams trainings.
Who is AMBIT designed to help? gives a more detailed description of the kinds of young people that AMBIT is designed to help.
If this is your first time in a TiddlyManual, you may need a little help in navigating around, but it works (on the surface at least) much like an ordinary website. See Using the Manual (or Understanding TiddlyManual format if you want more technical details, but explained simply) for this.

Takes a holistic approach

AMBIT places a high value on re-establishing the ordinary social/educational/vocational and recreational contacts that tend to shape and support young people, and aims to try to address a range of aspects of the young person life rather than focus entirely on the target problem. In this way, AMBIT intervenes across multiple domains of the young person's life.

Puts theory into practice

Drawing on a range of different theoretical frameworks, AMBIT aims to use mental health theories and evidence for work with highly disadvantaged young people who do not make use of mainstream services. In this sense - because the range of problems that AMBIT-influenced services address means that there may be many different treatment aims - addressing the young person's fundamental Relationship to help may be one of the core treatment aims shared by the many services that use or adapt this approach.

Manages risk

Considerable attention is given to ensure that community based practitioners maintain clear boundaries with clients and work safely in often somewhat chaotic, unpredictable andpotentially isolated situations.

Not a static thing

AMBIT is what has been called a "Deployment-focussed" model of new service design. Its novel wiki-manual defines this endless adaptation, while holding onto clear structure.

An "OpenSource" approach to therapy

AMBIT is strongly opposed to the notion that effective ways of working with youth can be turned into intellectual property or commodities. Its manual is freely available, and is built on developments from a wide range of fields. There are parallels between the OpenSource model of software development in computing and many of the ways that AMBIT is conceived of operating. The radical and award winning approach to treatment manualization encourages the development of local expertise and a Community of Practice between the different teams using it, who can make use of Comparing and Sharing functions in their locally adapted versions of the core AMBIT content.

Feedback from AMBIT-influenced teams

Here are some comments received in a 2014 survey of teams who have undertaken AMBIT training.

"AMBIT has been helpful in bringing together a shared sense of purpose for a team while under re-organisation"
"Team was newly set up when AMBIT training was attended so it has been key to the team's development and ethos from the beginning."
"We continue to use AMBIT as a focus to ensure that we work in a different way. AMBIT is becoming the language by which we do this"
"Has offered a set of principles for working with complex systems organised around mentalizing which we can compare ourselves against and relate to as we develop how we work"
"We are growing a pilot multidisciplinary young person's service (including support for providers of youth services) ... and find that AMBIT helps us better support young people as well as build non-adversarial and positive working relationships with colleagues from other services"

Relevant links

1. Core Features of AMBIT - This should be your next step in understanding about AMBIT - it provides the main "grab rails" for a practitioner to remember that determine his or her STANCE in the work, and the key features of PRACTICE that flow from this.
2. Mentalization - This is the key supporting theory, that shapes specific work with the young person and family, and the work of the team.
3. AMBIT Stance Exercises offer a range of Training exercises to practice different elements of the stance.
4. AMBIT FAQs answers some of the most frequently asked questions arising at the AMBIT trainings.