AMBIT Competencies covered in the Basic Training

12th June 2015

What is this?

See AMBIT Competencies for a description this. The list below is just the first half of the AMBIT Full Competency Framework - that is, just the core elements of practice that we hope trainees will achieve in their initial AMBIT training.

Self-AUDIT

A simple exercise in thinking about your skills is to rate yourself on each of the competencies. Rate yourself against each of the following 20 competencies according to the following scale:

Scoring: 0 = Not confident, 1 = Becoming confident, 2 = Confident

PART A: KNOWLEDGE FOR AMBIT

1. Knowledge of the theory of Mentalization*

An ability to draw on knowledge about the nature of mentalizing (see Mentalization)

An ability to draw on knowledge about the developmental basis of processes of mentalization (see Secure Base and Marked mirroring)

An ability to recognise mentalizing and patterns of non-mentalizing in both self and others (see Implicit mentalization; Explicit mentalization; Teleological thinking; Pretend mode and Psychic equivalence)

An ability to draw on knowledge that the vulnerability to loss of mentalization leaves the young person exposed to more primitive modes of experiencing internal reality that, in turn, undermines the coherence of self-experience (see Concrete Mentalizing difficulties)

2. Knowledge of the AMBIT approach*

An ability to draw on knowledge of the basic AMBIT framework (“core features”) summarised in the AMBIT wheel (see AMBIT Wheel and Core Features of AMBIT).

An ability to describe the AMBIT stance and the principle of holding the balance between competing dilemmas that are represented in it (see The Therapist's Mentalizing Stance and General features of a "Mentalizing Stance").

An ability to describe the four key practices in the AMBIT approach and to understand the relationship between the four practices as part of an integrated approach to effective intervention (see Working with your CLIENT; Working with your TEAM;Working with your NETWORKS;LEARNING at work).

An ability to recognise the limitations of the relative lack of evidence for the AMBIT approach for hard to reach young people (see Respect for Evidence and Is AMBIT evidence based?).

PART B: AMBIT PRACTICE

3. Ability to use mentalization in their work with young people and their carers*

An ability to draw on knowledge that the intervention aims at increasing the young person’s capacity to mentalize (see Highlighting and reinforcing Positive Mentalizing).

An ability to draw on knowledge that AMBIT formulates some of the mental vulnerabilities associated with hard to reach young people as resulting from the fragility of mentalization in the context of attachment relationships (see Formulation and Treatment Aims).

An ability to draw on knowledge of the developmental factors and experiences that are typically associated with a vulnerability to loss of mentalization (see Developmental Considerations).

An ability to adopt the mentalizing stance in working with young people (see The Therapist's Mentalizing Stance and General features of a "Mentalizing Stance").

An ability to use the mentalizing loop in working with young people and their carers (see Mentalizing Loop).

4. Ability to apply mentalization to work with colleagues*

An ability to draw on knowledge of mentalization to recognise that the mentalizing capacity of colleagues within a team (including oneself) is likely to fluctuate in response to anxiety, stress and other expected aspects of work with hard to reach young people (see Ripples in a Pond and Dive Boat).

An ability to draw on knowledge of attachment and mentalization to work towards creating a sense of safety within a team in order to facilitate mentalizing in oneself and others (see Secure Base).

An ability to draw on knowledge of attachment theory to recognise the value of availability and responsiveness in work between colleagues in a team (see Attachment theory).

5. Ability to apply mentalization to work across agencies and see problems from multiple institutional standpoints*

An ability to make sense of the behaviour of staff from other agencies in terms of understandable mental states and intentions of agents in that organisation (see Addressing Dis-integration).

An ability to recognise that beliefs about the practice of other agencies is likely to be influenced by unbalanced feedback patterns about such agencies (see Dis-integrative processes in a Multi-Agency context).

An ability to adopt a position of respect towards staff from other agencies and to demonstrate this by positive curiosity about their work with the young person (see Non-mentalizing, positioning and network problems).

An ability to accept that different agencies may be required to prioritise different aspects of a young person’s needs and that these different priorities may create tensions within a network around a young person (see Mentalizing service barriers).

6. Ability to intervene in multiple domains*

An ability to make sense of a young person's difficulties by considering the impact of these problems on many areas of his/her life and to recognise the way that these difficulties are likely to interact together (see Working in multiple domains).

An ability to work with both individual and systemic difficulties in trying to improve the life chances of the young person (see SystemsTheory).

An ability to engage with the wider community such as schools, colleges and youth services in working with the young person (see Working with the Social Ecology).

An ability to apply basic systemic ideas and techniques to intervening in relationship problems both within the family and between the family members and people in the wider community (see FamilyWork).

An ability to consider how wider systems, commissioning arrangements, service procedures and local policies impact on the work with young people and to aim to support such systems to operate in a more coherent way (see Addressing Dis-integration).

7. Ability to scaffold existing relationships to provide help.

An ability to explore with the young person their experience of relationships with others in their network and to facilitate the young person in mentalizing both their own and others’ experiences of such relationships (see Relationship to help).

An ability to be guided by the young person about who may be most helpful to them about their key problems independent of the person’s professional status or background training (see The AMBIT Pro-Gram).

An ability to focus work on building capacity and availability in existing (and potentially long lasting) resiliencies identified in the young person’s social ecology (see Focussing on Strengths).

An ability to actively support (by joining them at meetings etc) a young person’s engagement with more mainstream therapeutic, educational or social care/youth agencies (see Working in multiple domains).

An ability and willingness (temporarily, and with due attention to professional boundaries) to step outside of formally defined roles in order to support the work of another agency - if doing so supports the establishment of improved working and more effective intervention in another functional domain (see KeyWorker and Why intervene simultaneously in multiple domains?).

8. Ability to think together with colleagues*

An ability to draw on knowledge about the high likelihood and impact of episodes of non-mentalizing in the worker doing work of this kind (see Features of UNsuccessful Mentalizing and Keyworker well-connected to wider team).

An ability to apply mentalization in one’s interactions between colleagues within the team (see Work on the Self and Is Mentalizing just Reflective thinking?).

An ability to use the ‘thinking together’ approach to consulting with a colleague in a team, as a way of ensuring that sense is made of the worker’s own feelings about a particular young person or clinical situation, and the possible impact of this upon the work. (see Thinking Together).

An ability to respond to colleagues who seek help around a particular case in helping them to think together about the dilemmas around a particular young person or clinical situation (see Thinking Together).

An ability to challenge colleagues where evidence of a non-mentalizing approach to the work is present, and to support them to regain their own mentalized explanations for the behaviours that they are working with (see Local Session 04: Working with your Team).

9. Ability to assess network functioning using a disintegration grid.*

An ability to identify all key participants from the youth’s professional network who have an investment in the youth’s outcomes, including family members where appropriate and other formal and informal key stakeholders (see The AMBIT Pro-Gram).

An ability to make sense of the behaviour of others in the network in terms of intentional mental states (e.g. to apply the same insistence upon mentalized explanations for behaviour in working with professional colleagues as in working with young people and their families) (see Addressing Dis-integration).

An ability to work proactively to identify gaps (or dis-integrations) in the work of the multi-agency network, that might (mostly inadvertently) either diminish the effectiveness of the interventions by some parts of of the network, or damage the young person or family’s experience of contact with these various facets of “help” from the wider system by presenting them with conflicting or overwhelming demands (see Dis-integration grid).

An ability to facilitate collaboration between professionals at all levels of the service system that takes into account professional beliefs about the nature of the young person’s difficulties, what may be helpful in addressing these problems, and beliefs about role responsibilities in a multi-agency system (see Dis-integration).

An ability to help each of the key agencies to identify desired outcomes or initial goals, and to use this information to set overall treatment goals (see Advice on setting Treatment Aims and Goals).

10. Ability to manualize specific local practice.*

An ability to use the local web based version of the AMBIT manual in a fluent and confident way:

To locate the manual via a browser (www.tiddlymanuals.com)
To open it and orient oneself to the sections of the screen desktop
To navigate it and find specific material via the search function, via the indexes, or by following links, references and topics/sub-topics in the “Show related information” panel.
To use the “Snapshot” function in the manual in order to share a specific page or set of pages with a colleague (see How to read this Manual).

An ability to draw on basic knowledge as to how the manual has been constructed and how a local version of it may be adapted to describe and develop solutions to local service challenges (see I am authorized to edit to our local team's manual).

An ability to engage in team discussion about important areas of practice with young people in order to develop a shared approach to a particular difficulty or situation that commonly arises with this client group (see How to do team manualization).

An ability to contribute into achieving a consensus approach to common clinical dilemmas based on team reflection and discussion and to manualize practice guidance from this (see Respect local practice and expertise).

An ability to reflect with team colleagues on interactions with young people and/or professionals in the network and in a systematic way agreed within the team (e.g. discussion in a team meeting) in order to enable collective learning about effective practice (see Team Meetings).

An ability to make use of the team wiki manual in order to ensure that clinical decision making is consistent with evidence based practice and the AMBIT model as applied to the specific local team (see How to read this Manual which includes a video tour of the main features of the manual and Using the Manual).

See AMBIT Full Competency Framework for the extended list of competencies, and AMBIT Team Competencies for competencies relating to whole teams rather tan individuals.

DEVELOPING EVIDENCE ABOUT THESE COMPETENCIES

Relative Importance and Use of these competencies:

We asked 41 AMBIT practitioners at the AMBIT conference 2014 to give each competency a relative rating of its importance and its use in current practice.

High scores indicate more importance/use (see Competency use and importance ratings).