Introduction

The AMBIT training aims to provide team members with AMBIT Competencies covered in the Basic Training, but as AMBIT is a framework for LEARNING at work, so the full range of competencies is wider. Listed below is the full range of competencies that team's should aim to cover. See also AMBIT Team Competencies that cover the Core Features of AMBIT.

Self-AUDIT

A self-audit exercise is suggested with these competencies. Rate yourself against each of the following 20 competencies according to the following scale, in order to direct further training (including AutoDidact training):

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

The list below INCLUDES and ADDS to the ten AMBIT Competencies covered in the Basic Training

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).

PART C: ADVANCED COMPETENCIES

11. Knowledge of the common difficulties of under-served, (or ‘hard to reach’) young people and their families/carers across multiple domains.

• An ability to draw on knowledge of the psychological and interpersonal difficulties experienced by young people and family members/carers with multiple mental health, educational and social needs who are not seeking help for such problems (‘Hard to reach’ or Under-Served).

• An ability to draw on knowledge of the multiple risks factors (Complexity) that influence hard to reach young people (e.g. at the level of the individual, family/carers, peer, school and community).

• An ability to draw on knowledge of Family phenomena commonly associated with the multiple mental health needs of a ‘hard to reach’ young person (e.g. disorganised Attachment patterns, inconsistent parenting style, negative marital interactions, psychiatric disorders (Diagnoses), Physical Health matters), Educational needs (see Educational-Vocational Training), the SocialEcology (such as social service entitlements and economic factors (e.g. poverty) in a young person’s life - see Social-Ecological Work and SubsistenceSupport.

• An ability to reflect on the lack of Evidence associated with psychological therapies associated with this complex and often co morbid group

• An ability to draw on knowledge of the long term psychological, social and economic consequences of social exclusion such dropping-out of school, college and work and/or a history of offending (e.g. reduced wages, limited career opportunities and housing restrictions) and its links to Complexity and the nature of Hard to reach populations.

• An ability to draw on knowledge about the general (and specific local) approach to provision of services for such young people – and the psychological impact of multi-agency involvement in “complex” or “multi-problem” cases. See Addressing Dis-integration.

12. Knowledge of Attachment theory and help seeking as a way of making sense of 'Hard to reach' young people.

• An ability to draw on knowledge of Attachment theory and the processes involved in help seeking, as well as the implications of lack of help seeking (or atypical forms of help-seeking) for young people whose Relationship to help may contribute to them being described as Hard to reach.

• An ability to draw on knowledge that a Mentalization based approach is grounded in Attachment theory.

• An ability to adapt methods of practice to take into account the young person’s previous experiences of seeking help from adults (see Adapt your discourse and Contingencies, as opposed to Non-contingent responses).

13. Knowledge of systemic principles that inform the AMBIT approach

• An ability to draw on knowledge of SystemsTheory - that whatever affects one member of a system (e.g. a family, school or multi-agency network) may affect all other members.

• An ability to draw on knowledge that patterns of interaction within and outside a group may affect each member of that group (see Positioning Theory).

• An ability to draw on knowledge that patterns of interaction between professionals working with a young person may affect each member of such a network (Dis-integration).

14. Ability to engage with young people and their social context

• An ability to recognise the factors that inhibit Engagement with help for young people and to adapt the intervention to accommodate to these factors (see Relationship to help and the Therapeutic Bargain).

• An ability to identify trusted adults in the network around the young person (either family or professionals) and, where appropriate, to work through such adults in order to enhance the young person’s capacity to develop trust in others around key issues in his/her life (see StrengthsResiliencies and Scaffolding existing relationships.)

• An ability to carry out a process of gradual Engagement with a young person through the use of persistence that takes into account a formulation of the young person’s difficulty in responding to offers of help.

• An ability to promote engagement by employing core clinical skills (Engagement techniques including ordinary skills such as empathy, warmth, reflective listening, reframing, flexibility and instilling hope for change).

• An ability to draw on knowledge that engagement is a process over time rather than a single event and that a young person’s behaviour (e.g. contacting the service when upset or angry) may indicate (through the lens of Attachment theory) positive shifts in Engagement as much as what they say about the relationship (e.g. you’re all rubbish).

15. Ability to complete an AIM assessment.*

• An ability to draw on knowledge about the value of carrying an assessment of different Domains of a young person’s life (see Working in multiple domains).

• An ability to complete an AIM assessment of a young person either with a member of the network who knows the young person well or a family member as part of an initial assessment of the young person’s needs.

• An ability to complete an AIM assessment with the young person either using an on-screen (AIM Form) or paper version (AIM - paper version) or by using the AIM Cards as a method of understanding the young person’s perspective on his life and problems.

• An ability to score the AIM assessment and to use the AIM Form in the AMBIT manual to generate suggested interventions for that specific range of presenting problems indicated from that assessment.

• An ability to share the results of an AIM assessment with the young person and to construct a shared understanding of its meaning.

16. Ability to develop a mentalized formulation of the young person’s difficulties

• An ability to summarise information about a young person from a range of different sources in a concise and coherent manner. See Formulation and Treatment Aims. This builds on the idea of providing narrative continuity (one of the Features of Successful Mentalizing).

• An ability to reflect on the Formulation and Treatment Aims and to develop a description of the young person that takes account of their likely mental states and intentionality.

• An ability to share this mentalized Formulation and Treatment Aims with the young person in a manner which supports the capacity of the young person’s mentalizing and does not raise anxiety and/or affect (for instance see Assessment for SUD-Rx - Giving Feedback)

17. Ability to develop a shared care plan with the young person

• An ability to be curious about the young person’s ideas as to what would make his/her life better and, where possible, develop these into goals for the work together (see The Inquisitive Stance as part of The Therapist's Mentalizing Stance)

• An ability to process information gleaned from, and about, the young person and their network, using peer/supervisory support where indicated, and to draw up a preliminary ‘roadmap’ for the therapeutic work that might be possible or necessary (see Active Planning).

• An ability to broadcast one’s own therapeutic intentions (Broadcasting Intentions), concerns, non-negotiables, hopes, etc, tentatively, as a “work in progress”, inviting authentic collaboration to develop a care plan that takes account of the young person’s beliefs’ about what will be helpful.

• An ability to communicate ideas about evidence based interventions (see Respect for Evidence) in ordinary language to a young person in order to discuss what is likely to be helpful , and why.

• An ability to liaise with the young person about how the agreed Care Plan is communicated with family members and/or the professional network - see Active Planning: a core process with clients.

18. Ability to support the measurement of individual and team clinical outcomes

• An ability to recognise the importance of remaining curious as to whether a particular method of work with a young person is be experienced as helpful to them - see Outcomes and Respect for Evidence

• An ability to support and contribute to the development of systematic methods within a team to evaluating whether young people are experiencing the service as beneficial to their problems.

• An ability to focus on continued evaluation of outcome from multiple perspectives, ensuring that both the young person and the AMBIT worker communicate their respective viewpoints and consider the viewpoint of the other.

19. Ability to identify with, and access support from, the wider AMBIT Community of Practice.

• An understanding of the ideas behind the Community of Practice that AMBIT seeks to develop and support.

• An understanding of the way that the AMBIT tiddlymanual has “layers of authorship” – with all local versions sharing a common core, but being empowered to add to or overwrite this content in their own local version (see Using the Manual).

• An ability to locate links to other local versions of the AMBIT manual via the www.tiddlymanuals.com signposting site

• An understanding of the “OpenSource” aspects of the development of AMBIT

• An ability to use the “+ Getting started” page in a local AMBIT manual to receive news updates on the manualizing work by other AMBIT teams in the AMBIT Community of Practice, and to “clone and customise” relevant pages from another team into one’s own local manual.

• An ability to identify whether a page in the manual exists in different versions in other local manuals, and to compare those two versions (see Comparing and Sharing functions).

20. Ability to reflect on one's own, and the team's fidelity to AMBIT

• An ability to access and use the APrAT self audit form in relation to a specific case.

• An ability to use this AMBIT competencies framework to evaluate one's own further training needs.

• An ability to audit the team's practice against the Core Features of AMBIT

• An ability to accept the inevitability of variation in Outcomes in one's work with young people and families/carers.

• Demonstrate an openness to accept and learn from outcomes that have proven less successful than intended (See LEARNING at work.

DEVELOPING EVIDENCE ABOUT THE 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).