The problem AMBIT is designed to help with

Socially excluded youth with mental health problems and co-occurring difficulties (e.g. conduct disorder, family breakdown, homelessness, substance use, exploitation, educational failure) attract the involvement of multiple agencies. Poorly coordinated interventions often multiply in the face of such problems, so that a young person or family is approached by multiple workers from different agencies working towards different goals and using different treatment models; these are often overwhelming and may actually be experienced as aversive by the young person or their family. Failure to provide effective help is costly throughout life (effective early intervention in conduct disorder alone is estimated to save £150,000 per child; Friedli, 2007).

What is AMBIT?

AMBIT is a framework to support developing practice, rather than a self-contained model of therapy.

AMBIT is a collaborative project that involves feedback from practitioners, clients and evidence based treatment designers. It has been designed by and for community teams from Mental Health, Social Care, Youth work, or that may be purposefully multi-disciplinary/multi-agency. It emphasises the need to strengthen integration in the complex networks that tend to gather around such clients, minimising the likelihood of an experience of care that is aversive. AMBIT uses well evidenced ‘Mentalization-based’ approaches, that are at their core integrative (drawing on recent advances in neuroscience, psycho-analytic, social cognitive, and systemic "treatment models"). Evaluations at local levels have offered very promising results, and to date (2014) over 80 teams have been trained in the UK, Switzerland and USA. Publications in peer reviewed journals and presentations at international conferences have been well received, and demand for AMBIT training is very high.

AMBIT uses evidence based approaches developed for self-injurious, substance-using and often non-help-seeking, disaffected and socially excluded youth. It offers a robust framework within which to coordinate and integrate interventions from a range of agencies, which address complex problems that occur at the same time across a range of domains (from the biological, through individual psychological, family, and social interventions, and including Education and legal/forensic services.) At its core is the treatment model based on the science of “Mentalization” that has achieved strongly evidenced results with the condition known as adult borderline personality and also with adolescent self-injurious behaviour. AMBIT is being applied in a widening range of treatment settings. Mentalizing theory is favoured because it is intrinsically respectful to other schools of thinking, and it is relatively easy to train workers in the core competencies. AMBIT places a very powerful emphasis on developing strong supervisory relationships between teams of workers, who are thus supported to form strong individual relationships of trust with young people, while close attention to professional peer relationships counters the risk of such client-worker relationships themselves becoming a destabilising influence, as is unfortunately often the case in this field.

A key goal in AMBIT is to improve young people’s Relationship to help, to improve the likelihood of more adaptive help-seeking in the future, as well as addressing current symptoms, so prevention is at the heart of the AMBIT method of working.

AMBIT applies mentalization-based principles and practices in four main areas:

(a) In direct work with clients (young people and their families or carers)
(b) In shaping and supporting relationships between workers in teams
(c) In providing systematic approaches to identifying and addressing “dis-integration” in the complex multi-agency networks that gather around such youth
(d) In supporting local teams to adopt a learning stance towards their own practice, so that AMBIT is not simply a “one-size-fits-all” approach but supports the gathering of local outcomes evidence, and the use of this to develop a judicious balance between the use of existing evidence-based ways of working, and the onwards development of local practice that is culturally sensitive to the needs of local youth and to the organisational contexts in which this care is delivered.

AMBIT’s model for disseminating its knowledge and practices attempts to balance centrally designed interventions with constrained local adaptation of the model to fit local systems, client groups, and onwards learning. It is supported in this by AMBIT’s national award winning wiki-based “manualizing” technology (see https://manuals.annafreud.org for general signposting to all wiki manuals, and https://tiddlywiki.com to learn about the tech that powers these manuals).