AMBIT acknowledges the influence of many existing therapies on its development. MST is one such influence.
In its assertive outreach focus, tailored multimodal interventions, and single keyworker practice, there are clear similarities with Multisystemic Therapy (MST), another manualized outreach intervention for complex youth.
The research evidence for MST is much more advanced (Ogden, T., & Hagen, K. A. (2006). Multisystemic treatment of serious behaviour problems in youth: sustainability of effectiveness two years after intake. Child and Adolescent Mental Health, 11, 142-149). However, the evidence for effectiveness for MST outside of the centres where it has been developed is somewhat less strong, and cost effectiveness studies are not unambiguous in supporting it Vs. usual care that is treated with care.

In our view AMBIT and MST differ in the following ways:

• Firstly, AMBIT uses different methods of practice, in which mentalization is the primary organising principle, providing the integrative framework, as well as the therapeutic "stance" and one of the range of Specific interventions included
• AMBIT proposes a positive focus on the therapeutic relationship between child and keyworker. MST places very little emphasis on the quality of the therapeutic relationship between worker and child, and its main interventions are predominantly Cognitive and/or Behavioural.
• AMBIT has significantly fewer exclusion criteria, orienting itself pragmatically to whole service provision as much as to treatment integrity for a tightly defined caseload.
• From an organisational perspective, there is less prescription about organisational structure, and an explicit emphasis on assuming, building upon, and integrating with existing strengths within the local service ecology. MST places a high degree of emphasis on fidelity to their treatment model.
• AMBIT takes an OpenSource approach to the development and sharing of knowledge and learning. MST is a more conventional closed model with high levels of control over the content and dissemination of manuals and materials. AMBIT's wiki-based treatment manual is more than a reference text, but is a freely-available open-source web-based multimedia document that includes all our AMBIT training materials as they are developed.
• MST stresses fidelity to a single model of practice, whereas AMBIT actively eschews the idea of "AMBIT teams" and instead invites local teams to consider themselves AMBIT-influenced - but focussed on developing local learning and expertise and locally-relevant improvement measures. Hence local teams are encouraged to adapt there own local version of the AMBIT manual, co-authoring their own locally-attuned versions of the manual, albeit within evidence-based parameters (www.tiddlymanuals.com).
• We expect that AMBIT can be provided with lower training and running costs.

Some commissioners and service providers may be looking for ways to adapt local services rather than purchase a self-contained team and support services. There may also be advantages in relation to implementation costs, although AMBIT does not have first order evidence of effectiveness or downstream cost effectiveness in the way that MST plainly does. In these circumstances, notwithstanding the strength of evaluations supporting the likely effectiveness of MST, we suggest that AMBIT may be a useful addition to the menu of service options.

Trials - need a control?

As a method that, in many ways, seeks in systematic ways to document and develop best practice in effective local teams, AMBIT welcomes the opportunity to act as "Treatment as Usual" in any Randomised Controlled Trials of other manualised treatments! We promise to learn from any shortcomings in our model revealed from such trials, and the model - designed as it is to grow and adapt - will do so.