We don't create new systems of care, we join existing ones

It is tempting to believe that on the point of accepting a referral we professionals create a system of care around the client. This is almost never the case.

Of course in reality we join a pre-existing system of care; mostly informal, sometimes more or less effective (though we presume at the point of referral it is probably somewhat overwhelmed), and sometimes seen as more less risky (a drug dealer may be seen as a significant source of help to a young person who is desperate for any way to avoid feeling the way they are feeling; reliably available any time of the day or night, and always happy to "help".) This understanding underpins the tension that is captured in the two elements of AMBIT's principled stance (see Core Features of AMBIT for more on this) Scaffolding existing relationships and Managing Risk which can easily be experienced by workers as somewhat mutually contradictory.

The client and their network are the experts

One of the primary aims of AMBIT is to avoid disempowering our clients, their families or other pre-existing informal systems of care, so that they are not forced into having to abdicate responsibility for the young person/client to formal systems. Large formal systems of professionalised care/treatment have many great strengths, but they can also carry significant disadvantages.

In relation to learning, AMBIT's stance requires workers to practice Holding the Balance between the often contradictory principles of Respect local practice and expertise and Respect for Evidence. There is ample evidence that a Care Plan that has been developed collaboratively with the client, and wherever possible with their informal care network, is more likely to be followed and put into practice, and is more likely to demonstrate positive outcomes.

This means that incorporating and responding to service user feedback - both in the individual setting of a specific care/treatment episode, and more generally in the way that the team applies LEARNING at work - is a critical part of the work.

Manualizing with experts by experience

A team's attention to Manualization, as one of the Core Features of AMBIT that supports LEARNING at work, creates opportunities for Service User Feedback to feed into the process of a team's making sense of itself, and how it goes about it work. Novel features in the Wiki manual format facilitate this; further details about this can be found in Team Meetings .

This use of the invaluable 'knowledge and experience resource' that clients bring is also in line with government proposals for a partnership approach to health and social care. We believe that such a partnership will not only facilitate motivation in the family and build greater confidence in the client/keyworker relationship, but will enable more effective and lasting solutions. Thereby the family will not just be the recipient of intervention but will be active in the intervention process.

Employing service users

Users of a service, should be consulted and their feedback incorporated into the treatment program throughout the intervention. This should be clearly stated to families at the outset and monitored at regular intervals. It is especially important that a young person is consulted and is active in the decision making process. We invite teams to consider creating opportunities for ex-clients or family members to be invited to work or volunteer as 'expert patients' after their active engagement with the service draws to an end; either becoming involved in service delivery, or as advocates for others, or through contributing their skills and insights in helping the team to make further improvements to their approach.