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
This is the first book to describe Adaptive Mentalization-Based Integrative Treatment (AMBIT). This is an approach to working with people - particularly young people and young adults - whose lives are often chaotic and risky, and whose problems are not limited to one domain. In addition to mental health problems, they may have problems with care arrangements, education or employment, exploitation, substance misuse, offending behaviours, and gang affiliations; if these problems are all occurring simultaneously, any progress in one area is easily undermined by harms still occurring in another.
AMBIT 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".
- Speaks to the worker's experience of how hard this work can be (written from position of having had unique access to nearly 2000 workers doing this work in iterative field trials, alongside experimental/academic and theory) meaning workers can trust that the material comes from lived experience and field-tested outcomes, rather than just theory
- Respectful of a wide range of existing evidence based practices allowing for local adaptation and incremental change in teams, rather than requiring total step change. Creating an AMBIT framework of practice can support a wide range of existing evidence based practices to work better, rather than requiring workers to abandon existing (and valued) expertise
- Lively and engaging style of writing. Explains complex ideas in simple language, using lively metaphors and memorable analogies, so readers can absorb subtle, nuanced and complicated ideas easily. Memorable phrases and images act as helpful aide memoires
1: Setting the scene
2: How the engine works: Trust and making sense of each other and ourselves
3: Active Planning: Mapping the territory and navigational skills for AMBIT-influenced work
4: Working with your Clients
5: Working with your Team
6: Working with your Networks
7: Towards a learning stance in teams: Learning at work
8: "It was somebody I could trust": A descriptive case study of one young man's experience with an AMBIT-influenced team
9: There is no such thing as a standard AMBIT team
10: Adopting the AMBIT approach to changing wider systems of help
11: Future ambitions for the AMBIT project
Dickon Bevington, Consultant in Child and Adolescent Psychiatry and Medical Director, Anna Freud National Centre for Children and Families, UK and Cambridgeshire and Peterborough Mental Health (NHS) Foundation Trust, UK, Peter Fuggle, Clinical Director, Anna Freud National Centre for Children and Families, Liz Cracknell, and Peter Fonagy, Professor and Head, Research Department of Clinical, Educational and Health Psychology, University College London, UK
Prior to medical training, Dickon Bevington MA MBBS MRCPsych PGCert studied Anthropology, Philosophy and Comparative Religion at Cambridge. A Child and Adolescent Psychiatrist in the NHS in Cambridgeshire, he works with complex adolescents with substance use disorders. He is also Medical Director at the Anna Freud National Centre for Children and Families, where he co-leads the AMBIT project with Peter Fuggle, and develops and runs trainings in mentalization-based treatments. In collaboration with Jeremy Ruston, the inventor of TiddlyWiki, he led on the development of wiki-based treatment manuals. He has authored/co-authored papers, and chapters including the second edition of "What works for Whom: A Critical Review of Treatments for Children and Adolescents" (Guilford 2012).
Peter Fuggle, PhD, is a clinical psychologist and Clinical Director at the Anna Freud National Centre for Children and Families. Previously, he was Clinical Director of the NHS Islington Child and Adolescent Mental Health Service for over twenty years where he helped to develop a highly integrated community focussed service approach. His primary interests are in clinical outcomes, integrated helping systems and mentalization based approaches to helping children and families, particularly those who do not seek help.