Meeting the complex needs of some of the most vulnerable populations in our society often involves the need for connected networks of care providing health, social care, educational and voluntary sector services. This presents major challenges for both clients and practitioners for this to work well. Adaptive mentalization based integrative treatment (AMBIT) has been developed over the last 15 years to address the needs of both clients and practitioners in trying to make this work well. The basic framework for AMBIT was set out by the authors in AMBIT: A Guide for Teams to Develop Systems of Care in 2017 but continues to evolve through collaboration with practitioners across the world who work with people (both young people and adults) for whom many current services are not experienced as helpful.
AMBIT for People with Multiple Needs: Applications in Practice describes the progress of this collaboration and shows how AMBIT has been applied in health, social care and education settings across the world. Contributors convey the detail of what it is like to apply AMBIT to their work by combining case illustrations with detailed descriptions of therapeutic practice and technique, along with inspiring and remarkable stories of therapeutic change. The chapters examine therapeutic casework in very different services providing community and residential based care with adults and young people across Europe and the UK.
With AMBIT constantly evolving, the book explores recent developments in the AMBIT model and provides rich new thinking about how "helping" services can be supported to provide meaningful help and change.
Author(s): Peter Fuggle, Laura Talbot, Chloe Campbell, Peter Fonagy, Dickon Bevington
Publisher: Oxford University Press
Year: 2023
Language: English
Pages: 383
City: Oxford
Cover
Adaptive Mentalization-Based Integrative Treatment (AMBIT) for People with Multiple Needs
Copyright
Contents
Acknowledgements
Contributors
Abbreviations
1. Why has AMBIT come about?
1.1 Introduction
1.2 Many clients have multiple needs
1.2.1 Problems are often highly interconnected
1.3 Multiple needs attract multiple helpers
1.3.1 Collaboration between agencies is hard to achieve
1.3.2 Involving multiple services does not necessarily mean better help
1.3.3 The limitations of service redesign in addressing these problems
1.4 The helping process is crucial
1.4.1 The fragility of the helping process
1.4.2 The role of attachment theory
1.5 The worker’s state of mind is fundamental to help
1.6 Conclusion
1.7 The plan for the book
2. An introduction to AMBIT
2.1 Setting the scene
2.2 Introduction
2.3 Mentalizing: AMBIT as a mentalization-based approach
2.3.1 The fragility of mentalizing: a great power leveller
2.3.2 Mentalizing in four directions: balancing the wheel
2.4 Working with your Team
2.4.1 Mentalizing and non-mentalizing in teams and workers
2.4.2 Working with your Team: stance features
2.4.2.1 Individual keyworker relationship
2.4.2.2 Keyworker well connected to the team
2.4.3 Working with your Team: basic practice
2.4.3.1 Helping processes in teams
2.4.3.2 ‘Ripples in the pond’
2.4.3.3 ‘Who’s got your rope?’
2.4.4 Tools and techniques for Working with your Team
2.5 Working with your Client
2.5.1 Mentalizing and non-mentalizing in working with clients
2.5.2 Working with your Client: stance features
2.5.2.1 Scaffolding relationships
2.5.2.2 Managing risk
2.5.3 Working with your Client: basic practice
2.5.3.1 Epistemic trust
2.5.3.2 The mentalizing stance
2.5.3.3 Scaffolding relationships
2.5.3.4 ‘Active Planning’
2.5.4 Tools and techniques for Working with your Client
2.6 Working with your Network
2.6.1 Mentalizing and non-mentalizing in networks
2.6.2 Working with your Network: stance features
2.6.2.1 Meeting multiple needs
2.6.2.2 Integrating the help
2.6.3 Working with your Network: basic practice
2.6.3.1 Team around the Worker
2.6.3.2 Taking a mentalizing approach to addressing dis-integration
2.6.4 Tools and techniques for Working with your Network
2.7 Learning at Work
2.7.1 Mentalizing and non-mentalizing in relation to learning
2.7.2 Learning at Work: stance features
2.7.2.1 Respect for evidence
2.7.2.2 Respect for local practice and expertise
2.7.3 Learning at Work: basic practice
2.7.4 Tools and techniques for Learning at Work
2.8 Implications
3. Epistemic trust and mistrust in helping systems
3.1 Setting the scene
3.2 Mentalizing in real-world settings
3.3 Mentalizing: a strength and a vulnerability
3.4 Mentalizing and collaboration within helping systems
3.4.1 Joint attention and the ‘we-mode’
3.4.2 The we-mode and epistemic trust
3.4.3 Co-mentalizing and an epistemic match
3.5 What do we mean by non-mentalizing helping systems?
3.6 Why focus on mentalizing in systems?
3.7 AMBIT and non-mentalizing working contexts
3.8 Implications
4. Working out what is going on: Using the AIM cards with clients
4.1 Setting the scene
4.2 Introduction
4.3 What are the AIM cards?
4.3.1 A recap on mentalizing
4.4 Using the AIM cards with a client
4.4.1 Step 1: worker introduces the cards
4.4.2 Step 2: worker seeks agreement from client about using the cards
4.4.3 Step 3: client decides how to look through the cards
4.4.4 Step 4: client chooses labels for the piles of cards
4.4.5 Step 5: client sorts the cards into piles
4.4.6 Step 6: worker attunes to the client as they sort the cards
4.4.7 Step 7: worker and client explore how they have sorted the cards
4.4.8 Step 8: exploring whether there is anything the client might want to be different
4.4.9 Step 9: exploring who can help with the chosen cards
4.4.10 Other ways of using the cards when there is more significant ambivalence about help-seeking
4.4.11 Summary
4.5 What do clients say about using AIM cards?
4.6 Implications
5. Getting started with AMBIT: The ECID project in Barcelona
5.1 Setting the scene
5.2 Introduction
5.3 Working with your Client
5.3.1 Understanding adverse relational experiences as an impediment to relationships
5.3.2 Implications of adverse relational experiences in our work: what AMBIT offers with our clients
5.3.3 ECID goes live
5.3.4 Professional’s stance
5.4 Working with your Team
5.4.1 Design of the ECID team
5.5 Working with your Network
5.6 Learning at Work
5.7 Implications
6. Connecting psychotherapy to the streets: The Malmö approach
6.1 Setting the scene
6.2 The team today
6.3 How it started
6.4 The first meeting
6.5 How our thinking developed
6.6 The beginning
6.7 Our first clients
6.8 We become a team
6.9 AMBIT
6.9.1 Theoretical aspects
6.9.2 Working with your Client
6.9.2.1 Create contact: establishing epistemic trust
6.9.2.2 Care planning and linking to the network
6.9.2.3 Concrete targeted support
6.9.2.4 Emotional support
6.9.2.5 Coexistence
6.9.2.6 Reflective conversations
6.9.2.7 Parent work
6.9.2.8 Psychological assessment
6.10 Evaluation
6.11 Final reflection
6.12 Implications
7. AMBIT for adults with severe personality disorders: Experience from Utrecht, the Netherlands
7.1 Setting the scene
7.2 Working with adults with personality disorder
7.3 The context in which we work
7.4 Working with your Patient
7.4.1 Example: Working with your Patient
7.5 Working with your Team
7.5.1 Example: Working with your Team
7.6 Working with your Network
7.6.1 Example: Working with your Network
7.7 Learning at Work
7.8 Concluding remarks
7.9 Implications
8. Enhancing multiprofessional cooperation in a child and youth social service institution: Vorarlberger Kinderdorf, Austria
8.1 Setting the scene
8.2 Introduction
8.2.1 Who we are and what we did: the story in a nutshell
8.2.2 Initial contact with AMBIT
8.2.3 What were the problems we needed help with?
8.2.3.1 Staff well-being
8.2.3.2 The need to pay attention to the workers’ state of mind
8.2.3.3 Pedagogy and the problem of help-seeking for workers
8.2.3.4 Increasing case complexity
8.2.3.5 The stress of working in networks
8.3 Implementation in practice
8.3.1 The ‘bones’: the implementation process
8.3.2 The ‘flesh’: implementation in practice
8.3.2.1 Working with your Client
8.3.2.2 Working with your Team: the role of mentalizing in supporting collaboration
8.3.2.3 Working with your Network
8.3.2.4 Learning at Work
8.4 Evaluation
8.4.1 The clients’ perspective: using the AIM outcome evaluation
8.4.2 The stakeholders’ perspective: implementation process evaluation
8.4.3 What we learned about AMBIT implementation
8.4.3.1 Bumpy roads: what did not work so well
8.4.3.2 The little and big successes: what worked
8.5 Where are we now?
8.6 Looking back: the AMBIT implementation wheel
8.6.1 Core element: mentalizing
8.6.2 Working with the Implementation Team (local facilitators)
8.6.3 Working with the Teams (defining goals, Active Planning)
8.6.4 Working with the Network (cooperation across the organization)
8.6.5 Learning at Work (learning culture)
8.7 Implications
9. Creating and supporting a Team around the Worker
9.1 Setting the scene
9.2 Introduction
9.3 What is a Team around the Worker?
9.4 Learning from training about what supports a Team around the Worker
9.4.1 Mentalizing the worker: ‘This Team around the Worker thing seems like a good idea, so why don’t I want to do it?’
9.4.2 Trying it out: the importance of helping processes for the Team around the Worker
9.5 The Team around the Worker: a case example of AMASS in London
9.5.1 Building Team around the Worker into the service design
9.5.2 Requesting help versus making a referral
9.5.3 Seeking the family’s perspective on whether working with AMASS would be helpful
9.5.4 Supporting the development of helping processes between the social worker and the team
9.5.5 Building relationships with the young person using the Team around the Worker
9.5.6 Bridging other professionals into relationships where epistemic trust already exists
9.5.7 Team processes that support the Team around the Worker
9.5.7.1 Having the right mix of people who can work flexibly in the team
9.5.7.2 Establishing and sustaining help-seeking in the team: make it part of the work
9.5.7.3 Applying ‘Team around the Worker’ to group supervision
9.6 Implications
10. Working with networks: Implementing AMBIT in disrupted healthcare systems
10.1 Setting the scene
10.2 Introduction
10.3 The value of values: AMBIT in the age of disruptive dynamics
10.4 AMBIT as outpatient milieu therapy in the real world
10.5 Nothing unites people like a common enemy . . . but an enemy could become a friend
10.6 Can you establish mentalizing network meetings? The NET-Aim-Questionnaire
10.6.1 What will mentalizing network meetings improve?
10.6.2 Will using the NET-Aim-Q improve patient-related outcome measures?
10.7 The mentalizing case manager: the new specialist-generalist
10.8 The resonance of young people and their helping systems
10.9 ‘The Case of the Teenager Behind a Closed Door’
10.10 Implications
11. Applying AMBIT to teacher training: innovations in Germany
11.1 Setting the scene
11.2 Introduction
11.3 The needs of young people in special education settings
11.4 Introducing the pilot project: ‘Mentalization-based support for teachers’
11.5 Teacher training and stress levels in Germany
11.6 Using Active Planning to design the seminars
11.6.1 Sensitive attunement—understanding the needs of the student teachers
11.6.2 Broadcasting intentions—sharing our own ideas about what might help
11.6.3 Setting the plan
11.7 Reflections on the seminars
11.7.1 Using the mentalizing stance and AMBIT tools in team discussions about pupils
11.7.1.1 Vignette—helping a child who is persistently late
11.7.1.2 Conclusion to section
11.7.2 Developing mentalization-based collegial case counselling
11.7.2.1 Conclusion to section
11.7.3 Reviewing video logs using mentalizing techniques
11.8 Overall reflections on the seminars
11.8.1 The student teachers’ perspective
11.8.2 The facilitators’ perspective
11.8.3 Creating epistemic trust within the group
11.8.4 Dealing with emotions in teaching–learning fields
11.8.5 How to best capture learning
11.8.6 How to embed a mentalizing stance: what is good-enough mentalizing?
11.9 Implications
12. Applying AMBIT principles to the training process
12.1 Setting the scene
12.2 Introduction
12.3 An AMBIT-influenced approach to training and implementation support
12.3.1 What do you need? Attending to the state of mind of the workers
12.3.1.1 How do we help teams to work out what they need?
12.3.1.2 Engagement call
12.3.1.3 Consultation day
12.3.2 Training as an AMBIT-influenced helping process
12.3.2.1 Who’s got your rope? Sustaining a mentalizing stance as a trainer
12.3.2.2 Using ‘Active Planning’ to adapt the training process to the team
12.3.3 Supporting implementation in complex multiagency systems
12.3.3.1 Strengthening the well-connected team
12.3.3.2 Using training to promote network integration
12.3.3.3 Keeping a focus on implementation throughout the training
12.3.3.4 Supporting teams to implement AMBIT after the training
12.4 Evaluating our training approach
12.4.1 Is the training a positive experience?
12.5 Implications
13. Adopting a mentalizing approach to evaluating outcomes
13.1 Setting the scene
13.2 Introduction
13.3 Looking from the inside: outcomes work for the worker, manager, and client
13.3.1 Mentalizing the worker’s experience of outcomes work
13.3.2 Creating a culture of curiosity about outcomes
13.3.2.1 Sharing mental models about outcomes
13.3.2.2 Connecting outcomes to interest in intentional states
13.3.2.3 Using logic models to determine outcomes that matter
13.3.2.4 Discussing and feeding back outcomes with the whole team
13.4 Looking from the outside: outcomes for AMBIT-trained teams
13.5 Creating a shared outcomes framework
13.5.1 An example of a local evaluation using the AIM
13.5.2 Establishing the international AMBIT Study Group
13.6 Implications
14. What are the future directions for AMBIT?
14.1 Setting the scene
14.2 Introduction
14.3 Developing the basic AMBIT approach
14.3.1 Making AMBIT values explicit and improving our attention to EDI
14.3.1.1 Articulate AMBIT values and ethics
14.3.1.2 Uphold the values in our work
14.3.1.3 Improve how the AMBIT approach promotes EDI
14.3.2 A deployment-based approach to model development
14.3.3 Improving our knowledge of routine client outcomes
14.3.4 Developing a research programme on the core model
14.4 Increasing training capacity and widening diversity
14.4.1 Setting up international AMBIT Training Centres
14.4.2 Widening diversity within the AMBIT Programme Team and in the community of practice to improve learning and adaptation
14.4.3 Widening methods of dissemination through training and consultation
14.5 Improving implementation
14.5.1 Supporting implementation after training
14.5.2 Improving the wiki manual
14.6 Conclusion
Index
