Using the AIM assessment in the AMBIT manual

The AIM assessment is an adaptation of the validated HCAM (Hampstead Child Adaptation Measure) and is itself due to get validation following its use as one of the measures in the large multi-centre IMPACT study of adolescent depression. The AIM was adapted in order that it could be integrated within the AMBIT manual; there, through simple algorithms, it can generate ranked lists of links to manualized material that offer evidence-based responses to the variety of problems that young people present with, and results can be exported direct to an Excel or SPSS database. Here is a short video about its use:

The Community of Practice

I haven't been writing much here recently, as increasingly the AMBIT TiddlyManual IS the blog (see http://ambit.tiddlyspace.com). We have been working hard to increase the "surface area" of the community of teams who are using this material (there are nearly 60 versions of the AMBIT manual - accessible from http://www.tiddlymanuals.com) and here is a video about part of this work:

An AMBIT Conference - May 10th

Moving on - training across a city

The pace of trainings in AMBIT is quickening, and we are glad that we have five fantastic Associate trainers now, who will be running trainings increasingly independently soon. Most recently, we have trained an in-patient unit and an Intensive Support outreach team in Cambridgeshire, and we are in the middle of training 160 (yes, 160!) workers from across the whole of Belfast - psychologists, family therapists, psychiatrists, social workers, youth offending officers, nurses, OT's, etc, all drawn from multiple teams in a citywide network of CAMHS and aligned provision. This strikes us as extremely exciting, and not a little scary, but the opening day seemed to receive a warm welcome and to offer a reasonably good fit with perceived training needs. It does seem that the web-based manual that presents (increasingly clearly I think) "what you are getting into" has played a part in helping to support this major dissemination. This exciting Belfast project is encouraging us to address very seriously the whole notion of an evaluation framework for assessing the impact of such a training exercise, and of course some of this will involve examining what is working and what is not in respect of the web-based wiki manuals. One of the key points about a TiddlyManual wiki approach to 'treatment manual' is that it is fantastically flexible - and we (Dohhh, only recently!) have realised that there is masses of stuff that we can put up there to support trainings - like video of the key chunks of didactic material so that a less confident public speaker can watch pre-prepared video and then run exercises that we know have proven helpful in previous trainings. Equally, we are putting up a lot of training exercises for local teams to run "internally" to support and embed implementation of new methods of working. See the training materials in the AMBIT manual here

San Francisco to Norwich - dissemination

The AMBIT project is increasingly busy, which is a Good Thing, but carries its own challenges.

The thinking behind developing a really good internet-based manual/training resource is about developing ways to disseminate the guts of good-ideas-that-help cheaply and widely (Jeremy Ruston, inventor or TiddlyWiki, describes how a web based manual offers up a "large surface area" for minimal cost)...

So it seems to me that any other model of dissemination of effective practice needs to justify itself against these criteria, but for our part the challenge is to find ways to disseminate practice that is (and remains) demonstrably effective. The circle that needs squaring is how to deliver sufficient oversight and supervision to provide some assurance of qualitative positive and sustainable change, without making the whole operation so expensive that only populations with sufficient wealth can access it.

Part of our approach (in keeping with the AMBIT principle of "Respect for Local Practice and Expertise") is to emphasise the empowerment of local supervisory structures, and to encourage these to engage in the act of "auto-manualization" - documenting their own sense of "what we do well" and measuring outcomes ("Respect for Evidence") to validate this. This is why we avoid the idea of an "AMBIT team" - but prefer to think of local teams developing local excellence, influenced by, or building over the foundations in AMBIT. The AMBIT project is quite happy to be the ditch-digger and drain-layer for the development by local teams of dwelling places that offer excellent, culturally-attuned and effective service!

Another part of our approach is to try to develop webinar/online supervision resources that can be accessed from afar by AMBIT Leads in local teams - this is a work in progress and we hope to get it going early in 2013.

Another part of the dissemination quest is obviously talking about the model, and we seem to have been doing a lot of that recently. In the last three months of 2012 AMBIT and tiddlymanuals will have been presented at AACAP in San Francisco, London, Peterborough, Norwich, Oslo, Stockholm, Geneva. We are training teams at full capacity, too. Most recently 3 new teams in Norwich which are novel, multiagency (statutory and voluntary sector) teams that will purposefully span an extended age-range of teens to mid twenties, a service development that Norfolk should be congratulated for embracing in such a bold innovative way. We have a cluster of other statutory and non-statutory teams for training in London in the coming fortnight, then large numbers of practitioners in Belfast in the New Year... bookings stretching out into summer 2013, in fact!

So AMBIT has become very much more of a "thing", even though it is not really trying to be a thing, but a broad approach that supports local teams to develop and innovate in ways that combine and build upon something that approaches (we hope) closer and closer to the ideal of "evidence-based practice". These are exciting times, and the AMBIT project is having to address internal challenges relating to the expansion of its administrative, training and supervisory capacities. We are growing up, I guess.

MBT-F catches up, and the theme moves on

Well, at last we have found the time to make the switch for the MBT-F manual so that it has finally adopted the much improved new (v.3) AMBIT manual "theme".

Thank you to Jon Lister and Joshua Bradley from JandJ for their expertise in helping us do this.

A theme in TiddlySpace-speak is just a set of instructions that tell the browser (that you are using to "read" the site) how to behave - effectively it sets the look of the thing, and the interface. In terms of the theory at the basis of AMBIT and MBT-F, "mentalization", the design of the theme is where the authors must attempt to mentalize their readership - have their minds, their intentions and predicaments, in mind so that something contingent can be offered.

Why Wikis?

We are trying to balance palliation of the nostalgia for the simplicity, predictability and aesthetics of a book (titles, chapter headings, pages on a wooden desk, more?!) with the many other layers of possibility that the wiki-based format adds:

* gathered multimedia content
* non-linearity of content that can be re-organised in an infinity of ways
* inter-connectivity that encourages meaningful linking of content
* searchability
* cross-comparisons between geographically dispersed practitioners.

The more things improve in the manual (incrementally, incredibly slowly, but I think perceptibly) the more I am interested in the way this feeds into, even directly influences, the way that AMBIT is maturing as a model, and has been spreading in terms of uptake by teams. Manualizing and mentalizing are not so far apart.

We are now heavily booked for trainings right out into summer 2013, with a good mix of statutory and voluntary sector teams. We have a significant trial funded and in the planning stage in Cambridgeshire, which will be carried out over the next 3 years.

Better SEARCHING supports a COMMUNITY of PRACTICE

Here is a short video clip that shows how the SEARCH function in the AMBIT manual works, and where it is... as well as demonstrating how you can use it to peek at OTHER teams' working practices, and compare, contrast and share best practice. We do not promote the idea of "AMBIT teams", but rather locally expert teams that use AMBIT as a framework or a stepping stone to develop and share their own local excellence. The search bar is one way we are trying to foster this "Community of Practice". The ideas of Community of Practice are particularly articulated by Etienne Wenger and colleagues - it is a really neat way of seeing what the AMBIT project is using the manual to support.