Honoured, excited and not a litle over-awed to be in a golden-leafed Yale this week, for a conference on mentalization based treatments for children and families, in which I am speaking about AMBIT and running a training with Efrain Bleiberg on MBT-F. Next week I go down to New York, where I am talking at the American Academy of Child and Adolescent Psychiatrists annual conference about Mentalization - as part of Efrain's symposium; how it arises and why it is particularly challenged in Adolescence.
Thanks to our grants (see earlier post)the AMBIT project is gearing up for a growth spurt. As a coda, I realise that the preceding sentence contains an appalling bit of metaphor-mixing; images of heavy machinery (gears) alongside biological processes (growth) - hmmm, a metaphor within a metaphor, perhaps. I increasingly see one of the bonuses of Mentalization as being a concept that can help lubricate the existing 'heavy machinery' of evidence-based therapies (CBT, Psychodynamic approaches, Family work, etc) by helping them to rub alongside each other, encouraging what Peter Fuggle has called 'cross -border trade'. One of the interesting phenomena that we have seen is that the concept of mentalization, or M-B therapies themselves have been claimed as 'coherent with' or indeed 'plagiarised from' (!) a range of older and distinguished therapeutic and theoretical models, ones that, between themselves have often offered a rather unedifying spectacle of internecine strife ('last man standing wins'). Mentalizing, perhaps by being at least inoffensive to most, offers soemthing approaching a common language that neurosciences, cognitive-behaviourist, systems and psychoanalytic practitioners can sign up to. If I am right, that is real progress.
I hope to see progress for AMBIT in the coming months, with migration of the AMBIT and MBT-F manuals from Tiddlyspot and Tiddlyweb to the TiddlySpace site (I will put automatic forwarding and/or links into the orginal sites) - when this occurs it will become much easier for local services to incorporate this 'core' material in their own manual variants... allow for glitches and please support the brave few services that try this to start with...!
Sunday 24 October 2010
Wednesday 15 September 2010
TiddlySpace
Ultimately, the new and increasingly wonderful TiddlySpace version of TiddlyWiki, that builds on TiddlyWeb (described below), will be the place that hosts the treatment manual, and we hope to move the manuals there fairly soon.
Tiddlyspace is very exciting (no, really...!) Think of a group (us at the Anna Freud Centre) who offer up our core template of the AMBIT treatment manual. Our TiddlySpace will consist of Private space (where we, as a closed group, argue about the precise content and layout of the manual as it continues to mature) and Public space - all the bits of the manual that we have agreed we are happy to 'stand by' and to release as our best current effort.
Now, imagine another team - from, say, Tiddletown.
They train up in AMBIT, and start up their own TiddletownSpace . Because they are basically into AMBIT, or at least adapting it to their local needs, they opt to "include" the core AMBIT Space within their own Tiddletown Space - which means that all the public content within our original AMBIT Space is automatically included within their own space. They can then add any local implementation details, or indeed specific protocols that they believe better suit their population, but they interweave this material into the existing matrix of theory and practice that the original AMBIT core consists of, via links, tags, etc.
Of course the "inclusion" method that TiddlySpace adopts to help different groups/teams/"Spaces" to interact means that the AMBIT manual itself could conceivably be subdivided into more manageable chunks, that could separately be included within (or left out of) a local Space.
The most obvious example of this would be the part of the manual that, in a sense, is the most exciting, but which is also the hardest to implement, and that is the use of downloaded versions of the manual as integrated recording systems for separate young people. It is exciting because in our experience no complex treatment manual to date (except small ones that can be presented as physical "workbooks") has managed to get the worker to refer to it, or at least "be exposed to it" on a daily basis. If we are honest, most treatment manuals are tedious beyond belief, and are rarely read, and their capacity to truly influence practice is limited. If you are integrating your daily working notes within the manual, then (we argue) there is a much higher chance that you will "brush up" alongside manualized material and that your practice will be influenced by this contact. Especially if the material is not only dense text, but also comes in the form of quick film clip vignettes and role plays, demonstrating how to use specific techniques, etc.
To date none of the AMBIT teams around the UK (see TiddlyManuals) have yet really begun to use this in earnest, partly (I hope mainly) because of the continuing 'clunkiness' of the software, but partly because the concept is very alien. Anyway, to get back to TiddlySpace, all of these more explicitly 'interactive' aspects of the AMBIT manual could be in a separate "Space" that local teams could take, or leave, as they wish...
Tiddlyspace is very exciting (no, really...!) Think of a group (us at the Anna Freud Centre) who offer up our core template of the AMBIT treatment manual. Our TiddlySpace will consist of Private space (where we, as a closed group, argue about the precise content and layout of the manual as it continues to mature) and Public space - all the bits of the manual that we have agreed we are happy to 'stand by' and to release as our best current effort.
Now, imagine another team - from, say, Tiddletown.
They train up in AMBIT, and start up their own TiddletownSpace . Because they are basically into AMBIT, or at least adapting it to their local needs, they opt to "include" the core AMBIT Space within their own Tiddletown Space - which means that all the public content within our original AMBIT Space is automatically included within their own space. They can then add any local implementation details, or indeed specific protocols that they believe better suit their population, but they interweave this material into the existing matrix of theory and practice that the original AMBIT core consists of, via links, tags, etc.
Of course the "inclusion" method that TiddlySpace adopts to help different groups/teams/"Spaces" to interact means that the AMBIT manual itself could conceivably be subdivided into more manageable chunks, that could separately be included within (or left out of) a local Space.
The most obvious example of this would be the part of the manual that, in a sense, is the most exciting, but which is also the hardest to implement, and that is the use of downloaded versions of the manual as integrated recording systems for separate young people. It is exciting because in our experience no complex treatment manual to date (except small ones that can be presented as physical "workbooks") has managed to get the worker to refer to it, or at least "be exposed to it" on a daily basis. If we are honest, most treatment manuals are tedious beyond belief, and are rarely read, and their capacity to truly influence practice is limited. If you are integrating your daily working notes within the manual, then (we argue) there is a much higher chance that you will "brush up" alongside manualized material and that your practice will be influenced by this contact. Especially if the material is not only dense text, but also comes in the form of quick film clip vignettes and role plays, demonstrating how to use specific techniques, etc.
To date none of the AMBIT teams around the UK (see TiddlyManuals) have yet really begun to use this in earnest, partly (I hope mainly) because of the continuing 'clunkiness' of the software, but partly because the concept is very alien. Anyway, to get back to TiddlySpace, all of these more explicitly 'interactive' aspects of the AMBIT manual could be in a separate "Space" that local teams could take, or leave, as they wish...
Grants and goals
We are delighted that the AMBIT project (which heavily overlaps with the TiddlyManuals project described here) based at the Anna Freud Centre have just been awarded a generous grant from Comic Relief and from another private donor, which will allow us to place a considerable focus on development of the current AMBIT Manual so as to improve it - we hope very substantially.
The focus of the project for Comic Relief is to improve the access and reduce costs of quality training for workers on the front-line with "hard-to-reach" and complex youth (that's young people who have combinations of mental health problems, offending, substance use, and major vulnerabilities like family breakdown, abuse, etc - the most vulnerable youth one can imagine, really). One of the key vehicles for delivering this training and then supporting these workers to stay on track, is the online TiddlyManual. Increasingly we will be adding streaming video inserts - to model best practice - alongside the text entries that explain the theoretical underpinnings ("why we suggest doing it like that"), as well as didactic material, that might suit those who learn better by watching and listening rather than reading.
There will also be a big push to improve the user interface, which is still ropey, reflecting my beginner status as a web designer. Any practitioners using existing local versions of the manual (see TiddlyManuals) are reminded that it is their feedback that helps me see it afresh; only beginners retain that ability to see the "Emperor's new clothes" - when you spend too much time writing a wiki you start to rely on your memory rather than the signposting that most users rely upon.
Alongside this we will be working towards establishing a collaborative forum at the Anna Freud Centre, with some of the many non-statutory agencies working in this field. The purpose of this is really twofold: to share experiences and pool thoughts about the basic "skill set" that these workers need, and to share our experience of developing and delivering AMBIT in the field and our enthusiasm for the tiddlywiki approach to the manualization of treatment. At its core, what we like about the Tiddlymanual approach to treatment manualization it is the capacity to balance:
(a) the 'centralisation' and 'top-down' nature of sharing the most evidence-based aspects of practice with
(b) the radical devolution of manualizing to the level of the local team, so that a local version of the manual shares "our specific implementation of this way of working" alongside well-conducted measures of the outcomes for young people through working in this way, with these kids, and in this setting.
The focus of the project for Comic Relief is to improve the access and reduce costs of quality training for workers on the front-line with "hard-to-reach" and complex youth (that's young people who have combinations of mental health problems, offending, substance use, and major vulnerabilities like family breakdown, abuse, etc - the most vulnerable youth one can imagine, really). One of the key vehicles for delivering this training and then supporting these workers to stay on track, is the online TiddlyManual. Increasingly we will be adding streaming video inserts - to model best practice - alongside the text entries that explain the theoretical underpinnings ("why we suggest doing it like that"), as well as didactic material, that might suit those who learn better by watching and listening rather than reading.
There will also be a big push to improve the user interface, which is still ropey, reflecting my beginner status as a web designer. Any practitioners using existing local versions of the manual (see TiddlyManuals) are reminded that it is their feedback that helps me see it afresh; only beginners retain that ability to see the "Emperor's new clothes" - when you spend too much time writing a wiki you start to rely on your memory rather than the signposting that most users rely upon.
Alongside this we will be working towards establishing a collaborative forum at the Anna Freud Centre, with some of the many non-statutory agencies working in this field. The purpose of this is really twofold: to share experiences and pool thoughts about the basic "skill set" that these workers need, and to share our experience of developing and delivering AMBIT in the field and our enthusiasm for the tiddlywiki approach to the manualization of treatment. At its core, what we like about the Tiddlymanual approach to treatment manualization it is the capacity to balance:
(a) the 'centralisation' and 'top-down' nature of sharing the most evidence-based aspects of practice with
(b) the radical devolution of manualizing to the level of the local team, so that a local version of the manual shares "our specific implementation of this way of working" alongside well-conducted measures of the outcomes for young people through working in this way, with these kids, and in this setting.
Thursday 27 May 2010
Plymouth COT and writing in a TiddlyWiki
With my co-conspirator Peter Fuggle, we finished training a great team in Plymouth just recently - the COT (CAMHS Outreach Team) and wish them well. Their version of the AMBIT manual is http://imp.peermore.com/imp/recipes/plymouth/tiddlers.wiki
Some fairly late nights have resulted in a slightly cleaner feel to the AMBIT manual, I hope. We have reflected at some points that writing in the Tiddlywiki format is very different. You need (of course) to focus on the content that you provide, but AT LEAST as significant is the extent to which, and manner in which, you integrate what you write within the body of the document through links and tagging.
There is a curious analogy here; between the way the developing brain generates massively more synapses (links) than the adult brain requires, and then through late childhood and especially adolescence these start to be whittled away through use (or, more specifically, non-use). Use it or lose it. This is genuinely similar to the way in which the manual develops - an early wish to include everything, to link everything to everything else (resulting in a user experience of overwhelm - not so terribly unlike the infant's presumed experience, when a fairly simple (at least in my adult's mind's eye) experience triggers a cascade of responses (cognitive, sensory, physiological...) that overwhelm the dainty mentalizing in that new-fangled pre-frontal cortex, but instead fire up the big guns buried deep down in the amygdale, the basal ganglia - stuff that is designed to DO things!
Gradually there is the dawning recognition that certain pathways carry more social value (i.e. I use them more often!) and a simplification, and crystallization of the information flows in the manual begin to emerge. These recognitions occur particularly when the author recovers a meta-perspective - rediscovers the wiki through another's eyes - it is why feedback is such gold-dust. Genuine feedback ("I was looking at this and then I clicked here and then I was totally lost...") is truly gold-dust ... the opportunity to mentalize another reader's experience - and come o understand how they misunderstood what I had overlooked...
This human-interactive substrate, which is really the soil from which a wiki grows, quite fascinates me.
Some fairly late nights have resulted in a slightly cleaner feel to the AMBIT manual, I hope. We have reflected at some points that writing in the Tiddlywiki format is very different. You need (of course) to focus on the content that you provide, but AT LEAST as significant is the extent to which, and manner in which, you integrate what you write within the body of the document through links and tagging.
There is a curious analogy here; between the way the developing brain generates massively more synapses (links) than the adult brain requires, and then through late childhood and especially adolescence these start to be whittled away through use (or, more specifically, non-use). Use it or lose it. This is genuinely similar to the way in which the manual develops - an early wish to include everything, to link everything to everything else (resulting in a user experience of overwhelm - not so terribly unlike the infant's presumed experience, when a fairly simple (at least in my adult's mind's eye) experience triggers a cascade of responses (cognitive, sensory, physiological...) that overwhelm the dainty mentalizing in that new-fangled pre-frontal cortex, but instead fire up the big guns buried deep down in the amygdale, the basal ganglia - stuff that is designed to DO things!
Gradually there is the dawning recognition that certain pathways carry more social value (i.e. I use them more often!) and a simplification, and crystallization of the information flows in the manual begin to emerge. These recognitions occur particularly when the author recovers a meta-perspective - rediscovers the wiki through another's eyes - it is why feedback is such gold-dust. Genuine feedback ("I was looking at this and then I clicked here and then I was totally lost...") is truly gold-dust ... the opportunity to mentalize another reader's experience - and come o understand how they misunderstood what I had overlooked...
This human-interactive substrate, which is really the soil from which a wiki grows, quite fascinates me.
Sunday 7 March 2010
Multiple versions, over-writing a shared common core
If you go to TiddlyManuals.com now you will see the multiple versions that we have now "unleashed" - so that different teams working in different settings with slightly different groups of hard-to-reach youth can start to customise their own versions of the manual, marrying our core material with local attunements...
Had a good conference the other day on Mentalization-based treatments for Children, Adolescents at SOAS, the Brunei Gallery, where Peter Fuggle and I presented AMBIT, with a brief look at the manual. Aside from the lack of coffee a great place to gather, and incredibly exciting to see so many people (about 300) from all over the place.
Had a good conference the other day on Mentalization-based treatments for Children, Adolescents at SOAS, the Brunei Gallery, where Peter Fuggle and I presented AMBIT, with a brief look at the manual. Aside from the lack of coffee a great place to gather, and incredibly exciting to see so many people (about 300) from all over the place.
Friday 15 January 2010
Last name change - AMBIT
After howls of protest from almost everyone, who thought that M-BIO sounded like a washing powder, we have settled on AMBIT - Adolescent Mentalization-Based Integrative Therapy. No more changes.
It is now possible to acess all the various tiddlymanual variants via www.tiddlymanuals.com - which takes you to a tiddlywiki (hosted at the excellent www.tiddlyspot.com) where there are links through to all the current versions.
I am keen to get to the next phase of development, whereby each time a variation from the "core" AMBIT manual is added to a local version, this will be marked (the tiddler a different colour, etc) and a button will allow toggling between the different versions.
It is now possible to acess all the various tiddlymanual variants via www.tiddlymanuals.com - which takes you to a tiddlywiki (hosted at the excellent www.tiddlyspot.com) where there are links through to all the current versions.
I am keen to get to the next phase of development, whereby each time a variation from the "core" AMBIT manual is added to a local version, this will be marked (the tiddler a different colour, etc) and a button will allow toggling between the different versions.
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