An interesting "UnConference" today at MindTech in South London (theory being that the really useful things that happen in conferences tend to happen in the gaps between presentations, so an UnConference is mostly gaps, and little formal presentation.)
Follow it on twitter #mindtech
TIDDLYNOTES
One of the conversations was about designing a radically new approach to client notes - that could place the client at the centre of the system, rather than the current NHS IT systems - that are almost entirely top-down, functioning for the larger system first, the doctor second, and the patient hardly at all...
Now, I am not saying that it would be a cinch but go with me on this...
Think about TiddlySpace and all it does. Say I have a problem, and I go to my GP. Say I have a "MyHealthJournal" - a TiddlySpace-like wiki, and I have already included my GP's Space-about-me (what used be called my medical notes), so I have access to all my notes; and although the original content is curated by my GP, if I have different views or feel stuff has been left out, I can annotate my own version of my GP's notes within my Space. My version and my GP's version are clearly separate, comparable, and transparently useful as each note (tiddler in the Tiddlyspace vernacular) is taggable, searchable, link -able etc.
Now, because my problems are a bit complicated, I am referred to a social worker, and a psychotherapist too. I choose to include their spaces about me in my space too.
I can set access so that my psychotherapist can read my GPs notes, but my Social worker can't. My space also includes a Safety Space that all included spaces have reading and editing rights...
As far as I can see most of this is already feasible in a tiddlyweb environment like Tiddlyspace...
OK, we're talking about a few tweaks for security, for setting access levels to included spaces from other visitors to your space, then Bob's your uncle and the job's a good 'un... No but seriously, it is doable. The more interesting question is of course how the people using this system would learn to USE it...
Hard pressed health staff would I am sure worry about the additional demands that might be placed on them if they were expected to read all of this new material, as they could end up having no time to see and speak to clients or patients if they were trying to keep up with additional posts... But this like most things if thinkable is probably also manageable...
How might this fit with existing TiddlyManuals? Well, the functionality to use a downloaded copy of the manual as a set of notes is already built in, if a little clunky. Look in the AMBIT manual under the tag ICR (interactive case recording). We have placed this on hold, as we felt we needed to focus on the browsing and team editing functions first, but comes a time...
Friday, 30 March 2012
Thursday, 8 March 2012
Finally! New AMBIT theme arrives
Blimey, it's here. At last!
So, the feedback has always been that all that information is "just too like a jack-in-a-box that can leap out and overwhelm the poor venturer into AMBIT" Jonathan Lister and Joshua Bradley (funded thanks to Comic Relief) have worked away with us to shape it into something that is (I hope; we shall see) rather gentler. The video above gives a flavour of the thing, but I guess the proof of the pudding is in the hit rates - whcih are running at about 500 per month at present. Do please go and have a browse and send us some feedback.
So, the feedback has always been that all that information is "just too like a jack-in-a-box that can leap out and overwhelm the poor venturer into AMBIT" Jonathan Lister and Joshua Bradley (funded thanks to Comic Relief) have worked away with us to shape it into something that is (I hope; we shall see) rather gentler. The video above gives a flavour of the thing, but I guess the proof of the pudding is in the hit rates - whcih are running at about 500 per month at present. Do please go and have a browse and send us some feedback.
Friday, 9 December 2011
V.3.0 is nearly here
The new look AMBIT manual should be available in the coming week (or two)... Keep an eye on the site (http://ambit.tiddlyspace.com)!
Lots of Trainings
We have been busy training a lot of new teams in AMBIT, and the use of the TiddlyManual. As part of our Comic Relief grant, seven voluntary sector organisations are in the middle of trainings, and we are also training two CAMH (statutory NHS Child and Adolescent Mental Health) Services.
This is exciting as we now have a wiki based manual that these teams will be able to start working on, adapting their OWN locally adapted version.
In addition, the core training is increasingly crystallising into the key components of the approach, and we have separated out an additional one day training which we call the AMBIT Leads training, focusing much more intensively on sharing an understanding of the MANUAL, and how to put the TiddlySpace 'machinery' that supports this to work:
- The ability to manualize relevant bits of team practice 'on the hoof'
- The ability to compare, share, and adapt other teams' content.
- The use of the 'Snapshot' function in supervision sessions (I can pull out a relevant page of content, and email a link to just that page to my supervisee during the session.)
This is exciting as we now have a wiki based manual that these teams will be able to start working on, adapting their OWN locally adapted version.
In addition, the core training is increasingly crystallising into the key components of the approach, and we have separated out an additional one day training which we call the AMBIT Leads training, focusing much more intensively on sharing an understanding of the MANUAL, and how to put the TiddlySpace 'machinery' that supports this to work:
- The ability to manualize relevant bits of team practice 'on the hoof'
- The ability to compare, share, and adapt other teams' content.
- The use of the 'Snapshot' function in supervision sessions (I can pull out a relevant page of content, and email a link to just that page to my supervisee during the session.)
Tuesday, 15 November 2011
AMBIT and branded therapies
Our emphasis is increasingly on trying to offer AMBIT as a supportive - yet highly structured - framework for excellent local adapatation, rather than trying to force it onto the market as another "branded" therapy. Local "use-instances" of AMBIT are already directed at a range of different sub-populations, in different cultural milieux - see the signposting TiddlyManuals.com site.
In many ways AMBIT (and tiddlymanuals) is about empowering local services to clarify and build the most effective possible "Treatment as Usual", marrying evidence based practice (provided by our slowly-developing 'core' manual (here) with practice based evidence via the growing number of locally-adapted wiki treatment manuals, where teams manualize their own practice transparently, sharing and refining best practice in a collaborative network of 'open source' practitioners.
There is much emphasis on ensuring ease of implementation for AMBIT, and adaptability; this is most obviously represented in the form of tiddlywiki manuals, but is of course also one of the distinguishing features of mentalization per se; mentalization is exactly that psychological function seen as offering 'steerage' and 'navigation' through the complicated social universe which we inhabit - it is absolutely about supplying adaptability for the mentalizer!
In contrast to some other more rigidly-manualized approaches (which I could unfairly caricature as promoting a rather non-mentalizing stance that "We Know Best"), this is an alternative approach to the insistence that the rest of a service ecology should bend itself to the will of the manual-as-a-thing-in-itself. Our hypothesis is that most (if not all) well-conducted therapeutic techniques act to stimulate mentalizing, and indeed this is probably the 'curative feature' of all successful therapy; that there are many different ways to stimulate and support this most human of functions is hardly surprising!
A potential criticism of the fluid, dynamic approach to manualization that is exemplified by tiddlymanuals is that "it is impossible to perform a trial on "it" as there is no fixed or stationary "it" to test!" - Not so! It is quite possible to "freeze" a tiddlymanual by removing all the team editing capabilities for the duration of the trial. I have envisaged a sort of audit cycle that would consist of a cyclical pattern of locked-down outcomes evaluation, followed by a period of team-driven manualization, during which the lessons of the past year, and resolutions for the next, would be 'written in' to the team's manual. At present those teams just starting to try out manualizing themselves are tending to do it in "real time" - manualizing those practice issues that arise in the course of day to day work, which I am happy about. It seems to me that in this way teams develop a stronger sense of connection between "their" manual and their daily working expertise, as well as ensuring that they manualize live (rather than irrelevant) material.
In many ways AMBIT (and tiddlymanuals) is about empowering local services to clarify and build the most effective possible "Treatment as Usual", marrying evidence based practice (provided by our slowly-developing 'core' manual (here) with practice based evidence via the growing number of locally-adapted wiki treatment manuals, where teams manualize their own practice transparently, sharing and refining best practice in a collaborative network of 'open source' practitioners.
There is much emphasis on ensuring ease of implementation for AMBIT, and adaptability; this is most obviously represented in the form of tiddlywiki manuals, but is of course also one of the distinguishing features of mentalization per se; mentalization is exactly that psychological function seen as offering 'steerage' and 'navigation' through the complicated social universe which we inhabit - it is absolutely about supplying adaptability for the mentalizer!
In contrast to some other more rigidly-manualized approaches (which I could unfairly caricature as promoting a rather non-mentalizing stance that "We Know Best"), this is an alternative approach to the insistence that the rest of a service ecology should bend itself to the will of the manual-as-a-thing-in-itself. Our hypothesis is that most (if not all) well-conducted therapeutic techniques act to stimulate mentalizing, and indeed this is probably the 'curative feature' of all successful therapy; that there are many different ways to stimulate and support this most human of functions is hardly surprising!
A potential criticism of the fluid, dynamic approach to manualization that is exemplified by tiddlymanuals is that "it is impossible to perform a trial on "it" as there is no fixed or stationary "it" to test!" - Not so! It is quite possible to "freeze" a tiddlymanual by removing all the team editing capabilities for the duration of the trial. I have envisaged a sort of audit cycle that would consist of a cyclical pattern of locked-down outcomes evaluation, followed by a period of team-driven manualization, during which the lessons of the past year, and resolutions for the next, would be 'written in' to the team's manual. At present those teams just starting to try out manualizing themselves are tending to do it in "real time" - manualizing those practice issues that arise in the course of day to day work, which I am happy about. It seems to me that in this way teams develop a stronger sense of connection between "their" manual and their daily working expertise, as well as ensuring that they manualize live (rather than irrelevant) material.
Saturday, 5 November 2011
Another AMBIT training - Dec 1st
We are running another AMBIT training at the AnnaFreud Centre on Dec 1st - there are some spaces left.
This is an introductory training about the nature of Mentalization, it's application for child and adolescent mental health services, and particularly its application for hard to reach and socially excluded youth, for whom conventional services are often not accessible. And yes, we talk about the tiddlymanuals - AMBIT as an Open Source therapy.
http://www.annafreud.org/courses.php/14/an-introduction-to-ambit-as-a-mentalization-based-framework-for-camhs-practitioners
This is an introductory training about the nature of Mentalization, it's application for child and adolescent mental health services, and particularly its application for hard to reach and socially excluded youth, for whom conventional services are often not accessible. And yes, we talk about the tiddlymanuals - AMBIT as an Open Source therapy.
http://www.annafreud.org/courses.php/14/an-introduction-to-ambit-as-a-mentalization-based-framework-for-camhs-practitioners
Friday, 21 October 2011
Toronto - and a forthcoming v.3 new look
In a blustery rainy Toronto, speaking at the joint Canadian and American Academies of Child and Adolescent Psychiatry annual meeting. First workshop we (Efrain Bleiberg, Trudie Rossouw and I) did on mentalizing approaches to affectively unstable adolescents seemed well received. A symposium on mentalizing approaches to treatment next, on Saturday, with Peter Fonagy, Efrain, Trudie and Carla Sharp. I will be talking about AMBIT, MBT-F (Mentalization based treatment for families) and will include material on the tiddlymanual. Increasingly I like the notion of AMBIT as an 'open source therapy'... This is very much true to the nature of mentalizing in practice... Just like the programmers who throw open their source code for others to examine and help improve upon, so the mentalizing therapist takes a chance on 'throwing open' his or her thoughts, all the while marking them tentatively as 'just my best theory about what is going on here'. I love the open source 'mantra' - "Release early. Release often"... Really good match to mentalizing work, and draws a marked contrast between the stance that a mentalizing therapist takes and those of more 'knowing' or 'expert' schools of therapy, who may be perceived as withholding, or secretive, by their patients in ways that arouse emotional responses that then paradoxically block mentalizing...
Anyway, the other news is that a third generation of the user interface for tiddlymanuals is in development thanks to Jon and Josh at Withjandj and funded through the Comic Relief grant - the effort is all directed at smoothing (and soothing!) the user experience (once you adopt the frame of mentalizing it is like a benign virus that infects everything - web design is of course all about mentalizing the user!)..
The new design will aim for a crisper typeface, and will further emphasize the notion of tiddlers as paper on a desk (think wood, like the beautiful walnut2 theme for Firefox!) but we are working to make the 'meta-data' attached to each tiddler note even more intuitive, and to make it clearer for the user whether she is browsing or editing...
Should be released in a couple of weeks or less.
Anyway, the other news is that a third generation of the user interface for tiddlymanuals is in development thanks to Jon and Josh at Withjandj and funded through the Comic Relief grant - the effort is all directed at smoothing (and soothing!) the user experience (once you adopt the frame of mentalizing it is like a benign virus that infects everything - web design is of course all about mentalizing the user!)..
The new design will aim for a crisper typeface, and will further emphasize the notion of tiddlers as paper on a desk (think wood, like the beautiful walnut2 theme for Firefox!) but we are working to make the 'meta-data' attached to each tiddler note even more intuitive, and to make it clearer for the user whether she is browsing or editing...
Should be released in a couple of weeks or less.
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