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.
Tuesday, 4 October 2011
Manualizing Practice
A manual is where people who know how to do something write it down so that others can copy what they do and get the same results.
In a team this could just mean keeping minutes of team discussions and filing them in a place where everyone else knows to find them - so that those moments of clarity when we have met a problem, discussed and agreed how we might better manage it if were to happen again... don't get consigned to the dustbin of institutional amnesia!
Tiddlymanuals are about giving a team the opportunity to record its own ever-changing 'best estimate' of what best practice is, and to do so in a way that encourages outside scrutiny - that is radically rejecting of notions of 'intellectual property' as far as how best to help vulnerable and deprived youth.
The radical bit about Tiddlymanuals is the way that they allow a blending of centrally-curated "evidence-based" material, with locally-authored "practice-based" expertise. although what the viewer sees is a single integrated wiki, different groups of people are managing these different pools of content.
In the last weeks in my wonderful team in Cambridgeshire (CASUS) we've really started to try this out...
We had a case discussion the other day, chaired by my excellent trainee Meinou, and under her guidance, after the therapeutic case discussions were over, we talked briefly about how team meetings like this could be improved. It was one of those conversations that we have had many times before, and it could so easily have been "just another" one; this time, though, we were able to minute our discussions live, as we agreed "these are the things that would help better to shape the way we use the precious time we do have available"
As the team talked, so I minuted and checked that what I was writing fitted with other people's understanding - this is made much easier as the tiddlymanual is projected on the wall in the little room where the CASUS team meets, so that everything is transparent and explicit.
You can see the rough draft of how we shaped this ten minute discussion here - it is rough and ready, but that-in-itself will propel us to work harder to "get it right". Why? Because over time the wiki manual becomes the 'flag under which we sail' - which as a team i hope we will come to take pride in. It is just this "nimbleness" (going from discussion to publication in about 10 minutes) that wakes us up, keeps us on our toes...
Early on in my learning about wikis and open source, I was told that one othe mantras of the open source programmer is "RELEASE EARLY, RELEASE OFTEN". Why? Because there is nothing like real world exposure to (a) cull real world FEEDBACK (see here) and (b) spur one on to do better in awareness that our present efforts are short of the mark! I couldn't agree more, and this goes for ways of working therapeutically, as much as for developing computer code that others might find helpful,
In a team this could just mean keeping minutes of team discussions and filing them in a place where everyone else knows to find them - so that those moments of clarity when we have met a problem, discussed and agreed how we might better manage it if were to happen again... don't get consigned to the dustbin of institutional amnesia!
Tiddlymanuals are about giving a team the opportunity to record its own ever-changing 'best estimate' of what best practice is, and to do so in a way that encourages outside scrutiny - that is radically rejecting of notions of 'intellectual property' as far as how best to help vulnerable and deprived youth.
The radical bit about Tiddlymanuals is the way that they allow a blending of centrally-curated "evidence-based" material, with locally-authored "practice-based" expertise. although what the viewer sees is a single integrated wiki, different groups of people are managing these different pools of content.
In the last weeks in my wonderful team in Cambridgeshire (CASUS) we've really started to try this out...
We had a case discussion the other day, chaired by my excellent trainee Meinou, and under her guidance, after the therapeutic case discussions were over, we talked briefly about how team meetings like this could be improved. It was one of those conversations that we have had many times before, and it could so easily have been "just another" one; this time, though, we were able to minute our discussions live, as we agreed "these are the things that would help better to shape the way we use the precious time we do have available"
As the team talked, so I minuted and checked that what I was writing fitted with other people's understanding - this is made much easier as the tiddlymanual is projected on the wall in the little room where the CASUS team meets, so that everything is transparent and explicit.
You can see the rough draft of how we shaped this ten minute discussion here - it is rough and ready, but that-in-itself will propel us to work harder to "get it right". Why? Because over time the wiki manual becomes the 'flag under which we sail' - which as a team i hope we will come to take pride in. It is just this "nimbleness" (going from discussion to publication in about 10 minutes) that wakes us up, keeps us on our toes...
Early on in my learning about wikis and open source, I was told that one othe mantras of the open source programmer is "RELEASE EARLY, RELEASE OFTEN". Why? Because there is nothing like real world exposure to (a) cull real world FEEDBACK (see here) and (b) spur one on to do better in awareness that our present efforts are short of the mark! I couldn't agree more, and this goes for ways of working therapeutically, as much as for developing computer code that others might find helpful,
Wednesday, 3 August 2011
More chance to learn about implementation
I am pleased with how things are going.
AMBIT manuals
The multiple versions of the Core content of the AMBIT manual are starting bit by bit (and it was always meant to be bit by bit!) to inch towards differentiated, customised forms, that begin to address local specifics - "how we do this stuff here, with these kids, in these streets". Far be it from me to introduce comptetition into this collaborative exercise, but Kids company and the MAC team are giving the CASUS team a run for their money in starting to introduce regular slots to MANUALIZE their own practice in their own local versions, inter-digitating their contributions alongside the pre-formed manualization content about AMBIT that is curated from the Anna Freud Centre.
MBT-F manual(s)
At last, I have managed to put the MBT-F manual into the new AMBIT-theme, so that it has the same (we think greatly improved, though FEEDBACK is still something we crave) user interface as the AMBIT manual.
This user interface is thanks to the generous support of COMIC RELIEF, which is funding improvements to the manual, as well as training for non-statutory teams (there are still a few slots for FREE TRAINING in AMBIT for non-statutory teams in the UK if you rush to the Anna Freud Centre)
Fellowship at the CLARHC
I am thrilled to have been given a one year Fellowship at the Cambridge-based CLARHC (Collaboration for Leadership and Applied Research for Health and Care), starting in September. As a CLARHC Fellow, I get to spend a day a week working with Cambridge University academics, the Judge Business School, and other experienced clinicians to look specifically at the implementation of a TiddlyManual in a clinical, "real world" setting.
We are currently looking at different ways to do this, and some of the opportunities are more than exciting, involving the possibility of formal cluster analysis of outcomes for multiple teams engaging in AMBIT and using tiddlymanuals to support themselves in this - watch this space.
AMBIT manuals
The multiple versions of the Core content of the AMBIT manual are starting bit by bit (and it was always meant to be bit by bit!) to inch towards differentiated, customised forms, that begin to address local specifics - "how we do this stuff here, with these kids, in these streets". Far be it from me to introduce comptetition into this collaborative exercise, but Kids company and the MAC team are giving the CASUS team a run for their money in starting to introduce regular slots to MANUALIZE their own practice in their own local versions, inter-digitating their contributions alongside the pre-formed manualization content about AMBIT that is curated from the Anna Freud Centre.
MBT-F manual(s)
At last, I have managed to put the MBT-F manual into the new AMBIT-theme, so that it has the same (we think greatly improved, though FEEDBACK is still something we crave) user interface as the AMBIT manual.
This user interface is thanks to the generous support of COMIC RELIEF, which is funding improvements to the manual, as well as training for non-statutory teams (there are still a few slots for FREE TRAINING in AMBIT for non-statutory teams in the UK if you rush to the Anna Freud Centre)
Fellowship at the CLARHC
I am thrilled to have been given a one year Fellowship at the Cambridge-based CLARHC (Collaboration for Leadership and Applied Research for Health and Care), starting in September. As a CLARHC Fellow, I get to spend a day a week working with Cambridge University academics, the Judge Business School, and other experienced clinicians to look specifically at the implementation of a TiddlyManual in a clinical, "real world" setting.
We are currently looking at different ways to do this, and some of the opportunities are more than exciting, involving the possibility of formal cluster analysis of outcomes for multiple teams engaging in AMBIT and using tiddlymanuals to support themselves in this - watch this space.
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