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.

We Won!

We won the Guardian and Virgin Innovation Nation award! Wow... Really wasn't daring to hope for THAT!

Voting is open - PLEEEEEASE vote!

Get the vote out! The prestigious Guardian Innovation Nation Awards are decided on a combination of judge's points and public vote... Here is the link to the Guardian InnovationNation Voting page - please use it as soon as possible, and tell your friends! It would be a great boost to the project to win this.

Shortlisted for Guardian Award!

Great news - the AMBIT collaboration (represented by the most active "tiddly-manualers") has just been told that we are shortlisted for the Guardian and Virgin Business Media "Innovation Nation" award under the category for "Collaboration". See the website here.

You can see our introduction to the project at TiddlyManuals.

We have to provide a 100 word "pitch" for the project to go on the Guardian website, which is to canvas for the votes that will ultimately decide the winner...

After a lot of to-ing and fro-ing, this is where we have got to:

AMBIT's innovative open source approach radically improves knowledge sharing across NHS and voluntary sector teams working with highly vulnerable, disadvantaged, disillusioned UK youth. AMBIT offers "how-to-do-it" instructions which each team adapts, refines and improves, based on their local expertise (street level workers, local youth). Any improvements are shared, compared and integrated with other ideas from teams around the country, and existing evidence, constantly improving the effectiveness of the work. Supported by open source programmers, the AMBIT project fosters co-ownership of professional knowledge and multi-stakeholder participation through sharing, remixing and evolving text, diagrams, pictures and video content for professional ‘manuals’.

Not that this site sees more than the odd passing seagull, but if you are here, and you fancy supporting us (before May 30th this year!) do slip along to the Guardian website and vote for us!

Thanks, Dickon.

Netherlands love Mentalizing

Great conference at the end of last week in lovely Haarlem, outside Amsterdam, hosted by the newly launched MBT Netherlands organsation.

The conference was in the most beautiful concert hall venue; two stages, one radically modern, all swirling wood galleries, curving so they gave you the feeling of being inside a whale (but in a nice way.) The other was strict and classical with huge windows that poured in light and framed the medieval market place below - felt very honoured to be there.

AMBIT got a very positive welcome, for which I am most grateful, and the notion of TiddlyManuals seemed to interest people. The day afterwards a group of MBT treatment developers met to think specifically about MBT and Adolescence. What was so encouraging was the strong sense that two parallel processes were occurring.

First, there was increasing clarity and confidence that there is a shared common core of what underpins mentalizing therapies... that is both respectful of other branches of therapeutic endeavour, but also quite distinctive.

Second, there is a rich variety of implementations and variants, that seems entirely in keeping with the fact that Mentalizing is above all an imaginative activity, that must respond contingently to its setting if it is to be "what it says on the tin". So there are settings where MBT is using groups and individual work, and settings where it is using Family and Individual work, and settings where it is using all three. In Geneva (with Martin Debbane and colleagues) it works with youth mandated into treatment by courts, in London (Trudie Rossouw and colleagues) it has been deployed in CAMHS outpatient clinics and a "tier 4" specialist in-patient unit. AMBIT is just another (though even more heavily adapted, and actively adapting) variant in this sense...

What comes out of this (at least in my mind, and others seem interested in ways that may simply reflect their kind and polite manner in keeping with their mentalizing excellence, but I dare to hope is more!) is the goodness of fit with a Tiddlymanuals-type approach to the manualization of such an approach. Tiddlymanuals and their "amoeba-like" capacity to include content from multiple other wikis allow layers of core manual ("what is mentalizing, how it arises, the neuroscience, and how we translate all that into a basic mentalizing stance") along with sort "epi-" or "meta-manualizations" of the kinds of local tweaks, adjustments, responses and delivery systems that fit this to the specifics of a local social ecology... so all roads lead to tiddlyspace, tiddlywiki and the use of co-constructed wiki manuals n'est ce que pas?!