At its centre, AMBIT is underpinned by the core theory of mentalization. This is a developmental theory supported by an extensive body of empirical research (Fonagy, 2002; Fonagy & Bateman, 2016).
There is compelling evidence for the relevance of mentalizing as having a key role in the help seeking processes, especially the establishment of trust (specifically “epistemic trust”) (Egyed et al, 2014, Fonagy & Allison, 2014; Fonagy, Luyten, & Allison, 2015).
Applying Mentalization directly in face to face work with adolescents experiencing self harm and suicidality has shown positive results in a randomised control trial (Fonagy and Roussow (2012). AMBIT is also heavily influenced by a number of empirically based theories, in particular attachment theory and systemic theory.
Mentalization and Epistemic Trust references
- Fonagy P, Bateman AW. Adversity, attachment, and mentalizing. Compr Psychiatry. 2016 Jan;64:59-66. doi: 10.1016/j.comppsych.2015.11.006. Epub 2015 Nov 30. PMID: 26654293
- Egyed et al, 2014, Fonagy & Allison, 2014; Fonagy, Luyten, & Allison, 2015)
- Rossouw, Fonagy (2012) Mentalization-based treatment for self-harm in adolescents: a randomized controlled trial J Am Acad Child Adolesc Psychiatry. 2012 Dec;51(12):1304-1313
AMBIT advocates the need for local adaptations of its framework and we encourage AMBIT influenced teams to evaluate the impact of their work upon their clients’.
There is no one kind of ‘AMBIT team’ rather a wide range of services who apply the framework in various ways to fit their local needs. AMBIT therefore does not easily lend itself to a traditional Randomised Control Trial evaluation. However, across the community of teams applying AMBIT, there is a building evidence base consisting of local evaluations in ‘real world’ settings by teams who are reporting very positive outcome data.
From these outcomes we are of course not able to state that AMBIT directly causes these positive outcomes, however the outcomes do offer very encouraging support for AMBIT as a framework which helps teams to work effectively in very diverse settings to achieve positive results for their client groups.
For published papers describing outcomes reported by varied AMBIT influenced teams please see:
- Laura Talbot, Peter Fuggle, Zoe Foyston and Kim Lawson.(2020) Delivering an Integrated Adolescent Multi-Agency Specialist Service to Families with Adolescents at Risk of Care: Outcomes and Learning from the First Ten Years British Journal of Social Work (2020) 0, 1–20 doi: 10.1093/bjsw/bcz148
- Peter Fuggle, Dickon Bevington, Liz Cracknell, James Hanley, Suzanne Hare, John Lincoln, Garry Richardson, Nina Stevens, Heather Tovey and Sally Zlotowitz. (2014) The Adolescent Mentalization-based Integrative Treatment (AMBIT) approach to outcome evaluation and manualization: adopting a learning organization approach. Clinical Child Psychology, 1-17.
- Helen Griffiths, Abbi Noble, Fiona Duffy & Matthias Schwannauer. (2017) Innovations in Practice: Evaluating clinical outcome and service utilization in an AMBIT-trained Tier 4 child and adolescent mental health service. Child and Adolescent Mental Health
- Thomson, Griffiths, Fisher, McCabe, Abbott-Smith and Schwannauer. (2019) Treatment outcomes and associations in an adolescent-specific early intervention for psychosis service: Early Intervention In the Real World. Early Intervention In Psychiatry, 1-8.
- Fuggle et al (2021) Improving lives: Not just saying no to substances. Clinical Child Psychology and Psychiatry, 1–15, 2021.
- Stephen Pilling, Stephen Butler, Melanie O’Brien, Robert Hardy. (2014) Camden Transformation Team: Interim Report. University College London (report on request)
- Jensen, S. L., Bo, S., & Vilmar, J. W. (2021). What is behind the closed door? A case illustration of working with social isolation in adolescents using Adaptive Mentalization‐Based Integrative Treatment (AMBIT). Journal of Clinical Psychology, 1–16.
- Feedback from trainees
The learning from our trainees continues to shape and improve the model that we train, and this is integral to the model of ‘deployment focused innovation’ that AMBIT has been built on (Weisz J.R., Simpson Gray J. (2008) Evidence-Based Psychotherapy for Children and Adolescents: Data from the Present and a Model for the Future. Child and Adolescent Mental Health Volume 13, No. 2, 2008, pp. 54–65).
Feedback is divided into quantitative (questionnaires) and qualitative (free text):
Session Feedback Forms from 2018 - 2020 have been collated. The end of day session feedback form asks four key questions which trainees are asked rate, on a scale of 1-7 (with 1 being the least and 7 being the most).
- How engaged did you feel in the session?
- How did you find the quality of the facilitation?
- How helpful was the session in enabling you to learn knowledge, skills or ways of thinking?
- How much do you feel that you will be able to use the knowledge, skills or ways of thinking from this session in your work?
In 2018 - 2020, 1092 feedback forms have been completed. The table below presents the % of responses that were rated 6 or 7.
Question % of Responses Rated 6 or 7
- How engaged did you feel in the session? 83%
- How did you find the quality of the facilitation? 92%
- How helpful was the session in enabling you to learn knowledge, skills or ways of thinking? 87%
- How much do you feel that you will be able to use the knowledge, skills or ways of thinking from this session in your work? 83%
Less that 0.3% rated 1 or 2 for each of the questions.
At the end of each training day trainees are provided with the opportunity to give qualitative feedback on the training so far. Below is a selection of the feedback that trainees helpfully provide us with:
- It is nice that you can do AMBIT in parts and in our pace. Thank you for being so inspiring.
- I enjoyed the moments when our team could have frank conversations and learn together and even experience a bit of tension with the safety of having the facilitators there.
- I think that my work and the work of my team will change a great deal. Not only will we be mentalizing with our clients, but also the Network that we work with and thus bring these relationships closer and better. I am confident that I can enthuse the team to take on the skills that I shall deliver.
- It provides an easy to use framework to support staff with their work with clients, learning and work with other agencies.
- The facilitators were amazing at creating and holding a safe and supportive space and I really appreciated that.
- Love the calm approach from both facilitators and an acknowledgement of group needs. Meaningful approaches to tasks in order to help facilitate change positively. Thank you!
- The trainers were excellent, very approachable and knowledgeable.