The AMBIT approach: working with hard to reach youth

Date14 March 2016
Publication Date14 March 2016
AuthorPeter Fuggle,Dickon Bevington,Fiona Duffy,Liz Cracknell
SubjectHealth & social care,Mental health
The AMBIT approach: working with
hard to reach youth
Peter Fuggle, Dickon Bevington, Fiona Duffy and Liz Cracknell
Peter Fuggle and
Dickon Bevington both are
based at Anna Freud Centre,
London, UK
Fiona Duffy is based
at Royal Edinburgh Hospital,
NHS Lothian CAMHS,
Edinburgh, UK.
Liz Cracknell is based at
Cambridgeshire Adolescent
Substance Use Service
(CASUS), Cambridge, UK.
Purpose MBIT is a manualised mentalization-based approach to working with hard to reach young people
at risk of a wide range of life adversities including severe mental illness, substance misuse, family breakdown,
school exclusion, offending and homelessness. The on-line manual ( describes how
Adolescent Mentalization-Based Integrative Therapy (AMBIT) is a systemic intervention requiring attention to
four different domains of intervention simultaneously; much emphasis is placed on the support systems for
workers to maintain this balance in what are often chaotic working conditions. The purpose of this paper is to
illustrate how these four main components of the AMBIT approach link together in actual clinical practice.
Design/methodology/approach The authors illustrate the core techniques of the AMBIT approach,
namely, working with your client,working with your team,working with your networkand learning as a
teamwith a series of case vignettes, demonstrating the inter-relationship of these components rather than
seeing them as separate strands.
Findings A range of mentalization-based techniques such as thinking together, mentalized formulation,
disintegration gridsand web-based manualising are described and illustrated in relation to a series of case
vignettes in order to address barriers to effective practice. The vignettes emphasise how these components
must be linked together and held in balance, and how easily they become disconnected in working with
young peoples ambivalent or even hostile relationships to help.
Practical implications First, developing a shared, mentalized formulation of a young persons difficulties is
an important aspect of working with highly troubled young people. Second, mentalizing is a relational process
and is easily disrupted, for both workers and young people, by raised anxiety and affect, a common feature of
working with this client group. AMBIT provides specific methods, for example, thinking togetherfor
supporting the mentalizing of individual workers in their team in an explicit way. Third, workers from different
agencies may often find it difficult to make sense of each others behaviour and decision making. AMBIT
proposes the use of a mentalizing approach to this difficulty using a technique called a disintegration grid.
Finally, AMBIT proposes a new practitioner focused approach to manualising as a method by which a team
can become more explicit about its methods of working in order to support systematic practice and evaluate
Originality/value The innovative AMBIT approach proposes that clinicians need to attend to team and
network relationships at least as much as their relationship with the client, in addition to adopting a stance of
learning as a team from their casework. A high level of clinical skill is needed to support a team to achieve this
balanced approach to casework. This work is of interest to all multi-disciplinary teams working with hard to
reach young people.
Keywords Team, Adolescent, Mentalization
Paper type Case study
Adolescent Mentalization-Based Integrative Therapy (AMBIT) is a mentalization-based team
approach for services working with hard to reach young people with multiple difficulties including
mental health problems (Bevington and Fuggle,2012; Bevington et al., 2013; Fuggle et al., 2014).
Received 13 April 2015
Revised 4 August 2015
Accepted 7 September 2015
DOI 10.1108/MHRJ-04-2015-0012 VOL. 21 NO. 1 2016, pp. 61-72, © Emerald Group Publishing Limited, ISSN 1361-9322
PAG E 61

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