Discussion
To measure the effectiveness of AMBIT on teams, young people and their families (client), networks and our ability to learn an evaluation plan was developed.
At baseline we have feedback from AMYOS teams of AMBIT implementation and utility as being highly effective in managing complex work with clients, teams and networks and highly suitable to a transition to technology-focused modalities for all four aspects of the AMBIT wheel.
This is the proof that our framework helped us maintain connection despite working with complex and high risk and hard to reach youth often already managing in isolation, with ever changing rules and parameters during the pandemic and the changing lockdown stages and rules across different areas in Queensland. In fact, we adopted technology at super-speed to not only maintain but expand our clinical service to capture direct feedback from our youth.
Some of the feedback (real names have been changed to protect identity and all are recorded on our compliments and complaints register):
- 18-year-old female Alison "I can honestly tell you that I would not be alive if it hadn't been for the support from AMYOS, I truly don't think I would have been."
- “AYMOS worker has been fantastic supporting the Greenslopes Residential team and I'd like for this to be formally recognised. Without her input we would not have been able to manage such a distraught and complex young lady.”
- “They (AMYOS workers) understand the systems but sit a little outside it and can hold the different perspectives and how it's possible to work together to find a way forward.”
- Mother: “Justin has gone out with his friends to the city today. Has worked hard this weekend on his shifts at the cafe. His self-esteem is rocketing."
- “Thank you so much for all you and the team have done to help get Bess on the right path and back to her happy old self, as a mum I am so grateful and words can’t describe how lucky I am she had found such a wonderful caring team. Thank you from the bottom of my heart.”
Robust data collection and analysis by AMYOS teams across the state show that comparison of pre and post treatment outcomes indicated statistically and clinically significant improvements in mental health problems, perceived suicide risk and conduct problems.
In addition, reductions were seen in both the mean monthly admissions and total days spent in hospital for mental health problems following involvement with AMYOS compared to the previous 12 months. However, contrary to hypotheses there was an increase in the mean monthly visits to Emergency Departments (EDs) after involvement with the program.
There were improvements for adolescents over most measures of general functioning and mental health. Almost all clinician-rated measures showed significant improvements in scale scores consistent with large to very large effect sizes. There were reductions in reports of overall mental health problems, hostility, perceived suicide risk and engagement in risky behaviour.
Improvement was seen in the engagement of families in therapy over time and in adolescent engagement with a General Practitioner (GP).
Overall, parents reported greater improvements than adolescents. For instance, the reduction in emotional problems over time was statistically significant for parents, but not adolescents.
Lessons learnt
Transparent data, open communications and an equal investment in teams, young people and their families, networks and ongoing learnings allowed the AMYOS program to manage the complexity of the pandemic and innovate new ways of working. Embedding evaluation and data collection into practice allows an opportunity for staff and young people to engage in and reflect on the delivery of care.
References
Innovations in Practice: Adolescent Mentalization-Based Integrative Therapy (AMBIT) - a new integrated approach to working with the most hard to reach adolescents with severe complex mental health needs. Child and Adolescent Mental Health , 18 (1) 46 - 51. Bevington, D; Fuggle, P; Fonagy, P; Target, M; Asen, E; (2013)
Applying attachment theory to effective practice with hard-to-reach youth: the AMBIT approach. Dickon Bevington*, Peter Fuggle and Peter Fonagy Anna Freud Centre, London, UK (Received 30 July 2012; accepted 27 September 2014)
A Mentalization-Based Treatment Approach to Caring for Youth in Foster Care Maja Jacobsen M.Sc., Carolyn Ha M.A. & Carla Sharp Ph.D. Journal of Infant, Child, and Adolescent Psychotherapy.
Innovations in Practice: evaluating clinical outcome and service utilization in an AMBIT-trained Tier 4 child and adolescent mental health service Helen Griffiths1,2, Abbi Noble1, Fiona Duffy1,2 & Matthias Schwannauer1,2.
The Adolescent Mentalization-based Integrative Treatment (AMBIT) approach to outcome evaluation and manualization: adopting a learning organization approach. Peter Fuggle, Dickon Bevington, Liz Cracknell, James Hanley, Suzanne Hare, John Lincoln, Garry Richardson, Nina Stevens, Heather Tovey and Sally Zlotowitz.
