This paper addresses an approach to therapeutic work (Adaptive Mentalization-Based Integrative Treatment) that is directed toward young people who are often well known to multiple helping services; those whose needs are multiple and intersectional, and for whom efforts to intervene effectively are complicated by high levels of risk and low levels of what is conventionally expected in the form of “help-seeking.” The first section offers an introduction to AMBIT framed as a series of reflections emphasizing the social, cultural, and networked roots of mentalizing and the nature and demands of adaptation in the realities of working in complex outreach settings. The second section gives an example of one place-based iteration, the Equipo Clínico de Intervención a Domicilio (ECID) based in Barcelona and includes a summary of a recent outcome evaluation from these teams that work with excluded youth who have previously actively avoided invitations to use mainstream mental health services.