Implementation of Dialectical Behavior Therapy in Residential Treatment Programs: A Process Evaluation Model for a Community-Based Agency

Dialectical behavior therapy (DBT) can be challenging to implement in community-based settings. Little guidance is available on models to evaluate the effectiveness or sustainability of training and implementation efforts. Residential programs have much to gain from introduction of evidence-based practices, but present their own challenges in implementation. This paper presents a low-cost process evaluation model to assess DBT training piloted in residential programs. The model targets staff and organizational factors associated with successful implementation of evidence-based practices and matches data collection to the four stages of the DBT training model. The strengths and limitations of the evaluation model are discussed.

[1]  Michael J. Austin,et al.  Impact of Organizational Change on Organizational Culture , 2008, Journal of evidence-based social work.

[2]  A. Fruzzetti,et al.  Dialectical Behavior Therapy Training to Reduce Clinical Burnout in a Public Behavioral Health System , 2013, Community Mental Health Journal.

[3]  E. Wenger,et al.  cultivating communities of practice , 2002 .

[4]  Brandy L. Blasko,et al.  Clinician Ratings of Client Progress in a Therapeutic Community Treatment Setting: Do Ratings Predict Outcomes? , 2014 .

[5]  Andrew Georgiou,et al.  A realist evaluation of the role of communities of practice in changing healthcare practice , 2011, Implementation science : IS.

[6]  K. Woodberry,et al.  Family therapy and dialectical behavior therapy with adolescents: Part I: Proposing a clinical synthesis. , 2002, American journal of psychotherapy.

[7]  Shireen L. Rizvi,et al.  Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder. , 2010, Behaviour research and therapy.

[8]  Implementing Dialectical Behaviour Therapy: organizational pre-treatment , 2010, The Cognitive Behaviour Therapist.

[9]  D. Simpson.  Organizational Readiness for Stage-Based Dynamics of Innovation Implementation , 2009 .

[10]  Alec L. Miller,et al.  Dialectical behavior therapy adapted for suicidal adolescents. , 1997, Suicide & life-threatening behavior.

[11]  M. Linehan,et al.  The Course and Evolution of Dialectical Behavior Therapy. , 2015, American journal of psychotherapy.

[12]  W. Agras,et al.  Dialectical behavior therapy for binge eating disorder. , 1999, Journal of consulting and clinical psychology.

[13]  Renee M. Poulin,et al.  The use of dialectical behavior therapy skills training as stand-alone treatment: a systematic review of the treatment outcome literature. , 2015, Journal of clinical psychology.

[14]  A. Fruzzetti,et al.  Barriers and Solutions to Implementing Dialectical Behavior Therapy in a Public Behavioral Health System , 2014, Administration and Policy in Mental Health and Mental Health Services Research.

[15]  J. Feigenbaum.  Dialectical behaviour therapy: An increasing evidence base , 2007 .

[16]  Bryan J Weiner,et al.  Conceptualization and measurement of organizational readiness for change: a review of the literature in health services research and other fields. , 2008, Medical care research and review : MCRR.

[17]  W. Miller,et al.  A SMALL STUDY OF TRAINING IN MOTIVATIONAL INTERVIEWING: DOES ONE WORKSHOP CHANGE CLINICIAN AND CLIENT BEHAVIOR? , 2001 .

[18]  D. Simpson,et al.  Assessing organizational readiness for change. , 2002, Journal of substance abuse treatment.

[19]  Paul Sunseri.  Preliminary Outcomes on the Use of Dialectical Behavior Therapy to Reduce Hospitalization Among Adolescents in Residential Care , 2004 .

[20]  H. Gotham.  Advancing the implementation of evidence-based practices into clinical practice: How do we get there from here? , 2006 .

[21]  W. van den Brink,et al.  Dialectical Behavior Therapy of borderline patients with and without substance use problems. Implementation and long-term effects. , 2002, Addictive behaviors.

[22]  Julie M. Skutch,et al.  Which training method works best? A randomized controlled trial comparing three methods of training clinicians in dialectical behavior therapy skills. , 2009, Behaviour research and therapy.

[23]  M. Porter,et al.  Adapting a dialectical behavior therapy (DBT) group for use in a residential program. , 2000 .

[24]  Tracee Burroughs,et al.  Utilization of Evidenced Based Dialectical Behavioral Therapy in Assertive Community Treatment: Examining Feasibility and Challenges , 2013, Community Mental Health Journal.

[25]  Denise D. Ben-Porath,et al.  Treatment of individuals with borderline personality disorder using dialectical behavior therapy in a community mental health setting: Clinical application and a preliminary investigation , 2004 .

[26]  Sigrid James,et al.  Effectiveness and Implementation of Evidence-Based Practices in Residential Care Settings. , 2013, Children and youth services review.

[27]  H Schmidt,et al.  Dialectical behavior therapy for patients with borderline personality disorder and drug-dependence. , 1999, The American journal on addictions.

[28]  R. Hibbs,et al.  Implementing Dialectical Behaviour Therapy: Programme survival in routine healthcare settings , 2012, Journal of mental health.

[29]  J. Kogan,et al.  Understanding community mental health administrators' perspectives on dialectical behavior therapy implementation. , 2009, Psychiatric services.

[30]  Lawrence O. Schmidt,et al.  Trauma Professionals' Attitudes Toward and Utilization of Evidence-Based Practices , 2007, Behavior modification.

[31]  K. Koerner,et al.  Implementing dialectical behavior therapy. , 2002, Psychiatric services.

[32]  A. Lenz,et al.  Effectiveness of Dialectical Behavior Therapy for Treating Eating Disorders , 2014 .

[33]  R. McHugh,et al.  Balancing fidelity and adaptation in the dissemination of empirically-supported treatments: The promise of transdiagnostic interventions. , 2009, Behaviour research and therapy.

[34]  Celina Carter,et al.  Toward Treatment Integrity: Developing an Approach to Measure the Treatment Integrity of a Dialectical Behavior Therapy Intervention With Homeless Youth in the Community. , 2016, Archives of psychiatric nursing.

[35]  L. Tebartz van Elst,et al.  Psychotherapy of attention deficit hyperactivity disorder in adults , 2002, European Archives of Psychiatry and Clinical Neuroscience.

[36]  K. Koerner,et al.  Research on dialectical behavior therapy for patients with borderline personality disorder. , 2000, The Psychiatric clinics of North America.

[37]  Jeanne C. Rivard,et al.  Lessons Learned in Implementing Evidence-Based Practices: Implications for Psychiatric Administrators , 2006, Psychiatric Quarterly.

[38]  John T. Mitchell,et al.  A modified DBT skills training program for oppositional defiant adolescents: promising preliminary findings. , 2006, Behaviour research and therapy.

[39]  D. Connor,et al.  Staff Retention and Turnover in a Residential Treatment Center , 2003 .

[40]  Adam O. Horvath,et al.  The therapeutic relationship. , 1999 .

[41]  Scott D. Miller,et al.  The Session Rating Scale: Preliminary Psychometric Properties of a “Working” Alliance Measure , 2004 .

[42]  M. Åsberg,et al.  Stress and burnout in psychiatric professionals when starting to use dialectical behavioural therapy in the work with young self-harming women showing borderline personality symptoms. , 2007, Journal of psychiatric and mental health nursing.

[43]  K. Hawkins,et al.  Can line clinicians master the conceptual complexities of dialectical behavior therapy? An evaluation of a State Department of Mental Health training program. , 1998, Journal of psychiatric research.

[44]  É. Trupin,et al.  ¡ ectiveness of a Dialectical Behaviour Therapy Program for Incarcerated Female Juvenile O ¡ enders , 2002 .

[45]  M. Colton,et al.  Factors that contribute to high turnover among residential child care staff , 2007 .