Strengths and Limitations in DBT Implementations: A Mid-Stream, Mixed Methods Examination of Successes and Failures

Erin Miga, PhD1,3, Andre Ivanoff, PhD2,4, & Tony DuBose, PsyD2

1Cadence Child and Adolescent Therapy; 2Behavioral Tech, LLC, Seattle, WA; 3Behavioral Research & Therapy Clinics, University of Washington; 4Columbia University

While there is preliminary evidence to support the effectiveness and sustainability of real-world DBT healthcare settings1, few to no studies have conducted a systematic review of DBT implementations on a larger scale. This study assesses a sample of DBT programs nationwide, in order to gain a more systematic understanding of implementation barriers amongst active and inactive programs.

The current study builds on earlier research on the DBT Intensive Training Model 2,3 by including quantitative and qualitative methodologies, including a feedback loop follow-up interview.

The purposes of this study:

INTRODUCTION PHASE 2 RESULTS: INACTIVE VS. ACTIVE TEAMS

METHODS & PROCEDURE Mixed-Methods Approach:

Phase 1 (ACTIVE programs):

DBT Program Elements of Treatment

Questionnaire4 (PETQ: Schmidt, Ivanoff, &

Linehan, 2009)

Follow up telephone interview:

Review and synthesis of current status:

program strengths, weaknesses, and

next steps

Phase 2 (INACTIVE programs):

Barriers to Implementation

Questionnaire5 (BTI: Knox & Dimeff,

2001)

Follow-up consultation as requested

DISCUSSION

Better overall planning for the intensive

(n=11), including selection. level and

commitment of attendees

More clinicians intensively trained (n=8)

Administration commitment at outset to

do DBT to fidelity and devote sufficient

time to strategic planning (n=8)

What one thing would

teams do over?

Top 3 Goals

Achieved

Top 3 Barriers to

Implementation

Active only Active Inactive Reductions in

suicidal behavior &

hospitalizations (n=12)

Funding

constraints

(n=14)

Staff Turnover

(n=7)

Built DBT program

despite high

obstacles (n=7)

Staff

turnover

(n=12)

Funding cut

(n= 5)

Built

comprehensive

adherent program (n=5)

Time

constraints

(n=10)

Lack of support/

conflict with key

administrators

(n=5)

• This study integrates implementation

science and QI research in order to enhance

and personalize the customer training

experience

• Generally high rates (75%-98%) of

delivering DBT modes

• DBT programs are resilient: Only 15 %

(N=16) of the 105 teams reached reported

an inactive status

• Top barriers to implementation similar

across active and inactive programs, with

exception of inactive programs voicing lack

of administrative support/conflict

Looking Forward:

• Examine links: adherence & client

outcomes

• DBT on administration: use data to leverage

commitment, strategic planning

• DBT commitment strategies for staff prior

to attending intensive-more systematic

screening processes needed

• Additional attention needed in several

implementation domains, such as ongoing

outcome assessment, supervision &

adherence assessment, team selection and

cohesiveness

Phase 1: A random sample of 50%

of all teams (Final N=78) who

completed Dialectical Behavior

Therapy Intensive Training ™ by

Behavioral Tech, LLC from 2008-

2011

SAMPLE

Phase 2 (1 year later): Contacted

the other 50% of teams (Final

N=77) to assess implementation

obstacles for inactive programs

PHASE 1 QUANTITATIVE RESULTS

Are teams still doing DBT?

Are teams delivering the four modes of DBT?

Quality Assurance: Are programs tracking

treatment delivered?

• 40% conduct manual-based self-assessment of DBT program

adherence

• When collected, 20% of programs give individual DBT

adherence data to teams & supervisors for quality improvement

purposes

• 16% of DBT team leaders and consultants review fidelity

performance data

Yes = 74%

(N=58)

No = 10%

(N=8)

Unknown =

16% (N=12)

How many

programs hold

consultation

team? 90%

Designated

team leader? 80%

Teams meet

weekly? 74%

Identify DBT program elements currently in place amongst intensively trained

teams

Identify factors that contributed to DBT program

failures

Provide opportunity for reflection, self-assessment,

and dialog on stage of DBT implementation

Create immediate and direct feedback loop between

training needs and marketing/customer service

initiatives

Enhance Quality of Trainings and

Implementations

Strengths and Limitations in DBT Implementations: A Mid-Stream, Mixed Methods Examination of Successes and Failures

Erin Miga, PhD1,3, Andre Ivanoff, PhD2,4, Tony DuBose, PsyD2

1Cadence Child and Adolescent Therapy; 2Behavioral Tech, LLC, Seattle, WA; 3Behavioral Research & Therapy Clinics, University of Washington; 4Columbia University

References

1 Pasieczny, N., & Connor, J. (2011).The effectiveness of dialectical behaviour therapy in

routine public mental health settings: An Australian controlled trial. Behaviour Research and

Therapy, 49(1), 4–10.

2DuBose, A., Ward-Ciesielski, E., Landes, S., Korslund, K., Comtois, K., Ivanoff, A., Dimeff, L., &

Linehan, M. (August, 2011). The Dialectical Behavior Therapy Intensive Training Model ©

(ITM). Poster session presented at the First Biennial Global Implementation Conference.

Washington, D.C.

3 Landes. S., & Linehan, M..M. (2012). Dissemination and implementation of dialectical

behavior therapy: An intensive training model. In D.H. Barlow & R.K. McHugh (Eds.),

Dissemination and implementation of evidence-based psychological interventions. New York:

Oxford University Press.

4 Schmidt, H., Ivanoff, A., & Linehan, M. (2009). Program Elements of Treatment

Questionnaire. Seattle, WA. University of Washington Behavioral Research & Therapy

Clinics.

5Knox, S. & Dimeff, L. (2001). Barriers to Implementation. Behavioral Tech, LLC.