Barriers and facilitators affecting the sustainability of dialectical behaviour therapy programmes: A qualitative study of clinician perspectives

Abstract

| INTRODUC TI ONDialectical behaviour therapy (DBT) is an intensive, evidence-based, outpatient treatment that applies cognitive and behavioural strategies to target problematic behaviours (Linehan, 1993). DBT was originally developed to treat individuals with chronic suicidality and high-risk behaviours, presentations that can be costly to the health system overall (e.g. costs associated with higher rates of healthcare service utilisation such as inpatient hospitalisations; Bender et al., AbstractDialectical behaviour therapy (DBT) is a psychological treatment developed for individuals experiencing chronic suicidality and high-risk behaviours. Despite the substantial evidence supporting the effectiveness of DBT, many programmes have problems with its sustainability. The goals of the current qualitative study were to identify factors that impact the sustainability of DBT programmes within a publicly funded mental health system and identify factors that are particularly relevant for youth DBT programmes. Interviews with trained adult and youth DBT clinicians (N = 31) were conducted to explore their experiences providing DBT. Three major themes that emerged as barriers to the sustainability of DBT programmes included the following: systemic challenges, conflicts within the consultation teams and clinician burnout. Factors influencing the success of DBT programmes included the following: systemic support, clinician commitment and "buy in", and team cohesion.Factors specific to providing DBT with youth (i.e. level of commitment, simplifying the language, and parental investment) and recommendations for sustainability for adults and youth programmes were also identified. Findings of this study provide valuable information on factors impacting DBT programmes within the unique context of a Canadian mental health service system, where community-based services are publicly funded. These findings have clear clinical utility and can be used to generate solutions to clinicians' perceived barriers and to foster perceived facilitators within similar contexts. K E Y W O R D Sbarriers, clinicians perspectives, dialectical behaviour therapy, service deliver, sustainability | 69 POPOWICH et al.

Does organisational sustainability policies affect environmental attitude of employees? The missing link of green work climate perceptions

“…Since the last 40 years, many studies have established the adverse impact of actions and activities of humankind on earth (Popowich, Mushquash, Pearson, Schmidt, & Mushquash, 2020). It has been recognised that on the one hand, there is an increase in air, water, noise pollution, and on the other hand, there is depletion of natural resources; both are caused by human behaviour (Prillwitz & Barr, 2011).…”

Dialectical behaviour therapy: effect of a coordinated implementation approach on programme sustainability

“…Broad similarities were found in both studies whereby the factors influencing sustainability were akin to those specific to implementation as reported by Swales et al (2012) and King et al (2018). From the perspective of clinicians, barriers to sustainability included systemic challenges such as high rates of staff turnover, conflicts within consultation teams and clinician burnout, particularly in providing DBT programmes without adequate support by the mental health system (Popowich et al, 2020). This was similar to the viewpoint of health administrators who also reported resource concerns as well as staff selection and turnover as barriers to DBT sustainability (Quetsch et al, 2020).…”

“…The two studies conducted in the US and Canada explored factors which influence sustainability as well as issues experienced by DBT teams after they completed training (Popowich et al, 2020;Quetsch et al, 2020). Broad similarities were found in both studies whereby the factors influencing sustainability were akin to those specific to implementation as reported by Swales et al (2012) and King et al (2018).…”

“…Two studies were based in the United Kingdom (UK: Swales et al, 2012;King et al, 2018) and reported primarily quantitative data. The other two, qualitative in nature, were based in the United States (US: Quetsch et al, 2020) and Canada (Popowich et al, 2020).…”

Built to last? Barriers and facilitators of healthcare program sustainability: a systematic integrative review

“…Implementers being realistic in their expectations, including realistic timelines, adequate resourcing, ongoing engagement with staff delivering the program, and with program recipients, facilitated sustainability [ 65 ]. Staff members’ beliefs about the advantages of programs facilitated sustainability [ 47 , 55 , 68 ], whereas negative attitudes and fear of change were barriers [ 37 , 69 , 70 ]. Staff members who perceived that a new program would have negative consequences for their autonomy and workload was identified as a barrier [ 27 , 69 ].…”