Barriers and Solutions to Implementing Dialectical Behavior Therapy in a Public Behavioral Health System

Abstract

Dialectical Behavior Therapy (DBT) is an evidence-based treatment that is considered to be the standard of care in treating individuals with BPD, however there have been few published studies to identify the challenges and solutions for implementing DBT in community-based settings. The current study identified the barriers and solutions within a system-wide roll-out of DBT within a large, urban public health system encompassing both community mental health and substance abuse treatment settings. Qualitative interviews were conducted with 19 clinicians receiving DBT training over a period of 13 months. A content analysis revealed three themes that were identified as challenges to the DBT implementation process including program development and recruitment of patients, a lack of administrative support or organizational investment in DBT, and time commitment of DBT. In order to transfer DBT into a public behavioral health system, investment from both clinic-level and system-level administrators is required. Strategies to prevent drift, such as developing train-the-trainer model, are discussed.

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

“…Some of the barriers identified in this study are consistent with those documented in the literature surrounding the implementation and sustainability of DBT as well as other evidence‐based treatments (e.g. high rates of staff turnover; Ben‐Porath et al, ; Carmel et al, ; DiMeo, Moore, & Lichtenstein, ; Herschell et al, ), while others were novel and/or specific to DBT (e.g. clinician burnout).…”

“…A number of studies have investigated barriers and facilitators associated with the implementation of DBT in a variety of service contexts (Ben‐Porath, Peterson, & Smee, ; Carmel, Rose, & Fruzzetti, ; Chugani & Landes, ; Ditty, Landes, Doyle, & Beidas, ; Herschell, Kogan, Celedonia, Gavin & Stein, ; King, Hibbs, Saville, & Swales, ; Landes et al, ; Swales, Taylor, & Hibbs, ). Most employed qualitative research methods to explore clinicians' and/or administrators' opinions about DBT.…”

“…Most employed qualitative research methods to explore clinicians' and/or administrators' opinions about DBT. Several organisational barriers to the implementation of DBT were identified and were associated with limited resources within programmes including a lack of funding for training (Carmel et al, ; Herschell et al, ), low managerial support (Swales et al, ), high rates of staff turnover (Ben‐Porath, Peterson, & Smee, ; Carmel et al, ; Chugani & Landes, ), concerns related to the programme's fit with existing practices (Carmel et al, ) and insufficient referrals (Herschell et al, ). Other common barriers identified were related to the consultation teams (Ditty et al, ), the time commitment associated with the programme (Ben‐Porath et al, ; Carmel et al, ) and themes related to individual clinicians—including staff selection for training (Ben‐Porath et al, ).…”

“…Facilitators were identified in a few of the studies and seemed to mirror the identified barriers. For example, facilitators included systemic support (Carmel et al, ), staff interest and expertise (Landes et al, ) and positive team dynamics (Ditty et al, ).…”

The development and theoretical application of an implementation framework for dialectical behaviour therapy: a critical literature review

“…There were 11 discussion papers ( [11,12,[14][15][16][17][18][19][20][21][22]) and as these were considered the weakest form of evidence they were not included in the synthesis, but are detailed in Table 1. As seen in Table 2, nine papers collected retrospective ( [23][24][25][26][27][28][29][30][31]) and five papers ( [32][33][34][35][36]) collected prospective implementation data. There were 16 programme descriptions ( [37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52]) and 19 trial process analyses ( [53][54][55][56][57][58]<...>…”