Dialectical behavior therapy for justice-involved veterans (DBT-J): Feasibility and acceptability.

Abstract

Justice-involved veterans are a high-risk, high-need subgroup serviced by behavioral health services within the Veterans Health Administration (VHA) system. Justice-involved veterans often have complex mental health and substance use difficulties, a myriad of case management needs, and a range of criminogenic needs that are difficult to treat with traditional outpatient VHA services. The present study represents an initial evaluation of dialectical behavior therapy for justice-involved veterans (DBT-J), a novel psychotherapy program providing 16 weeks of skills-based group therapy and individualized case management services to veterans with current or recent involvement with the criminal justice system. A total of 13 veterans were successfully enrolled into this initial acceptability and feasibility trial. Results broadly suggested DBT-J to be characterized by high ease of implementation, successful recruitment efforts, strong participant attendance and retention, high treatment fidelity, and high acceptability by veteran participants, DBT-J providers, and adjunctive care providers alike. Although continued research using comparison conditions is necessary, veterans who completed participation in DBT-J tended to show reductions in criminogenic risk across the course of treatment. Cumulatively, these findings suggest DBT-J holds potential as a VHA-based intervention to address the various needs of justice-involved veterans. Impact StatementJustice-involved veterans are a high-risk, high-need subgroup serviced by behavioral health services within the Veterans Health Administration (VHA) system. Dialectical behavior therapy for justiceinvolved veterans was developed as a novel psychotherapy program providing 16 weeks of skills-based group therapy and individualized case management services to justice-involved veterans. Results suggest DBT-J to be acceptable and feasible for use in a VHA outpatient setting.

Dialectical behavior therapy for justice-involved veterans: Changes in treatment targets in a small, pre–post design clinical trial.

“…Previous data suggested that JIVs participating in DBT-J tended to experience reductions in criminogenic risk across the course of treatment, which were maintained for at least 1 month following DBT-J completion (Edwards, Dichiara, Epshteyn, et al, 2022). Results of the present study expand on these findings by replicating previously observed reductions in criminogenic risk.…”

“…proved vital to ensuring participant engagement. A more thorough summary of these strategies is detailed elsewhere (see Edwards, Dichiara, Epshteyn, et al, 2022). Although continued research is needed, such strategies will likely prove vital to future expansion and implementation of DBT-J.…”

“…In contrast to implementation barriers faced by recent forensic-oriented programming (Blonigen et al, 2021, 2022; Kim et al, 2019) and traditional DBT programming (Landes et al, 2017, 2020), findings from a recent small-scale trial (Edwards, Dichiara, Epshteyn, et al, 2022) suggested DBT-J to be both acceptable and feasible for delivery in VHA settings. Specifically, findings highlighted high ease of implementation, adequate and sustainable referral procedures, strong participant engagement, and high acceptability by veteran participants, DBT-J providers, and referring providers.…”

“…Participants’ case management needs were assessed using the Quality-of-Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF; Stevanovic, 2011) and the DBT-J Case Management Checklist (CMC; Edwards, n.d.). The Q-LES-Q-SF is a brief self-report measure of satisfaction in various areas of wellness (e.g., physical health, social relationships, leisure, etc.).…”

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Dialectical Behavior Therapy for Justice-Involved Veterans (DBT-J; Edwards, Dichiara, Epshteyn, et al, 2022) was recently developed as an integrative psychotherapy + case management intervention to address the range of complex criminogenic, mental health, substance use, and case management needs commonly faced by justice-involved veterans. Research to date suggests delivery of DBT-J to be both acceptable and feasible (Edwards, Dichiara, Epshteyn, et al, 2022). However, data on therapeutic change experienced by DBT-J participants has been limited.

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