Evaluating the national multisite implementation of dialectical behaviour therapy in a community setting: a mixed methods approach

Abstract

Background: The implementation of evidence-based interventions for borderline personality disorder in community settings is important given that individuals with this diagnosis are often extensive users of both inpatient and outpatient mental health services. Although work in this area is limited, previous studies have identified facilitators and barriers to successful DBT implementation. This study seeks to expand on previous work by evaluating a coordinated implementation of DBT in community settings at a national level. The Consolidated Framework for Implementation Research (CFIR) (Damschroder et al., Implementation Sci. 4:50, 2009) provided structural guidance for this national level coordinated implementation. Methods: A mixed methods approach was utilised to explore the national multisite implementation of DBT from the perspective of team leaders and therapists who participated in the coordinated training and subsequent implementation of DBT. Qualitative interviews with DBT team leaders (n = 8) explored their experiences of implementing DBT in their local service and was analysed using content analysis. Quantitative surveys from DBT therapists (n = 74) examined their experience of multiple aspects of the implementation process including orienting the system, and preparations and support for implementation. Frequencies of responses were calculated. Written qualitative feedback was analysed using content analysis. Results: Five themes were identified from the interview data: team formation, implementation preparation, client selection, service level challenges and team leader role. Participants identified team size and support for the team leader as key points for consideration in DBT implementation. Key challenges encountered were the lack of system support to facilitate phone coaching and a lack of allocated time to focus on DBT. Implementation facilitators included having dedicated team members and support from management.

Reviewing the availability, efficacy and clinical utility of Telepsychology in dialectical behavior therapy (Tele-DBT)

“…A frequently reported barrier to implement the standard DBT program was the unwillingness of individual therapists to offer phone consultation. Flynn et al [ 60 ] reported similar findings in a survey exploring challenges experienced by clinical sites of implementation of DBT in community settings. Common issues concerned therapists’ reluctance, lack of management support and issues regarding clinical responsibility.…”

Implementing individual placement and support (IPS): the experiences of employment specialists in the early implementation phase of IPS in Northern Norway. The IPSNOR study

“…Previous research suggests that the sectoral responsibility for IPS must be addressed more clearly as the service sits at the interface between public sectors responsible for welfare services and health services, which may confuse issues of ownership and responsibility [ 11 ]. Activities carried out prior to the start of the practical work, such as planning and fostering supportive organisational conditions, are especially important to the success of implementation, with a need for a mandatory service plan for coordinated implementation to be produced [ 56 , 57 ]. The importance of involving actors besides the employment specialists, such as clinical teams, in implementation is highlighted in the IPS international literature.…”

A Feasibility Study Investigating Mechanisms of Change in Public Mental Health Dialectical Behaviour Therapy Programmes

“…These features limit the extent to which comprehensive DBT can be implemented with fidelity in routine clinical settings, where limited funding and high staff turnover are common, and adherence to treatment models are not routinely monitored (Feigenbaum et al, 2012). The lack of organisational and administrative support, together with the limited funding and low prioritisation of introducing new, evidence-based practice in mental health, have all been cited as common barriers to implementation of DBT in public mental health at a global level (Carmel, Rose, & Fruzzetti, 2013; Flynn et al, 2020; King, Hibbs, Saville, & Swales, 2018; Swales et al, 2012).…”