Should discharge be collaborative? Assessing flexible discharge dates in an intensive outpatient dialectical behavior therapy program.

Abstract

Deciding when to terminate treatment can be complex. We examined clients (N = 121, female 66.9%, White 84.7%) that possessed an anticipated termination date, while also allowing for shared decision making to graduate treatment early or to extend treatment. Among early graduates (n = 29), we found decreases in stress ( p = .001, d = 0.65), anxiety ( p < .001, d = 0.57), and difficulties in emotional regulation ( p = .004, d = 0.49) and increases in Snyder's hope ( p < .001, d = 0.51) and mindfulness ( p = .03, d = 0.34) but not in integrative hope or depression. Among extended graduates (n = 42), we found decreases in difficulties in emotional regulation ( p < .02, d = 0.39), but insignificant findings regarding depression, anxiety, stress, Snyder's hope, integrative hope, or dispositional mindfulness between their anticipated termination date and their actual termination date. At last survey, stress was the only significant predictor of graduation status ( p = .05) indicating that for every 1-point decrease in stress, the odds for graduation increased by a factor of 1.14 (CI [1.01, 1.26]). Overall, we found support for early graduation but less support for extending termination beyond an anticipated discharge date. This study argues for an evidence-based solution to understanding collaborative termination, one that is informed by clinical expertise, patient preferences, and research. Public Significance StatementThis article provides practical information regarding evidence-based practices for team leaders, clinicians, and administrators about the mental health of clients that graduated before a set termination date and clients whose treatment extended beyond a set termination date.