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Joyce M, Kells M, Flynn D, Wall S, Boylan E, Dunne L. Dialectical behaviour therapy: effect of a coordinated implementation approach on programme sustainability. Ir J Psychol Med 2024:1-4. [PMID: 38647028 DOI: 10.1017/ipm.2024.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Sustainability of DBT programmes and the factors which potentially influence this has received little attention from researchers. In this article, we review the literature reporting on sustainability of DBT programmes in outpatient settings. We also seek to advance the limited knowledge on this topic by reporting on the sustainability of DBT programmes delivered by teams that trained via a coordinated implementation approach in Ireland. As part of this perspective piece we conducted a systematic literature search which identified four studies reporting on DBT programme sustainability. All four reported on programmes delivered by teams that had received training as per the DBT Intensive Training Model. The findings of these studies are summarised and we consider the effect on DBT programme sustainability of introducing a coordinated implementation approach in Ireland.
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Affiliation(s)
- M Joyce
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - M Kells
- Mental Health Services, Cork Kerry Community Healthcare, Health Service Executive, Inniscarraig House, Cork, Ireland
| | - D Flynn
- Mental Health Services, Cork Kerry Community Healthcare, Health Service Executive, St. Finbarr's Hospital, Cork, Ireland
| | - S Wall
- National DBT Office Ireland, Inniscarraig House, Cork, Ireland
| | - E Boylan
- National DBT Office Ireland, Inniscarraig House, Cork, Ireland
| | - L Dunne
- National DBT Office Ireland, Inniscarraig House, Cork, Ireland
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2
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Larkin C, Arensman E, Boudreaux ED. Preventing Suicide in Health Systems: How Can Implementation Science Help? Arch Suicide Res 2023; 27:1147-1162. [PMID: 36267036 DOI: 10.1080/13811118.2022.2131490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Suicide prevention is an emotive, complex goal for clinicians and health systems. Effective interventions for suicidality do exist; however, many patients do not receive them because implementation efforts tend to be time-limited and unsystematic. Implementation science is the study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice. This narrative review introduces implementation science to suicide researchers, with a special focus on healthcare settings. We outline prominent theories, methods, and measures, as well as examples of implementation research from suicidology. By embracing the principles of implementation science, suicidologists can help to close the gap between evidence-based practice and routine practice, thereby improving the delivery and uptake of suicide-related interventions and prevention programs.
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Harned MS, Schmidt SC, Korslund KE, Gallop RJ. Development and Evaluation of a Pragmatic Measure of Adherence to Dialectical Behavior Therapy: The DBT Adherence Checklist for Individual Therapy. Adm Policy Ment Health 2023; 50:734-749. [PMID: 37284966 PMCID: PMC10246542 DOI: 10.1007/s10488-023-01274-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 06/08/2023]
Abstract
This paper presents two studies conducted to develop and evaluate a new pragmatic measure of therapist adherence to Dialectical Behavior Therapy (DBT): the DBT Adherence Checklist for Individual Therapy (DBT AC-I). Study 1 used item response analysis to select items from the gold standard DBT Adherence Coding Scale (DBT ACS) using archival data from 1271 DBT sessions. Items were then iteratively refined based on feedback from 33 target end-users to ensure relevance, usability, and understandability. Study 2 examined the psychometric properties of the DBT AC-I as a therapist self-report and observer-rated measure in 100 sessions from 50 therapist-client dyads, while also evaluating predictors of therapist accuracy in self-rated adherence. When used as a therapist self-report measure, concordance between therapist and observer ratings was at least moderate (AC1 ≥ 0.41) for all DBT AC-I items but overall concordance (ICC = 0.09) as well as convergent (r = 0.05) and criterion validity (AUC = 0.54) with the DBT ACS were poor. Higher therapist accuracy was predicted by greater DBT knowledge and adherence as well as more severe client suicidal ideation. When used by trained observers, the DBT AC-I had excellent interrater reliability (ICC = 0.93), convergent validity (r = 0.90), and criterion validity (AUC = 0.94). While therapists' self-rated adherence on the DBT AC-I should not be assumed to reflect their actual adherence, some therapists may self-rate accurately. The DBT AC-I offers an effective and relatively efficient method of evaluating adherence to DBT when used by trained observers.
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Affiliation(s)
- Melanie S Harned
- VA Puget Sound Health Care System, 1660 South Columbian Way, Mailstop S-116-MHC, Seattle, WA, 98108, USA.
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, USA.
- Department of Psychology, University of Washington, Seattle, WA, USA.
| | - Sara C Schmidt
- VA Puget Sound Health Care System, 1660 South Columbian Way, Mailstop S-116-MHC, Seattle, WA, 98108, USA
| | | | - Robert J Gallop
- Department of Mathematics, West Chester University, West Chester, PA, USA
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Frost G, Strodl E, Swannell S, Macdonald K, Madson K. A Feasibility Study Investigating Mechanisms of Change in Public Mental Health Dialectical Behaviour Therapy Programmes. Behav change 2023. [DOI: 10.1017/bec.2023.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Abstract
Few studies have investigated the feasibility of researching brief forms of dialectical behaviour therapy (DBT) for borderline personality disorder (BPD) in public mental health settings. This study aimed to provide preliminary evidence for the feasibility of implementing DBT over a 6-month period for BPD symptoms within Australian public mental health services. Of the 79 participants with BPD recruited, 62 commenced and 24 participants completed the therapy. The participants attended one of three outpatient DBT programmes and completed measures of BPD symptoms, DBT skills-use, and difficulties with emotion regulation at baseline and after 6 months of treatment. A major challenge with feasibility identified was the high attrition rate (61%). However, for completers there were significant improvements in BPD symptoms, DBT skills-use, and difficulties with emotion regulation. These effect sizes were used to estimate the sample sizes needed by future larger trials of brief DBT for BPD in public health settings. The implementation of brief DBT for BPD patients within a public mental health outpatient setting, appears to result in significant reductions in BPD symptoms. However, further exploration of strategies to reduce drop-out rates are required.
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Chanen AM, Nicol K. Five Failures and Five Challenges for Prevention and Early Intervention for Personality Disorder. Focus (Am Psychiatr Publ) 2022; 20:434-438. [PMID: 37200880 PMCID: PMC10187394 DOI: 10.1176/appi.focus.22020016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Despite global consensus regarding the early detection of personality disorder, current approaches to early intervention have failed to deliver for the majority of young people. This only serves to reinforce the enduring effects of personality disorder on functioning, mental and physical health, resulting in a reduction of quality of life and life expectancy. Here, we describe five significant challenges facing prevention and early intervention for personality disorder: identification, access to treatment, research translation, innovation and functional recovery. These challenges highlight the need for early intervention to shift from niche programmes in specialist services for a select few young people to become established in mainstream primary care and specialist youth mental health services. Reprinted from Curr Opin Psychol 2021; 37:134-138, with permission from Elsevier. Copyright © 2021.
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Affiliation(s)
- Andrew M Chanen
- Orygen, Melbourne, Australia, and Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Katie Nicol
- Orygen, Melbourne, Australia, and Centre for Youth Mental Health, The University of Melbourne, Australia
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Moe C, Brinchmann B, Rasmussen L, Brandseth OL, McDaid D, Killackey E, Rinaldi M, Borg M, Mykletun A. Implementing individual placement and support (IPS): the experiences of employment specialists in the early implementation phase of IPS in Northern Norway. The IPSNOR study. BMC Psychiatry 2021; 21:632. [PMID: 34930203 PMCID: PMC8690340 DOI: 10.1186/s12888-021-03644-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For decades there has been a continuous increase in the number of people receiving welfare benefits for being outside the work force due to mental illness. There is sufficient evidence for the efficacy of Individual Placement and Support (IPS) for gaining and maintaining competitive employment. Yet, IPS is still not implemented as routine practice in public community mental health services. Knowledge about implementation challenges as experienced by the practitioners is limited. This study seeks to explore the experiences of the front-line workers, known as employment specialists, in the early implementation phase. METHODS Qualitative data were collected through field notes and five focus group interviews. The study participants were 45 IPS employment specialists located at 14 different sites in Northern Norway. Transcripts and field notes were analysed by thematic analyses. RESULTS While employment specialists are key to the implementation process, implementing IPS requires more than creating and filling the role of the employment specialist. It requires adjustments in multiple organisations. The new employment specialist then is a pioneer of service development. Some employment specialists found this a difficult challenge, and one that did not correspond to their expectations going into this role. Others appreciated the pioneering role. IPS implementation also challenged the delegation of roles and responsibilities between sectors, and related legal frameworks related to confidentiality and access. The facilitating role of human relationships emphasised the importance of social support which is an important factor in a healthy work environment. Rural areas with long distances and close- knit societies may cause challenges for implementation. CONCLUSION The study provides increased understanding on what happens in the early implementation phase of IPS from the employment specialists' perspective. Results from this study can contribute to increased focus on job satisfaction, turnover and recruitment of employment specialists, factors which have previously been shown to influence the success of IPS. The greatest challenge for making "IPS efficacy in trials" become "IPS effectiveness in the real world" is implementation, and this study has highlighted some of the implementation issues.
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Affiliation(s)
- Cathrine Moe
- Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway. .,Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.
| | - Beate Brinchmann
- grid.420099.6Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway ,grid.10919.300000000122595234Department of Community Medicine, UiT – The Arctic University of Norway, Tromsø, Norway
| | - Line Rasmussen
- grid.420099.6Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway
| | - Oda Lekve Brandseth
- grid.420099.6Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway
| | - David McDaid
- grid.13063.370000 0001 0789 5319Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Eóin Killackey
- grid.488501.0Orygen, Melbourne, Australia ,grid.1008.90000 0001 2179 088XCentre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Miles Rinaldi
- grid.439450.f0000 0001 0507 6811South West London and St George’s Mental Health NHS Trust, London, UK
| | - Marit Borg
- grid.420099.6Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway ,grid.463530.70000 0004 7417 509XUniversity of South-Eastern Norway, Drammen, Norway
| | - Arnstein Mykletun
- grid.420099.6Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway ,grid.10919.300000000122595234Department of Community Medicine, UiT – The Arctic University of Norway, Tromsø, Norway ,grid.412008.f0000 0000 9753 1393Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway ,grid.418193.60000 0001 1541 4204Division for Health Sciences, Norwegian Institute of Public Health, Oslo, Norway
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van Leeuwen H, Sinnaeve R, Witteveen U, Van Daele T, Ossewaarde L, Egger JIM, van den Bosch LMC. Reviewing the availability, efficacy and clinical utility of Telepsychology in dialectical behavior therapy (Tele-DBT). Borderline Personal Disord Emot Dysregul 2021; 8:26. [PMID: 34717772 PMCID: PMC8556811 DOI: 10.1186/s40479-021-00165-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 09/14/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Telepsychology is increasingly being implemented in mental health care. We conducted a scoping review on the best available research evidence regarding availability, efficacy and clinical utility of telepsychology in DBT. The review was performed using PRISMA-ScR guidelines. Our aim was to help DBT-therapists make empirically supported decisions about the use of telepsychology during and after the current pandemic and to anticipate the changing digital needs of patients and clinicians. METHODS A search was conducted in PubMed, Embase, PsycARTICLES and Web of Science. Search terms for telepsychology were included and combined with search terms that relate to DBT. RESULTS Our search and selection procedures resulted in 41 articles containing information on phone consultation, smartphone applications, internet delivered skills training, videoconferencing, virtual reality and computer- or video-assisted interventions in DBT. CONCLUSIONS The majority of research about telepsychology in DBT has focused on the treatment mode of between-session contact. However, more trials using sophisticated empirical methodologies are needed. Quantitative data on the efficacy and utility of online and blended alternatives to standard (i.e. face-to-face) individual therapy, skills training and therapist consultation team were scarce. The studies that we found were designed to evaluate feasibility and usability. A permanent shift to videoconferencing or online training is therefore not warranted as long as face-to-face is an option. In all, there is an urgent need to compare standard DBT to online or blended DBT. Smartphone apps and virtual reality (VR) are experienced as an acceptable facilitator in access and implantation of DBT skills. In addition, we have to move forward on telepsychology applications by consulting our patients, younger peers and experts in adjacent fields if we want DBT to remain effective and relevant in the digital age.
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Affiliation(s)
- Hanneke van Leeuwen
- Vincent van Gogh Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Stationsweg 46, 5803, AC, Venray, the Netherlands. .,Cognition and Behaviour, Donders Institute for Brain, Radboud University, Nijmegen, the Netherlands. .,Dialexis, Training institute for Dialectical Behavior Therapy, Nijmegen, The Netherlands.
| | - Roland Sinnaeve
- Dialexis, Training institute for Dialectical Behavior Therapy, Nijmegen, The Netherlands.,UPC KU Leuven, Kortenberg, Belgium.,Department of Neurosciences, Mind Body Research, KU Leuven, Leuven, Belgium
| | - Ursula Witteveen
- Dialexis, Training institute for Dialectical Behavior Therapy, Nijmegen, The Netherlands.,GGNet for Psychiatry, Apeldoorn, the Netherlands.,Dutch Centre for treatment in DBT (NB-DBT), Harderwijk, the Netherlands
| | - Tom Van Daele
- Expertise Unit Psychology, Technology & Society, Thomas More University of Applied Sciences, Antwerp, Belgium
| | - Lindsey Ossewaarde
- Centre for Anxiety and Obsessive-Compulsive Disorders, Vincent van Gogh Institute for Psychiatry, Venray, the Netherlands
| | - Jos I M Egger
- Vincent van Gogh Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Stationsweg 46, 5803, AC, Venray, the Netherlands.,Cognition and Behaviour, Donders Institute for Brain, Radboud University, Nijmegen, the Netherlands.,Stevig Specialized and Forensic Care for People with Intellectual Disabilities, Dichterbij, Oostrum, The Netherlands
| | - Louisa M C van den Bosch
- Dialexis, Training institute for Dialectical Behavior Therapy, Nijmegen, The Netherlands.,Dutch Centre for treatment in DBT (NB-DBT), Harderwijk, the Netherlands
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8
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Flynn D, Kells M, Joyce M. Dialectical behaviour therapy: Implementation of an evidence-based intervention for borderline personality disorder in public health systems. Curr Opin Psychol 2021; 37:152-157. [PMID: 33588325 DOI: 10.1016/j.copsyc.2021.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 12/07/2020] [Accepted: 01/02/2021] [Indexed: 11/16/2022]
Abstract
Dialectical behaviour therapy (DBT) is an intervention with demonstrated efficacy and effectiveness for individuals with borderline personality disorder. In recent years, research has shifted focus to the evaluation of DBT implementation in routine clinical settings. In this article, we consider the empirical evidence that guides clinicians and managers in health services with local implementation of DBT in community settings. Research on this topic has most recently advanced to the evaluation of coordinated implementation efforts. Although coordinated implementation has merit, it does not mitigate all implementation challenges. Consideration of implementation facilitators and barriers in DBT can also be applied to other evidence-based interventions for BPD and for adaptations for individuals with early-stage symptomatology. Ongoing research and evaluation in these areas is recommended.
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Affiliation(s)
- Daniel Flynn
- Mental Health Services, Cork Kerry Community Healthcare, Health Service Executive, St. Finbarr's Hospital, Cork, Ireland.
| | - Mary Kells
- Mental Health Services, Cork Kerry Community Healthcare, Health Service Executive, Inniscarraig House, Western Road, Cork, Ireland.
| | - Mary Joyce
- National Suicide Research Foundation, Western Gateway Building, University College Cork, Cork, Ireland.
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Chanen AM, Nicol K. Five failures and five challenges for prevention and early intervention for personality disorder. Curr Opin Psychol 2021; 37:134-138. [PMID: 33513519 DOI: 10.1016/j.copsyc.2020.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/14/2020] [Indexed: 02/09/2023]
Abstract
Despite global consensus regarding the early detection of personality disorder, current approaches to early intervention have failed to deliver for the majority of young people. This only serves to reinforce the enduring effects of personality disorder on functioning, mental and physical health, resulting in a reduction of quality of life and life expectancy. Here, we describe five significant challenges facing prevention and early intervention for personality disorder: identification, access to treatment, research translation, innovation and functional recovery. These challenges highlight the need for early intervention to shift from niche programmes in specialist services for a select few young people to become established in mainstream primary care and specialist youth mental health services.
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Affiliation(s)
- Andrew M Chanen
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia.
| | - Katie Nicol
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
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