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Decker SE, Matthieu MM, Smith BN, Landes SJ. Barriers and Facilitators to Dialectical Behavior Therapy Skills Groups in the Veterans Health Administration. Mil Med 2024; 189:1055-1063. [PMID: 37104810 DOI: 10.1093/milmed/usad123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/22/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION Dialectical behavior therapy (DBT) is a multimodal evidence-based suicide prevention psychotherapy with barriers to full implementation. This study qualitatively examined barriers and facilitators to the DBT skills group treatment mode, which can be implemented as a stand-alone intervention. Using data from a national mixed-methods program evaluation of DBT in the Veterans Health Administration (VHA), this is the first article to examine barriers and facilitators to DBT skills groups implemented with a DBT consultation team or as a stand-alone intervention. MATERIALS AND METHODS A subset of data from semi-structured telephone interviews of six clinicians and three administrators (n = 9 respondents) was analyzed to provide complementarity and expansion on prior quantitative findings. The data were coded using an iterative process based on content analysis and a codebook based on the Promoting Action on Research Implementation in Health Services framework. The study was approved by the institutional review board for the Palo Alto VA Health Care System. RESULTS Barriers and facilitators were organized by Promoting Action on Research Implementation in Health Services domains of evidence, context, and facilitation. Results showed how reduced leadership support and low receptivity to providing DBT skills groups functioned as barriers and also identified a barrier not described earlier in the literature: the perception that this group could conflict with expanding access to care for more veterans. The results showed how leadership supported implementation, including by mapping clinic grids and supporting training, and also revealed how a supportive culture among providers facilitated division of labor between skills group providers, and how offering a treatment that filled a gap in services supported the group. At some sites, a provider with prior DBT experience was instrumental in starting DBT skills groups or developing ongoing training. CONCLUSIONS Qualitatively analyzed barriers and facilitators to a group-delivered suicide prevention intervention, DBT skills groups, expanded on quantitative findings on the importance of leadership support, culture, and training as facilitators. Future work implementing DBT skills group as a stand-alone treatment will need to address the barrier of receptivity and perceived barriers about access to care.
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Affiliation(s)
- Suzanne E Decker
- VA Connecticut Healthcare System, Mental Illness Research Education and Clinical Center, West Haven, CT 06516, USA
- VA Connecticut Healthcare System, Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, West Haven, CT 06516, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511, USA
| | - Monica M Matthieu
- Central Arkansas Veterans Healthcare System, Behavioral Health Quality Enrichment Research Initiative (QUERI), North Little Rock, AR 72114, USA
- College for Public Health and Social Justice, School of Social Work, Saint Louis University, Saint Louis, MO 63103, USA
| | - Brandy N Smith
- Central Arkansas Veterans Healthcare System, Behavioral Health Quality Enrichment Research Initiative (QUERI), North Little Rock, AR 72114, USA
- Central Arkansas Veterans Healthcare System, South Central Mental Illness Research Education and Clinical Center (MIRECC), North Little Rock, AR 72114, USA
| | - Sara J Landes
- Central Arkansas Veterans Healthcare System, Behavioral Health Quality Enrichment Research Initiative (QUERI), North Little Rock, AR 72114, USA
- Central Arkansas Veterans Healthcare System, South Central Mental Illness Research Education and Clinical Center (MIRECC), North Little Rock, AR 72114, USA
- Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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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] [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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Søndergaard AA, Juul S, Poulsen S, Simonsen S. Mentalizing the therapist – Therapist experiences with short-term mentalization-based therapy for borderline personality disorder: A qualitative study. Front Psychiatry 2023; 14:1088865. [PMID: 37009129 PMCID: PMC10061093 DOI: 10.3389/fpsyt.2023.1088865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/01/2023] [Indexed: 03/18/2023] Open
Abstract
BackgroundMentalization-Based Therapy (MBT) was originally developed as a structured psychotherapy approach developed to treat borderline personality disorder (BPD) lasting up to 18 months in outpatient settings. However, a short-term (5 months) MBT program has recently been developed. No studies have investigated how MBT therapists experience the shift towards conducting short-term MBT for BPD.ObjectiveThe objective of this study was to explore therapist experiences with conducting short-term MBT for outpatients with BPD in the Danish mental health services.MethodsSemi-structured qualitative interviews were conducted with seven therapists about their experiences with short-term MBT after a one-year pilot phase. The interviews were verbatim transcribed and analyzed using thematic analysis.ResultsThe following four major themes from the therapists’ experiences with short-term MBT were found in the qualitative analysis: (1) The longer the better, (2) Change processes can be intellectual or experiential, (3) Short-term therapy is hard work, and (4) Termination is more challenging in short-term MBT.ConclusionMost therapists were overall reluctant towards changing from long-term to short-term MBT. These therapist experiences could inform implementation of short-term MBT in mental health settings in the future.
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Affiliation(s)
- Amanda Ark Søndergaard
- Stolpegaard Psychotherapy Centre, Mental Health Services in the Capital Region of Denmark, Gentofte, Denmark
- Copenhagen Trial Unit, Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Copenhagen, Denmark
- *Correspondence: Amanda Ark Søndergaard,
| | - Sophie Juul
- Stolpegaard Psychotherapy Centre, Mental Health Services in the Capital Region of Denmark, Gentofte, Denmark
- Copenhagen Trial Unit, Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Copenhagen, Denmark
| | - Stig Poulsen
- Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Capital Region of Denmark, Denmark
| | - Sebastian Simonsen
- Stolpegaard Psychotherapy Centre, Mental Health Services in the Capital Region of Denmark, Gentofte, Denmark
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Pascoe KM, Petrescu-Prahova M, Steinman L, Bacci J, Mahorter S, Belza B, Weiner B. Exploring the impact of workforce turnover on the sustainability of evidence-based programs: A scoping review. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2:26334895211034581. [PMID: 37090007 PMCID: PMC9981891 DOI: 10.1177/26334895211034581] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Evidence-based programs (EBPs) are used across disciplines to integrate research into practice and improve outcomes at the individual and/or community level. Despite widespread development and implementation of EBPs, many programs are not sustained beyond the initial implementation period due to many factors, including workforce turnover. This scoping review summarizes research on the impact of workforce turnover on the sustainability of EBPs and recommendations for mitigating these impacts. Methods We searched 10 databases for articles that focused on an EBP and described an association between workforce turnover and the sustainment or sustainability of the program. We created a data abstraction tool to extract relevant information from each article and applied the data abstraction tool to all included articles to create the dataset. Data were mapped and analyzed using the program sustainability framework (PSF). Results and Discussion A total of 30 articles were included in this scoping review and mapped to the PSF. Twenty-nine articles described impacts of workforce turnover and 18 articles proposed recommendations to address the impacts. The most frequent impacts of workforce turnover included increased need for training, loss of organizational knowledge, lack of EBP fidelity, and financial stress. Recommendations to address the impact of workforce turnover included affordable and alternative training modalities, the use of champions or volunteers, increasing program alignment with organizational goals, and generating diverse funding portfolios. Conclusion The sustainment of EBPs is critical to ensure and maintain the short- and long-term benefits of the EBP for all participants and communities. Understanding the impacts of workforce turnover, a determinant of sustainability, can create awareness among EBP-implementing organizations and allow for proactive planning to increase the likelihood of program sustainability.
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Affiliation(s)
- Kelley M Pascoe
- School of Public Health, Department of Health Systems and Population Health, University of Washington, Seattle, USA
| | - Miruna Petrescu-Prahova
- School of Public Health, Department of Health Systems and Population Health, University of Washington, Seattle, USA
- School of Public Health, Health Promotion Research Center, University of Washington, Seattle, USA
| | - Lesley Steinman
- School of Public Health, Department of Health Systems and Population Health, University of Washington, Seattle, USA
- School of Public Health, Health Promotion Research Center, University of Washington, Seattle, USA
| | - Jennifer Bacci
- School of Pharmacy, University of Washington, Seattle, USA
| | - Siobhan Mahorter
- School of Public Health, Department of Health Systems and Population Health, University of Washington, Seattle, USA
| | - Basia Belza
- School of Public Health, Department of Health Systems and Population Health, University of Washington, Seattle, USA
- School of Public Health, Health Promotion Research Center, University of Washington, Seattle, USA
- School of Nursing, University of Washington, Seattle, USA
| | - Bryan Weiner
- School of Public Health, Department of Health Systems and Population Health, University of Washington, Seattle, USA
- School of Public Health, Department of Global Health, University of Washington, Seattle, USA
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