Symposium 6 – October 14, 2011 (MC: Kate Comtois)
Implementing Dialectical Behavior Therapy: Dissemination & Survival of DBT Programs
Presentation Slides Video of Presentation
Presenter: Michaela Swales, PhD
Authors: Michaela Swales, Betsi Cadwaladr, University Health Board & School of Psychology Bangor University, UK, Richard Hibbs, Integral Business Support Ltd, and Beverley Taylor, School of Psychology, Bangor University UK
Abstract: Dialectical Behaviour Therapy is an evidence-based treatment for suicidal behaviours presenting in the context of borderline personality disorder (BPD). In the UK DBT is recommended by the National Institute of Clinical Excellence as a treatment for adult women with BPD in whom reduction in self-harming and suicidal behaviours is a clinical priority (NICE, 2009). Transferring efficacious treatments to routine clinical practice settings presents numerous challenges. This presentation will: (i) report on a study that compared the rates of dissemination of DBT into routine healthcare settings in both the UK and the US. Data from this study raises issues about the speed of transfer and the types of training programme needed to effectively promote dissemination: and (ii) present a survival curve for DBT programmes seeded in the UK and report on factors associated with survival and ‘death’ of DBT programmes. Data from this study support the importance of organizational readiness to implement the treatment but also point to the importance of a longer-term strategy for programme sustainability.
Lessons Learned on Sustainability of Older Adult Community Behavioral Health Services
Presentation Slides Video of Presentation
Presenter: Emily Watson, MPH
Authors: Alixe McNeill, and Emily Watson, National Council on Aging
Abstract: National Council on Aging (NCOA) reports on a small study of 12 agencies that provided behavioral health services to older adults funded by federal demonstration grants. Through telephone interviews with grantee agencies, NCOA identified level of sustained services at two years + post grant. Using a sustainability factor framework based on implementation research literature, NCOA identified factors that agency staff considered important to continuing full services, partial services or ending grant-funded services. Factors in the community, organization and program that influence sustainability were considered. We will report on the strategies and sources of financing used by agencies to sustain services. NCOA will review the upcoming paper, Lessons Learned on Sustainability of Older Adult Community Behavioral Health Services currently being reviewed by SAMHSA for publication. This study, conducted in 2010, was funded by SAMHSA and NCOA.
Clinicians’ Use of Cognitive Therapy in Community Settings after Intensive Consultation
Presentation Slides Video of Presentation
Presenter: Shannon Wiltsey Stirman, PhD
Authors: Shannon Wiltsey Stirman, National Center for PTSD, Boston University, Katherine Toder, University of Pennsylvania, Christopher Miller, VA Boston Healthcare System, and Amber Calloway, National Center for PTSD, Boston University
Abstract: There has been extensive discussion in the literature about the difficulties associated with promoting the adoption of empirically supported psychotherapies in non-research settings (Stirman, Crits-Christoph, & DeRubeis, 2004). Although the effectiveness of certain EBPs in community settings has been established (Merrill, Tolbert, & Wade, 2003), few clinicians are explicitly using full protocols EBPs in their practice (Goisman, Warshaw, & Keller, 1999; Santa Ana et al., 2008). The purpose of this mixed-methods study is to examine the organizational and individual factors that are associated with clinicians’ sustained use or discontinuation of cognitive therapy after receiving training in a community-based cognitive therapy program. Forty clinicians completed surveys of organizational climate, culture, and readiness for change, as well as surveys of their attitudes towards, and use of EBPs at baseline, immediately post-consultation, and over a 24 month follow-up period. Clinicians also participated in in-depth interviews at 9-24 months post-consultation. We will report on survey results, short responses, and interview data. Clinician perspectives on CT’s effectiveness, modifications necessary for their clientele, barriers, and facilitators of sustainability will be examined. Baseline survey data and training scores will be used to examine patterns of response across differing organizational contexts and training outcomes.