Dialectic behavioural therapy7/4/2023 ![]() ![]() Studies which have explored implementation of EBP in general healthcare settings report similar implementation facilitators and barriers to those which focus on DBT. The transfer of EBP from research into an existing healthcare service can be challenging and time-consuming, and requires persistence. In line with this, best practice guidelines for the delivery of evidence-based interventions in mental health services also recommend DBT for the treatment of BPD in community settings (e.g. ). Their study and subsequent effectiveness evaluations (e.g. ) have reported positive outcomes for individuals with BPD who participate in community based DBT programmes. ![]() Comtois and colleagues were the first to evaluate the effectiveness of DBT in a community mental health setting. In addition to efficacy, DBT has demonstrated effectiveness in routine clinical settings. Participation in DBT has shown improved outcomes for individuals specifically reductions in suicidal behaviour, suicidal ideation, BPD symptoms, depression, and health service utilisation. ) which have investigated its efficacy at multiple independent sites within different healthcare infrastructures and different countries. DBT is the most researched treatment option with more than a dozen randomised controlled trials (e.g. Treatments such as dialectical behaviour therapy (DBT ), schema therapy, mentalisation-based therapy, and transference-focused psychotherapy have been developed for treating BPD. Additionally, the treatment of individuals with BPD is often described as complex and costly. The implementation of EBP for borderline personality disorder (BPD) in community settings is especially important as individuals with this diagnosis are amongst the most extensive users of inpatient and outpatient mental health services. Trial registrationĬ ID: NCT03180541 Registered June 7th 2017 ‘retrospectively registered’.Īdvancement in the treatment of, and recovery from, mental health disorders requires integration of evidence-based practice (EBP) into community mental health services. The results highlight the importance of a mandated service plan for the coordinated implementation of an evidence-based treatment in a public health service. Future research should pay particular attention to the domain of characteristics of individuals involved in DBT implementation. Barriers and facilitators were identified across several domains of the CFIR and are consistent with a recently published DBT implementation Framework (Toms et al., Borderline Personal Disord Emot Dysregul. ![]() The barriers and facilitators identified in this study are broadly similar to those reported in previous research. Implementation facilitators included having dedicated team members and support from management. Key challenges encountered were the lack of system support to facilitate phone coaching and a lack of allocated time to focus on DBT. ![]() Participants identified team size and support for the team leader as key points for consideration in DBT implementation. Resultsįive themes were identified from the interview data: team formation, implementation preparation, client selection, service level challenges and team leader role. Written qualitative feedback was analysed using content analysis. Frequencies of responses were calculated. 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. Qualitative interviews with DBT team leaders ( n = 8) explored their experiences of implementing DBT in their local service and was analysed using content analysis. MethodsĪ 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. 4:50, 2009) provided structural guidance for this national level coordinated implementation. The Consolidated Framework for Implementation Research (CFIR) (Damschroder et al., Implementation Sci. This study seeks to expand on previous work by evaluating a coordinated implementation of DBT in community settings at a national level. Although work in this area is limited, previous studies have identified facilitators and barriers to successful DBT implementation. 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. ![]()
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