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Table 2 Implementation papers, programme descriptions and trial process analysis papers

From: The development and theoretical application of an implementation framework for dialectical behaviour therapy: a critical literature review

Reference Country & service context Paper type Methodology DBT outcomes Implementation relevant outcomes
Implementation papers
Chwalek & McKinney, 2015 [24] America (and Germany). Range of mental health services Retrospective data collection Survey and interviews of music therapists N/A 38.3% of respondents endorsed implementing DBT in music therapy practice
Ditty et al., 2015 [26] America. Mental health services Retrospective data collection Survey and interviews with therapists trained in DBT exploring inner setting constructs of CFIR framework N/A 96% of respondents provided individual therapy, 99% provided skills groups, 97% attended a consultation team and 87% provided phone skills coaching
Carmel et al., 2014 [23] America. Public behaviour health system Retrospective data collection Telephone interviews with therapists N/A Therapists received ten days (80 h) of DBT training over 13 months
Herschell et al., 2014 [35] America Prospective data collection Quantitative survey of therapists pre and post implementation Therapists reported trend reduction in patient A&E visits and hospitalisations Therapist training ranged from 32 to 96 h (maximum 96 h) and received on average 25.67 h of phone consultation
Swales et al., 2012 [31] UK. Range of inpatient, outpatient and forensic services Retrospective data collection Telephone interviews with DBT team members 7.1% said improved patient outcomes were an implementation facilitator 62.8% of programmes remained active at five years. 57% of programmes provided all DBT components
Dimeff et al., 2011 [32] America. Prospective data collection Randomised controlled trial with DBT naïve therapists N/A E-learning resulted in best knowledge retention at 15 week follow-up
Dimeff et al., 2009 [33] America. Prospective data collection Randomised controlled trial with DBT naïve therapists N/A 80% of therapists completed training. Online training best at improving knowledge. Instructor led training better than reading the training manual at increasing self-efficacy and satisfaction
Herschell et al., 2009 [36] America. Community mental health services Prospective data collection Qualitative interviews pre implementation with county level mental health administrators N/A N/A
Perseuis et al., 2007 [28] Sweden. Outpatient services Retrospective data collection Survey and interviews with DBT trained therapists N/A Therapists worked part-time in the DBT team. Tendency for greater staff burnout over time, but not statistically significant. Reduced occupational stress
Sharma et al., 2007 [30] America. Psychiatric residency Retrospective data collection Survey of residency directors and senior residents. Also presented a case study Patient hospitalised then discontinued DBT therapy 56% of residency programmes had no lectures on DBT and 32% provided no DBT supervision
Frederick & Comtois, 2006 [27] America Retrospective data collection Survey of psychiatry residency graduates who had attended at least one DBT workshop N/A 23% of respondents practiced all DBT components. Most practiced at least one DBT component
Cunningham et al., 2004 [25] America Retrospective data collection Interviews with BPD patients who had received DBT therapy Reduced hospitalisations and increased vocational work N/A
Perseius et al., 2003 [29] Sweden Retrospective data collection Interviews with DBT therapists and patients Patients reported positive outcomes. Patients had been in therapy for at least 12 months Therapists gained a new perspective and DBT influenced how therapists solved problems in their own lives
Hawkins & Sinha, 1998 [34] America. Department of mental health and addiction services Prospective data collection Correlated therapist DBT knowledge to demographics and training through repeated measures and naturalistic service outcome data Archival data suggested DBT training led to better patient outcomes: less A&E, inpatient, seclusion and restraint use Training and the amount of time practiced DBT had a moderate correlation with DBT knowledge
Other papers
James et al., 2015 [60] America. Psychiatric facility Trial process analysis Service embedded repeated measures evaluation Good outcomes Grant funded participants had higher attrition
Kinsey & Reed, 2015 [43] America. Native American tribe outpatient mental health and substance use service Programme description N/A N/A Programme had run for 14 years and had a good relationship with the tribal community
Baillie & Slater, 2014 [39] UK. Community intellectual disability service Programme description Mostly discussion Some evidence that patients developed emotion regulation and distress tolerance skills DBT service had been in operation for four years
Engle et al., 2013 [42] America. College counselling service Programme description Between groups Reduced psychiatric and substance use hospitalisations. Reduced college absence due to mental health problems Team received intensive training. Carried caseloads of up to seven patients plus one skills group
Arroyo et al., 2012 [38] America. Mount Sinai East Harlem health outreach project Programme description N/A Anecdotal evidence of patient improvement Implemented skills group only. Therapists received fortnightly supervision
Lajoie et al., 2011 [44] America. Residency run clinic Programme description N/A N/A Implemented all core DBT components
Morrissey & Ingamells, 2011 [47] UK. Learning disability forensic secure service Programme description Naturalistic outcomes reported Reduced symptoms and distress. Reduced perceived risk Implemented programme over six years
Pasieczny & Connor, 2011 [66] Australia. Adolescent mental health service Trial process analysis Between groups Patients of intensively trained therapists had better outcomes in terms of DSH and suicide attempts Therapists worked in DBT team part-time. Therapist adherence ranged nine-to-12 (maximum achievable = 12)
Little et al., 2010 [46] America. Residential service Programme description N/A Self-reported patient improvement and positive feedback DBT was the best implemented treatment in the service; had furthest reach, most staff support and needed less senior administrative support. Minimal attrition
Sampl et al., 2010 [48] America. Correctional setting Programme description N/A N/A Primarily just implemented skills group
Blennerhassett et al., 2009 [54] Ireland. Community mental health team Trial process paper Repeated measures Improved risks, symptoms, functioning and subjective wellbeing. Reduced hospitalisations and reduced costs Therapists completed intensive training but DBT team not established in the service
Kerr et al., 2009 [62] America. Low resourced rural training clinic Trial process analysis Case study There were “meaningful” changes in suicidality and misery ratings The therapist received DBT training and supervision. Could not access DBT skills group, so provided skills training in individual therapy sessions. Also provided adapted phone skills coaching
Hjalmarsson et al., 2008 [59] Sweden. Outpatient services Trial process analysis Repeated measures Patients had reduced para-suicidal behaviours and psychological distress 18 therapists trained and worked part-time on DBT team. DBT now provided by the service as a routine treatment. Attrition low
Woodberry & Popenoe, 2008 [71] America. Adolescent and family outpatient clinic Trial process analysis Repeated measures Good outcomes reported Five therapists received intensive training, the rest received less intensive or in-service training. The hospital provided some money to support staff training
Comtois et al., 2007 [57] America. Harbour view mental health services- community mental health centre Trial process analysis Repeated measures Reduced DSH, A&E visits and inpatient admissions Noted DBT staff were highly trained. Implemented all DBT components and incorporated access to DBT relevant services
Prendergast & McCausland, 2007 [67] Australia, Adult mental health outpatient service Trial process analysis Between groups Reduced depression and frequency of suicide attempts and hospitalisations. Improved patient functioning and reduced intervention duration The team comprised 12 therapists. Attrition was 31%
Zinkler et al., 2007 [52] UK. Newham project for BPD Programme description N/A Reduced hospitalisation and DSH frequency Annual service cost £92,000. Therapists worked part-time on DBT team. Staff satisfaction and retention high
Brassington & Krawitz, 2006 [56] New Zealand. Mental health service Pilot trial process analysis Repeated measures Good outcomes reported Implementation reportedly successful. Team staffed by part-time therapists and at the end of the trial team had a dedicated budget
Koons et al., 2006 [65] America. Division of vocational rehabilitation Trial process analysis Repeated measures At six months improved depression, hopelessness, anger expression, work role satisfaction and number of hours worked Provided just DBT skills group
Lew et al., 2006 [45] America. Intellectual disability service Programme description Provided service outcome data Eight learning disability patients completed the programme. DSH gradually reduced Staff carried caseloads of eight. Parents and staff also attended the skills groups
Nelson-Gray et al., 2006 [64] America. Outpatient adolescent clinic Trial process analysis Repeated measures Reduced negative behaviours, externalising and internalising symptoms, and depression. Increased positive behaviours Trained a high number of graduate students and these students achieved 88% intervention delivery fidelity over eight groups
Vitacco & Van Rybroek, 2006 [50] America. Forensic hospitals Programme description Primarily a discussion paper N/A N/A
Nee & Farman, 2005 [63] UK. Female prisons Trial process analysis Between groups (with a waiting list control) The majority of completers showed overall improvement with notable effect sizes Implementation problems believed to contribute to high attrition
APA Gold Award, 2004 [37] America. Grove street adolescence residence- residential care service Programme description N/A Outcome data indicated the programme was effective Provided all DBT components and had 18.7 full time equivalent staff members
Ben-Porath et al., 2004 [53] America. Urban community mental health centre Trial process analysis Repeated measures Reduced life threatening, therapy interfering and QOL interfering behaviours Implemented all core DBT components. Three of the eight DBT team members left within six months
Katz et al., 2004 [61] Canada. Adolescent inpatient service Pilot trial process analysis Between groups Reduced behavioural incidents on ward. Equivalent to TAU in reducing para-suicidal behaviour, depression symptoms and suicidal ideation at one year follow-up Provided skills group, individual therapy and milieu therapy
Sunseri, 2004 [49] America. Residential centre for adolescents Programme description Naturalistic outcomes reported Reduced attrition, inpatient days and duration of restraint and seclusion Staff confidence grew with DBT implementation
Eccleston & Sobello, 2002 [58] Australia. Prison service Pilot trial process analysis Repeated measures Trend improvement supported by patient feedback Anecdotally, a range of staff saw programme benefits
Rathus & Miller, 2002 [68] America. Adolescent outpatient clinic Trial process analysis Between groups Reduced hospitalisations and increased retention but did not reduce suicide attempts DBT transportable to real-world settings: provided in a hospital, not a university-based clinic
Trupin et al., 2002 [69] America. Incarceration centre for female juvenile offenders Trial process analysis Between groups Only one unit showed reduced behaviour problems Only one unit showed less staff use of punitive responses. Not all staff adherent to DBT
van den Bosch et al., 2002 [70] Netherlands. Addiction treatment centre Trial process analysis Randomised controlled trial Reduced DSH but did not improve substance use Over time therapists said they felt less isolated, more competent and experienced more work satisfaction. Consultation team attendance 100%. Attrition 37%
Bohus et al., 2000 [55] Germany. Inpatient service Pilot trial process analysis Repeated measures Reduced DSH, disassociation phenomena and depressive symptoms Intervention was rated positively by staff and patients and this was an impetus to conduct the trial
Wolpow et al., 2000 [51] America. Residential programme Programme description Included a service evaluation Patients gave positive feedback and observations were positive Residential staff became more positive about DBT
Gold Award, 1998 [41] America. Mental health centre Programme description N/A Positive patient outcomes and reduced costs reported 13 staff in DBT team. Provided all DBT components plus additional DBT related services. Team funding the equivalent of £520,000 per annum
Barley et al., 1993 [40] America. Inpatient psychiatric hospital Programme description Naturalistic outcome evaluation Reduced para-suicidal behaviour Transitioned to a DBT model over a two year period
  1. Abbreviations: BPD Borderline Personality Disorder, CFIR Consolidated Framework for advancing Implementation science, DBT Dialectical Behaviour Therapy, DSH Deliberate Self-harm, QOL Quality of Life, TAU Treatment As Usual, UK United Kingdom