Table 1 Themes and Sample Quotes from Administrative Leaders on DBT Implementation and Sustainability

“folks all agreed that DBT was effective and valuable.”

“the team appreciated all of the training.”

“figuring out scheduling and coverage was tough.”

“the on-call phone contact scares therapists.”

“[the] motivational component [was] helpful.”

“outpatient and DBT are supportive and fit nicely together.”

“[the] consistency is tough … It’s easier to get caught up in the chaos.”

“as an administrator, you have to realize that the training is resource–intensive [and that you] have to balance that out. We now are getting a higher reimbursement, which is helpful, but [we] didn’t get that for the first year.”

“we had to get cell phones for them. You would need to change the job description [of the therapists] to include on-call time.”

“we do get more insurance fees when we see clients.”

“You really have to select the right people. [They] have to be as committed to the model and agency as possible.”

“have to have … appreciation for the importance of fidelity.”

“can’t be married to a different theory and must be willing to change.”

“you have to be a strong, assertive clinician.”

“clinician apprehension … they are concerned about being adherent.”

“clinicians have to be open-minded and willing to try anything.”

“Having clients accept responsibility for their own behavior is difficult.”

“Initially groups were tough … clients [had] strong personalities and war stories, but there has been lots of change and personal development with those clients.”

“we’re finding that we have had a few [client] hospitalizations.”

“need a clear cut plan and goal.”

“[Therapists] would have liked more skills training and hands-on examples of how to implement skills training in depth sooner.”

“Administrators should also know that it is a difficult population and expensive [treatment] to implement.”