Practice Settings and Dialectical Behavior Therapy Implementation: A mixed method analysis
Dissemination and Implementation
Background and Significance: Implementation science is the study of transferring innovation into practice. Guided by The Consolidated Framework for Implementation Research (CFIR), this study analyzes Dialectical Behavior Therapy (DBT) utilization in the real world. Such an inquiry informs DBT-uptake in settings, whereby increasing employment of the current gold standard treatment for suicide, non-suicidal self-injury, and behavioral dysregulation. Methods: Seventy-nine intensively trained DBT clinicians completed an online survey that quantified implementation outcomes and practice-setting variables. Practice setting variables were compared to DBT implementation using bivariate analyses. Twenty sequential semi-structured interviews bolstered quantitative findings while exploring the field of inquiry that could not be quantified. Findings and Limitations: Supervision, team cohesion, team communication, and team climate were significantly correlated with DBT implementation and bolstered by qualitative themes. Four other practice-setting variables were related with moderate significance and little qualitative support, and additional hypotheses were generated. Limitations require consideration of the current research as exploratory. Conclusions: The four variables with the clearest connection to DBT implementation can be characterized as interpersonal variables within practice settings. These findings contribute to the identification of key drivers of successful DBT implementation within settings. Future researchers are advised to develop and test implementation strategies incorporating these findings. Practitioners should be mindful of these variables when implementing DBT.
Jeffrey S. Applegate, Ph.D.
Sara J. Landes, Ph.D.