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Community-based behavioral health administrator perspectives on sustainability of Dialectical Behavior Therapy: a qualitative evaluation.

ABSTRACT: Background:Substantial resources have been invested in evidence-based practice (EBP) implementation in community settings; however, research suggests that EBPs do not always sustain over time. Method:This qualitative study explored the perspectives of 13 community behavioral health agency leaders regarding the sustainability of an EBP 25 to 28?months following the original training period. Administrators from 10 agencies were interviewed to understand the complexities of the implementation process, sustainability of Dialectical Behavior Therapy, and their recommendations to enhance implementation and sustainability. Results:A content analysis revealed five emergent themes: treatment model opinions, resource concerns, staff selection/ turnover, population characteristics, and recommendations for future implementation. Conclusions:These themes likely would be helpful in informing the design of future implementation and sustainability initiatives sensitive to the challenges of integrating EBPs in community settings.

SUBMITTER: Quetsch LB

PROVIDER: S-EPMC7047370 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Community-based behavioral health administrator perspectives on sustainability of Dialectical Behavior Therapy: a qualitative evaluation.

Quetsch Lauren B LB Herschell Amy D AD Kogan Jane N JN Gavin James G JG Hale Gaven G Stein Bradley D BD

Borderline personality disorder and emotion dysregulation 20200228

<h4>Background</h4>Substantial resources have been invested in evidence-based practice (EBP) implementation in community settings; however, research suggests that EBPs do not always sustain over time.<h4>Method</h4>This qualitative study explored the perspectives of 13 community behavioral health agency leaders regarding the sustainability of an EBP 25 to 28 months following the original training period. Administrators from 10 agencies were interviewed to understand the complexities of the imple ...[more]

PMID: 32161650

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Project description:BackgroundCare coordination has been a common tool for practices seeking to manage complex patients, yet there remains confusion about the most effective and sustainable model. Research exists on opinions of providers of care coordination but there is limited information on perspectives of those in the insurance industry about key elements. We sought to gather opinions from primary care providers and administrators in Minnesota who were involved in a CMS (Center for Medicare and Medicaid Services) transformational grant implementing COMPASS (Care Of Mental, Physical And Substance-use Syndromes), an evidence-based model of care coordination for depressed patients comorbid with diabetes and/or cardiovascular disease. We then sought to compare these views with those of private insurance representatives in Minnesota.MethodsWe used qualitative methods to conducted forty-two key informant interviews with primary care providers (n = 15); administrators (n = 15); and insurers (n = 12). We analyzed the recorded and transcribed data, once de-identified, using a frameworks analysis approach.ResultsWe identified six primary themes: 1) a defined scope, rationale, and key partnerships for building comprehensive care coordination programs, 2) effective information exchange, 3) a trained and available workforce, 4) the need for a business model and a financially justifiable program, 5) a need for evaluation and ongoing improvement of care coordination, and 6) the importance of patient and family engagement. Overall consensus across stakeholder groups was high including a call for payment reform to support a valued service. Despite their role in paying for care, insurance representatives did not stress reduced utilization as more important than other outcomes.ConclusionsPrimary care providers and administrators from different organizations and backgrounds, all with experience in COMPASS, in large part agreed with insurance representatives on the main elements of a sustainable model and the need for health reform to sustain this service.

Project description:BackgroundRadically Open Dialectical Behaviour Therapy (RO DBT) is a novel transdiagnostic treatment that targets 'maladaptive overcontrol'; a transdiagnostic cluster of traits associated with excessive emotional and behavioural inhibitory control. Outcomes are promising for adults with a range of psychiatric disorders. No study to date has explored the adolescent experience of RO DBT.MethodsOf the 25 eligible adolescents who received RO DBT between March 2015 and April 2017, 15 (14-17 years) consented and completed a semi-structured interview about their experience of treatment within 1 month of discharge. Interviews were recorded and then transcribed manually. Free text responses were analysed using reflexive thematic analysis.ResultsThe majority (n = 13) had a primary diagnosis of anorexia nervosa, although comorbidity was the norm, with 80.0% having two or more predicted comorbid psychiatric diagnoses. All had received some prior psychological treatment. Four themes were identified from analysis of transcripts: 1) Broadening Horizons, 2) Building Connections, 3) Flexibility, 4) Information Overload. Generally, RO DBT was perceived as helpful in both content and process. The focus on social and broader well-being, rather than specific mental health symptoms, was considered beneficial by many. Adolescents appreciated the group-based format of skills classes and reported benefiting from learning and practicing skills each week. The fourth theme, Information Overload, highlighted that for some, the amount of content felt overwhelming and that it was hard to remember and digest all the information, suggesting that adaptations, or simplifications, may be required to ensure accessibility for adolescents.ConclusionsRO DBT is perceived as a relevant and beneficial new treatment for adolescents with maladaptive overcontrol. The broad treatment focus is perceived as unique and of particular benefit. It is reported to help with general and social functioning and foster cognitive and behavioural flexibility. Nevertheless, the amount and complexity of material was felt to be very large by some and may suggest the need for modified adolescent-specific materials.

Dataset Information

Community-based behavioral health administrator perspectives on sustainability of Dialectical Behavior Therapy: a qualitative evaluation.

Publications

Community-based behavioral health administrator perspectives on sustainability of Dialectical Behavior Therapy: a qualitative evaluation.

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