Innovations in Practice: Feasibility and provision of dialectical behavior therapy skills training for adolescents and their families.

BACKGROUND: Suicide is a leading cause of death for adolescents in the United States. Widespread implementation of evidence-based practices for this population remains challenging due to resource shortages and system barriers. Dialectical Behavior Therapy for Adolescents (DBT-A) has robust research support, with positive clinical outcomes when implemented with fidelity. At the same time, implementation requires individual therapy with trained clinicians, a resource which may not be available at the level required in some communities. The current study uses theoretical frameworks from adult implementations of Dialectical Behavior Therapy (DBT) where treatment was provided in a DBT Skills Training format without weekly individual therapy to examine skills training for adolescent clients with suicidal behaviors and is the first published study regarding feasibility of skills training for this population. METHODS: Adolescents and their families were offered DBT Skills Training while on the waitlist for DBT-A. Of the 125 families referred, 48 chose DBT Skills Training and 77 opted to wait for DBT-A, creating a natural quasi-experimental design useful in exploring differences between DBT-Skills Training and DBT-A. RESULTS: There were no significant differences between the two groups at baseline. Rates of treatment completion were similar between the two groups. CONCLUSIONS: Results from the current study demonstrate similar rates of treatment drop-out and treatment completion between DBT Skills Training and DBT-A, suggesting DBT Skills Training without individual therapy for adolescents is feasible and warrants additional research.

Acceptability of Telehealth for Multidiagnostic Suicidal Patients in a Real-World Dialectical Behavior Therapy Clinic During the COVID-19 Pandemic.

Objective: This study aimed to evaluate the acceptability of Dialectical Behavior Therapy (DBT) delivered through telehealth to complex, suicidal patients during the COVID-19 pandemic. Methods: We surveyed 163 adult participants enrolled in outpatient services at a private, free-standing DBT clinic certified by the DBT-Linehan Board of Certification for its fidelity to the treatment. Treatment satisfaction was assessed, as well as ease of telehealth over time, differences in satisfaction between patients who had previously experienced face-to-face treatment and those who had only experienced telehealth, patients' beliefs regarding the impact of telehealth on their progress, and preference for face-to-face versus telehealth services. Additionally, participants' reasons for liking and disliking telehealth were reported. Results: The average overall satisfaction rating was 82.26 (±18.71) on a 100-point scale. Factors identified as being relevant to satisfaction included increased access to care, saving time and money, and increased comfort participating in therapy from home. Factors identified as relevant to dissatisfaction included feeling less connected to therapists and other patients. The majority of participants reported that telehealth positively impacted or did not impact treatment progress. Satisfaction was significantly related to participants' perception of telehealth's impact on progress in treatment. Demographic variables were also included in the analyses, but were unrelated to satisfaction. Conclusions: Findings indicate that, from the point of view of consumer satisfaction, telehealth appears satisfactory for delivery of DBT and may play an increased role in behavioral health care postpandemic.