Process evaluation of dialectical behavior therapy dissemination: Knowledge retention and recursive training effects
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Process evaluation of dialectical behavior therapy dissemination: Knowledge retention and recursive training effects Amber M. Holbrook 1
&
Susan R. Hunt 2 & Mary Renata See 3
Accepted: 25 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Dialectical behavior therapy (DBT) can be challenging to implement with fidelity to the model. Residential treatment settings are frequently overlooked as sites of implementation for DBT despite the potential benefits. This mixed-methods process evaluation examines the impact of DBT training in five residential programs on provider DBT-specific knowledge, staff turnover rates, and staff perceptions of training impact on their practice. Post-training staff knowledge levels varied considerably, but on average demonstrated substantial DBT-related knowledge retention. Staff turnover rates did not change significantly in four of five programs despite showing an overall trend in reduction. Qualitative results suggest substantial recursive training effects consistent with the DBT model. Themes emerged related to the impact of the training on effectiveness of practice with clients, application of DBT skills in staff personal lives, and positive effects on program culture. Results have implications for better understanding the mechanisms of successful dissemination of DBT across treatment settings. Keywords Dialectical behavior therapy . Evidence-based practice . Implementation research . Process evaluation . Implementation science
Background and Significance Residential treatment settings are often overlooked as potential sites for provision of evidence-based interventions (James et al. 2013). Although diverse in their structures and therapeutic approaches, residential settings typically offer a 24-h, multidisciplinary care environment to clients when the acuity of their behavioral health disorders or difficulty with daily living skills do not permit maintenance in a less-structured setting (Abt Associates 2008). Implementation of evidence-based practices (EBPs) such as dialectical behavior therapy (DBT), in residential programs that service individuals with mental health disorders has the potential to increase the quality and efficacy of care for this population. * Amber M. Holbrook [email protected] 1
Graduate Department of Social Work, West Chester University, Anderson Hall, West Chester, PA 19383, USA
2
Resources for Human Development, Inc, 4700 Wissahickon Avenue, Philadelphia, PA 19144, USA
3
West Chester University, Anderson Hall, West Chester, PA 19383, USA
DBT is a comprehensive, specialized adaptation of cognitive behavioral therapy, originally developed for the treatment of borderline personality disorder. Effective in reducing suicidal and parasuicidal behaviors, while simultaneously increasing treatment retention (Neacsiu et al. 2010; Panos et al. 2014; Soler et al. 2009; Swenson et al. 2002), DBT aims to both decrease quality-of-life interfering behaviors and enhance behavioral skills such as emotional regulation, distre
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