Implementing DBT in a System or Organization
Advice for Starting a DBT Program
Behavioral Tech, LLC is actively attending to the science of implementation and using these principles to guide our recommendations. The Behavioral Tech implementation model aims to train providers and administrators at a level appropriate to their backgrounds and goals, while also examining the impact of the broader organizational context in which trainees work. This model takes into account a number of factors that may impact a successful adoption and implementation, including client and practitioner factors, organizational support, and training program quality (Turner & Sanders, 2006; Beidas & Kendall, 2010).
In this section, we outline the steps for new teams planning to start a DBT program in a larger mental health system. Any team implementing any type of program, DBT or non-DBT, must have five key types of administrative support to ensure development and stability of the program.
- Financing, including a budget, for the program.
- Adequate staffing levels.
- Designated time to learn and implement the treatment.
- Confidential meeting space (e.g., offices and group rooms).
- A leader and team who are granted authority over the plan for design and implementation of the program.
Before starting any program, we encourage you to identify the administrators whose support is crucial to your program. Speak with them informally to talk over the possibility of a new program. Then, write a one page bulleted plan and a five page in-depth plan for development of your program. Have both plans critiqued by people within the system who are in favor of, or neutral about, your plans. Use their feedback to improve your plan, then submit them to your administrator(s) and ask for a formal meeting to present the plan.
How to Get DBT into an Entire System
Achieving true implementation of any evidence based practice requires a significant commitment of time and resources from dedicated staff. Whether your goal is raising the level of staff clinical skills, building a continuum of care for a specific client population, or responding to the demands of a licensing or legal entity, we will work with you to design an effective training and implementation model. After you and your administrator(s) have outlined a detailed design that meets the five conditions above, there are many ways to proceed. The following questions will guide your thinking and provide answers to the next steps:
- What specific goals or problems are being addressed with training?
- Is training the appropriate intervention for the problem you need to solve?
- What time frame will you have from the beginning to the end of your project?
- What funding is in place or will need to be in place in order to bring training to your setting?
- Who are your stakeholders and how can they assist you?
- Do you have buy-in from all the stakeholders?
Behavioral Tech can work with a system of any size or nature to tailor the most effective training and/or implementation plan. Depending on outcome goals, funding, and staff to support the initiative, full implementation of DBT can take anywhere from one to four years.
While implementation science is still developing, several key components appear to be consistent across the literature. These components include:
- A thorough orientation and preparation
- A strong implementation team within the organization
- A thoughtful pairing of the appropriate staff/participants with appropriate curricula
- The coordination of training with coaching and feedback from expert consultants, which includes frequent and timely performance assessments with expert consultants throughout the implementation process
- Strategic plans for sustainability
Keeping in mind that we can tailor the training to you, there are three main paths for system implementation:
- OPTION ONE: Onsite orientation and strategic planning combined with one or more teams attending an offsite Dialectical Behavior Therapy Intensive Training™ and consultation.
- OPTION TWO: Onsite orientation and strategic planning, Dialectical Behavior Therapy Intensive Training™, supplemental training, and follow-up training, paired with consultation.
- OPTION THREE: A series of onsite trainings designed to promote a cultural shift within the milieu; teach all staff (both clinicians and direct care staff) the principles of dialectics, validation, and behavior change; and ensure that all staff are versed in DBT skills. In addition, one or more teams would receive Dialectical Behavior Therapy Intensive Training™ and consultation.
For more information on what we offer, please contact Client Services at 206.675.8588 or at firstname.lastname@example.org.
Any training that is available to individuals and teams can be offered as a custom training package in your program setting. To learn more about DBT training options, see our Levels of Training.