Dialectical behaviour therapy for treating adults and adolescents with emotional and behavioural dysregulation: study protocol of a coordinated implementation in a publicly funded health service

Child Adoles Ment Health

Kells

Joyce

et al. 2018

Self Cite

Background Dialectical behaviour therapy for adolescents (DBT‐A) is an intervention with a growing evidence base for treating adolescents with emotional and behavioural dysregulation. This study describes the implementation and effectiveness of 16‐week DBT‐A across multiple sites in publicly funded child/adolescent mental health services (CAMHS) in Ireland. Method The Consolidated Framework for Implementation Research was used to guide this national implementation. Fifty‐four clinicians from seven CAMHS teams completed DBT training and delivered the 16‐week DBT‐A programme. Eighty‐four adolescents with emotional and behavioural dysregulation participated in the intervention and outcome measures were administered at preintervention, postintervention and 16‐week follow‐up. Results Significant reductions on all outcome measures were observed for DBT‐A participants including presence and frequency of self‐harm, suicidal ideation and depression. Reductions in the number of acute inpatient admissions, bed days and emergency department visits were also reported. Conclusions DBT‐A can be successfully implemented in CAMHS settings and yield positive outcomes for adolescents with emotional and behavioural dysregulation.

Section: Outcome Measuresmentioning

confidence: 99%

“…Therapist-reported measures. DBT therapists on each team completed therapist assessment forms developed by the research team to measure health service utilisation (Flynn, Kells, Joyce, Suarez et al, 2018). Data collected included presence and frequency of self-harm, emergency department (E.D.)…”

Section: Outcome Measuresmentioning

confidence: 99%

Innovations in Practice: Dialectical behaviour therapy for adolescents: multisite implementation and evaluation of a 16‐week programme in a public community mental health setting

Child Adoles Ment Health

Kells

Joyce

et al. 2018

Self Cite

Background Dialectical behaviour therapy for adolescents (DBT‐A) is an intervention with a growing evidence base for treating adolescents with emotional and behavioural dysregulation. This study describes the implementation and effectiveness of 16‐week DBT‐A across multiple sites in publicly funded child/adolescent mental health services (CAMHS) in Ireland. Method The Consolidated Framework for Implementation Research was used to guide this national implementation. Fifty‐four clinicians from seven CAMHS teams completed DBT training and delivered the 16‐week DBT‐A programme. Eighty‐four adolescents with emotional and behavioural dysregulation participated in the intervention and outcome measures were administered at preintervention, postintervention and 16‐week follow‐up. Results Significant reductions on all outcome measures were observed for DBT‐A participants including presence and frequency of self‐harm, suicidal ideation and depression. Reductions in the number of acute inpatient admissions, bed days and emergency department visits were also reported. Conclusions DBT‐A can be successfully implemented in CAMHS settings and yield positive outcomes for adolescents with emotional and behavioural dysregulation.

“…It is envisaged that our findings on the costs of treating BPD can be used alongside studies investigating the effectiveness of evidence-based treatments for BPD, such as DBT, schema therapy, mentalisation based therapy or transference focused psychotherapy (Departament de Salut Generalitat de Catalunya, 2011; Stoffers et al 2012). DBT is the recommended evidencebased treatment for persons with BPD (Government of Ireland, 2006), and is currently being implemented in Ireland through the National DBT Project (Flynn et al 2018b). Furthermore, these future studies can then inform the development of national guidelines that promote effective and cost-effective treatments for BPD, and inform budgeting and resource allocation decisions.…”

Section: Discussionmentioning

confidence: 99%

“…This paper is part of a larger study examining the effectiveness and cost-effectiveness of dialectical behaviour therapy (DBT) for treating individuals with BPD. The participants in this study include all recruited participants at baseline (see Flynn et al 2018b for study protocol). 1 Data collection occurred between February 2014 and March 2016.…”

Section: Data Collection and Samplementioning

confidence: 99%

Borderline personality disorder: resource utilisation costs in Ireland

Bourke

Murphy

et al. 2018

Ir. j. psychol. Med.

Objectives. Borderline personality disorder (BPD) is characterised by recurring crises, hospitalisations, self-harm, suicide attempts, addictions, episodes of depression, anxiety and aggression and lost productivity. The objective of this study is to determine the use of direct health care resources by persons with BPD in Ireland and the corresponding costs.Methods. This prevalence-based micro-costing study was undertaken on a sample of 196 individuals with BPD attending publicly funded mental health services in Ireland. All health care costs were assessed using a resource utilisation questionnaire completed by mental health practitioners. A probabilistic sensitivity analysis, using a Monte Carlo simulation, was performed to examine uncertainty.Results. Total direct healthcare cost per individual was €10 844 annually (ranging from 5228 to 20 609). Based on a prevalence of 1% and an adult population (18-65 years) of 2.87 million, we derived that there were 28 725 individuals with BPD in Ireland. Total yearly cost of illness was calculated to be up to €311.5 million.Conclusions. There is a dearth of data on health care resource use and costs of community mental health services in Ireland. The absence of this data is a considerable constraint to research and decision-making in the area of community mental health services. This paper contributes to the limited literature on resource use and costs in community mental health services in Ireland. The absence of productivity loss data (e.g. absenteeism and presenteeism), non-health care costs (e.g. addiction treatment), and indirect costs (e.g. informal care) from study participants is a limitation of this study.

“…Outcome measures for this study were chosen based on identification of clinically relevant constructs for both participant groups. These measures are a subset of a larger battery of measures used to evaluate DBT‐A as part of a coordinated implementation study (Flynn, Kells, Joyce, Suarez, & Gillespie, ). The outcome measures used for the comparison in this study were as follows:…”

Section: Methodsmentioning

confidence: 99%

Dialectical behaviour therapy for adolescents: a comparison of 16‐week and 24‐week programmes delivered in a public community setting

Gillespie

Joyce

Child Adoles Ment Health

et al. 2019

Self Cite

Background Dialectical behaviour therapy for adolescents (DBT‐A) is an intervention with a growing evidence base for treating adolescents with emotional and behavioural dysregulation. Previous studies have reported on varying lengths of treatment, however, and optimal treatment duration has not yet been identified. While the treatment developers initially proposed a 16‐week programme, they have more recently recommended an extension to 24 weeks. This study compares outcomes for adolescents and parent/guardians who participated in 16‐ and 24‐week DBT‐A programmes in a community setting. Methods Eighty‐four adolescents and 100 parent/guardians participated in 16‐week DBT‐A, while 68 adolescents and 67 parent/guardians participated in the 24‐week programme. Outcome measures for adolescents included the presence and frequency of self‐harm, suicidal ideation and depression; and for parents were burden, grief and parental stress. Outcomes were assessed at pre‐ and postintervention. Linear mixed‐effects models were used to estimate the treatment duration effect (24‐week vs. 16‐week) utilising all available data at pre‐ and postintervention. Results Data analyses showed a reduction in the presence and frequency of self‐harm at postintervention for adolescents in both programmes. Both adolescent and parent participants in the 16‐ and 24‐week programmes also showed changes indicating significant improvement on all self‐report outcome measures (p < .05). A treatment duration effect was identified with adolescents in the 24‐week programme reporting greater gains on measures of suicidal ideation and depression (p < .05). However, drop‐out rates were higher for the 24‐week programme. Conclusions The findings of the current study indicate that 24‐week DBT‐A may have additional benefits in comparison to 16‐week DBT‐A in terms of further reductions in suicidal ideation and depression. Given the nature of this study, it was not possible to explore a potential time effect, however, so these results should be interpreted with caution. Further research will assist in determining an optimal programme duration of DBT‐A.