Does Insurance Matter? Implementing Dialectical Behavior Therapy with Two Groups of Youth Engaged in Deliberate Self-harm

Abstract

This paper presents the outcomes of a Dialectical Behavior Treatment (DBT) program, implemented in intensive outpatient care with two groups of adolescents (n=55 and n=45), ages 12–18, who engaged in deliberate self-harm (DSH) but had different insurance/funding sources and risk backgrounds. This pre-post study examined variability in clinical functioning and treatment utilization between the two groups and investigated moderating risk factors. Findings support DBT’s effectiveness in improving clinical functioning for youth with DSH regardless of insurance type. However, lower rates of treatment completion among youth without private insurance call for extra engagement efforts to retain high-risk youth in DBT.

Outpatient Dialectical Behavior Therapy for Adolescents Engaged in Deliberate Self-Harm: Conceptual and Methodological Considerations

“…Four studies utilized a non-control group preand post-test comparison design; two included extended post-treatment follow-up (Fleischhaker et al, 2011; James et al, 2014; Tørmoen et al, 2014; Woodberry & Popenoe, 2008) and two studies included a comparison group (Mehlum et al, 2014; Rathus & Miller, 2002). Mehlum et al (2014) was the only randomized control trial study utilizing a usual care as the control condition.…”

“…In the Fleischhaker et al (2011) study, although the sample size was small ( N = 12) the results indicated significant improvement in the areas of suicidality, self-harm, emotional dysregulation, and depression both at the end of treatment and at one-year follow-up. The more recent studies by James et al (2014), Tørmoen et al (2014), and Mehlum et al (2014) also utilized Rathus and Miller’s shortened adolescent DBT program with similar positive outcomes in regards to reduced self-harm at post-treatment and at 1 year follow-up in the case of the Tørmoen study. Of note is that the James study included intensified services similar to the original Rathus and Miller (2002) study.…”

“…This trend was observed in four of the reviewed studies (Fleischhaker et al, 2011; Mehlum et al, 2014; Rathus & Miller, 2002; Tørmoen et al, 2014). The two additional studies (James et al, 2014; Woodberry & Popenoe, 2008) noted that subjects demonstrated symptoms consistent with BPD (i.e. emotional dysregulation and self-harm) but did not specifically require this as an inclusion criterion.…”

“…Although the LPC was used in three studies, only Fleischhaker et al (2011) used this measure as a pre-test post-test outcome measure. Finally, the Woodberry and Popenoe (2008) study used items from the Trauma Symptom Checklist for Children (TSCC: Briere, 1996), and the James et al study (2014) relied on items from the Youth Outcome Questionnaire-Self-Report 2.0 (Y-OQ-SR; Wells, Burlingame, & Rose, 2003). With more standardized measures emerging, researchers are encouraged to explore more reliable, consistent and valid methods for assessing DSH across the treatment spectrum (from intake to ongoing monitoring) such as the LPC and SASII (Gratz, 2001; Linehan et al, 2006) in combination with weekly behavioral counts.…”

“…Specifically, Woodberry and Popenoe (2008) utilized a 15-week treatment structure, Fleischhaker et al (2011) a 16- to 24-week format, James et al (2014) a 16-week 32 sessions format, Tørmoen et al (2014) a standard once a week for 16 weeks format, and Mehlum et al (2014) used a 19-week adaption. Overall results were positive, supporting this shortened approach with significantly reduced adolescent depression, anger, dissociative symptoms, overall symptoms, functional difficulties, desire to self-harm, and suicidality.…”