Implementation in National Systems

Abstract

The National Dialectical Behaviour Therapy (DBT) Project, Ireland was established in 2013 in the Republic of Ireland. The aims of the project were twofold: to implement DBT in Community Mental Health Services across Ireland and to evaluate this coordinated implementation of DBT at a national level. This chapter describes the process of implementing DBT in the public health system in Ireland. It first describes how the need emerged for a coordinated national implementation, and the framework put in place to establish and put this coordinated initiative into action. It then considers challenges to a national implementation of an evidence-based treatment such as DBT and approaches that were employed to overcome such challenges. The chapter concludes with a summary of implementation outcomes and key learnings from this initiative as well as recommendations and considerations for DBT implementation and ongoing sustainability in community mental health services.

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

“…The planning stage was primarily conducted by the two clinical leads of the project. Once the coordinating team were appointed, support was provided to the clinical leads for the activities of the planning stage (outlined in detail in Flynn, Kells, & Joyce, ). Therefore, a top–down approach to implementation was adopted where procedures were set in place at the outset of the project and followed by all teams who successfully secured a place to train with the National DBT Project.…”

“…In following the steps as part of the ‘Process’ construct, previously identified barriers and facilitators could be given due consideration throughout the different stages of the project. Barriers and facilitators were identified and accounted for based on the clinical leads’ understanding of the research literature, their own experience of implementation, and through consultation with the DBT training providers (outlined in detail in Flynn, Kells, & Joyce ). Table presents a summary of barriers and facilitators and how they were addressed in this coordinated implementation initiative.…”

“…While there was growing interest in DBT provision for adults and adolescents in Ireland, challenges regarding securing of funding for individual team training and awareness of how best to establish DBT in community services continued. A proposal was put forward to a National Office for Suicide Prevention (established to coordinate suicide and self‐harm prevention activities in Ireland) to coordinate the implementation of DBT in the Irish public health service (Flynn, Kells, & Joyce, ). This proposal was successful and the National DBT Project Ireland was established in 2013.…”

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

“…In Ireland, DBT is typically delivered in community‐based mental health settings in the public health service (Flynn, Kells & Joyce, ). This was a multisite study conducted in the public community mental health service across Ireland.…”

“…Coinciding with these findings, clinicians in Child and Adolescent Mental Health Services (CAMHS) across Ireland have sought interventions such as DBT‐A to treat the increasing number of adolescents presenting to their services with self‐harm and/or suicidal behaviour in recent years. With a growing national interest in DBT provision for both adults and adolescents, the National DBT Project Ireland was established in 2013 to coordinate DBT training in the Irish public health service (Flynn, Kells, & Joyce, ). Between 2013 and 2016, the National DBT Project trained 23 DBT teams in community settings; 13 teams in Adult Mental Health Services (AMHS) and 10 in CAMHS.…”