Implementing dialectical behaviour therapy in routine practice: an evaluation of a national CAMHS DBT service for adolescents

Abstract

Self-harming behaviours are reported to be increasing amongst young people and are associated with increased risk of suicide. The recently published UK clinical guidelines highlight that cross-sector awareness and early psychosocial assessment of self-harming is necessary, alongside careful triaging as to the level of support required. Dialectical behaviour therapy for adolescents (DBT-A) is a recommended intervention for young people with more severe difficulties. The current study aims to contribute to the data available to inform ongoing clinical decisions about the feasibility and implementation of DBT-A by reporting the intervention method, participant characteristics, and clinical outcomes of a national (UK) DBT service for young people with high levels of need and risk. Young people who commenced treatment between 2015 and 2021 were included. Completion rates, reasons for non-completion, and discharge pathways are reported. Measurement and changes in outcomes, including self-harm, in-patient bed days, accident and emergency department attendances and education/work status, are reported, as well as for routine outcome measures assessing emotion dysregulation and symptoms of emerging borderline personality disorder, depression and anxiety. The clinical significance of these outcomes are considered. Ideas for service evaluation, which are feasible and replicable in busy clinical settings are proposed, as well as a discussion of potential adaptations to standardised protocols needed in this context to fit with National Health Service (NHS) resources and the needs of the target population. Key learning aims (1) To learn about the implementation of dialectical behaviour therapy (DBT) and concurrent outcome monitoring in a UK National Health Service CAMHS out-patient setting. (2) To understand the clinical profile and response to treatment of young people with high levels of suicidal and non-suicidal self-harming behaviours. (3) To present a potential method for outcome monitoring and collection for CAMHS DBT services.

Dialectical behaviour therapy outcomes for adolescents with autism spectrum conditions compared to those without: findings from a seven-year service evaluation

“…The National & Specialist Child and Adolescent Mental Health Services (CAMHS), DBT service is a Tier 4 community service which accepts referrals from CAMHS across the UK, if symptoms of emerging BPD are indicated in an individual below the age of 18 (see Camp et al , 2023, and Smith et al ., 2023, for service description). After initial assessment, clients are offered up to six sessions of DBT pre-treatment, during which they choose whether to opt-in to the full DBT treatment programme.…”

Gender- and sexuality-minoritised adolescents in DBT: a reflexive thematic analysis of minority-specific treatment targets and experience

“…Fruzzetti, 2019). This service context has deviations from the original DBT for adolescents model, such as a separate parent/carer group rather than multi-family skills group, to allow implementation in a tier-4 national health service context (see Camp et al, 2023 andSmith et al, 2023 for further explanation). Further details of this service context can be found in Camp et al (2023).…”

“…Research into the experiences of GSM young people in DBT and related interventions is in its infancy and represents an important area of study given the poor experiences, higher mental health difficulties, and over-representation in DBT settings (Camp et al, 2023;Camp et al, in press;Harned et al, 2022). Future research could focus on the implementation and evaluation of these recommendations, the potential development of specific and/or adapted DBT skills/principles for GSM-associated dilemmas, and to explore and increase anti-oppressive and culturally sensitive competencies in clinicians working with GSM young people.…”

“…It is of note that the proportion of GSM young people who are referred and assessed as suitable for this national DBT programme is high, 63-65% and 11-17%, respectively, compared with the proportion in the UK population (Camp et al, 2023;Camp et al, in press;Office for National Statistics, 2021a, 2021b. As DBT is largely principle driven, there is scope and flexibility to include experiences relating to GSM identities and minority stressors in aspects of the programme.…”

“…Therefore, findings are to be understood largely as their contextual interpretation of the data, with input from the remaining authors, independent researchers, and the two GSM youth. Findings are also from a specialist NHS DBT context with deviations from the original DBT for adolescents' model (for details, see Camp et al, 2023), which may impact the generalisability to other settings and populations. Young people meeting inclusion criteria for DBT usually have significant problems with emotions, identity and relationships.…”