Staff perspectives on implementing dialectical behavior therapy skills groups in the Veterans Health Administration

Area of Science:

• Implementation science
• Mental health services research
• Suicide prevention

Background:

• Reducing veteran suicide is a critical priority for the Veterans Health Administration (VHA).
• Dialectical behavior therapy skills groups (DBT-SG) are a potential innovation for suicide prevention.
• Understanding barriers and facilitators for DBT-SG implementation in the VHA is essential.

Purpose of the Study:

• To explore barriers and facilitators to implementing dialectical behavior therapy skills groups (DBT-SG) within the Veterans Health Administration (VHA).
• To inform the design of a hybrid Type 1 effectiveness-implementation trial.

Main Methods:

• Conducted 35 individual semistructured qualitative interviews with VHA staff.
• Included therapists, suicide prevention coordinators, and leaders at local and national levels.
• Utilized rapid qualitative analysis to identify key themes.

Main Results:

• Leadership expressed desire for innovative suicide prevention methods.
• Knowledge of DBT varied significantly among staff.
• Implementation challenges included staff shortages and burnout, exacerbated by COVID-19.
• DBT-SG may need adaptation for diverse veteran populations (e.g., Indigenous, homeless, urban).
• Virtual DBT-SG delivery shows potential for increased reach and access, requiring risk management.

Conclusions:

• Enthusiasm for DBT-SG is high within the VHA.
• Implementation faces challenges within a stressed healthcare system.
• DBT-SG, particularly virtual formats, holds promise for VHA suicide prevention.
• Successful implementation necessitates attention to staffing, provider well-being, and veteran diversity.