An implementation "Field Trial" of DBT for adolescents with bipolar disorder: Training procedures and therapist...

The only efficacious psychosocial intervention for decreasing suicide attempts among adolescents with bipolar disorder (BP) is an adaptation of Dialectical Behavior Therapy (DBT). Yet myriad factors, including clinician training, limit DBT uptake. To enhance dissemination, we systematically operationalized, implemented and studied procedures for training and supervising community clinicians to adherently deliver DBT for adolescents with BP.

This study was conducted at a University-affiliated clinic serving youth with BP. Guided by the Enhanced-Replicating Effective Programs (E-REP) framework, we focused on internal and external facilitation components. Participants included master's level therapists (n = 3) at the implementation site; expert training and consultation were provided by an independent site. Validated measures of therapist satisfaction and acceptability, barriers and facilitators, and therapist competency were assessed at 0, 6, 12, 24 months using validated measures.

Data indicate high satisfaction and acceptability with the DBT approach and supervision model. Therapists initially identified difficulty changing their practice and low patient skills application as barriers; these improved with time. Administrative-level barriers were few, though therapists consistently cited competing demands. Ratings of the implementation climate, specifically perception of the environment's support for DBT, decreased over time (nonsignificant trend). All therapists passed the external DBT certification process by study-end and maintained fidelity through 2-years via independent adherence coding.

The resultant training and supervision model of DBT for adolescents with BP holds promise to inform dissemination efforts for this high-risk population. Data indicate careful attention to therapist- and organizational-level facilitators and barriers should be considered throughout the implementation process.

govID:NCT03661333.