Barriers, facilitators, and benefits of implementation of dialectical behavior therapy in routine care: results from a national program evaluation survey in the Veterans Health Administration.
National implementation of evidence-based psychotherapies (EBPs) in the Veterans Health Administration (VHA) provides important lessons on the barriers and facilitators to implementation in a large healthcare system. Little is known about barriers and facilitators to the implementation of a complex EBP for emotional and behavioral dysregulation-dialectical behavioral therapy (DBT). The purpose of this study was to understand VHA clinicians' experiences with barriers, facilitators, and benefits from implementing DBT into routine care. This national program evaluation survey measured site characteristics of VHA sites (N = 59) that had implemented DBT. DBT was most often implemented in general mental health outpatient clinics. While 42% of sites offered all four modes of DBT, skills group was the most frequently implemented mode. Fifty-nine percent of sites offered phone coaching in any form, yet only 11% of those offered it all the time. Providers were often provided little to no time to support implementation of DBT. Barriers that were difficult to overcome were related to phone coaching outside of business hours. Facilitators to implementation included staff interest and expertise. Perceived benefits included increased hope and functioning for clients, greater self-efficacy and compassion for providers, and ability to treat unique symptoms for clinics. There was considerable variability in the capacity to address implementation barriers among sites implementing DBT in VHA routine care. Mental health policy makers should note the barriers and facilitators reported here, with specific attention to phone coaching barriers.
National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA. SJLandes@uams.edu.|University of Arkansas for Medical Sciences, 4301 W. Markham St., #755, Little Rock, AR, 72205, USA. SJLandes@uams.edu.|Central Arkansas VA Health Care System, VISN 16 South Central Mental Illness Research Education and Clinical Center (MIRECC), NW, Washington, DC, USA. SJLandes@uams.edu.
Sara J
SJ
Landes
National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA.
Allison L
AL
Rodriguez
National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA.
Brandy N
BN
Smith
Central Arkansas VA Health Care System, 2200 Fort Roots Drive, Building 58, North Little Rock, AR, 72114, USA.|College for Public Health and Social Justice, School of Social Work, Saint Louis University, Tegeler Hall, Suite 300, 3550 Lindell Blvd., Saint Louis, MO, 63103, USA.
Monica M
MM
Matthieu
National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA.|Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road Suite 3217, Stanford, 94305-5719, USA.
Lindsay R
LR
Trent
VISN 2 Center of Excellence for Suicide Prevention, NW, Washington, DC, USA.
Janet
J
Kemp
Office for Suicide Prevention, Mental Health Service, US Department of Veterans Affairs, NW, Washington, DC, 20420, USA.
Caitlin
C
Thompson
D001521:Behavior Therapy; D006284:Health Plan Implementation; D006801:Humans; D000071252:Mentoring; D015397:Program Evaluation; D011795:Surveys and Questionnaires; D013689:Telephone; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology; D058014:Veterans Health
Barriers; Dialectical behavior therapy; Implementation; Phone coaching; US Department of Veterans Affairs