Implementing a Residential Dialectical Behavior Therapy Informed Treatment Model to Improve Adolescent Mental Health: Feasibility, Fidelity, and Acceptability

Figures & data

Table 1. Functions, methods and modes of DBT-A versus CDM.

Function	Methods/Strategies	Modes in DBT-A	Modes in CDM	Delivery in CDM
Enhance client motivation and use of skillful behavior	Commitment and exposure strategies, behavioral assessment, chain analysis, contingency management, cognitive modification.	Individual sessions	Individual sessions	Weekly individual sessions with individual counselor. Length of 45–60 minutes.
Enhance skills acquisition and capabilities	Modeling, behavioral rehearsal, psychoeducation, coaching, feedback, homework.	Skills group training with caregivers	Skills group training for adolescents	120 minutes weekly group skills training incorporating a five-module format over a six-week rotation.
Generalization to environment	Phone consultation, homework, in vivo and crisis interventions, relationship repair.	Phone consultation	Milieu	Trained staff reinforce skills. Token economies support skillful behavior.
Enhance therapist capabilities and motivation.	Weekly consultation, treatment manuals, supervision, continuous training and acquiring knowledge.	Consultation team	Consultation team	Two weekly consultation team meetings (120 minutes total). Weekly supervision for on-site coordinators.
Structure the environment	Case management, family interventions.	Case management	Case management	Case management by staff.

Based on Salsman & Linehan (2006), Rathus and Miller (2014), Schmidt & Russo (2019)

Table 2. Time-points for data collection.

Measure	Type	Informant	Time-point
Feasibility of Intervention Measure	Self-report	Residential Staff	Oct 2020
Intervention Appropriateness Measure	Self-report	Residential Staff	Oct 2020
Acceptability of Intervention Measure	Self-report	Residential Staff	Oct 2020
DBT Program Fidelity Scale	Observer rating	Adolescents, Residential Staff and Leaders	April 2019
CDM Program Fidelity Logs	Fidelity logs	Residential Leaders	May 2018 – June 2020
Adherence and Competence Checklist	Self-report	Residential Staff	Dec 2018 – May 2021
Milieu Mode Elements Checklist	Self-report	Adolescents and Residential Staff	Nov 2018 – April 2020

Figure 1. Provider ratings of adolescent skills attainment, motivation, commitment and progress.

Table 3. Congruence with DBT program fidelity across institutions.

	Items	Item mean and range (max 5)	Overall scale means and range
Program Elements	4	4.05 (3.00–4.75)	16.20 (12–19)
Consultation team	6	3.58 (2.67–4.17)	21.50 (16–25)
Milieu-treatment	4	3.83 (2.75–4.75)	15.30 (11–19)
Adolescent assessment	1	4.8 (4–5)	-
Crisis management	1	5 (5–5)	-
Adaptation Elements	1	4 (2–5)	-
Overall Scale	17	3.93(2.94–4.59)	66.80 (50–78)

Salsman, N., & Linehan, M. M. (2006). Dialectical-Behavioral therapy for borderline personality disorder. Primary Psychiatry, 13(5), 51.

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Rathus, J. H., & Miller, A. L. (2014). DBT skills manual for adolescents. Guilford Publications.

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Schmidt, H. III, & Russo, J. C. (2019). The structure of DBT programmes. In M. A. Swales (Ed.), The Oxford handbook of dialectical behaviour therapy (pp. 121–146). Oxford University Press.

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Data Availability Statement

Due to the sensitive nature of this research, participants of this study did not agree for publicly share their data, therefor, supporting data is not available.