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Evaluation ViewAttendees 3

Category: Dissemination & Implementation Science

Symposium 117 - Implementation determinants of suicide prevention psychotherapy in a national healthcare system: Adaptations of DBT at Veterans Health Administration

Sunday, November 19, 2023
8:30 AM – 10:00 AM PST
Location: Beckler (302), Level 3
CE: 1.5

Keywords: Implementation, Suicide, Veterans
Level of Familiarity: All
Recommended Readings: Toms, G., Williams, L., Rycroft-Malone, J., Swales, M., & Feigenbaum, J. (2019). The development and theoretical application of an implementation framework for dialectical behaviour therapy: A critical literature review. Borderline Personality Disorder and Emotion Dysregulation. 6,2. https://doi.org/10.1186/s40479-019-0102-7,   King, J.C., Hibbs, R., Saville, C.W.N., & Swales, M. (2018). The survivability of dialectical behaviour therapy programmes: A mixed methods analysis of barriers and facilitators to implementation within UK healthcare settings. BMC Psychiatry 18, 302. https://doi.org/10.1186/s12888-018-1876-7,  

Landes, S.J., Rodriguez, A.L., Smith, B.N., Matthieu, M.M., Trent, L.R., Kemp, J., & Thompson, C. (2017). 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. Translational Behavioral Medicine, 7(4), 832-844. doi: 10.1007/s13142-017-0465-5.

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DeCou, C., Comtois, K., Landes, S.J. (2019). Dialectical behavior therapy is effective for the treatment of suicidal behavior: A meta-analysis. Behavior Therapy, 50(1), 60-72. doi: 10.1016/j.beth.2018.03.009

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United States military veterans experienced a suicide rate that was 52.3% higher than for non-veteran United States adults in 2019 (Veterans Affairs, 2021). The Veterans Health Administration (VHA) has made substantial efforts to reduce veteran suicide, including implementing specific psychotherapies, increased monitoring of at-risk veterans, and increased outreach to at-risk veterans (Veterans Affairs, 2018). Understanding implementation determinants (barriers and facilitators) of suicide prevention treatments is essential to ensuring that these lifesaving treatments can reach the individuals who need them (Davis et al., 2021).

Dialectical Behavior Therapy (DBT) is a well-supported suicide prevention psychotherapy (DeCou, Comtois, & Landes, 2019).  Implementation determinants of multi-component comprehensive DBT have been studied in public mental health settings: barriers have included limited staff time (Landes et al., 2017; Carmel et al., 2014), challenges related to phone coaching (Landes et al., 2017), practitioner turnover (King et al., 2018), and low administrative support (Carmel et al., 2014). Given the need to offer veterans targeted suicide prevention treatments, some researchers have developed DBT adaptations that target specific components of suicide risk or that may be more feasible to implement in a complex healthcare system. This symposium presents data on implementation determinants of DBT adaptations in VHA, a large public health system. First, Dr. Suzanne Decker presents implementation determinants for DBT Skills Groups with therapist consultation team drawn from a mixed-methods formative evaluation at four VHA sites. Next, Dr. Frances Aunon presents qualitative data on implementation determinants to DBT Skills Groups with therapist consultation team drawn from a VHA supported national training. Third, Dr. Emily Edwards presents barriers and facilitators to a specific adaptation of DBT for justice-involved veterans. Finally, Dr. Marianne Goodman presents implementation determinants to a DBT-based safety planning group intervention. Implementation science and DBT expert Dr. Sara Landes will review common and unique findings from these four projects and suggest further directions for the suicide prevention psychotherapy field.  Examining factors that facilitate or impede the use of suicide prevention psychotherapies can help systems understand how to solve barriers or shore up facilitators, ensuring that potentially lifesaving treatments can reach those at risk.

Learning Objectives:

At the end of the session, the learner will be able to:
  • Describe barriers and facilitators to implementing suicide prevention psychotherapies adapted from DBT in a national healthcare organization.
  • Identify common and specific implementation determinants affecting DBT-adapted suicide prevention psychotherapies in VHA.
  • Identify solutions to further implement suicide prevention psychotherapies in a national healthcare organization.
  • Plan future directions for suicide prevention psychotherapy implementation.
  • Select research designs or implementation strategies that support suicide prevention psychotherapy adoption.
  • Educational Goal: Improve knowledge of implementation determinants to DBT-adapted treatments in a national public healthcare setting.
  • Educational Goal: Discuss future directions for implementing suicide prevention psychotherapies in a national public healthcare setting.