3 - (SYM 117) Adapting DBT for Justice-involved Veterans: Lessons Learned from Small-scale Trials Within the Department of Veterans Affairs

Background: Criminal justice involvement is often under-examined as a risk factor for Veteran suicide. However, recent estimates suggest 11% of Veteran suicide deaths are precipitated by legal problems. Risk for suicide is particularly high among justice-involved Veterans (JIVs) with co-occurring difficulties, such as mental health and/or housing concerns. Adequately addressing Veteran suicide therefore likely requires explicit targeting of the difficulties faced by JIVs.

Method: Dialectical Behavior Therapy for Justice-Involved Veterans (DBT-J) was designed to address the heightened suicide risk, antisocial behaviors, mental health and substance use concerns, community-based structural barriers, and case management difficulties often faced by JIVs. Combining elements from the Risk-Need-Responsivity Model, Dialectical Behavior Therapy, and Socioenvironmental Disadvantage Model into a 16-week, integrative program, DBT-J provides weekly group therapy, biweekly case management, and measurement-based care to eligible JIVs. 35 JIVs were enrolled from 2021-2022. Feasibility and acceptability were assessed by soliciting feedback from participants, DBT-J providers, and referring providers and by monitoring treatment fidelity and rates of referral, attendance, and engagement.

Results: Results broadly reflected high ease of implementation, successful recruitment efforts, strong participant attendance and retention, high treatment fidelity, and high acceptability by veteran participants, DBT-J providers, and adjunctive care providers alike. Data informed ongoing quality improvement efforts, including strategies surrounding referral procedures, participant engagement and retention, and management of resources required for program delivery.

Conclusions: Preliminary results attest to the feasibility and acceptability of DBT-J. Findings highlight potentially useful strategies for tailoring and delivering DBT-based programming for specialized, at-risk, and traditionally difficult-to-engage populations. In light of these findings, continued research comparing DBT-J against alternative interventions is warranted to further investigate this treatment’s efficacy.