2 - (SYM 117) Qualitative Assessment of Facilitators and Barriers to DBT Skills Group Implementation Within the Veteran's Health Administration

Background: Due to elevated suicide rates among Veterans, the Veterans Health Administration (VHA) has identified suicide prevention as a top clinical priority. Dialectical Behavior Therapy (DBT) is an evidence-based treatment to reduce suicide behavior and contains four components: individual therapy, DBT Skills Group, therapist consultation team, and phone coaching. The DBT Skills Group, which teaches coping skills necessary to reduce suicide behaviors, and has been shown, in combination with a therapist consultation team, to be as effective as DBT in reducing suicide ideation. To increase Veteran access to skills-based interventions, an initiative to train VHA clinicians in DBT Skills Groups plus therapist consultation team is underway. This initiative includes a six-session highly experiential training followed by monthly expert-led consultation for six months.  Guided by the Integrated Promoting Action on Research Implementation in Health Services framework using qualitative interviews with clinicians participating in this national initiative, we examined barriers and facilitators potentially affecting the implementation of DBT Skills Group as a function of the characteristics of the intervention and the training, training recipients, the inner and outer context for supporting DBT, and facilitation of its implementation. 

Methods: We conducted semi-structured interviews with 11 VA clinicians post-training and 6 VA clinicians after monthly consultation for the first cohort of trainees to explore barriers to and facilitators of the adoption, implementation, and maintenance of DBT Skills Groups. Interviews were audio-recorded and analyzed using rapid content analysis.

Results: Primary implementation facilitators included the interactive training incorporating behavioral rehearsal, strong alignment with existing values, and shared values and perceived closeness with consultation team and leadership. Implementation barriers included challenges with the logistics of implementation, anxiety related to learning new content and balancing required preparation time with current workload, and potential gaps in leadership support.

Conclusions: While VA providers evaluated expressed strong endorsement of the training and of their teams, context-level barriers hindered effective implementation. In response to feedback, the DBT Skills Group training and consultation incorporated a strong focus on troubleshooting logistical barriers to better support successful implementation.