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Symposia

Dissemination & Implementation Science

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

1 - (SYM 117) Formative Evaluation of Implementing an Adapted Suicide Prevention Treatment: DBT Skills Groups for High-risk Veterans in the Veterans Health Administration

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



Background: Dialectical Behavior Therapy (DBT) is a multi-component suicide prevention treatment (individual therapy, skills group, telephone coaching, therapist consultation team). Recent research suggests DBT skills groups (DBT-SG) with a consultation team may result in reduced self-directed violence, but DBT-SG has rarely been studied among high-risk veterans. Guided by the integrated-Promoting Action on Research Implementation in Health Services (I-PARIHS) framework, we conducted a mixed-methods formative evaluation of implementation determinants to DBT-SG at four VHA medical centers.



Methods: Clinical and administrative stakeholders completed the Organizational Readiness for Change Assessment (ORCA) evidence and context scales. Semi-structured interviews were conducted with stakeholders to explore inner and outer context (e.g., local organizational factors), innovation (e.g., DBT-SG), recipient characteristics (e.g., goals, skills), and facilitation (e.g., roles and services that might support DBT-SG adoption).



Results: Thirty VHA stakeholders (staff, clinicians, local/national leaders; White [90%], female [77%], Master’s degree or higher [100%]) completed ORCA scales. Respondents indicated agreement that DBT-SG is supported by evidence including RCTs, clinical experience, and patient preferences (mean ± standard deviation: 4.2 ± 0.5). Respondents were less certain whether general resources (3.3 ± 0.9), leader culture (3.8 ± 1.0), leader behavior (3.5 ± 1.1), and leader feedback (3.5 ± 1.0) provided a successful environment to implement DBT-SG. In qualitative interviews (N=35), participants at all sites noted leadership support for suicide prevention. Potential context barriers included parking, travel, virtual appointments, physical space, and cultural adaptation.



Conclusion: In a mixed-methods formative evaluation of DBT-SG at four VHA medical centers, stakeholders felt DBT-SG is supported by evidence. There was strong perceived leadership support for DBT-SG but less agreement about leadership culture and resources supporting implementation. Site-level solutions acknowledging inner and outer context are needed to support DBT-SG being adopted, implemented, and reaching veterans at high-risk for suicide.