Barriers and solutions to implementing dialectical behavior therapy in a public behavioral health system
Open accessAbstract
Dialectical behavior therapy (DBT) is an evidence-based treatment that is considered to be the standard of care in treating individuals with BPD, however there have been few published studies to identify the challenges and solutions for implementing DBT in community-based settings. The current study identified the barriers and solutions within a system-wide roll-out of DBT within a large, urban public health system encompassing both mental health and substance abuse treatment settings. Qualitative interviews were conducted with 19 clinicians receiving DBT training over a period of 13 months. A content analysis revealed three themes that were identified as challenges to the DBT implementation process including program development and recruitment of patients, a lack of administrative support or organizational investment in DBT, and time commitment of DBT. In order to transfer DBT into a public behavioral health system, investment from both clinic- and system-level administrators is required. Strategies to prevent drift, such as incorporating a train-the-trainer model, are discussed.
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Implementing DBT in community settings faces challenges such as staff training, turnover, and financial constraints in seeking and sustaining services.
“However, research has documented that implementing DBT in community settings faces challenges like staff training, turnover, and financial constraints in seeking and sustaining services (Swenson et al., 2002; Carmel et al., 2014).”
From Can dialectical behavior therapy skills group treat social anxiety disorder? A brief integrative review (2024) · cites this paper as Carmel et al., 2014
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“However, research has documented that implementing DBT in community settings faces challenges like staff training, turnover, and financial constraints in seeking and sustaining services (Swenson et al., 2002; Carmel et al., 2014).”
Background
- Authors
- Carmel, A., Rose, M. L., & Fruzzetti, A. E.
- Affiliations
- University of Washington (US)
- San Francisco Department of Public Health (US)
- University of Nevada, Reno (US)
- Corresponding author
- Carmel, Adam
- Venue
- Administration and Policy in Mental Health and Mental Health Services Research
- Published
- 2013-06-11
- Volume
- 41
- Issue
- 5
- Pages
- 608-614
- ISSN
- 0894-587X (ISSN-L)
- 1573-3289
- PMC
- PMC3835762
- OpenAlex
- W2007681415
- Cited by
- 112
- References
- 33
- Citations by year
- 2026: 10 · 2025: 6 · 2024: 6 · 2023: 9 · 2022: 4 · 2021: 36 · 2020: 9 · 2019: 8 · 2018: 13 · 2017: 4 · 2016: 3 · 2015: 3 · 2014: 1
- FWCI
- 2.59
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Administration and Policy in Mental Health and Mental Health Services Research (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (T32MH082709)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- dialectical behavior therapy, implementation barriers, community mental health services, train-the-trainer model, organizational support, patient recruitment, program development, addiction treatment, borderline personality disorder
- MeSH terms
- Adult, Behavior Therapy, Borderline Personality Disorder, California, Community Mental Health Services, Female, Humans, Male, Program Development
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