Carmel Adam, Rose Monica Leila, Fruzzetti Alan E
University of Washington, Box 359911, Seattle, WA, 98104, USA,
Adm Policy Ment Health. 2014 Sep;41(5):608-14. doi: 10.1007/s10488-013-0504-6.
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.
辩证行为疗法（DBT）是一种循证治疗方法，被认为是治疗边缘型人格障碍（BPD）患者的护理标准，然而，很少有已发表的研究来确定在社区环境中实施DBT的挑战和解决方案。本研究确定了在一个涵盖心理健康和药物滥用治疗环境的大型城市公共卫生系统中全面推广DBT时的障碍和解决方案。在13个月的时间里，对19名接受DBT培训的临床医生进行了定性访谈。内容分析揭示了三个被确定为DBT实施过程挑战的主题，包括项目开发和患者招募、对DBT缺乏行政支持或组织投入，以及DBT的时间投入。为了将DBT引入公共行为健康系统，诊所和系统层面的管理人员都需要进行投入。文中还讨论了防止治疗偏离的策略，如采用培训培训师模式。
