Landes Sara J, Matthieu Monica M, Smith Brandy N, McBain Sacha A, Ray Elizabeth
Central Arkansas Veterans Healthcare System.
University of Arkansas for Medical Sciences.
Cogn Behav Pract. 2021 Feb;28(1):66-76. doi: 10.1016/j.cbpra.2019.10.005.
Dialectical Behavioral Therapy (DBT) is an effective treatment for borderline personality disorder (BPD), yet many healthcare facilities struggle to implement one of the modes of DBT, phone coaching. The aims of this study were to present barriers and reported solutions regarding the implementation of DBT phone coaching. We conducted a sequential mixed methods national program evaluation that included a quantitative self-report survey completed by Department of Veterans Affairs (VA) facilities (N=59) offering any of the four modes of DBT. Subsequent qualitative interviews using a semi-structured interview guide informed by the Promoting Action on Research Implementation in Health Services (PARIHS) were completed with DBT providers and administrators from a subset ( = 16) of these VA sites. Four themes, the lack of tools and policies, compensation for phone coaching, clinician willingness to conduct phone coaching, and consistent program and leadership support were identified and illustrated in a case study. This study also offered concrete recommendations for those health care organizations, managers, administrators, and clinicians who may be interested in implementing phone coaching at their health care facilities.
辩证行为疗法（DBT）是治疗边缘性人格障碍（BPD）的一种有效疗法，但许多医疗机构在实施DBT的一种模式——电话辅导方面存在困难。本研究的目的是呈现实施DBT电话辅导的障碍及所报告的解决方案。我们开展了一项全国性的序贯混合方法项目评估，其中包括由退伍军人事务部（VA）提供DBT四种模式中任何一种服务的机构（N = 59）完成的定量自我报告调查。随后，我们使用由卫生服务研究实施促进行动（PARIHS）指导的半结构化访谈指南，对这些VA机构中的一部分（n = 16）的DBT提供者和管理人员进行了定性访谈。通过一个案例研究确定并阐述了四个主题：缺乏工具和政策、电话辅导的补偿、临床医生进行电话辅导的意愿以及持续的项目和领导支持。本研究还为那些可能有兴趣在其医疗机构实施电话辅导的医疗保健组织、经理、管理人员和临床医生提供了具体建议。
