jean galle, lmsw clinical manager. residential treatment facility (rtf) ◦ total of 40 beds ◦...

Jean Galle, LMSWClinical Manager

Residential Treatment Facility (RTF)◦ Total of 40 beds ◦ Three regular RTF units divided by age and

gender◦ 12 bed Intensive Treatment Unit

GROW Program (RTC)o16 bed Critical Care program for adolescent girls

with significant trauma history who present with self harming behaviors

DBT at a GlanceDBT began as an application of the standard behavior therapy of the 1970s to treat suicidal individuals

Developed in the early 1990s by Marsha Linehan to treat adult women with histories of self-harm and suicidal behavior, often diagnosed with Borderline Personality Disorder (BPD). These clients were not responding to treatment as usual and they tended to have long histories of failed treatment and multiple hospitalizations.

DBT has since been adapted to work with multiple client populations, including adolescents and their families.

Brief Overview of DBT DBT implementation and sustainability at FLC

A belief in the client’s essential desire to grow and progress, as well as the belief in the client’s essential desire to change underpins the treatment

Throughout the treatment, the emphasis is on building and maintaining a positive, interpersonal, collaborative relationship between client and therapist

Individuals who want to be dead do not have the requisite skills to build a life worth living

Acceptance Change

Individual Therapy

Skills Group

Coaching

Consultation Group

The task of delivering DBT as a service is shared among all members of the clinical team vs. a select few◦ Helps make work load more manageable for

groups and allows more youth to be able to attend group

◦ Creates a common language for clinicians◦ If someone leaves there is still a core group

dedicated to DBT. Any new clinician then receives DBT clinical training within the first six months of their employment

Clinical team delivered a series of trainings to all unit, school and nursing staff on core components of DBT that could be applicable to all youth (Biosocial Theory, Validation, Coaching & Chain Analysis/Repair)

Weekly email to all of campus outlining the DBT skill being taught that week in group

Monthly Peaceful Communities Newsletter highlights a TCI skill in connection with a DBT skill

Clinical Team implemented 24 hour rule

Partnering with unit staff to be skill coaches vs. “therapists”

Closer analysis of how staff should respond to youth outlined in safety plans

Change in how we use 1:1 supervision

Overall we continuously look at how we can use our relationship to increase or decrease behavior

Consultation time for clinicians is considered highly important and valuable time. Support is given to the clinicians so they can attend.

DBT retreats in the summer.

Engagement with others in more pro-social ways

Increased ability to spend independent time in the community

Commitment to treatment and the ability to verbalize to others how treatment has been beneficial to them