program presentation team telemark

8/14/2019 Program Presentation Team Telemark

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Program presentationTeam Telemark


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General description

Location: Telemark county, Norway Aprox. 170.000 inhibitants

Educational setting leading to certificationTelephone supervision from USATherapists from two cooperating clinicsAdult outpatient setting6 therapists in the team6-8 clients in the first group

Each therapist has got 1-2 clients in individualtreatment

Planned 2 complete rounds, total duration of 60weeks


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Organizational map


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Narrative description of our DBT-program

Outpatient setting.In the first round we have chosen to only take in

female patients with BPD (SCID II) and self-harm

to tissueWe are 6 therapists from different clinical divisionsand geographical locations.

The therapists will circulate as leader/co-leader ofthe skills training group

We offer a full comprehensive DBT program


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Our DBT-program

Individual therapy Each patient will have aprimary therapist to develop and monitor thetreatment plan. The primary therapist is a

member of our DBT team. Skills training modules- All four skills training

modules are taught during weekly classes over a30-weeks cycle. The clients are encouraged to

participate in two complete cycles. Modulescover Interpersonal Effectiveness, CoreMindfulness, Emotion Regulation, and DistressTolerance skills. New members may join a group

during any of the Core Mindfulness modules.


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Our DBT-program, cont

Phone consultations The therapists are available 24/7for skills coaching on the phone. There may be someindividual modifications. This helps to assure thatindividuals have the skills they need to manage

situations effectively. DBT Consultation Team Meetings- To ensure that thestructure of each persons treatment is maintained, theconsultation team meets weekly for case review,ongoing training and supervision.

Complementary/Environmental Support ServicesThese services include psychiatric consultation toreview medication issues and referral for inpatientservices, when needed. It may also include involvement

of community services, couples therapy, cooperationwith GP, etc.


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Functions and modes

- Five functions


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Enhancing capabilities


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Improving motivation


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Ensuring generalization to naturalenvironment


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Structuring the environment


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Enhancing therapist capabilities &motivation


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Therapists

From two cooperating clinicsFour therapists from Sykehuset Telemark, SkienTwo therapists from DPS Notodden/SeljordTwo therapists are psychologistsTwo therapists are medical doctorsTwo therapists are nursesFive therapists work in an inpatient settingOne therapist work in an outpatient setting


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Clients in the first group

Six clients, can be expanded to eightRecruited from our two clinicsRecruited from a wider geographical areaAge 19 to 32Five of six have had several admissions to hospitalVariable coping skillsVariable ways of copingSome clients well known to the therapist, some

new to the therapist


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Criteria for inclusion/exclusion

Inclusion F 60.3 Borderline

diagnosis (SCIDII)

Emotionaldysregulation

Impulsivebehaviour

Women Self-harming (to

tissue) Suicidal/parasuicida

l ideations Probable ability to

adhere to the

treatment Geo ra hical

Exclusion Psychosis (MINI) Drug

dependence, notnecessarily drugabuse

Bipolar disorder(MINI)

Low IQ (


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Pre-inclusion psychiatricevaluation

SCID IIMINI (General psychiatric screening)SIMS (Self Injury Motivation Scale)

HAD (Hospitality Anxiety and Depression Scale)SCL-90 R (Symptom Check List)GAF


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DBT-presentation to the Clients

Biosocial theoryElements of the treatment, rationaleThe working model

Presentation of mutual rights and dutiesTreatment contract


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Therapists Agreement

Adherence to the treatment modelContinuing educationAccepting external supervisionParticipation in the Consultation TeamRotating participation in the Skills Training GroupMutual obligation with the clients

Individual treatmentTelephone consultationsBackup case management


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Clients agreement

Commitment to the treatment targetsCommitment to the treatment program

Participate in the Skills Training GroupAdherence to the individual treatment

Adherence to the rules for telephone consultationsAccept confidentialityEstablish and work towards individual goals


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Protocol: Individual therapy

Recognize current emotional state If necessary: Repair relationships If necessary: Follow-up phone consultations Mindfulness training

Review progress (diary cards, priority: suicidality) Targets as way of organizing sessions:

Suicidality, self-harmingTherapy interference

Quality of life Attend to relevant stage Progress in other modes Closure:

Homework, summarize session

Cheerleading, reassuring, troubleshooting


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Protocol: Telephone Consultation

Be available during crisis, attend to the contract Two conditions:

Skills management

Relational repair Focus on the current problem 24-hour rule Keep available the crisis protocols

Consider scheduling phone calls Consider therapist initiated phone calls No psychotherapy on the phone No pejorative interpretations


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Protocol: Skills training group

Welcome and agenda Mindfulness exercise Examine diary cards

Examine homework from last session Questions about new material last session Presentation of new material Homework assignments for next session

Minor modification from standard DBT:Sessions of 4 x 30 minutes, with three breaks lasting

10-15 minutes each


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Protocol: Crisis Intervention

Assess suicide risk, eventually self-harm risk (If necessary: move to the suicidal crisis protocol)

Give priority to affect over content Focus on the situation here and now Explore the immediate problem Start problem solving:

Advice and direct suggestionsSuggest use of behavioural skills (DBT-skills)

Discuss consequences of actions, confrontingbelieves

Reinforce productive actions

Focus on affect tolerance

Obtain a commitment to a plan


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Protocol: Suicidal behaviour

Assess the risk of suicide Try to remove lethal items Emphatically instruct the client not to commit

suicide or to stop parasuicidal activities While validating pain, maintain that suicide is not a

good solution. Generate hopeful statements and solutions

Reinforce non-suicidal responses When suicidal risk is imminent and high: Keep

contact, else adhere to the treatment plan. Get a commitment to a non-suicidal behavioural

plan


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Protocol: Suicidal behaviour (cont.)

When the situation is unstable in spite of theintervention, with no real commitments, and therisk of suicide is continued high and imminent:

Consider emergency services


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Evaluation procedures

Inpatient daysBefore, during and after the DBT program

Psychometrics before, during and at termination

SCL-90, GAF, HADS AttendanceSkills-training group, individual therapy

Homework accomplishment Monitoring clients self-reported behaviour and

thoughts from diaries:Suicidal behaviour and thoughts, self-harming

episodes, use of alcohol and drugs, reportedsuffering


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Coordination: Clients impression

The clients are informed that behind the treatmentthere is a consultation team, coordinating theDBT program.

Each client have met, and have been presented to,all the members of the consultation team Skills trainers are recruited from the consultation

team, so that the leaders of the group rotates

amongst all the individual therapists In the case that the primary therapist for somereason is not available, another therapist from theconsultation team will step in.


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Coordination: Team aspects

Increasing coordination

Therapists get to know each

other better

Therapists get a betterunderstanding of the conceptof DBT

Therapists spend time togetherbeyond the consultation team

meetings The consultation team has a

steadily focus on coordinationof the program

Decreasing coordination

Therapists have other duties,

interfering with the DBT

program Therapists come from two

different clinics, with differenttasks and priorities

Therapists work in different

clinical and geographicalsettings


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DBT Blog

http://dbtnorge.posterous.com/

If you are interested, please contact us:

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program presentation team telemark

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