3 - (SYM 5) The Los Angeles County Roll out of DBT (LACRODBT)

Dissemination and Implementation of DBT has long been a challenge in resource strapped community mental health systems. “Train and pray” models do not suit the complexity of implementing the model and do not routinely include work sample reviews or fidelity scores. Spurred by the success of the Los Angeles County Roll Out of CBT (LACROCBT)  (which was in turn inspired by IAPT) LACRODBT was launched in 2020 which is closer in model to a 9 month clinical practicum with didactics, consultation, work sample reviews, and competency scoring. This study reports the preliminary clinical findings of the treatment to date.

Participants: 74 adolescent and adult clients receiving comprehensive DBT through LACRODBT from 41 trainee clinicians Clients completed diary cards weekly. Diary cards tracked urges and instances of suicidal behavior, non-suicidal self-injury (NSSI), and substance use, as well as intensity of emotions and helpfulness of skills.

Using Hierarchical Linear Modeling, changes in clients’ diary card ratings were tested over the course of treatment. Findings showed decreased urges for suicide, NSSI, and substance use, less instances of substance use, as well as reduced intensity of sadness, shame, anger, and fear with increased joy and perceived helpfulness of skills over time, No significant changes in frequency of suicidal behavior and NSSI were detected.

The preliminary findings from this study indicate DBT trainees can produce significant improvements in primary treatment targets. The lack of statistically significant change in suicidal behavior and NSSI may be a result of low base rates for these behaviors, especially given that they were not required for inclusion. A limitation of this study is the lack of complete data, however this is common in quality assurance projects. Despite many challenges in disseminating DBT in large community mental health settings, these results demonstrate that such projects can be feasible and effective.