How to Successfully Implement Adapted Dialectical Behavior ... DBT...  Adapted Dialectical Behavior

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  • How to Successfully Implement Adapted Dialectical Behavior (DBT) Programs for the Intellectually

    Disabled Diversified Finance & Health Services, Inc. 2015

    Kelly M. Shuler, MSW, LMSW, CHt, QIDP Mark Mitchell, MSW, LMSW, QIDP

  • Diversified Finance & Health Services, Inc. 2015

    WELCOME

    AND HOUSEKEEPING

  • Mindfulness Exercise

    Diversified Finance & Health Services, Inc.2015

  • What is DBT?

    Dialectical Behavior Therapy: Handout

    Popularized by Marsha Linehan, PhD (1993, Cognitive Behavioral Treatment of Borderline Personality Disorder, New York: Guilford Press)

    Combines therapeutic validation and acceptance of person along with cognitive and behavioral change strategies.

    Biosocial Theory of BPD: Handout

    Diversified Finance & Health Services, Inc. 2015

  • DBT Addresses skills deficits in Mindfulness, Emotion Regulation,

    Interpersonal Effectiveness, and Distress Tolerance

    More recently expanded to treatment of other populations (eating disorders, substance abuse, Child/Adolescent, sex offenders)

    Studies in consumers with ID

    2004 (Dykstra & Charlton)

    2006 (Lew et al)

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  • First Objective: 1. Identify ways in which an

    Adapted Dialectical Behavior Therapy (DBT) program can

    positively impact organizations.

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  • How can a DBT program positively impact your

    organization? Group discussion:

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  • Agency Cost Reduction Reduction in Hospitalizations Costs Decrease Staff Turnover and Burnout Decrease Overall Care Costs (i.e. CLS Hours, Staff Ratios,

    Emergency Care Expenditures) Reduction in Vocational Support Costs Decrease in Crisis Intervention Costs Increase in Natural Supports Decrease in Housing Subsidies and Related Costs Decrease in Revenue Expenditures Related to Lower Incarceration

    Rates Decrease in Costs Related to Alternative Placements Decrease in Utilization of Psychiatric Services Decrease in Administrative Involvement with Crisis Issues

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  • Person Receiving Services Mental Health Stabilization/Medication Management Employment Stabilization Improved Family/Interpersonal Relations Skill driven Stable Housing/Decrease in Homelessness Less Staff/Provider Turn-over Decrease in Legal Issues Reduce School Integration Issues Decrease in Suicide Ideation/Attempts Improved Quality of Life

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  • Develop measureable outcomes

    Now that you have identified areas of change. Develop measureable outcomes and collect data to share with administration.

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  • Second Objective:

    2. Describe the basic process of developing and providing an Adapted DBT Informed program.

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  • Adapted DBT Manual Stays true to Linehans philosophy

    Maintains fidelity to original material Workbook/video tapes

    Concrete vs Abstract Materials

    Feedback from group members

    Review your manual for updates and adaptations yearly to reflect lessons learned and process improvements

    Personalization of manuals and diary cards

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  • Identify Team Members Psychiatrist

    Consultant

    Clinical Supervisor

    DBT therapist (2-4), LMSW, LLP, LPC

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  • Weekly Consultation Team Meeting

    Ring mindfulness bell to begin

    Mindfulness exercise

    Assign roles within meeting

    Discussion of previous weeks group and individual therapy sessions including DBT target stages

    Review issues and concerns with consultant

    30 minutes of preparation for next group

    Develop group therapy agenda

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  • Training for Staff Read Marsha

    Linehans Books Review Marsha

    Linehans videos Attend a 5-day

    training Utilize a consultant:

    Diversified Finance & Health Services (Mark Mitchell and Kelly Shuler)

    Diversified Finance & Health Services, Inc. 2015

  • Identifying Group Members

    Identify participants through referral from psychiatric services

    Request for referrals from Supports Coordinators/Case Managers

    Attend staff meetings and present criterion for eligibility

    Identify between 14 16 possible candidates as some people do not choose to participate

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  • PRE-ENGAGEMENT PHASE Therapist is assigned and establishes contact

    for initial appointment

    During initial appointment, therapist assesses appropriateness and willingness to commit to the process

    Individual objectives are identified and contracts are signed

    Provide flyer for orientation session and discuss who to invite (eg. family, staff, supports)

    Diversified Finance & Health Services, Inc. 2015

  • DBT Orientation Agenda Sign In Sheet

    1. Welcome: introduce DBT Team. Discuss the use of the bell.

    2. Mindfulness: mindfulness exercise

    3.Biosocial theory of Borderline Personality Disorder

    4. DBT Overview: * Skills you will learn are:

    a. Mindfulness b. Emotional Regulation

    c. Distress Tolerance d. Interpersonal Effectiveness.

    5. Expectations:

    a. There is a one year commitment

    b. Group to meet x1 weekly every Tuesday from 2:30-4:00pm/break included

    c. Participate in 1:1 counseling sessions x1 weekly

    d. Call your therapist if you are not able to attend group or 1:1 session.

    e. Missing 4 session in a row will be cause for termination from the program

    f. You will need to practice outside of group by completing worksheets that the therapist provides.

    g. You will receive phone coaching as needed

    6. Video

    7. Pizza and Pop

    8. Q & A session

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  • Group Therapist Roles Mindfulness role Runs mindfulness

    exercise; observer group dynamics; takes notes; leads wind down

    Good Cop Teaches the lesson; engaging all group members; cheerlead group members and provide validation

    Bad Cop Reviews weekly worksheets; asks if group members want praise, validation or problem solving from other group members; watch for therapy interfering behaviors; rings bell to refocus group

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  • Group Rules Each group works toward developing their own rules the following rules are important to any group: Turn off cell phones. Allow others to finish speaking. Be respectful. No side bar conversations. No cursing or swearing. What is said in DBT stays in DBT. Dress appropriately for group. Show up on time. No drugs or alcohol is to be used in group. No outside relationships with group members. No weapons. Bring completed worksheet assignments with you for therapy sessions each week. Bring your book to group each week. No pictures taken in group.

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  • Weekly Individual Therapy: 45-60 minutes

    Finalize Goal and Objectives

    Diary Cards lead individual session

    Stage 1 targets

    Do they understand the materials?

    Chain Analysis if indicated

    Stages 2, 3 and 4 applying new skills to life issues

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  • Group Feed back and Graduation

    feedback

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  • Linehan, Marsha (2014). DBT Skills Training Manual, Second Edition, Guilford Publishing.

    Burdick, Debra (2013). Mindfulness Skills Workbook for Clinician and Clients. PESI Publishing & Media.

    Dykstra and Charlton, (2008). Adapting DBT for Special Populations.

    Michelle Shauger, MD; Kathleen Mohring, MA, LPC; Kenneth Antkowiak, MS, LLP; Mark

    Mitchell, MSW, LMSW; Kristen Barlow, MSW: Dialectical Behavior Therapy for Individuals with Intellectual Disability: Adaptations & Outcomes.

    Linehan, Marsha (1993). Cognitive Behavior Treatment of Borderline Personality

    Disorder. New York: Guilford Press.

    Bibliography

    Diversified Finance & Health Services, Inc. 2015

  • Diversified Finance & Health Services, Inc.

    Questions and

    Answers

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  • Contact Information Diversified Finance & Health Services, Inc.

    Kelly M. Shuler, MSW, LMSW, CHt, QIDP

    President/Executive Director

    517-304-7561 (cell)

    517-262-6966 (office)

    Email:kellyshuler1964@gmail.com

    AND

    Mark Mitchell, MSW, LMSW, QIDP

    Independent Consultant

    734-223-8084 (cell)

    517-262-6966 (office)

    Email:mitchellm2468@gmail.com

    Address: P.O. Box 312, Pinckney, MI 48169

    Diversified Finance & Health Services, Inc. 2015