Table 2 Aids to Implementing DBT

Intervention characteristics

Quality of DBT evidence base

Perceived advantage of implementing DBT

DBT training

“Evidence on efficacy and cost savings also had a significant impact in securing Trust manager’s interest and support”

“Business plan presented to commissioners comparing costs of often unsuccessful inpatient programmes, allegedly DBT informed, with adherent programme.”

“The training we had from the British Isles team was excellent and central to our success. We make reference to it frequently in consult meetings.”

Outer setting

Acceptability of DBT by clients

“In the past, when DBT was at risk of cuts due to financial pressures, we were able to arrange for ex-clients and current clients to talk to the senior management and explain the impact and benefits DBT had had on their lives.”

Inner setting

Shared willingness to implement DBT

Leadership engagement

“We regularly meet for CPD opportunities (every 6 months) on DBT adherence and how we are implementing DBT. We use recordings/triadic observation of the 1:1 session to evaluate therapist behaviours and try to stay focused on the Consultation Supervision group agreements.”

“…so there is senior management support to find a solution quickly. Including to find resource to train a considerable number of new staff and ensure that their roles in relation to DBT are made clear going forward.”

Individual characteristics

Practitioner skills

Practitioner attitudes

Practitioner readiness

“Clinicians highly skilled and experienced so take great pleasure in learning and adhering to effective but also very creative model.”

“We have a team of highly motivated DBT therapists and the service has developed a good and growing reputation with referrers to the service.”

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Implementation process

Appointment of DBT team leader

Execution of implementation plan

“…but the DBT lead worked to gain this [management buy-in] and the success of the programme has led to this over time.”

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