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Understanding Community Mental Health Administrators' Perspectives on Dialectical Behavior Therapy Implementation

Dr. Herschell, Dr. Kogan, and Dr. Stein are affiliated with the University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh. Dr. Kogan, Ms. Celedonia, Mr. Gavin, and Dr. Stein are with Community Care Behavioral Health Organization, Pittsburgh. Send correspondence to Dr. Stein at Community Care Behavioral Health, One Chatham Center, 112 Washington Pl., Suite 700, Pittsburgh, PA 15219 (e-mail: steinbd{at}ccbh.com).

In this study, key informant interviews were conducted with 13 administrators from nine community-based mental health agencies implementing dialectical behavior therapy in order to assess their perspectives on implementation. Four major themes were identified. They include opinions about dialectical behavior therapy and its fit with existing practices, resource concerns (for example, reimbursement issues, time commitment, and staff training), staff selection for training and staff turnover, and ongoing client referrals. Understanding agency administrators' unique perspectives and addressing their concerns is critical to treatment implementation given administrators' role in determining whether and how a treatment will be implemented. Better understanding of the fit between dialectical behavior therapy and existing service structures, the impact of staff turnover on implementation, and the resources required for implementation are all needed to ensure successful implementation and sustainability.

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