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Does Insurance Matter? Implementing Dialectical Behavior Therapy with Two Groups of Youth Engaged in Deliberate Self-harm

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Abstract

This paper presents the outcomes of a Dialectical Behavior Treatment (DBT) program, implemented in intensive outpatient care with two groups of adolescents (n = 55 and n = 45), ages 12–18, who engaged in deliberate self-harm (DSH) but had different insurance/funding sources and risk backgrounds. This pre-post study examined variability in clinical functioning and treatment utilization between the two groups and investigated moderating risk factors. Findings support DBT’s effectiveness in improving clinical functioning for youth with DSH regardless of insurance type. However, lower rates of treatment completion among youth without private insurance call for extra engagement efforts to retain high-risk youth in DBT.

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Notes

  1. We also analyzed clinical functioning trajectories using hierarchical linear modeling. Since HLM analysis did not detect variability in the slopes by key covariates, but only differences in the intercepts thereby confirming results presented here, we opted to use the analysis of variance approach to capture pre-post differences in outcome.

  2. There was a negligible effect of funding type on Interpersonal Relations; however, baseline differences had previously been determined between privately funded and grant-funded youth. Subsequent linear regression with this variable, using the posttest score as the DV and controlling for pretest score indicated no effect of funding.

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Acknowledgment

This work was funded in part by NIMH K01 MH077732-01A1 (PI: S. James) and UniHealth Foundation. It was also supported by the National Institute of Health Disparities and Minority Health of the National Institutes of Health under award number P20MD006988 and by the Implementation Research Institute (IRI), at the George Warren Brown School of Social Work, Washington University in St. Louis; through an award from the National Institute of Mental Health (R25 MH080916-01A2) and the Department of Veterans Affairs, Health Services Research & Development Service, Quality Enhancement Research Initiative (QUERI).

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Authors and Affiliations

  1. Institute for Social Work and Social Welfare, University of Kassel, Kassel, Germany

    Sigrid James

  2. Department of Social Work and Social Ecology, Loma Linda University, Loma Linda, CA, USA

    Sigrid James, Kim R. Freeman, Danessa Mayo, Joshua P. Morgan & Susanne B. Montgomery

  3. California State University San Bernardino, San Bernardino, CA, USA

    Matt L. Riggs

  4. San Bernardino County Behavioral Health Department, San Bernardino, CA, USA

    Joshua P. Morgan

  5. Loma Linda University Behavioral Medicine Center, Redlands, CA, USA

    Mary Ann Schaepper

  6. Loma Linda University Behavioral Health Institute, Redlands, CA 92373, USA

    Susanne B. Montgomery

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  1. Sigrid James
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  2. Kim R. Freeman
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  3. Danessa Mayo
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James, S., Freeman, K.R., Mayo, D. et al. Does Insurance Matter? Implementing Dialectical Behavior Therapy with Two Groups of Youth Engaged in Deliberate Self-harm. Adm Policy Ment Health 42, 449–461 (2015). https://doi.org/10.1007/s10488-014-0588-7

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