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It Takes a Village: A Mixed Method Analysis of Inner Setting Variables and Dialectical Behavior Therapy Implementation

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Abstract

Guided by the Consolidated Framework for Implementation Research, this mixed method study explored the relationship between inner setting variables and dialectical behavior therapy (DBT) implementation. Intensively trained DBT clinicians completed an online quantitative survey (n = 79) and a subset were sequentially interviewed using qualitative methods (n = 20) to identify relationships between inner setting variables and DBT implementation. Four interpersonal variables—team cohesion, team communication, team climate, and supervision—were correlated with the quantity of DBT elements implemented. Qualitative themes corroborated these findings. Additional variables were connected to implementation by either quantitative or qualitative findings, but not both.

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Acknowledgments

The authors thank Dr. Kelly Koerner, Dr. Tony Dubose, Dr. Erin Miga, and Dr. Jeffrey Applegate for advising this study’s design. The authors also thank Dr. Thomas Lynch for strategizing qualitative interviewing, Dr. Minseop Kim for reviewing all statistical analyses, and Dr. Allison Gonzalez for coding a qualitative interview for triangulation. Finally, the first author thanks Dr. Shari Manning and Dr. Katherine Comtois for manuscript preparation advice. This research is based on results from the doctoral dissertation of Matthew Ditty. Funding for this research project was supported by NIMH grants to Beidas (MH099179). Additionally, the preparation of this article was supported in part 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) and Quality Enhancement Research Initiative (QUERI), Department of Veterans Affairs Contract, Veterans Health Administration, Office of Research & Development, Health Services Research & Development Service. Dr. Beidas is an IRI fellow.

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Authors and Affiliations

  1. The Ebright Foundation, LLC, 2800 Lancaster Ave., Suite 6, Wilmington, DE, 19810, USA

    Matthew S. Ditty

  2. National Center for PTSD, VA Palo Alto Health Care System, Palo Alto, CA, USA

    Sara J. Landes

  3. University of Washington, Seattle, WA, USA

    Sara J. Landes

  4. School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA

    Andrea Doyle

  5. Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Rinad S. Beidas

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  1. Matthew S. Ditty
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  2. Sara J. Landes
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  3. Andrea Doyle
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  4. Rinad S. Beidas
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Correspondence to Matthew S. Ditty.

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Ditty, M.S., Landes, S.J., Doyle, A. et al. It Takes a Village: A Mixed Method Analysis of Inner Setting Variables and Dialectical Behavior Therapy Implementation. Adm Policy Ment Health 42, 672–681 (2015). https://doi.org/10.1007/s10488-014-0602-0

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