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DBT Intensive Presentation

DBT Intensive Presentation
by

matis miller

on 31 December 2014

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Transcript of DBT Intensive Presentation

Problems Along The Way Chemed-LCSC DBT Program Finish Line The Beginning... Team of 6 therapists
3 weekly skills training groups (Adult Female, Adult Male, Graduate Group)
20 clients receiving DBT treatment Clients requesting more processing time in skills group.
We don't have adequate time to address agenda items during team meetings.
Model of most effective way to structure a DBT Graduate Group
A client requested a different team therapist because she felt it was a poor match.
A client requested to stop skills training and to continue DBT individual therapy.
We perform mindfulness exercises regularly at team meetings.
Our goal is to increase mindfulness exercise from 2 minutes to 4 minutes.
We are each working to generalize mindfulness awareness to our daily lives by implementing personal mindfulness practices. Mindfulness Observing our own limits and while being accepting of others
Require that team members provide repairs for lateness
Doing a chain analysis followed by solution analysis when members are late to meetings
A team member takes the role of observer at meetings in order to keep the team mindful of our Agreements. We work to encourage, validate, and support team members who are burning out. Our Team Agreements Inclusion Criteria Becoming a Team Footsteps To Becoming More Mindful..... The Learning, Journey, and Growth Continues.......... "Change Is The Only Constant!" Our Journey 1. Attend pretreatment interview by DBT trained therapist
2. Must be experiencing emotional dysregulation and interpersonal difficulties
3. Must be willing to commit to 6 months of treatment
4.. Must be homogeneous to other group members
5. Must be receiving ongoing individual therapy
6. Must agrees not to see simultaneous therapists
7. If engaging in self-harm, high risk behavior, or step-down from higher level of care must do individual therapy with DBT team member
8. Must be above age 18 10 Mindfulness Activities our Team Enjoys: Square Breathing
Sound Ball
Mindful Eating
Mindfulness of Music
Snap Crackle Pop
Mindfulness of Sound Machine
Mindfulness of Hands on Table
Mindfulness of Pine Cones
Mindfulness of Red Prisms
Mindful Coloring Exclusion Criteria 1. Adult Female- 9 women

2. Adult Male- 8 men
Both groups meet weekly and are facilitated by 2 DBT clinicians. All members struggle with severe emotion dysregulation and interpersonal difficulties. Some members have joined the program as a step down from a higher level of care, while others have been referred by external outpatient therapists and community liaisons. Clinicians follow program protocol as specified in the DBT manual.
Protocol is that the point of entry is at the start of mindfulness. We officially limit the groups to 8 members. If members miss 3 consecutive groups or individual sessions, they have opted out of DBT treatment.
Evaluation procedures to ensure adherence to DBT model include observation of groups by the program director, and consultation team meetings. DERS are used to measure treatment outcomes.

3. Graduate Group- 4 Women
This group is for women who have completed at least one year of DBT skills and are no longer exhibiting behavioral dyscontrol (self harm, suicidality). Group members lead mindfulness exercises and teach modules. The group also focuses on developing goals in members' individual lives and taking steps towards achieving them. Discussionsfocus on implementing skills in everyday life through use of chain analysis.
New strategies are helping individuals strengthen their ability for healthy emotional experiencing. Group meets bi-monthly and members can come and go as they please. The group is based on the DBT-ACES model.
All DBT program participants must be seen by individual therapists on a weekly basis. Priority for program entry is given to those participants who are in individual therapy with DBT team members. 13 out of 21 members are seeing team members individually for treatment. The remaining are seeing non-DBT individual therapists due to the fact that they had prior long term relationships before entering the program.

Individual therapists who are not DBT team members are asked to sign an agreement in which they agree to take primary responsibility for client's risk and crisis management. Team consultations are limited to full program participants. DBT therapists observe their own personal limits and boundaries with regard to phone coaching. The general agreement among therapists is to do their utmost to provide individual DBT clients with phone coaching as needed to ensure generalization of skills.

Clients who are receiving skills group only are directed to call their individual [non-DBT] therapists when in crisis. They are instructed to call 911 should their therapist be unavailable. Individual therapists provide case management services and link clients to community resources as needed. Case management services are provided according to the DBT principle of Consultation to the Client. Individuals being referred to the program receive a 30-45 minute pretreatment interview that focuses on orientation to DBT and treatment components, bio-social theory, assessment of eligibility, and commitment. They are then asked to sign a contract committing to at least 6 months of program and agreeing to attend weekly group and individual sessions and to complete any required homework.

Regular inter-agency meetings are helping us move toward better coordination between the agencies and are helping us identify potential referral sources. This also helps improve communication between agency directors and administrators.

An administrative assistant was hired with specific duties including screening and assigning clients to appropriate therapists from both agencies. This has helped to streamline the entry process for both clients and clinicians.

Factors that interfere with coordination: We are working with two large agencies with established systems and protocols that are not always syntonic. For example, one agency is federally funded and accepts multiple insurances, the other only accepts Medicaid. Both work with a sliding scale fee. Skills Training
Groups Individual Therapy Phone Coaching Consultation Team Meetings Case Management Five Components Structure of the Program Coordination of Program 1. Miss three consecutive individual or group sessions
2. Extreme therapy-interfering behavior
3. Violate DBT Program contract [refuse to participate or engage with the treatment model] DBT Outpatient Program Sara Gelbwachs
Executive Director, LCSC Goldy Jaraslowitz, LCSW
Director of behavioral Health,
Chemed Organizational Structure Matis Miller, LCSW, ACT
DBT Program Director Sara Lerner, LCSW
Outpatient Director LCSC DBT Clinicians Chemed DBT Clinicians Jodie Touboul, LCSW
Shoshana Benoliel, LSW
Salomon Schwartzberg, LSW Shalom Francis, LCSW
Mindy Jacobson, LCSW Team of 6 therapists
3 weekly skills training groups (Adult Female, Adult Male, Graduate Group)
21 clients receiving DBT treatment The DBT team meets weekly for 75 minutes with all team members present. We utilize the consultation team to discuss programmatic issues, provide each other with clinical consultation and support, ensure adherence to DBT principles, and problem solve any issues that arise in the course of treatment.

We start each team meeting with a mindfulness exercise, followed by reviewing 1 DBT Agreement. We use the DBT target hierarchy as a guide in prioritizing issues to be discussed and setting an agenda. Plans for Ongoing Learning We will attend future Behavioral Tech 2-day trainings and Advanced Trainings

Team Leader is Diplomate of Academy of Cognitive Therapy and will share his learning from posts regarding research in the field of CBT/DBT

Regularly review postings and literature from NEA.BPD website Skills training currently consists of 3 groups Esther Spiegal,
Intake Coordinator The question:

How can we provide an evidenced based treatment for BPD that was accessible across socioeconomic status and culturally sensitive to the Orthodox Jewish Community? The creative Solution:

There already existed two agencies that provided mental health services to the community at low cost. The answer lay in finding synthesis between the opposing agencies in order to build a comprehensive DBT program staffed by intensively trained clinicians. Moving Ahead We have begun a waitlist for a friends and family group

We are in the process of working on planning education lectures open to the community to learn about BPD and its treatment utilizing BPD video series

Planning stages to add two clinicians to team
Full transcript