Ten Step Guide to Setting up Your DBT Service

This is a guide for service providers to take them from the first idea of starting a DBT program to making the application for Intensive Training.

 

  1. Identify the clinical need in your service. Gather statistics about how many patients would potentially benefit from the DBT program. These statistics will help your business case. 
  2. Assess the provision of DBT in neighbouring services. The Government is trying to standardise care and move away from a ‘postcode lottery’. If DBT is available in neighbouring localities but your service doesn’t have a DBT program it strengthens your case.
  3. Look at the current resource-usage of your target DBT clients. Count up in-patient days, crisis interventions, A & E visits, Use of duty or out-of-hours services, and critical incidents. Quantify both planned contact time and un-planned contact time that is spent with this client group in your service. This forms part of the rationale for reducing costs by introducing DBT.
  4. Investigate the literature on the cost-effectiveness of DBT in your type of service. Make contact with other similar service providers that currently have a DBT program to help strengthen your argument.
  5. Identify key staff who would be involved in providing the DBT program. Form an informal reading group – set a task to read an article or book chapter on DBT each week and discuss your findings. Get people engaged in the idea of making a program. Identify the most enthusiastic people.
  6. Send people on some one or two day workshops, invite a DBT consultant to speak with your interested staff members, or find some DBT practitioners who have a successful program to give you some tips and encouragement.
  7. Look at the five functions of DBT (see separate sheet). Begin to identify the logistics of how this might work in practise – room availability, staff availability, and cover for staff to release them to do DBT activities. Start with a wish-list, then begin to problem-solve the obstacles. This forms part of your feasibility study.
  8. Now you have the beginnings of a business case and a feasibility proposal identify your stakeholders – who has to authorise this? Who will fund it? Who might add their support (e.g. service-user groups)? Brainstorm what these people have to gain or lose. See your proposal through their eyes. What will be their motivation to agree to this? What obstacles might they foresee – can you include any solutions? Write up your proposal weighted towards their priorities. Present your proposal to the stakeholders.
  9. Bond with your interested staff members; in DBT a community of therapists treat a community of clients. There is a long road ahead to establish your program and these people are your journeymen. You will have to encourage each other through the process, sharing joys and disappointments. Identify your team for the intensive training. Find out what motivates each person. Make sure they know what’s involved in the short term (during the training) and in the long term (to sustain your program). Get commitment from each person in your newly formed consult team.
  10. Lobby everyone you can think of to strengthen your case, to help overcome obstacles and to offer support. Now make your application for Intensive Training. During the application process your training providers should assess your readiness to enter the training, and if you have followed the ten steps you have a greater likelihood of success.