Dialectical Behavioral Therapy at Hillsides Finger Lakes Campus

Dialectical Behavioral Therapy at Hillside’s Finger Lakes Campus Jean Galle, LMSW Clinical Manager

Hillside Finger Lakes Campus v Residential Treatment Facility (RTF) ◦ Total of 40 beds ◦ Three regular RTF units divided by age and gender ◦ 12 bed Intensive Treatment Unit v GROW Program (RTC) o 16 bed Critical Care program for adolescent girls with significant trauma history who present with self harming behaviors

DBT at a Glance DBT began as an application of the standard behavior therapy of the 1970 s to treat suicidal individuals Developed in the early 1990 s by Marsha Linehan to treat adult women with histories of self-harm and suicidal behavior, often diagnosed with Borderline Personality Disorder (BPD). These clients were not responding to treatment as usual and they tended to have long histories of failed treatment and multiple hospitalizations. DBT has since been adapted to work with multiple client populations, including adolescents and their families.

Agenda for Today Brief Overview of DBT implementation and sustainability at FLC

Basic Premises A belief in the client’s essential desire to grow and progress, as well as the belief in the client’s essential desire to change underpins the treatment Throughout the treatment, the emphasis is on building and maintaining a positive, interpersonal, collaborative relationship between client and therapist Individuals who want to be dead do not have the requisite skills to build a life worth living

Dialectics Acceptance Change

Components of DBT Individual Therapy Skills Group Coaching Consultation Group

DBT at Hillside

Team Approach The task of delivering DBT as a service is shared among all members of the clinical team vs. a select few ◦ Helps make work load more manageable for groups and allows more youth to be able to attend group ◦ Creates a common language for clinicians ◦ If someone leaves there is still a core group dedicated to DBT. Any new clinician then receives DBT clinical training within the first six months of their employment

Ongoing Education and Training to all Staff Working with Youth Clinical team delivered a series of trainings to all unit, school and nursing staff on core components of DBT that could be applicable to all youth (Biosocial Theory, Validation, Coaching & Chain Analysis/Repair) Weekly email to all of campus outlining the DBT skill being taught that week in group Monthly Peaceful Communities Newsletter highlights a TCI skill in connection with a DBT skill

Looking at how we Reinforce Youth’s Behavior Clinical Team implemented 24 hour rule Partnering with unit staff to be skill coaches vs. “therapists” Closer analysis of how staff should respond to youth outlined in safety plans Change in how we use 1: 1 supervision Overall we continuously look at how we can use our relationship to increase or decrease behavior

Commitment to Supporting those Doing the Work Consultation time for clinicians is considered highly important and valuable time. Support is given to the clinicians so they can attend. DBT retreats in the summer.

The Impact of DBT

Decrease in Self-Harm Incidents

Decrease in Utilizing ED/CPEP in Response to Incidents

Decrease in Enhanced Supervision in response to Incidents

What We See in Youth Engagement with others in more pro-social ways Increased ability to spend independent time in the community Commitment to treatment and the ability to verbalize to others how treatment has been beneficial to them