The DBT-Linehan Board of Certification (DBT-LBC) has launched the recognition of DBT Programs with the active participation and endorsement of Marsha M. Linehan, Ph.D., founder and developer of DBT. Programs that pursue the certification process elect to have experts in the treatment observe, review and evaluate the practices of their DBT program. Such review can confirm sound practices and indicate areas of departure or drift from program standards, both core elements of effective treatment dissemination. DBT-LBC Program Certification designates that a program has a Team Leader who is certified as a DBT-LBC-Certified Individual Clinician and that the DBT Program has successfully implemented the core practices of DBT. This distinction may also be a factor for clients or families selecting a provider, for referral networks guiding consumers, or for determining therapist reimbursement rates from third-party payers.
The goal of Program Certification is to support and encourage a proliferation of DBT programs providing adherent treatment. Importantly, it provides a ‘roadmap’ for programs to follow, highlighting critical elements that should be present in every DBT program. The process discriminates between recommendations to the program that must be addressed for the program to be certified versus suggestions made by site reviewers, which may share creative solutions and common practices observed in other programs. Programs are encouraged to address deficiencies using the recommendations and continue with the site review process to ultimate certification. Thus, Program Certification is another element in the broad set of resources for clinicians and programs implementing DBT.
***COVID update to short term changes in Program Certification***
While the site review is the most rewarding component of the entire process for us and gives the team an opportunity to highlight their program, we understand that COVID-19 has impacted that ability. Until restirctions are lifted for travel and larger group meetings, we are conducting all site reviews using a virtual format.
Here's how that happens:
We (reviewers) would request a schedule that would allow us to observe, virtually, all components of your program, including:
• Team Meeting
• Skills Group (adult and multi-family/adolescent)
• Interviews with 4 current clients (approximately 30 minutes)
• Interview with 1 family/guardian, if applicable for an adolescent program (approximately 30 minutes)
• Interviews with up to 4 current staff clinicians (approximately 45 minutes)
• Team Leader interview (Approximately 45 minutes to 60 minutes)
• Documentation review
All documentation review that is usually done on site, will be done via a HIPPA compliant online platform with a shared screen so that the reviewer can review and discuss the documentation with the interviewee. If you proceed virtually, we will need an additional consent from the group members as well as the clients being interviewed that states they consent to being observed/interviewed via telehealth.
Please note, this is only a temporary change to the Site Visit component of the Program Certification process in response to COVID-19 and no other components to the process have changed. We are hopeful that we will be able to do in-person site visits in the near future.
Purpose of Program Certification
The awarding of DBT-LBC Program Certification indicates that the program has the structure and practices consistent with the delivery of a comprehensive (or adapted) implementation of Dialectical Behavior Therapy. It has undergone an extensive review that consists of scoring of responses to a Program Fidelity Scale questionnaire, program document and file review to see the structure of the DBT program, interviews with treatment providers and clients, and on-site observations of the DBT program practices in action. This award does not guarantee the quality that every client will receive in the Dialectical Behavior Therapy Program, or that every treatment session is done with a high level of fidelity. (DBT-LBC Individual Clinician Certification reviews the practice of clinicians.). Certified Programs have demonstrated that they have the capacity and intent to provide Dialectical Behavior Therapy adherently. The goal of Program Certification is to support and encourage a proliferation of DBT programs providing adherent treatment. Importantly, it provides a ‘roadmap’ for programs to follow, highlighting critical elements that should be present in every DBT program.
For a DBT Program to be eligible to apply for certification, the Team Leader must have completed DBT-LBC certification as an individual Clinician. The Team Leader will be the person responsible for completing the application on line. We suggest that every program considering applying first complete the Program Fidelity Scale (PFS). This is an overall review of your program and the degree to which you currently meet the requirements we will be looking for. Once there is confidence that those expectations are met, the application can then be initiated.
Steps in the Program Certification Process
1. Review the Program Fidelity Scale (PFS), available for download, to assess your DBT program's readiness to apply.
2. Team leaders who are certified as Individual Clinicians by the DBT-Linehan Board of Certification may begin the program certification process by completing the online application and PFS included there. To locate the online application, Log into My Account on the DBT-LBC website and go to the “Program Application” tab. The application consists of identifying information about the program, the team leader, members of the team, the elements of DBT included, and questions about the consultation team and processes with clients in the program.
3. The application fee of $450 must be submitted with the application to proceed to the next step.
4. Two DBT-LBC Program Certification Site Reviewers, all of whom are volunteers who have gone through training, will be assigned to each DBT Program applicant. All reviewers have participated or are currently participating in comprehensive DBT programs or are DBT-LBC Certified Clinicians. They will review the application to determine initial qualifications and communicate with the Team Leader as to the next step.
5. The Team Leader will be asked to upload program documentation to their DBT-LBC account. Required Program Forms (or explanations for how the information is provided elsewhere) are:
a. Intake Assessment Forms
b. Treatment Plan forms, including consent forms
c. Phone coaching forms
d. Copies of blank Diary Cards used
e. Skills Group progress note form
f. Past year's schedule of modules offered with timesframes for each
g. Two months of progress notes from each skills training -*reviewed on site
h. Consultation Team form for client's chart noting specific issues for a client and recommendations by the Team
i. Consultation Team agenda form and/or documentation/notes form
j. Client handouts provided other than skills handouts from the Linehan training manual
k. Crisis contact information
l. Clinic brochures provided to referral sources, clients, other providers (includes Team membership requirements)
m. Team meeting minutes for past 2 months -- *reviewed on site.
- Review participation of all Team members over time;
- All meeting elements recorded;
- TIB of therapists noted and followed up on;
- Solutions adequate to therapist's request;
- Risk of 4 misses discussed and client progress and recommitment addressed.
n. Describe your orientation procedure/training plan/supervision of other therapists. For example, expected trainings to be accomplished in 'x' amount of time after joining the Team; having session tapes reviewed by Team Leader or designee; a description of your template for helping new Team members or those new to DBT get up to speed in their knowledge and practice of DBT.
o. Complete Program Manual with all Policy and Procedures spelled out. (See below for quidelines)
6. A fee of $1500 is submitted when the program documentation is uploaded. All documents should be uploaded in a single zip file.
7. The next step is called the "Desktop" review. It's an extensive process, likely taking up to a month. Based on the PFS scores and review of program documentation, the program will be assessed as to how it functions, what it includes in service delivery, what its policy and procedures are for various program elements, etc. During this assessment, the Reviewers will be in contact with the Team Leader to address any questions. This step results in a review of your program and how it looks on paper. Once it appears to be able to deliver DBT, the Reviewers will schedule a site visit to observe how the program delivers the treatment in actual practice. One of our objectives with Program Certification is to assist in providing clear guidance on what programs need to include and offer feedback on what seems to be missing. No site visits will be scheduled unless the program looks like it is capable of delivering adherent DBT. If work is needed on some elements to get there, feedback will be offered and programs will have up to 6 months to modify their exisitng programs and re-submit the documentation for a second review.
8. The final fee of $2000 is paid before the site visit.
9. The site visit consists of both Reviewers visiting the clinical setting for a full 8-hour day of observation of the key program elements as they are happening. The schedule for the day is developed in coordination with the Team Leader to accommodate all the required elements of the site visit, described below.
a. Reviewer Confidentiality Agreement: Both reviewers doing the site visit will be expecting to sign a global confidentiality agreement at the beginning of the site visit. The Agreement, drawn up by the Program, indicates all client information obtained by them will be used solely in service to the certification process. Any proprietary information will also remain confidential.
b. Team Leader interview to start the day: Reviewers will discuss with the Team Leader their role and responsibilities within the program and how the administrative functions are handled.
c. Consultation Team observation: The visit is scheduled for a day the Consultation Team meets.
d. Skills Group observation: If it isn't possible to observe a live skills group on the day of the site visit, the program will provide a video of a skills group.
e. Clinician interviews: DBT-LBC Individually Certified clinicians do not have to be interviewed. If there are fewer than five clinicians in the program, the team leader selects three to be interviewed. If there are six or more clinicians in the program up to 50% are interviewed, but no more than 10. Again, the Team Leader selects all clinician interviewees from among the clinicians who are not Individually Certified. Obviously, if all Team members are certified, the site visit is accomplished much more quickly. Each clinician interviewee will, prior to the visit, choose 3 of their files to be included as part of the clinician interview process.
f. Client interviews: The Team Leader arranges for its Program clients to be contacted, provided with informed consent, asked to participate and scheduled for interviews. Up to 4 clients may be interviewed.
g. Debriefing (optional): The Team Leader can request a meeting at the end of the day to debrief. Final certification results will not be given at that time.
The Reviewers have agreed to volunteer their time to do this entire certification process, including the site visit, in order to keep the costs for Program Certification to a minimum. The only cost to programs for the Reviewers service is for the travel expenses of these volunteers. These costs will need to be reimbursed to DBT-LBC before the final report and granting of certification is communicated.
Timeframe for Program Certification
1. We encourage efficiencies in this process. After the application is submitted, approved and the request for document uploads is requested, you have no more than 2 months to be sure everything is sent for consideration by the Reviewers. This prevents duplication of application review for them and moves your application forward in a timely way.
2. Our goal is to have the entire process completed in less than 6 months
3. Once the site visit is conducted, the scoring and work by the Reviewers and the Program Certification committee may take up to a month. We strive for timeliness in getting everyone’s schedules coordinated.
4. Certification is granted for a 5-year period with annual Maintenance of Certification required.
The Program Certification Application