To subscribe to the DBT-Linehan Board of Certification quarterly newsletter, please submit a request through the Contact Us link http://www.dbt-lbc.org/index.php?page=101127  on the website.   Not all articles from the newsletter are posted here.  See what you are missing!

New scholarships available for DBT-LBC Program Certification
The DBT-Linehan Board of Certification is pleased to announce the availability of The Michael Chambers Memorial Scholarship Fund (MCMS). This fund was initiated to increase access to certification and to help address financial barriers which could interfere with prospective programs becoming DBT-LBC certified. The scholarship is particularly seeking to fund DBT Programs which are small in size, and/or primarily serving low income, disenfranchised or marginalized individuals. The eligible awardees receive a $2000 scholarship towards the Program Certification fees. Additional information around eligibility criteria and the application process can be found on the Program Certification Information page on the website: link: http://www.dbt-lbc.org/index.php?page=101121. The Scholarship committee is intent on increasing community access to DBT-LBC Certified Programs and further increasing knowledge around the importance of certification, with a goal of awarding five scholarships per year. Efforts are also underway to add to and grow the current level of funding in the MCMS to sustain scholarship availability for years to come.

The desire and demand for DBT has never been higher as this treatment continues to be disseminated world-wide for increasing numbers of client populations and in varied settings. Many DBT clinicians and programs are well trained and are doing excellent work. At the same time, many of us have had the experience of meeting a new client who shares the experience of “already doing DBT- it didn’t help!” While even experts have some occasional clinical outcomes that are less than positive, it has become evident that there are some clinicians and programs that are not delivering adherent, comprehensive DBT as developed by the treatment developer, Dr. Marsha Linehan. The risk is significant as substandard treatment fails to help those in need, increases feelings of hopelessness around treatment in general, increases risk of negative outcomes, and may bias individuals against a treatment which could be life-changing.

To address this growing concern, several years ago the DBT-Linehan Board of Certification (DBT-LBC), with the active participation and endorsement of Dr. Linehan, created a DBT Clinician Certification process to help prospective clients, families, and other professionals identify practitioners who had demonstrated the knowledge and ability to deliver adherent DBT. We are extraordinarily happy to report that the DBT-LBC launched the Program Certification arm of the process in mid-2017.

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 – both organizationally to support the clinicians in delivering the treatment as well as clinically to review that all elements of the treatment are present. The review process, done by two trained Site Reviewers, offers feedback to the Program that discriminates between recommendations to the program that must be addressed for the program to be certified and suggestions, which may offer improvements that motivated programs might value implementing but are not required for the program to be certified. The awarding of DBT-LBC Program Certification indicates that the program has the structure and practices consistent with the delivery of a comprehensive 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. 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.
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) https://dbt-lbc.org/index.php?page=101141. This document will help you preview the expectations and understand the degree to which you currently meet the requirements and whether you are ready to start the program certification process. This is an overall review of your program and gives you confidence that those expectations will be met.

The Program Certification application is only accessed through a Certified Clinician's DBT-LBC online profile. To get a good understanding of what is required in Program Certification and its application, please see the Application Self-Assessment https://dbt-lbc.org/index.php?page=101141.


We encourage DBT Programs to become certified and hope that the availability of scholarship assistance helps interested programs be able to pursue this valuable certification. Please check out the website for more information and feel free to Contact Us via the website with any questions. Thanks for your dedication!

Steps to Review your DBT Program for Certification Consideration:
a. Review and complete PFS Scale link: https://dbt-lbc.org/index.php?page=101141
b. Perform a Self-Assessment link: https://dbt-lbc.org/index.php?page=101141
c. Review or begin application (only DBT-LBC Certified Clinicians will have access to the application because one of the Program Certification requirements is that at least the team leader must be certified)

Alec L. Miller, PsyD
DBT-Linehan Board of Certification, Certified DBT Clinician
Chair, Michael Chambers Memorial Scholarship Fund Committee

Portland DBT Institute Receives Program Certification
By
Andrew White and Linda Dimeff
When individual certification first became available the Portland DBT Institute jumped at the chance. We had seen firsthand individuals who had continued to suffer after receiving what they thought was DBT, only to find they had not received DBT at all. We felt strongly about DBT programs setting the bar high and having clear criteria for what constitutes DBT. We also found when our clinicians went through the certification process, it had a huge positive impact on the clinic as a whole- people began forming study groups for the exam, sharing case conceptualizations, and increased their recording of sessions to get feedback from peers.
We applied for (and received!) our clinic certification in 2017. This process helped highlight areas of our services where we could tighten up and pushed us to shore those areas up. We have used the certification results to better meet the challenges of delivering high fidelity services to a growing population. Maintaining a high standard of service delivery for over one thousand clients per year and twenty-five full time therapists is a difficult task requiring a great deal of clinic infrastructure.
The on-site review process included feedback to both clinical and management staff which has further helped us to understand the relationship between how a principle or policy is expressed and the way in which it is experienced by individuals in the clinic. Clients interviewed by the review team expressed appreciation for having their voices heard as well as a greater connection to the clinic.
The impact of certification has been far greater than the sum of its parts. Certification has become a point of pride for staff and clients and has an ongoing positive impact. Much more than an administrative task the review process has been designed with the goal of adhering to core DBT principles around increasing staff’s competency and motivation to do the treatment. The completion of the certification process and third-party recognition around our delivery of DBT is an honor and reflects our core values as a clinic. 

The Importance of Providing Linehan Board Certified Dialectical Behavior Therapy for Borderline Personality and Substance Use Disorder. 

Family Perspective - by Regina Piscitelli

In light of the current opiate crisis in the United States it is more important than ever for families and clients to have access to both DBT-Linehan Board Certified programs and DBT-Linehan Board Certified therapists. About 78% of adults that suffer from BPD also have experienced a substance use disorder (Kienast, Stoffers, Bermpohl, & Lieb, 2014) and there is an increase of up to four times more risk of suicide (Darke, Ross, & Williamson, 2005). Heroin users with BPD have an increase of negative consequences and develop more health related problems. There is also a higher likelihood of heroin overdose (Darke, Ross, &Williamson, 2005). The possibility of an overdose creates an environment where families live in constant fear and uncertainty.

For nearly two decades, Dr. Linda Dimeff, PhD has collaborated with Dr. Marsha Linehan, PhD to develop an adaptation of DBT for BPD individuals who also have substance use disorders (SUD). Comorbidity of BPD and opioid addiction results in a more severe and persistent course of both disorders. People with multi-diagnosis are much more difficult to treat. The DBT-SUD treatment model is based on the standard DBT treatment model but targets specifics related to BPD and substance use disorders. Research has shown that implementing the DBT-SUD treatment model results in less drug use, better global assessment, lower drop out and continued gains. These studies provide evidence that DBT-SUD is effective in treating substance use problems while simultaneously addressing other complex problems.

The importance of including family in the treatment provided for the client gives the family the opportunity to learn some of the basic DBT ideas and skills that clients are learning in the program and explore ways to provide an environment for clients balancing a validation focus with acceptance strategies. Having the family involved promotes a better outcome and motivates the client to stay in treatment.

With the opioid epidemic gripping our nation and people dying from overdose at alarming rates it is important for clients and families to have available DBT-Linehan Board Certified programs and DBT-Linehan Board Certified therapists that are competent in delivering effective evidence based DBT. The potential lethal consequences that could result due to BPD-SUD underlines the need of finding a therapist or program that is Linehan Board Certified and adherent in DBT that can provide a treatment that is evidence based, board reviewed and held to the highest standards.

 

References:

Darke, S., Ross, J., Williamson, A., & Teesson, M. (2005). The impact of borderline personality disorder on 12-month outcomes for the treatment of heroin dependence. Addiction, 100(8), 1121-1130. Doi:10.1111/j.1360-0443.2005.01123.x


Kienast, T., Stoffers, J., Bermpohl, F., & Lieb, K. (2014). Borderline personality disorder and comorbid addiction: Epidemiology and treatment. Deutsches Arzteblatt International, 111 (16), 280-286.
http://doi.org/10.3238/arztebl.2014. 0280