FAQs About Clinician Certification

1. Are you or your program certified by the DBT-LBC™?
2. Do you provide DBT treatment?
3. What was your training for providing DBT?
4. Do you provide both the individual therapy component of DBT and the skills component?
5. If so, is the skills training offered in a group setting and how long does group last each week?
6. How long does your program take to complete 1 cycle of skills training?
7. Do you allow a client/family to complete the skills training curriculum 2 times?
8. Is continued participation in your DBT services based on some type of ongoing assessment of symptom improvement?
9. Do you provide phone coaching between sessions as needed? Are there any limits placed on phone calls or between session contacts?
10. Do you belong to a consultation team that meets weekly and includes only other DBT trained therapists?
11. Do you use a daily diary card?
12. What adaptations have you made to the research supported methods of providing DBT? Why were those adaptations necessary?

Unfortunately, our medical system is overwhelming and it’s not your fault. Break this up into steps to make it simpler. First, find some therapists you think offer DBT. You can find a list of clinicians who have DBT-LBC™ certification here, https://dbt-lbc.org/../../index.php?page=101163 and for DBT-LBC™ certified programs here, https://dbt-lbc.org/../../index.php?page=101167.

Second, call those in your area to start to learn about what they offer. A list of questions to ask can be found under the website’s Certification tab and “FAQs About Clinician Certification” link here: https://dbt-lbc.org/../../index.php?page=101145.

Third, if none of them take your insurance, go through your insurance company using the single case agreement/network exception request document provided here https://www.dbt-lbc.org/index.php?page=101175.

Good luck!

We at DBT-LBC understand that the availability of DBT-LBC™ Certified Clinicians and Programs is still very limited. We expect that as time goes by the number of DBT-LBC™ Certified Clinicians and Programs will grow significantly. We are committed to making the process for certification accessible to clinicians and programs so that the availability will increase. Please know that clinicians and programs who have undergone the intensive process required for certification have met high assessment standards in providing DBT treatment in a manner consistent with the research on the efficacy of the treatment. Clinicians and programs that are not yet certified by DBT-LBC™ may provide high quality DBT treatment that meets all of the criteria listed in the single case agreements/network exception scripts. If you are unable to find a DBT-LBC™ Certified clinician or program, clinicians and programs providing adherent DBT services in line with the criteria listed in the single case agreements/network exception scripts are the next best option. However, getting a single case agreement/network exception request authorization specifically for DBT with a clinician or program that does not meet the criteria for adherent DBT may ultimately hurt future consumers by having an insurance company pay for a treatment that is not supported by research and may not have the successful outcomes of adherent DBT. Insurance companies may then become less willing to agree to cover adherent DBT because of unsuccessful outcomes of non-adherent DBT and the fact that they may not know the difference between the two.

At the current time DBT-LBC™ does not provide scholarships for DBT treatment. However, there are some organizations that provide scholarships for treatment if a consumer has a particular diagnosis like an eating disorder or Complex-PTSD or has experienced particular traumas in their life. It may be helpful to google these scholarship opportunities and apply if you meet their criteria.

We know this can be frustrating and discouraging. Unfortunately, some insurance plans will not approve single case agreements/network exception requests without a significant fight from the consumer (and some will never agree to one). Some consumers have even attempted to get a lawyer or other advocate involved. There is no one route that promises success. Using the single case agreement/network exception scripts can help, as can responding to specific requests from insurance companies related to data on the “efficacy of comprehensive DBT” and soon to be published data on the increased success of DBT treatment when it is provided adherently. It is also important to know your rights within your particular state. Some states, like Maryland, have laws in place that require insurance companies to agree to single case agreements/network exception requests in certain situations.

Your next step is to follow the appeals process that your insurance company has in place. Sometimes you will need to get the help of a patient advocate assigned through your insurance company. Sometimes you or the provider you want to see will have to complete additional paperwork and send in additional clinical information. You or the provider may be asked to speak with an insurance company clinician to plead your case. Whichever next step is required by your particular insurance company, it makes sense to keep pushing forward! Many times a single case agreement/network exception request is authorized with only one additional appeal.

The primary differences are related to the amount of effort the consumer will need to put in to get the services paid for AND the amount of money the consumer will have to lay out for services.  Here are some additional differences: 

Out of Network Benefits

• Out of network benefits are a part of many insurance plans and reimburse a percentage of the total charges for therapy services either directly to the therapy provider or to the consumer.  Using out of network benefits does not require that you get a particular provider authorized with them before receiving treatment (but may require pre-authorization for particular service types).  Also, there is usually a deductible that must be met first before the insurance company starts paying out of network benefits.  
• Depending on the particular therapy provider, the out of network reimbursement process can take any of the following forms:

1. The consumer may be required to pay the full fee for services up front and then submit an invoice to their insurance company showing payment made to receive a reimbursement check for the allowed percentage. 
2. Some providers may be willing to wait for payment until the unpaid invoice is sent in by the consumer to the insurance company and the consumer receives reimbursement.  After receiving the reimbursement check the consumer will pay the therapy provider.
3. Other providers may be willing to submit invoices for out of network reimbursement directly to the insurance company and wait until they receive a reimbursement check.  Once they receive the check they will provide the consumer with an invoice for the balance owed.

• Each consumer’s financial situation and insurance plan differ, and for some people using out of network benefits is not an option because:

o   The insurance plan does not have an out of network reimbursement allowance

o   The deductible is very high and a consumer cannot afford it

o   Even once the deductible has been met, the percentage reimbursed for out of network benefits leave a balance with the therapy provider that the consumer cannot afford

Single Case Agreement/Network Exception

• Consumers are allowed to file for a single case agreement/network exception request with their insurance company so that an out of network provider is paid on a one case basis as if that provider were in-network.  If a consumer is successful in getting one of these agreements, then the insurance company will pay a set fee for each service that is agreed upon by the provider.  Sometimes this ends up being the provider’s normal fee and sometimes it is a reduced fee that is negotiated between the provider and the insurance company.  With a single case agreement/network exception request, the consumer is required to pay their normal co-pay/co-insurance and CANNOT be billed for any remaining balance that results from the insurance company paying less than the provider’s full fee.
• Single case agreements/network exception requests require that the consumer (or provider) apply for this agreement and receive authorization BEFORE it goes into effect.  Charges for any services attended prior to the application for a single case agreement/network exception request fall on the consumer.  As such, it is important to start the process as soon as possible once the decision is made to pursue this route.
• Most single case agreements/network exception requests are denied on the first attempt and will need to be appealed.  This is usually because the insurance company claims that in network providers already exist who can provide the same services (see the single case agreement/network exception scripts for how to respond to these denials).
• Single case agreements/network exception requests are authorized for a specific date range AND a specific number of services.  Extensions will need to be filed if a consumer needs more services beyond those authorized in the initial single case agreement/network exception request.  There are no guarantees that an extension will be granted and additional appeals may be required.

First, as you have probably gathered from the information on this website, DBT is a highly specialized treatment that requires extensive training, ongoing education and that the clinician works with a team of other DBT trained clinicians. This specialization means that there are fewer trained DBT therapists than there are general therapists. Also, because of the time, energy, and cost of providing DBT, many therapists do not participate with insurance companies, Medicaid, or Medicare due to the low reimbursement that they provide, something that DBT-LBC™ is also trying to change!

Second, there are currently only a small number of DBT-LBC™ Certified Clinicians and Programs compared to non-certified clinicians and programs. This is due largely to the fact that DBT-LBC™ clinician certification only came into effect in 2014, and DBT-LBC™ certification of programs started in the middle of 2017.

We expect that as time goes by the number of DBT-LBC™ Certified Clinicians and Programs will grow significantly. We also hope to work towards the long-term goal of increasing reimbursement so that more DBT-LBC™ Clinicians and Programs will become in-network within insurance companies, Medicaid and Medicare.

The 3 consecutive sessions must be within 2 years of submission

The three completed cases must have been completed within 3 years of application approval.

At this time, DBT-LBC is accepting English only videos

If you encounter upload problems, try uploading with FIREFOX or CHROME.  They provide enhanced capabilities over Internet Explorer and typically resolve most Java issues.

Firewalls can also slow down or stop the upload process.  Try temporarily turning off firewalls.

NOTE: Some business networks may have restrictions.  If your IT department has blocked or slowed connections to outside Cloud sources, attempting uploads to Box from an office setting may be slow or fail.  Try your upload from a different setting or contact your IT department to temporarily reconfigure settings to allow you to successfully upload to Box.

Your internet browser may have file-size upload limits.  For example, Internet Explorer applies file-size upload and download limits that supersede Box account-level upload limits.  Users accessing Box through Internet Explorer versions 6, 7, and 8 can upload files up to 2GB in size.  Users on Internet Explorer versions 9, 10, and 11 can upload files up to 4 GB in size.  If you have difficulty uploading your files, check your internet browser for any known file-size limits.

And see the compression tool mentioned below called Handbrake to shrink your file size.

You are limited to 5GB per file.  

Note, however, that smaller files will be faster to upload.  This may mean that you need to compress files prior to upload.  There are many ways to compress files.  This link will take you to one such free tool called Handbrake:  https://handbrake.fr/

No!  If you see a prompt asking you to upgrade your account, double check that you have not attempted to upload to YOUR personal Box account.  

As a reminder, it is important that you not upload in any manner other than directly to your DBT-LBC applicant folder on Box as other upload processes may not afford you the HIPAA protections required for PHI.

The videos will be coded to evidence-based adherence standards for DBT.  One of the three submitted videos must meet adherence standards.  If the video does not pass review, a second submission set of three, provided within 3 months, will be required but at no additional fee.

If the second submission is unsuccessul as well, an additional 6 month wait will be necessary.  In this case, we recommend consultation with a trained DBT clinician to assist you.

Since there are so many different computers, cameras and phone devices with individual specifications and internet connection speeds, it awill be difficult for us to troubleshoot applicants' technical issues.  Please try your best to seek technical help on your own.

Most webcams will work.  Be sure the audio can be heard!  If you use a smart phone or tablet, be aware that most will not record more than 35 to 50 minutes at a time.  You may have to start the recording twice.  Please note:  if this happens, be sure to copy BOTH parts of the same session if it is a two-part video.

Also, if you receive a phone call on your smart phone, it will stop the recording and you will have to start over.  There may be some smart phones that allow you to disable the cellular function without disabling the recording function.

Some people use cameras that are installed on their computers; others use $20 webcams that they hang in an effective position in their office. We will try to take every video format possible.

When the video is focused on both, there is more complete information for the coder, even though both are likely to be in profile.  However, clients have the right to refuse to be on camera.  If that occurs, focus the camera on the therapist.  Seeing the therapist is most important.

It should be video but audio would be accepted.  Audio puts the applicant and the coder at a disadvantage because it is more difficult to determine adherence to DBT.  Video allows the coder to see the non-verbal responses to the client, which often give us clues about strategies that are being used.

After passing the exam, you will receive an invitation email to log back into your account where you will find very specific instructions on how and where to submit the required files.  How to name the files will be clearly spelled out. 

Each of the three videos should include a copy of a redacted diary card reviewed in the session and a Session Information Form Work Product - Video Submission for the session.  If for any reason you deviated from standard delivery of DBT in a way that is nevertheless consistent with the principles of DBT, let us know why you did so.

The videos submitted must be of a client that is in stage 1 (Pre-treatment sessions 1-4 will also be coded). Recordings should be of complete sessions, usually around 45 - 60 minutes.

Submit 3 consecutive video sessions of the same client..

Your first response will be an acknowledgement that your payment was received.  That means we also have your application in our system too.

The application review process actually takes more steps than you might think.  Your application is assigned to a reviewer who may take up to two weeks to get it reviewed the first time.  Every item entered needs to be reviewed to be certain all requirements are met.  Some pretty surprising errors occur, so we look everything over carefully for accuracy.  When the first review is completed, we may send you an email indicating what items may need your attention before we can proceed.  Once that is done, all the documents that were uploaded are reviewed and some things need to be verified from the primary source that issued them.  For example, we check directly with the licensing board that issued your license.  After Primary Source Verification is completed, the clinical review of the application is done.

All that can take a 4 to 6 weeks or more to accomplish.  We hope you will be patient; we are trying to be completely accurate, thorough and responsible with the certification process.

Adherence coding of DBT therapy sessions involves the observation of both verbal and non-verbal behaviors on the part of the client and the therapist. For that reason, video recordings give the adherence coder a much more comprehensive view of the session. We can code audiotapes of therapy sessions, but the absence of seeing the non-verbal behaviors that occur in DBT sessions may influence the coding outcomes.  Video is therefore much preferred.

Follow this link http://www.dbt-lbc.org/../index.php?page=101158 to see what the fees are for filing the application, registering to take the exam, and submitting your Work Product.

On the Clinician Certification Information page all the headings in green are links to the pages with further explanation of each of the items, including the fees.  Hover your cursor over them and you will see they are active links.

Well, yes, AND there is considerably more work to process an application done via paper and pen.  If you absolutely are unable to use the online version and you contact us, we will send you a paper version of the application to complete.  We will then enter your information for you on the website as all applications are being tracked, updated and processed that way for everyone's convenience.  Unfortunately, due to the increased work involved, we will be charging an additional processing fee of $100 - making the total application fee for the non-online version $255, which is also not refundable once submitted.

Professionals are usually awarded a certificate when they attend trainings approved for continuing education credits by the sponsoring agency.  A certificate merely indicates attendance at the training and does not measure any knowledge or performance components of the training offered.  Certification is completely different.  For a complete explanation, check out this page - http://www.dbt-lbc.org/../index.php?page=101118

It is not necessary to be certified before developing a DBT program.  It will be necessary for at least the Team Leader of your DBT team to be certified for your DBT Program to be eligible to apply for program certification.

For the complete list of requirements, please check out the website at http://www.dbt-lbc.org/../index.php?page=101120

A master's degree or higher is required as well as active licensure with no restrictions and in good standing in your appropriate practice discipline.

As you can imagine, there is tight security around the test questions to assure a fair exam for everyone.  No sample exams will be made available, but we have included a few sample questions so that you can see the format that questions will take.  These sample questions will not be on the exam but will merely serve as illustrations.  Find them at: http://www.dbt-lbc.org/index.php?page=101151

The DBT-Linehan Board of Certification is neither a charity, business, or social service, but a hybrid of all three. It could be characterized as a not-for-profit service that benefits the public through improved access to quality providers and critical healthcare knowledge vital to a vulnerable population. The service also enhances the DBT profession and those it serves through the development of high standards. The mission statement link provides a clear statement of what DBT-LBC's purpose is.  http://www.dbt-lbc.org/../index.php?page=101130

The Linehan Institute does not offer any form of certification.  The DBT-Linehan Board of Certification is the only DBT certification program in the US endorsed by Dr. Marsha Linehan, the treatment developer.

No.  You may be given a certificate of attendance at training sessions you go to.  This merely indicates your presence for the allotted time period.  See the page that explains the difference between certificates and certification for a complete explanation.  http://www.dbt-lbc.org/index.php?page=101118