Please include the following information in your program’s policies and procedures manual:

DBT Program Elements

  • Describe the basis for your DBT program
  • DBT Program’s mission statement
  • Describe your agency and the community of clients served
    • Specify children, adolescents, adults
    • Specify any special populations served
  • Describe how clients are referred to your program
  • Describe how the following elements are executed in your program:
    • Individual Therapy
    • Skills Training Group
    • Skills Coaching
    • Consultation Team
    • Auxiliary Modes of Treatment
  • Provide information on:
    • Admission criteria to your DBT Program
    • Structure of Treatment (Including expectations about participation, duration of treatment)
    • Inclusion and Exclusion Criteria
    • Policy for 4-misses
    • Policy for 24-hour rule
    • Policy for treatment continuation
    • Policy for how progress is measured and evaluated
    • Discharge criteria
    • Policy for including caregivers (if applicable) (Detail how they are included in treatment, what commitments are required of them during the process of treatment, frequency of contact with the therapist, etc.)
    • Policy for vulnerable or dependent clients
    • Policy for assigning therapists to clients
    • Policy for assigning clients to skills groups
    • Policy for auxiliary providers (including psychiatrists, dieticians, case managers, etc.)
  • Protocol for Delivering Stages of Treatment
    Please detail what each of the following stages of treatment entail in your program, how a client’s treatment stage is determined, and how you determine the need for treatment continuation, and how a client moves between the following stages:

    • Pretreatment
    • Stage I
    • Stage II
    • Stage III
  • Discharge criteria
    • Policy for discharge from treatment
    • Policy for re-entering treatment after being discharged for any reason

Adolescent vs. Adult Programs

If your program sees both adolescent and adult clients, please specify programmatic differences between the two programs. Please specify any differences in policies and procedures.

Staff Policies

  • Please describe:
    • Hiring practices for DBT therapists, students, and interns
    • Policy for primary source verification
    • Attendance requirement and responsibilities for DBT therapists, students, and interns
    • How Team members are oriented to DBT Team
    • How DBT Team commitment is obtained
    • When a staff member is eligible to join the DBT Team
    • Staff onboarding and training plan for new DBT Team members
    • Ongoing staff training plan
    • In-service or continuing education requirements for staff
    • Procedures for clinical supervision
    • Documentation of clinical supervision

Outside Referral Sources

  • Description (and example) of any outside provider contracts (These may include working with outside primary therapists, medication management, etc.)
    • Policies for outside providers to attend Consultation Team (if applicable)

Crisis Planning, Policies and Procedures

  • Please detail your:
    • Crisis Intervention Plan (for clients)
    • Egregious Behavior Protocol (for your program)
    • Crisis Response Protocol (for your program)
    • Policy for client emergency and/or between-session contact with therapists
    • Risk assessment protocols used (LRAMP, etc.)

Between-Session Contact (Phone Coaching)

  • Please detail your policy on phone coaching and if this includes phone calls, text messages, emails, etc.
    • Therapist availability outside of sessions
    • How clients are oriented to skills coaching
    • Program expectations around clinician limits and response time to client phone coaching contact
    • How client contact is documented and followed-up on
    • How can clients reach their therapist between sessions and after hours
    • If on-call phone is shared, how do other therapists access client treatment plans or emergency contact information
    • How is coverage for out of town therapists selected and communicated to clients?
    • Please detail other strategies for skills generalization within your program
    • Please detail additional limits related to skills coaching
    • Please identify how clients obtain crisis management/ support from DBT program
    • Please identify how clients are instructed to engage in relationship repair outside of sessions

DBT Adaptations (if applicable)

  • If DBT has been adapted in any way (i.e., does not meet standards in any of the above criteria), please describe:
    • The barriers to standard implementation
    • Efforts to apply standard implementation and outcomes
    • How you would describe the adaptation made
    • Any client data collected and assessed to determine the impact of the adaptations
    • How you are preserving the principles of DBT
    • Any relevant research that informed your adaptations

Non-DBT Program Elements (if applicable)

  • If there are any non-DBT Program Elements, please describe how these are delivered as to not conflict with the principles of DBT or confuse DBT practices or content

Quality Monitoring and Improvement

  • What outcome data is collected by your program
    • How is data analyzed and or reported
    • How is data analysis reviewed and put to use (Individually and Programmatically)
    • Rationale for how data is collected and reported (By the therapist and Program)
    • Please detail any quality monitoring procedures your program has in place to assess for adherence
    • Please specify how your program monitors drift from DBT Program Adherence
    • Please detail any improvement procedures your program has in place
    • Please detail your Program Continuity Plan in case the identified Team Lead leaves the clinic, is out for an extended period of time, etc.

Multiple Locations (as applicable)

  • If your program has multiple locations, please specify how the sites differ from each other, how therapists are assigned to each location, are there therapists that are endemic to one location, how adherence is monitored, etc. If there are multiple locations or teams, you will need a certified clinician on all teams.

Appendix: Program Forms

  • Please submit the following documentation with your Program Manual as an Appendix. Please be sure all forms submitted either have client information de-identified or they are a blank templated sample. If you submit blank forms that are not DBT specific, please provide instructions as to where you identify DBT-specific information (i.e., targets, information from chains, information from solution analysis, case conceptualization, etc.). Please submit these sample forms for each program so your program reviewers can get a true sense of how your documentation appears in a client chart.
    • Consent forms for treatment
    • Therapy contract
    • Intake assessment form
    • Informed consent
    • Emergency contact form
    • Treatment plan forms
    • Phone coaching forms
    • Blank diary cards
    • Behavior Chain Analysis Form
    • Suicide Risk Assessment and Intervention Protocol
    • Crisis intervention plan
    • Individual progress note
    • Skills group progress note
    • Past year’s schedule of modules with time frames for each
    • Consultation Team note for client’s chart(please include specific issues addressed for a client and recommendations by the Team)
    • Consultation Team agenda form (blank)
    • Client handouts provided other than from the Linehan Training Manual
    • Clinic brochures provided to others
    • Links to website detailing the DBT Program
    • Data collection forms
    • Sample data analysis within the past year
    • Consultation Team Meeting notes for past 2 months. Must include:
      • Review of Team Members over time
      • Meeting elements recorded
      • TIB of therapists noted and followed-up
      • Solutions adequate to therapist’s request
      • Risk of 4 misses discussed and client progress and recommitment addressed