Research in Action December 2016
ServiceNet’s DBT Program Highlighted at National Convention
A poster presentation featuring ServiceNet’s work in community-based Dialectical Behavior Therapy (DBT), was delivered in October 2016 at the 50th annual convention of the Association for Behavioral and Cognitive Therapies (ABCT). Presenters were Dr. Leonard A. Doerfler, Professor and Director of the Counseling Psychology Program at Assumption College in Worcester, Massachusetts; Dr. Anna Remen, Director of DBT Services for ServiceNet; and Dr. Adam Volungis, Assistant Professor of Psychology at Assumption College.
Doerfler collaborated with Volungis, Remen, and Jennifer Geerstma, Director of Research for ServiceNet, to identify pertinent characteristics of clients enrolled in DBT. ServiceNet clinicians have been providing DBT interventions for more than 20 years, making the agency a unique community-based model for study outside the university research setting.
Dialectical Behavior Therapy is a psychotherapeutic technique designed to help treat people who have been diagnosed with borderline personality disorder. This disorder is characterized by problems with emotional regulation, including episodes of depression and rage; concerns about abandonment; and poor coping techniques, including impulsive and suicidal behaviors.
The treatment approach practiced by ServiceNet involves regular individual therapy as well as group sessions which emphasize skill-building, phone coaching, and a therapist consultation team. The model also includes clients’ use of daily diary cards to help them track their behaviors and understand how to best apply the skills and insight they have gained.
While DBT has been proven effective in many controlled studies, there has been little work done to test the efficacy of DBT in community-based programs. Conditions in the community can differ significantly from the conditions participants experience in a controlled trial, and it is important to understand what makes these populations distinct.
The primary finding was that most individuals who entered treatment in a community-based DBT program were severely distressed and likely to engage in high-risk behaviors. In the months preceding their treatment, many had spent time in emergency rooms and/or on inpatient psychiatric units. They also self-reported a high level of symptoms associated with depression and Post-Traumatic Stress Disorder (PTSD). So they were dealing with their experience in ways that were costly to both themselves and the community.
Another key finding of the study was that clients had a high level of sleep disturbances. While this factor might seem to pale in comparison to acute high-risk behaviors, its impact on individuals’ quality of life can make it more difficult for them to take control of their behavior. One conclusion of the study, therefore, was that simple sleep hygiene education, in addition to DBT treatment, could go a long way toward helping clients feel better faster.
New Dashboard Serves as Model to Inform Quality Improvement Efforts
ServiceNet’s REACH Early Intervention Program has been serving young children and their families in Franklin and Hampshire Counties and the North Quabbin region for almost 40 years. Working with children from birth to age three who have, or are at risk for, a developmental delay, REACH provides parents with a better understanding of how they can help their children grow and thrive. REACH services range from assessment and care planning to physical, occupational, and speech therapy, to community playgroups and individual home visits.
Part of the REACH program’s success is its longstanding commitment to quality improvement. And having the most accurate available data is essential to this process. So REACH has worked in partnership with ServiceNet’s Quality, Research & Compliance (QRC) team to create dashboards that give them more detailed information about the population they serve, and that track referral sources and duration and impact of treatment. REACH then uses this information in its overall program planning, and to develop targeted improvement strategies.
“A dashboard, at its best, provides an easy to understand communication tool that all staff can use in shaping their work,” said James Olchowski, Data Coordinator with the QRC. “And while REACH has benefitted by having the information they need to fuel their quality improvement efforts, our QRC team has gained experience in creating effective, usable dashboards that can serve as a model for other teams throughout ServiceNet.”
Autism Services Database Soon to Be Launched
ServiceNet’s Autism Services program staff will soon have a simple way to record their administration of the Affect-Based Language Curriculum (ABLC) assessment. The ABLC is used to track children’s progress in a variety of social and linguistic tasks.
Since the ABLC is a lengthy assessment, administering it on paper takes a long time, and paper files take up a lot of space. It is also cumbersome to search through the tests to analyze them.
With the new online system developed by ServiceNet’s Quality, Research & Compliance department, Autism Services staff members will be able to skip the paper and record the assessment on their computers. The information they enter will go into a searchable database that will be used to improve services.