DCYF Expert Stories: Dialectical Behavior Therapy

September 9, 2021
Young people gathering for a discussion with an adult.

Staff voice: ITM Consultant and DBT Expert Beth Rogers provides insight into Juvenile Rehabilitation’s Dialectical Behavior Therapy

In 1998, DCYF’s Juvenile Rehabilitation (JR) conducted a pilot Dialectical Behavior Therapy (DBT) project at Echo Glen Children’s Center to find a more effective therapeutic intervention to help youth experiencing crisis. The pilot resulted in reduced self-harm, reduced suicide precaution levels, and increased positive relationships between staff and youth. Because of these positive results, DBT became a part of the Integrated Treatment Model (ITM) across all JR facilities.

University of Washington Psychology Professor and adjunct Psychiatry Professor Dr. Marsha Linehan developed DBT for chronically suicidal and self-harming individuals. Dr. Linehan identified four therapeutic components to help reduce the urge to self-harm or desire to die:

  • Individual therapy
  • Skills training groups
  • Phone coaching
  • Consultation for therapists

The phone coaching component is particularly valuable – therapists coach clients in the moment when negative feelings are overwhelming. Dr. Linehan believed this to be much more effective than waiting up to a week to process the event with their therapist.

In JR, our youth are coached by staff all day long – not just when they are in crisis or wanting to self-harm. In addition to regular coaching, youth in DCYF’s care establish “Life Worth Living” goals and are surrounded by a team of people who know their goals and the skills they need to practice to reach them. And the team regularly supports youth with positive reinforcements that the youth themselves identify (e.g., later bedtimes, extra recreation, video game time, treats, etc.).

JR has not had a completed in-residence suicide in 20 years. If this were our only win, it would be sufficient, but there is another big win. JR regularly conducts Quality Assurance (QA) observations of all its living units to determine adherence to the treatment model. The 2020 study An Evaluation of Dialectical Behavior Therapy for Juveniles in Secure Residential Facilities compared JR’s QA data and recidivism rates for formerly incarcerated youth. This study found a one-point increase in Environmental Adherence scores corresponded to a 51.7% reduction in felony recidivism. The study shows that when implementing DBT according to the model, recidivism is reduced significantly.

When JR first implemented DBT, staff were sent to intensive trainings with ample focus on DBT. With new behavioral health resources in the 2021-23 biennial budget, JR is revamping intensive training and is hiring DBT specialists who will receive clinical supervision from a DBT expert. JR will also dedicate resources to expanding QA. These steps will help ensure JR continues to provide the best possible therapeutic interventions to the youth and young adults in DCYF’s care.

To learn more about DBT in JR residential care, visit https://dcyf.wa.gov/services/juvenile-rehabilitation/treatment-programs/residential-care.