Abstract
BackgroundIn the Republic of Ireland, borderline personality disorder (BPD) is a feature of approximately 11–20% of clinical presentations to outpatient clinics within mental health services. These estimates are similar to other countries including the UK and USA. Dialectical behaviour therapy (DBT) is an intervention with a growing body of evidence that demonstrates its efficacy in treating individuals diagnosed with BPD. While a number of randomised controlled trials (RCTs) have demonstrated the efficacy of DBT, there is limited research which evaluates the effectiveness of this model when applied to real world settings. Funding was secured to co-ordinate DBT training in public community-based mental health services across Ireland. As no other study has evaluated a co-ordinated national implementation of DBT, the current study proposes to investigate the effectiveness of DBT in both adult and child/adolescent community mental health services across Ireland, evaluate the coordinated implementation of DBT at a national level, and complete a comprehensive economic evaluation comparing DBT versus treatment-as-usual.Methods/ designThis study takes the form of a quasi-experimental design. Individuals attending community mental health services who meet criteria for participation in the DBT programme will be allocated to the intervention group. Individuals who live in areas in Ireland where DBT is not yet available, and individuals who choose not to participate in the intervention, will be invited to participate in a treatment-as-usual comparison group. Self-report clinical measures and health service use questionnaires for DBT participants (and parent/guardians as appropriate) will be administered at pre-, mid- and post-intervention, as well as follow-up for participants who complete the intervention. Survey and interview data for DBT therapists will be gathered at three time points: prior to DBT training, 6 months after teams begin delivery of the intervention, and 2 years following training completion.DiscussionIt is anticipated that the results of this study will provide evidence for the effectiveness of DBT for patients, and report on recommendations regarding best practice guidelines for implementation of DBT and its economic merit in a publicly funded service.Trial registrationClinicalTrials.gov ID: NCT03180541; Registered June 7th 2017 ‘retrospectively registered’.
Highlights
In the Republic of Ireland, borderline personality disorder (BPD) is a feature of approximately 11–20% of clinical presentations to outpatient clinics within mental health services
It is anticipated that the results of this study will provide evidence for the effectiveness of Dialectical behaviour therapy (DBT) for patients, and report on recommendations regarding best practice guidelines for implementation of DBT and its economic merit in a publicly funded service
The study protocol is outlined here to offer clinicians and researchers in publically funded health systems an opportunity to consider the methodological quality of this effectiveness study with a critical view
Summary
The study protocol is outlined here to offer clinicians and researchers in publically funded health systems an opportunity to consider the methodological quality of this effectiveness study with a critical view. Research on effectiveness of DBT when implemented in a coordinated manner could provide an important contribution to improving routine mental health care for patients with BPD. The protocol offers clarity on quality, quantity and experience of participating in a coordinated implementation of DBT at a national level. This could potentially provide evidence on how best to overcome barriers to implementation in publicly funded health systems. One of the limitations in previous research on DBT effectiveness is the variability in outcome measures utilised to assess clinical effectiveness This protocol matches outcome measures to treatment targets for DBT in an attempt to create a standardised battery of measures that can be applied across any research setting. No study to our knowledge has reported on the effectiveness of the 16-week DBT programme as described by Miller and colleagues [28] for adolescents in community settings so it is anticipated that the results of this study will contribute to this gap in the literature
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