Implementing a Residential Dialectical Behavior Therapy Informed Treatment Model to Improve Adolescent Mental Health: Feasibility, Fidelity, and Acceptability

Abstract

Dialectical Behavior Therapy (DBT) is an outpatient treatment that addresses severe emotional and relational difficulties and is successfully applied across diagnoses, populations, and settings. In this feasibility study, we examined a residential DBT-informed treatment model in Norway, the Care and Development Model (CDM), aimed to improve adolescent mental health outcomes. Study participants included 42 adolescents (22 males and 20 females) with a mean age of 15.13 years (SD = 1.41, range 13–17 years), as well as the adolescents’ caregivers and residential staff. Data collection lasted from May 2018 until May 2021 and combined standardized self-report measures of program feasibility and acceptability, including treatment satisfaction and alliance, as well as customized program fidelity measures combining on-site observation and interviews with adolescents and staff, protocol data on treatment characteristics, and self-report checklists for treatment adherence. Results indicate that residential staff consider the implementation of CDM appropriate, but also distinct challenges were mentioned regarding the population and setting. Moderate to high satisfaction and alliance levels were reported by both adolescents and therapists. The CDM program shows promise and may be feasible and acceptable, although considerable effort to implement it is required. Implications for practice and research are discussed.