Telehealth Adapted DBT Multi-Family Skills Group for Adolescents with Suicidality and Non-suicidal Self Injury

• In Event: Implementation and Evaluation of TeleGroup Interventions for Youth in the Wake of the COVID-19 Pandemic

Abstract

Introduction: Although Dialectical Behavior Therapy (DBT) is one of the leading treatments for adolescent suicidality and nonsuicidal self-injury (NSSI) (Ougrin et al., 2015), little is known about whether it can be delivered through alternative modes like telehealth. There is evidence that computerized elements of DBT are feasible and effective for adults (Wilks et al., 2018), though no research has been done on technologically supported delivery of DBT for youth. Social distancing, stay-at-home recommendations, and other recent public health guidelines following COVID-19 created an urgent need to adapt services for youth from in-person to telehealth. Research on telehealth DBT is now highly needed to support best practices for this complex high-risk population. The current study describes the rapid telehealth adaptation of an outpatient multi-family DBT program for clinically referred adolescents and their caregivers. We also present feasibility, acceptability, and participant preferences and experiences of a DBT multi-family skills group following this shift in treatment delivery in response to COVID-19.

Methods: The study involved 23 participants, including 11 adolescents (mean age = 16.76, 91% female) and their 12 caregivers (75% female) who were enrolled in a DBT outpatient program at a medical center. Adolescents were clinically referred for suicidality, NSSI, and other comorbid mental health concerns. Treatment consisted of weekly individual therapy for adolescents, weekly 90-minute multi-family skills group for adolescents and caregivers, along with phone coaching for youth and parents, and weekly DBT consultation team for providers. Following stay-at-home and social distancing guidelines issued in March 2020 in response to COVID-19, the multi-family skills group was first rapidly adapted to an asynchronous format for 3 weeks, followed by implementation of a synchronous telegroup. All participants experienced the group in-person prior to COVID-19, as well as the asynchronous and then synchronous modes of delivery. Participants completed self-report questionnaires assessing feasibility, acceptability, satisfaction, usefulness, and other aspects of their treatment approximately 2 months after the rapid shift away from in-person group.

Results: Overall, participants rated high levels of feasibility and acceptability of synchronous DBT telegroup. Seventy three percent of adolescents and 92% of caregivers reported being satisfied with telegroup as an alternative to no group. Fewer adolescents (36%) and caregivers (67%) were satisfied with telegroup as an alternative to in-person. A majority of adolescents (64%) and caregivers (58%) ranked in-person group as their preferred mode, with asynchronous telegroup being least preferred. Most adolescents (73%) reported that synchronous telegroup was just as, or even more helpful than in-person group, while the majority of caregivers (66%) rated synchronous telegroup as less helpful than in-person. Treatment retention was high (92%) during this period. Qualitative feedback suggested that improved audio/video quality and shorter duration of telegroup sessions would improve patient experience.

Conclusion: Findings suggest that telehealth adaptation of DBT multi-family skills group is feasible and acceptable to patients. Telehealth DBT is a promising alternative when there are barriers to in-person delivery. Some patients may still prefer and benefit most from in-person treatment. Implications, limitations, and future directions for research and practice will be discussed.

Authors

• Kyrill Gurtovenko, University of Washington
  Presenting Author

• Kalina Babeva, Seattle Children's
  Non-Presenting Author

• Freda Liu, University of Washington
  Non-Presenting Author

• Hilary Mead, Seattle Children's
  Non-Presenting Author

• James Williamson, University Of Washington
  Non-Presenting Author

• Nicole M Stettler
  Non-Presenting Author

• Cesalie Stepney, Seattle Children’s Hospital
  Non-Presenting Author

• Samuel McGinnis, Seattle Children’s Hospital
  Non-Presenting Author

• Andrea Hartman, Seattle Children's Hospital
  Non-Presenting Author

• Molly Cevasco, Seattle Children’s Hospital
  Non-Presenting Author

• Lauren Boydston, University of Washington
  Non-Presenting Author

• Stephanie Pickering, Seattle Children's Hospital
  Non-Presenting Author