Dialectical Behaviour Therapy
How Did We Arrive At This Treatment ?
• JS Care was established in 2005 and has opened 6 homes within the Wakefield area over the last 16 years. JS Care has developed an excellent reputation for delivering high quality care for adults with complex needs including learning disabilities, autism, personality disorder and a range of other mental disorders. We now receive referrals country wide and have established excellent relationships with Local Authorities and Clinical Commissioning Groups.
• In 2017, we were approached to set up a residential service as part of the Transforming Care Programme which aimed to discharge patients with Learning Disabilities and Mental Health conditions from secure hospitals and reduce further hospital admissions. Libby Lawrence joined our team to provide specialist mental health training and psychological support for our staff. She then began adapting Marsha Linehan's mainstream DBT modules for service users with both Learning Disabilities and Mental Disorders such as Personality Disorders discharged into our care.
DBT is a NICE recommended treatment for Borderline Personality Disorder (or EUPD) but has proved effective for other trauma related disorders and an evidence base is now gathering for it's use with the Learning Disability population. Libby began delivering adapted DBT in 2018 to 4 of our service users recently discharged from hospital. These service users all had trauma backgrounds, Mental Disorders and Learning Disabilities. DBT supported them to change their thoughts, feelings and behaviours. We quickly saw a reduction in self harm, attacks on staff and destruction of property.
• In March 2020, we discussed our company ethos and the future and decided that we wanted to become a full DBT service.
• We now knew that DBT was working so we decided to train more staff to deliver it. We considered various options and decided to book on the Association of Psychological Therapies (APT) masterclass ten-day course.
We advertised for interested parties and had over thirty applications. We held interview dates which were tough we included DBT principles such as mindfulness and role play to make sure our chosen practitioners had the necessary skills and commitment required.
We then whittled the numbers down to fifteen to go on the training. We chose some managers, some staff, and some new starters we felt this mix was really good in terms of knowledge skills and motivation.
The Level 4 in DBT Counselling consisted of:
DBT Skills Development Group
Setting The Foundation
Where Are We Now
•We introduced morning check in, and evening debriefs every day.
• We totally changed supervision to become a more person-based model that was a supportive and developmental tool.
• We introduced mental health check ins and welfare meetings.
• We focused on debriefs after behaviours so we could develop a culture of learning and always trying to improve.
• We introduced a structured key working programme with clear goals and targets that service users were fully involved in.
• We changed the physical appearance of the homes making them more homely and less institutionalised making them feel warm and welcoming.
• We involved staff in care planning and risk assessing so that they felt valued.
• We invested in an electronic recording system so that we could become a paperless organisation and be more professional
•Upon completion of our Level 4 in DBT we decided the best course of action was to focus on our Mellieha site and Aspen Court
•This means we would have eleven practitioners on that site giving us a real chance to embed DBT, 30 by the end of 2021.
•We created a DBT hub on site where staff can meet to prepare their work, reflect, share ideas and deliver sessions
• In November 2021 we will begin another DBT Master Class with APT, increasing the number of Qualified DBT Practitioners to 28 across the whole of JS Care Ltd
Where Are We Now?
• Weekly consult meetings
• Dedicated DBT resource drive
• All DBT practitioners 6 hours a week off rota to prepare, deliver and evidence DBT.
• Set up a one-day DBT introduction course for all staff.
• Set up one to one therapeutic support for any staff experiencing problems or concerns.
• Adapted DBT materials to individual service user needs.
• Invested in teaching materials to have flexibility in delivery.
• Introduced service user meetings and an introduction to group work.
• Introduced a DBT skill of the week.
• Included DBT in team meetings as an opportunity to learn.
• Lesson plans to deliver and record all sessions.
• Introduction to phone call support and coaching
• Practitioners mentoring new staff and teaching skills.
• Practitioners offering mental health check ins and motivational conversations.
• Homes decorated and displays put up to promote and develop DBT culture.
• Next fifteen cohorts for DBT identified for course in November.
• Commitment from senior management to implement DBT in an additional three homes.
• All service users have a new DBT formulation.
• Specifically designed paperwork for this client group.
•All service users on the Mellieha site have had some DBT input and have a DBT practitioner assigned to them.
•There has been a massive increase in the confidence and outgoing nature of the service users.
• They are doing more activities showing more independence
•The service users are becoming more goal focused and driven and trying to achieve goals.
•Staff are seeing the work being done by the DBT practitioners , joining in, asking questions, being curious and seeing how they can help and support the programme.
•Staff are reflecting more and looking at creative ways of improving the lives of the service users.
The Ultimate GOALS?
•To become a DBT centre of excellence
•To create our own adapted DBT programme that is person centred to all our service users
•To give all our service users a reason to get up to look forward to their day and have realistic and achievable goals that are important to them.
•To give staff an environment and platform to deliver a high quality individual care and treatment programme that really makes a difference.
•To create a DBT culture where everyone feels valued and important
•To put a smile on a face every day
•To be recognised as one of the leading providers in the UK with a DBT culture.
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