(PS5-93) Expanding Access to Dialectical Behavior Therapy (DBT) for High Acuity Youth in Washington State Through a State-Provider-University Partnership

Self-injurious thoughts and behaviors (SITB) are a serious mental health concern for youth, and incidence rates of adolescent SITB have increased in recent years (Cybulski et al, 2021). Although there are several evidence based treatments for youth SITBs, leading approaches like Dialectical Behavior Therapy (DBT) present a range of challenges in establishing and sustaining adherent full-model programs in real world settings (Carmel et al., 2014). Training and implementation standards for DBT are often infeasible given realities of health care policies and the logistics of routine community care (Haynos et al., 2017). Studies highlight organizational-level (e.g., lack of funding for training, staff time commitment, poor fit with existing practices), provider-level (e.g., clinician burnout, time commitment), and patient-level barriers (e.g., time commitment, logistical barriers of attending appointments) to implementation of DBT in community settings (Popowich et al., 2020; Swenson et al., 2002). Evidence for wider scale implementation of DBT in community settings highlights the necessity for cross sector collaboration to ensure that training and treatment efforts are implemented in ways that meet both the needs of the work force and the service seeking population (Flynn et al., 2021; 2020). The current presentation will describe a community and policy focused state-provider-university partnership approach to the design and implementation of a scalable DBT based clinical training model for high acuity youth in Washington state (WA). As part of a broader policy based initiative to reform behavioral health care practices in WA, CoLab for Community and Behavioral Health Policy collaborated with community and systems partners to co-design a DBT based clinical training approach. The co-design process followed a model recognized by implementation scientists (Walker et al., 2023), and included iterative needs assessment and feedback from policy partners and behavioral health agency leaders. After achieving alignment on goals and values, getting buy-in from service agency partners, and identifying a feasible training format, we proceeded to implement a series of training sessions with direct service staff. Service staff consisted of clinical supervisors, clinicians, and peer support partners. Service staff (N = 58) participated in live polling and discussions about their strengths, challenges, and training priorities throughout training model delivery and development. Staff also completed the Intervention Usability Scale (IUS; Lyon et al., 2021) and Feasibility of Intervention Measure (FIM; Weiner et al., 2017) after each training. Preliminary data shows participants rate the trainings and DBT strategies as useful (M = 79.39, SD = 13.45) and feasible (M = 4.47, SD = 0.65). About 88% of staff report actively using learned DBT strategies in their work, and 87% report the strategies are helpful to the families they work with. Further quantitative and qualitative findings will be presented. We will also discuss dilemmas and factors that complicated or catalyzed this work, share next steps for this project, and discuss how this approach can be generalized to other contexts focused on increasing access to DBT in community settings.