(PS9-35) Suicidality and Transition-Aged Youth: Examining Payment Choices in DBT (EPiC-DBT) and Structural Barriers to Access

Abstract Text: Transition-aged youth (TAY), ages 18-24, are uniquely positioned at a critical stage of development that intersects with structural barriers (Martel, 2021) and increases susceptibility to suicidal ideation. The transition from adolescence into adulthood involves complex life adjustments, such as employment, that TAY are tasked to navigate within the context of rising inflation (Martel, 2021). Research suggests that TAY are overrepresented as disconnected youth or adolescents who are not enrolled in work or school. Compared to connected adolescents, disconnected TAY encounter higher lifetime unemployment rates, lower educational attainment, and increased recidivism (Martel, 2021). Compared to all other racial and ethnic groups, Black/African-American TAY experience higher rates of unemployment contributing to disproportionate rates of chronic stress and serious thoughts on suicide (Mental Health America, 2024). This project aims to compare state-specific barriers to providing mental health treatment, specifically Dialectical Behavior Therapy (DBT), to TAY with serious thoughts on suicide.


DBT is a transdiagnostic and empirically supported treatment commonly used to ameliorate suicidality and address emotional dysregulation in pathology such as borderline personality disorder (Miller, 2015). EPiC-DBT was a cross-sectional survey study that analyzed quantitative and qualitative data for mental health clinicians (N= 277) who have received DBT training and/or are DBT-certified through the Linehan Board Certification. Clinicians completed online surveys that described their clinical practice, barriers to providing DBT, and wishes for increasing care access. We compared clinicians’ reported barriers to providing DBT to data from Mental Health America that ranked states based on the prevalence of youth with serious thoughts of suicide. A binary variable was created (High/Low) with cutoffs established by splitting states in half based on their respective categories.



Chi-square analyses suggest that TAY- serving clinicians in states with high rates of youth suicidal ideation do not exhibit different barriers to providing DBT compared to lower-ranking states. Although quantitative data suggest that clinicians, across state lines, encounter the same barriers to providing DBT to TAY, qualitative data will be analyzed to understand the unique barriers that clinicians face based on their state of practice and insurance coverage. Furthermore, we will compare barriers encountered by TAY-serving clinicians to clinicians who serve diverse patient populations across the lifespan and geographic locales. Covariates, such as comprehensive and noncomprehensive DBT, will be assessed. By understanding national barriers encountered by DBT clinicians in providing DBT services to TAY, we hope to inform clinical practice and policies that bolster access to DBT for a particularly vulnerable group.