Barriers and facilitators affecting the sustainability of dialectical behaviour therapy programmes: A qualitative study of clinician perspectives

Dialectical behaviour therapy (DBT) is a psychological treatment developed for individuals experiencing chronic suicidality and high‐risk behaviours. Despite the substantial evidence supporting the effectiveness of DBT, many programmes have problems with its sustainability. The goals of the current qualitative study were to identify factors that impact the sustainability of DBT programmes within a publicly funded mental health system and identify factors that are particularly relevant for youth DBT programmes. Interviews with trained adult and youth DBT clinicians (N = 31) were conducted to explore their experiences providing DBT. Three major themes that emerged as barriers to the sustainability of DBT programmes included the following: systemic challenges, conflicts within the consultation teams and clinician burnout. Factors influencing the success of DBT programmes included the following: systemic support, clinician commitment and “buy in”, and team cohesion. Factors specific to providing DBT with youth (i.e. level of commitment, simplifying the language, and parental investment) and recommendations for sustainability for adults and youth programmes were also identified. Findings of this study provide valuable information on factors impacting DBT programmes within the unique context of a Canadian mental health service system, where community‐based services are publicly funded. These findings have clear clinical utility and can be used to generate solutions to clinicians' perceived barriers and to foster perceived facilitators within similar contexts.     

人口统计学特征对公共服务动机有什么影响?来自元分析的证据

采用元分析方法探讨人口统计学特征与公共服务动机之间的关系。经筛选, 共纳入138篇492个独立样本(N = 1078442)。结果发现, 性别、年龄、教育程度、组织任期、工作任期、职位等级和收入与公共服务动机之间均呈显著的正相关关系, 且与公共服务动机不同维度之间的关系均存在差异, 婚姻状况与公共服务动机间不存在显著的相关关系。此外, 公共服务动机测量工具、测量时间点和文化背景对部分人口统计学特征与公共服务动机之间的关系有调节作用。研究结果为人口统计学特征如何影响公共服务动机提供了较为精确的估计, 对于发展公共服务动机理论, 激励员工工作积极性, 提高公共部门服务水平都有重要意义。     

Clinical cut‐off point for the Distrust dimension of the Dimensional Clinical Personality Inventory 2 (IDCP‐2)

The Clinical Dimensional Personality Inventory 2 (IDCP ‐2) is a 206‐item self‐report tool developed for the assessment of 12 dimensions (divided into 47 factors) of personality pathology. One of the scales comprising the instrument, the Distrust scale, is intended to provide psychometric information on traits closely related to the Paranoid Personality Disorder (PPD ). In the present research, we used the Item Response Theory and the Receiver Operating Characteristic curve analysis to establish a clinical meaningful cutoff for the Distrust scale. Participants were 1,679 adults, among outpatients diagnosed with PPD , outpatients diagnosed with other PD s, and adults from the community. The Wright map revealed that outpatients were located at the very high levels on the latent continuum of the Distrust scale, with a very large effect size for the mean difference between patients and non‐patients. The ROC curve supported a cutoff at −1.00 score in theta standardization which yielded 0.87 of sensitivity and 0.54 of specificity. Findings from the present investigation suggest the IDCP ‐2 Distrust scale is useful as a screening tool of the core features of the PPD . We address potential clinical applications for the instrument and discuss limitations from the present study.     

Battered women's coping strategies and psychological distress: differences by immigration status

People are rarely passive, and battered women are no exception. This study investigated the types of coping strategies women of Japanese descent (both Japan-born and U.S.-born) chose and their perceived effectiveness in dealing with their partners' violence. Japan-born respondents were significantly less likely to use active strategies and perceived them to be less effective than did U.S.-born respondents. For the Japan-born, the more effective they perceived active strategies, the higher their psychological distress, whereas the more effective they perceived passive strategies, the lower their psychological distress. In contrast, for the U.S.-born, the higher the perceived effectiveness of active strategies, the lower their psychological distress, and the perceived effectiveness of passive strategies had little effect on their psychological distress. The complex relationship between individuals' country of birth, the choice and perceived effectiveness of coping strategies, and psychological distress calls for increased attention to the role of culture in studies of coping and domestic violence.     

The Use of Multitrait–Multimethod Data for Detecting Nonlinear Relationships: The Case of Psychological Climate and Job Satisfaction

Previous monomethod research has found mixed support for nonlinear effects between certain job characteristics (e.g., job autonomy, job complexity) and outcome variables (e.g., job performance). We hypothesized that these weak nonlinear findings may be due to the prevalence of monomethod research that can lead to a lack of complete measurement and/or introduce common methods variance, either of which may mask the true shape of relationships. Using hierarchical regression analyses and a multitrait–multimethod (MTMM) research design, we found strikingly different results between monomethod and MTMM data when considering the relationships between three psychological climate variables and job satisfaction. While the monomethod results mirrored earlier inconclusive findings, the MTMM data indicated that nonlinear equations explained significantly more of the relationship between all three climate dimensions and job satisfaction. These results suggest that the use of MTMM data allows one to more effectively test for nonlinear effects. Furthermore, these nonlinear results suggest that the format of employee questionnaires should probably change from asking how much an employee has of certain constructs to asking does the employee want more or less of these constructs.     

Partner Violence, Social Support, and Distress Among Inner-City African American Women

This study examined the role of social support in the partner violence–psychological distress relation in a sample of African American women seeking medical care at a large, urban hospital (n = 138). Results from bivariate correlational analyses revealed that partner violence was related to lower perceived social support and greater psychological distress, and lower social support was related to more distress. Furthermore, findings based on path analysis indicated that low levels of social support helped account for battered women's increased distress. Findings point to the need for service providers to screen for partner violence in nontraditional sites, such as hospital emergency rooms, and to address the role of social support resources in preventive interventions with African American battered women.     

The Process of Family Reconstruction after DNA Testing for Huntington Disease

The needs of families to reconstruct their relationships in response to the DNA testing for Huntington disease of one or more of their asymptomatic members are presented. Data were collected from family interviews with 18 families, and from their responses on a post interview questionnaire. Findings are that families need to (a) address unfinished business associated with the decision for testing; (b) bring family members, peripheral in the decision for testing, into the loop; (c) reorganize patterns of communication and roles altered by the testing and heal ruptures in family membership; and (d) revise family stories about illness to provide a meaning for HD and explain the test results in a way that leaves them with a sense of mastery. Findings suggest that families should be more involved in the initial decision for testing of a member and that protocols should be established to provide help for their ongoing adjustment.     

The Therapeutic Factors Inventory: Development of a Scale

Although Yalom's (1995) framework of the therapeutic factors facilitating outcome in group has been accepted by group specialists, no empirically based instrument assesses all of these factors. The Therapeutic Factors Inventory (TFI), with 11 scales based on the therapeutic factors, has been designed to fill this gap. This article summarizes the development and preliminary reliability testing of the TFI. Each scale of the instrument demonstrated high internal consistency; however, one scale obtained unacceptably low test-retest reliability. Further validity testing is needed. Implications of these findings are discussed.