DBT Programming

DBT Outcomes Measurement

Outcomes measurement and monitoring help persons with co-occurring disorders to manage their treatment, which can sharply reduce the need for higher levels of care. The IBHS DBTCON uses several assessment and outcome measurement tools to assess clients, guide treatment, and assess the programs' progress and outcomes. The IBHS DBTCON program consistently uses the following assessment and outcome measure tools.

Daily Living Activities - 20 (DLA-20)

The DLA-20 Daily Living Assessment is a functional assessment and outcome measurement tool IBHS utilizes across all programs. The DLA-20 allows our program to access hard data, examine progress or lack of progress in residents, and in doing so, partner with residents toward their recovery. It is an approach that can improve the chances for people with co-occurring disorders to live more independently and participate more fully in their communities. 

The Daily Living Activities-20 is a research-backed outcomes tool utilized in psychiatric residential rehabilitation to measure daily living areas impacted by co-occurring disorders. The DLA-20 supports the functional assessment needs of our agency. It provides a quick way to identify where interventions are needed so clinicians can address functional deficits on individualized treatment plans. The DLA-20 is intended for use with all residents entering our program. The program director, case manager, and recovery-oriented coaches typically have the most information about the daily functioning of the resident based on referral information received and are best prepared to complete the DLA-20. The tool has been shown to take approximately 6 to 10 minutes to complete after an assessment.

All Staff are expected to attend a comprehensive 3.5-hour training on the DLA for an understanding of the tool. This training is provided by one of the five certified trainers of the DLA-20 at IBHS; those individuals are the Executive Director, the Administrative Director, the Outpatient Rehabilitation Services Program Director, the DBT PRR Program Administrator, and the Community Support Program Administrator. IBHS will gather this data upon admission, after the first 30 days, and every 90 days of treatment through discharge for outpatient and every 30 days for residential programs. The DLA-20 is completed at each treatment plan review/update and drives the treatment plan. These outcomes will generate a better understanding of residents' needs, targeting treatment interventions with treatment planning and, ultimately, outcome data that will help us gain facts on what is working and not working within our program. The data will be examined each quarter, and at the end of the year, the data will result in action plans for the program.

Borderline Symptom List (BSL-23)

The Borderline Symptom List – Short Version (BSL-23) is a 23-item self-rating instrument for specific assessment of borderline personality disorder (BPD) symptomatology in adults (18+). The scale assesses DSM BPD diagnostic criteria (e.g., affective instability, recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior, and transient dissociative symptoms) in addition to items that are based on borderline-typical empirical findings regarding self-criticism, problems with trust, emotional vulnerability, and proneness to shame, self-disgust, loneliness, and helplessness (Kleindienst et al., 2020).

Individuals with high scores on the BSL-23 are more likely to have BPD and associated challenges with managing emotions, self-image, relationship issues, and general functioning in everyday life.

Psychometric Properties

The BSL-23 items are based on criteria of the DSM-5, on the revised version of the Diagnostic Interview for Borderline Personality Disorder, and on the experiences of both clinical experts and input from BPD (Kleindienst et al., 2020). The BSL-23 has a single-factor structure and excellent psychometric properties, with high internal consistency with a Cronbach's of 0.97 and test-retest reliability of 0.82 within one week (Bohus, 2009). These properties have been replicated in several studies that validated the translations of the BSL-23 into 18 foreign languages (Kleindienst et al., 2020). The BSL-23 also has strong convergent validity with correlations between the BSL-23 and depression as measured by the BDI (r = 0.87), as well as general severity of psychopathology as measured by the SCL-90-R GSI (r = 0.89; Bohus, 2009).

Kleindienst et al. (2020) tested the BSL-23 on over 1,000 adults and developed cut-off scores and severity levels (none or low, mild, moderate, high, very high, and extremely high) for clients with BPD. They found that individuals with a severity grade of "none or low" were virtually free from diagnostic BPD criteria and had a high level of global functioning corresponding to few or no symptoms. Severity grades indicating "high" to "extremely high" levels of BPD symptoms were observed at a much higher rate in treatment-seeking patients (70.0%) than in a healthy control group with no prior psychopathology history (0.0%)

IBHS DBTCON uses the BSL-23 to evaluate the level of functioning. We use this tool at intake, discharge, and every 90 days for outpatient and 30 days for residential clients.

DBT Ways of Coping Checklist (DBT WCC)

The Ways of Coping Checklist (Folkman & Lazarus, 1980) is a 68-item measure that describes several thoughts and acts (coping strategies) a person may use to cope with a threatening situation.

The DBT WCC has three subscales, the skills subscale, the general dysfunctional coping factor, and the blaming others factor scale,

IBHS DBTCON uses the DBT WCC at intake, and discharge, every 90 days for outpatient clients, and every 30 days for residential clients to measure progress in skills acquisition and use.

Reasons for Living Inventory (RFL)

The RFL is a self-report questionnaire that measures clients' expectancies about the consequences of living versus killing oneself and assesses the importance of various reasons for living. The measure has six subscales: Survival and Coping Beliefs, Responsibility to Family, Child-Related Concerns, Fear of Suicide, Fear of Social Disapproval, and Moral Objections.

Citation: Linehan M.M., Goodstein J.L., Nielsen S.L., & Chiles J.A. (1983). Reasons for Staying Alive When You Are Thinking of Killing Yourself: The Reasons for Living Inventory. Journal of Consulting and Clinical Psychology, 51, 276-286.

BHS DBTCON uses the RFL at intake, and discharge, every 90 days for outpatient clients, and every 30 days for residential clients to measure the client's expectations about the consequences of living versus killing oneself and to assess the importance of various reasons for living.

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The Columbia - Suicide Severity Rating Scale (C-SSRS)

The C-SSRS is a suicidal ideation and behavior rating scale created by researchers t Columbia University, the University of Pennsylvania, the University of Pittsburgh, and New York University to evaluate suicide risk. IBHS DBTCON uses the C-SSRS during the initial assessment and ongoing as needed at a minimum annually.