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The purpose of this paper is to reflexively examine the challenges of implementing a community dialectical behaviour therapy (DBT) service for adults with intellectual disabilities (ID) and describes the practical lessons learned about how to maximise the effectiveness of DBT with this client group.

A brief overview of DBT is provided and reference is made to literature which highlights the potential benefits of providing a DBT service to clients with an ID. This is followed by a discussion of the clinical presentation of the clients receiving DBT in the service that is the focus of this case study. Using a reflexive approach, a detailed discussion follows of the challenges faced in implementing a community DBT service for the clients served.

Solutions to a variety of challenges faced in four years of service delivery are described, key lessons learned are highlighted, together with issues meriting further research.

This case study and its implications are limited to community DBT services. Another limitation is that, although outcome data have been collected over the past two years, the dataset is not yet large enough to draw statistical conclusions.

The paper describes adaptations to treatment structure and strategy which the authors believe are necessary to improve treatment outcomes in community DBT services for adults with ID. In particular, the practical experience suggests that a didactic approach to teaching DBT skills is not effective and should be replaced by the “community of learners” approach that involves the trainer contingently responding to client input. Pre-set lesson plans inhibit the trainers’ ability to respond contingently.

The existing literature on providing a DBT service for people with an ID has principally focused on providing a rationale for providing this type of intervention, and on assessing outcomes. Given that this is still a relatively new type of provision for this client group, a detailed examination of process issues is called for.

Dialectical behaviour therapy (DBT) (Linehan, 1993) is a comprehensive psychological treatment that was first developed for suicidal individuals with a diagnosis of borderline personality disorder. The model has successfully been used to address violence and aggression in a forensic setting (Evershed et al, 2003). The National High Secure Learning Disability Service (NHSLDS) piloted an adapted DBT programme suitable for men with mild learning/intellectual disabilities in 2004, and the programme has been developed over a period of six years. This paper describes the rationale for development of the programme, how the programme has evolved, the major modifications to mainstream DBT that it incorporates, and the challenges that remain.

The purpose of this paper is to evaluate the effectiveness of the dialectical behavior therapy (DBT) training which was provided to community agency staff (N=18) implementing DBT in the community with street-involved youth.

Staff participated in a multi-component approach to training which consisted of webinars, online training, self-study manuals, and ongoing peer consultation. To evaluate assess the effectiveness of the training, questionnaires assessing evaluating DBT skills knowledge, behavioral anticipation and confidence, and DBT skills use, were completed at baseline, immediately post-training, four to six months post-training, and 12-16 months post-training. Additionally, the mental health outcomes for youth receiving the DBT intervention are reported to support the effectiveness of the training outcomes.

Results demonstrate that the DBT skills, knowledge, and confidence of community agency staff improved significantly from pre to post-training and that knowledge and confidence were sustained over time. Additionally, the training was clinically effective as demonstrated by the significant improvement in mental health outcomes for street-involved youth participating in the intervention.

Findings suggest that this evidence-based intervention can be taught to a range of staff working in community service agencies providing care to street-involved youth and that the intervention can be delivered effectively.

These findings help to close the knowledge-practice gap between evidence-based treatment (EBT) research and practice while promoting the implementation of EBT in the community to enhance positive youth outcomes.

Despite the growing awareness of supply chains on industry 4.0 (I4.0) capabilities as the enabler of sustainable performance, little is known about what accelerates this interaction. Prior studies have focused on the ambidexterity dilemma and the need to adopt sustainable inter-organizational governance to drive I4.0 capabilities while achieving sustainable performance. To address these issues, this paper aims to explore the distinct and combined effects of several approaches such as digital business transformation (DBT), organizational ambidexterity (OA) and circular business models (CBMs) on the relationship between I4.0 capabilities and sustainable performance.

Drawing upon a hybrid methodology including structural equation modeling and fuzzy set qualitative comparative analysis, this paper develops and tests a hypothetical model using data collected from 306 organizations in Europe, Asia and Africa.

The study findings lead to several important implications concerning the potential paths linking I4.0 and sustainable performance. Notably, the DBT was found to mediate this relationship by integrating circular principles to devise business models. Moreover, OA was found to substitute the CBMs in developing new sustainable business models and reconcile sustainability.

The study is among the first to analyze the combined effects of OA, DBT and CBMs on the relationship between I4.0 capabilities and sustainable performance at the supply chain level. Moreover, the findings propose several solutions to resolve the sustainability dilemma through I4.0 capabilities, DBT, OA and CBMs.

There are few publications on personality disorder in adults with intellectual disability (ID), and on borderline personality disorder (BPD) specifically. Publications concerning treatment are sparse, despite the high symptom burden in these patients. This paper aims to discuss these issues.

Six patients with BPD and ID were recruited from the same inpatient unit. Behaviour problems and mental health symptoms were scored on admission and discharge. Information about treatment, length of stay, etc. was taken from case files.

Both mental health symptoms measured by the SCL-90-R, and behaviour problems measured by the Aberrant Behaviour Checklist were significantly reduced on discharge. In the active treatment period, the two main aspects of treatment were validation and practicing new solutions when emotional and behavioural problems occur, i.e. skills training.

The limitations related to this study are that the study is conducted in one milieu only. Another limitation is that the patients were admitted over a five-year period, where, some changes were made in the treatment approach.

Inpatient treatment of this patient group seems to be effective if individually adjusted to the patient’s psychopathology, ID and communication style. Close co-operation between the individual therapist and milieu therapists is essential.

There is a need for intervention studies on BPD in ID. This study may be a valuable contribution.

This paper has been written following an influential therapeutic encounter that we experienced while working with an emotionally distressed woman. The barriers that can get in the way of providing a structured therapeutic approach are discussed. The paper focuses on dialectical behaviour therapy as a treatment model, and discusses how the concept of ‘dialectics’ provide an over‐riding context for case conceptualisation (Linehan, 1993). The dialectical dilemmas and powerful dynamics that can be enacted between individuals, teams and patients in their endeavours to cope with distress will be illustrated. The dialectical philosophy is described and elaborated upon, providing a framework for the synthesis of clinical interpersonal encounters and metaphorical concepts of a therapy seesaw. The paper discusses how these ideas can guide us in our work with emotionally distressed individuals.

The purpose of this paper is to undertake a preliminary evaluation of a novel intervention – Recovery Inspiration Group, which uses recovery stories to promote hope and inspiration for recovery among people with complex mental health difficulties.

The Recovery Inspiration Group was delivered to women on a specialist personality disorder inpatient unit, who were concurrently participating in a dialectical behaviour therapy (DBT) Programme. In total, 12 service users participated in the RIG and as part of the intervention, wrote down key reflections after hearing each recovery story. A thematic analysis of these reflections formed the primary basis of the evaluation. Descriptive statistics derived from a service user feedback survey (n=6) supplemented the qualitative findings.

Three themes were identified in the qualitative data, suggesting that participants had engaged with recovery-oriented reflections and experiences: recovery stories as validating and inspiring; Generalisation of DBT skills; shifting perspectives of recovery: doing better rather than being better. The survey results unanimously endorsed the RIG as a worthwhile and validating experience, which participants would recommend to other service users.

Recovery Inspiration Group appears to be a low-cost and easily replicable intervention with the potential to promote hope and inspiration for recovery among people with complex mental health difficulties.

Recovery Inspiration Group is a novel approach to harnessing the wisdom of people with lived experience of mental health difficulties, to foster hope among users of mental health inpatient services.

External facilitation has been shown to increase the implementation and aid sustainment of new clinical practices. The purpose of this paper is to describe the addition of facilitation to web-based training on dialectical behavior therapy (DBT) skills to promote adoption of this intervention among diverse mental health providers at US Veterans Health Administration facilities.

In total, 41 participants completed six web-based modules and met in two groups monthly over nine months by telephone with a facilitator who was also an experienced DBT skills group therapist. All participants agreed to conduct a DBT skills group as part of training. The facilitators employed a variety of engagement strategies to meet the evolving needs of participants during the training period. Participants completed an online evaluation of the modules and their facilitation experience at six weeks post-training and responded to an e-mail query at five months post-training about conducting a DBT group.

Overall, participants found the training and monthly interprofessional calls with the facilitator useful. Five months post-training, 33 of 41 participants reported conducting a DBT skills group, thus improving access to this intervention. Participants said the biggest barrier to training was finding time during clinic hours to complete the modules, despite assurances of support from local leaders.

This project provides evidence that virtual facilitation enhances training and promotes the adoption of new clinical practices.

There has been a significant expansion of secure psychiatric service provision in the UK, but little discussion about the most appropriate principles on which to base these services. There is longstanding tension between security and treatment that can be difficult to resolve. Solution‐focused ideas may provide a bridge between these two issues, by improving multi‐disciplinary working and providing an appropriate relationship style that optimises the delivery of care to forensic patients.

The Transformers programme is a community-based intervention for people with an intellectual disability (ID) who have emotion regulation difficulties, which can manifest as aggressive and challenging behaviour. The programme was adapted from the Stepping Stones programme (Oxnam and Gardner, 2011) – an emotion regulation programme for offenders with an ID who live in an inpatient setting. The purpose of this paper is to describe the development of the Transformers programme that has been implemented at an ID service, which provides secure and supervised care to people who have been convicted of an imprisonable offence or have high and complex behaviour needs.

The Transformers programme is delivered in weekly sessions over a six-month period in a group format. The focus is on helping group members to develop skills in recognising and understanding negative emotions and learning skills to cope effectively with such emotions. Treatment covers a variety of modules including relaxation, goal setting, chain analysis, emotion recognition, and emotion regulation. Specific strategies used include role-plays, DVDs, and quizzes.

This paper presents the rationale, developmental history, and description of a specific approach to the treatment of emotion regulation difficulties.

The paper aims to inform health professionals working in the field of ID.