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This paper aims to present preliminary findings regarding the types of adaptations made to dialectical behavior therapy (DBT) and their effectiveness in working with a population who have both intellectual disabilities and mental illnesses.

A pilot study conducted with adolescent clients in a day treatment program was completed in an effort to determine the effectiveness of dialectical behavior therapy for special populations (DBT‐SP). The study utilized all three components of DBT, in addition to the normal milieu management techniques. As such, clients received DBT‐SP focused individual therapy, skills training groups using the DBT‐SP skills training manual, and the whole treatment team staff participated in a DBT‐SP supervision/consultation group. Observations of client behavior by staff, client outcome when leaving the program, and daily diary card information was collected.

Although there are a number of issues that must be addressed when providing psychotherapy to individuals with intellectual disabilities and mental illnesses, many psychotherapeutic techniques are effective if they are suitably modified (Bütz et al., 2000; Nezu and Nezu, 1994) as has been found with DBT‐SP.

As with most pilot studies, there are many limitations to the data. While each client serves as his/her own control, there is no random control group as all the youths receive DBT‐SP. Further, DBT‐SP is used in conjunction with other techniques and the study lacks the ability to control for any additional factors in the students' environment that may influence their behavior. In addition, clients enter and leave the program at different times, and so the data gathered can be hard to interpret. Thus, far, the data are suggestive, but not conclusive, regarding the effectiveness of DBT‐SP.

The information in this paper will be useful to therapists providing treatment to clients with intellectual disabilities and mental illnesses.

Recent reports by the Institute of Medicine (IOM) signal a substantial yet unrealized deficit in patient safety innovation and improvement. With the aim of reducing this dilemma, we provide an introductory account of clinical error resulting from poorly designed systems by reviewing the relevant health care, management, psychology, and organizational accident sciences literature. First, we discuss the concept of health care error and describe two approaches to analyze error proliferation and causation. Next, by applying transdisciplinary evidence and knowledge to health care, we detail the attributes fundamental to constructing safer health care systems as embedded components within the complex adaptive environment. Then, the Health Care Error Proliferation Model explains the sequence of events typically leading to adverse outcomes, emphasizing the role that organizational and external cultures contribute to error identification, prevention, mitigation, and defense construction. Subsequently, we discuss the critical contribution health care leaders can make to address error as they strive to position their institution as a high reliability organization (HRO). Finally, we conclude that the future of patient safety depends on health care leaders adopting a system philosophy of error management, investigation, mitigation, and prevention. This change is accomplished when leaders apply the basic organizational accident and health care safety principles within their respective organizations.