4 - (Sym 57) Dialectical Behavior Therapy Improves Mental Health Outcomes Among Adolescents in Confinement

On any given day approximately 48,000 youth are confined due to their involvement in the U.S. juvenile or criminal legal systems. Most (92%) are held in locked facilities, with two-thirds held for longer than a month. Black and Native American youth are extremely overrepresented in these facilities, with disparities particularly pronounced among Black boys and girls and Native American girls; white youth are underrepresented. About two-thirds of boys and three-quarters of girls in confinement have a diagnosable psychiatric condition; nearly half meet criteria for a substance use disorder. One treatment showing promising effects for improving mental health and reducing recidivism among youth in confinement with significant trauma histories is Dialectical Behavior Therapy (DBT). Originally designed to treat borderline personality disorder, DBT incorporates mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness to address a range of behavioral health concerns. The current study aimed to assess the impact of comprehensive DBT on mental health among youth in confinement.

Participants were 113 youth in a long-term post-adjudication facility which implemented a comprehensive DBT program (including individual/family therapy, skills training groups, coaching for residents, staff education/support teams, and mental health staff team consultation). Youth participated in weekly DBT skills groups and individual therapy for the duration of their confinement, completing pre- and post-treatment assessments. Assessments included the Difficulties in Emotion Regulation Scale Short-Form (n=110 complete cases), Trauma Symptom Checklist for Children (n=77 valid complete cases), Beck Youth Inventory (n=44 complete cases), and the Adolescent Anger Rating Scale (n=67 complete cases). Paired samples t-tests with complete cases were used to examine within subject changes.

Youth were on average 15.4 years old (SD=1.1), 31.9% girls, and identified as 69.0% Latinx, 22.1% Black, 8.0% White, 0.9% Native American; youth reported exposure to on average 6.4 different trauma types (SD=2.7; 5% no trauma exposure). Most (94%) successfully completed the program, with 5.5 months on average between pre/post-tests (SD=1.9). Statistically significant improvements in emotion regulation and mental health (anxiety, depression, anger, posttraumatic stress, dissociation, disruptive behavior, self-concept) were observed (p’s< .05). Results demonstrate promising effects of DBT on mental health for youth in confinement.