Desert Visions Youth Wellness Center

The Desert Visions Youth Wellness Center in Sacaton, Arizona

MSPI Funding Supports Staff DBT Training and Leads to Improved Outcomes at Desert Visions Youth Wellness Center

Desert Visions Youth Wellness Center stands out as a compelling example of how a small amount of additional, targeted funding can dramatically improve both program outcomes for behavioral health clients and job satisfaction for clinic staff. In this case, the additional funding came from the Indian Health Service’s (IHS) Methamphetamine and Suicide Prevention Initiative (MSPI or Initiative).

Desert Visions, a residential treatment center serving Native youth with a primary diagnosis of substance abuse or dependence, received the funding award, along with 126 other Tribal, IHS, urban Indian and youth programs, in 2009. Congress appropriated MSPI funding in answer to testimony from Tribal leaders, health practitioners and public health experts highlighting the incidence of suicide and prevalence of methamphetamine use in their communities. Congress intended the Initiative to support pilot projects using or adapting evidenced-based or practiced-based programming, as well as projects developing promising practices. The funding allowed projects to address suicide or methamphetamine use, or both issues. For Desert Visions, the MSPI provided the funding necessary to train staff in Dialectic Behavioral Therapy, which, in turn gave the staff the ability to better address the co-occurring disorders experienced by a majority of the clients at the Center.

Recognizing the Need

This expanded training fills a great need. While Desert Visions focuses on treating substance abuse or dependence, the overwhelming majority of the youth come to Center with dual diagnoses. Most clients have contemplated suicide or engaged in destructive or self-harming behavior at some point prior to their admission to Desert Visions. That fact, added to a host of other challenges faced by the youth, makes suicidal ideation and self-harming behavior a real threat to the Center’s resident population. Leadership at Desert Visions recognized that one of the causes of unsuccessful treatment outcomes was a lack of training in certain therapies well-suited to addressing self-destructive behavior such as cutting and suicidal ideation. Additionally, many of the adolescents engaging in self-destructive behaviors also showed poor interpersonal skills and a significant inability to regulate their emotions. This combination often resulted in client behaviors that caused staff burn out.

Introducing Dialectic Behavioral Therapy as a Means to Address Co-Occurring Disorders

Providing Dialectic Behavioral Therapy (DBT) training gave Desert Visions staff members additional, effective tools to address these types of presenting issues. DBT is a comprehensive cognitive-behavioral treatment that has been shown to be effective with disorders involving self-harm, emotional dysregulation, and co-occurring disorders including substance abuse. With the implementation of DBT, Desert Visions has been able to integrate an evidenced-based therapeutic modality with traditional/spiritual practices. Interventions include concepts of mindfulness-- everything is connected to everything else; Wise Mind- spirituality; and being centered, present, and in the moment. Interventions also incorporate cultural and spiritual practices including talking circles, sweat lodges, and smudging.

Promising Results for Desert Visions and Similar Treatment Programs Serving Native Youth

With additional tools and new intervention approaches, the Center has gained the enhanced ability to intervene therapeutically in situations that, in the past, may have resulted in termination of treatment. Desert Visions notes three key successful outcomes linked to the new therapeutic modalities: 1) a higher number of adolescents successfully completing treatment, 2) improved delivery and coordination of care by all staff, and 3) improved ability by the adolescents to utilize skillful/effective behavior instead of self-destructive/harmful behavior.

In addition to expanding training opportunities, MSPI funds have also allowed Desert Visions to reinforce the evaluative arm of programming. Evaluation includes a number of activities and provides a more detailed picture of the program’s promising results. For example, clients complete the Youth Outcome Questionnaire-SR (YOQ-SR) upon admission and weekly thereafter, throughout their treatment stay. (The YOQ-SR is a 64 item questionnaire that measures outcome related to intra-personal distress, somatic complaints, interpersonal relations, social problems, and behavioral dysfunction.)

Outcomes are used by the clinical staff in collaboration with the clients and their families to modify treatment throughout the client’s stay at Desert Visions in order to meet treatment goals. A review of clinical outcome data using the YOQ-SR for all clients served in 2011 demonstrated that 98% of all graduating clients had statistically significant changes in their scores on the YOQ-SR. Of the clients who did not graduate successfully, 66% still had statistically significant change when discharged. Overall, nearly 90% of all clients coming to Desert Visions in 2011 had measurable, significant improvement.

The community has taken note of the Center’s success as well. Tribal leaders have strongly supported Desert Visions’ use of the MSPI funding, while parents and family members have commented on the positive changes in the youth when they visit and participate in family therapy.

Challenges and Lessons Learned

The Desert Visions leadership acknowledges that change brings its own challenge. As with any new treatment modality, the transitions challenge old ways of thinking and ask staff members to learn new skills, adjust to new procedures, and get comfortable with a new approach. Furthermore, these adjustments must take place in a challenging environment.

To help ensure a smooth transition and overall work satisfaction, the Center incorporates follow-up training and provides ongoing support systems to staff. Support systems include weekly team meetings. Each staff joins a team of five to six people, and each team works toward improving skills, fostering a team spirit, and reducing the likelihood of staff burnout.

Next Steps and Take-Away Thoughts

Over the course of the MSPI project, Desert Visions has used funding to successfully balance valuable assets like institutional memory with the ability to embrace a new and promising ways of operating. Clients, their families, and Desert Visions staff are seeing the impressive results of this responsive approach. As Desert Visions carries on its work, it creates a model other programs can implement – and this holds the potential to bring improved outcomes to youth and their families across Indian Country.