DBT-Kids program at Kinark; a conversation with Dr. Trull and Dr. Hancock  

January 25, 2024

Some children are what one might call “sensitive.” Perhaps they are shy or prefer to play alone. Other kids could be considered highly sensitive; they might be very aware of every little thing going on around them, are highly empathetic, or exhibit anxiety in new situations. Then there are children who are deemed exquisitely sensitive. These exquisitely sensitive kids’ reactions to seemingly harmless stimuli can catastrophically impact their day and those around them. These kids truly have a very difficult time managing themselves and experience a lot of distress. This is where Dialectical Behaviour Therapy (DBT) has proven to be effective; specifically, with mental health conditions resulting from problematic efforts to control intensely negative emotions.  

Someone who would benefit from DBT experiences problems regulating emotions to the point of ruinous impact to their daily life. For kids, that might be the inability to attend school, struggles to maintain friendships due to emotional outbursts, or family interactions that lead to them engaging in verbal or physical aggression.  DBT supports improved emotion regulation through the balance of helping families accept where the child is at in any given moment, while at the same time, teaching ways to change how they notice, understand, and respond to emotions.  

Dr. Alan Fruzzetti, Ph.D. and Dr. Armida Fruzzetti, Ph.D., recently developed the DBT-Kids protocol, a variation of Dialectical Behaviour Therapy to better support preadolescent children (ages 7 – 12) within the context of their families, DBT-K is breaking new ground as a multi-level intervention approach. This innovative new approach to DBT therapy is the first of its kind in Ontario. In fact, Kinark is the first and only provider in Canada to be implementing the DBT-Kids protocol developed by the Fruzzettis.  

Dr. Graham Trull and Dr. Megan Hancock led the efforts around the implementation of the DBT–Kids therapy program at Kinark and offer their insights around what that process was like, as well as the success of the program.  

Dr. Hancock and Dr. Trull, can you tell us more about the DBT-K program at Kinark?  

The DBT-K program is currently running at 3 Kinark sites (Peterborough, Northumberland and Durham). It is a 25-to-45-week program depending on the needs and treatment requirements of each individual, that involves children learning developmentally  appropriate DBT skills, caregivers learning to use DBT skills within their  parenting , and most uniquely, family therapy, where everyone gains skills to function better as a family unit.?  

When was the DBT-K program introduced at Kinark? And why was it implemented?  

The program was implemented over the course of the past year, with the full model first being offered in Spring 2023. It was implemented because the outpatient mental health programs at Kinark Child and Family Services observed an increase in the number of youth aged 12 and under being referred for services due to challenges with regulating emotions, leading to physical and verbal aggression towards others, as well as self-harm and suicidal urges and threats.   

Historically, the treatment of these children tends to be lengthy, with challenges applying the skills learned in treatment when the child is in the home and school environments.?The DBT-K program offered an approach that would better meet the needs of these complex children and families.  

What drew you to Dr.’s Alan and Armida Fruzzetti’s work?  

Dr.’s Alan and Armida Fruzzetti are experts in the field of DBT, as well as working with families. Their approach offered flexibility in the delivery of DBT to these children and families compared to other DBT-based interventions. They have demonstrated effectiveness in their work, and we had confidence in our ability to train staff in the approach and deliver the program in a community-based setting.  

You mentioned that historically treatment of these children has been lengthy. How long would treatment typically take compared to the DBT-K program?  

It wouldn’t be uncommon for a child with this set of difficulties to be in treatment for 2 or more years due to risk behaviours and other high needs. This is in contrast to the DBT-K program, which is 25 to 45 weeks in length.    

How many clinicians and providers make up the DBT-K care teams?   

At present, the teams in each location consist of 5-7 clinicians, with plans to train more team members in the coming year. At a given time, a family would have contact with 1 individual/family therapist, and 2 group facilitators running the parent group.  

Do you feel the program has been successful? Why?  

Thus far, families are reporting success in the program, with observable reductions in behaviours of concern (e.g. verbal and physical aggression, self-harm), and improvements in parent-child relationships and family functioning. The team feels positive about this treatment program and the structure and effectiveness that is offered within DBT-K. The weekly staff DBT consult portion of the program has been highly valued by clinicians, who would typically be struggling to manage these children/families on their caseload.   

Do you envision any enhancements being made to this program going forward?  

Our plan for the next year is to begin formal data collection within the program to look at outcomes for these children and families. Other enhancements will be based on feedback from current clients. We want to continue to work on delivering the program to our highest needs families, being aware of barriers such as transportation, socio-economic challenges, and time commitments.  

To inquire and learn more about the DBT-Kids program at Kinark, please call our Central Intake team at 1-888-454-6275.   

Content provided by Dr. Graham Trull, Ph.D., C.Psych. and Dr. Megan Hancock, Ph.D., C.Psych. CMHO Conference presentation: Implementation of DBT–Kids Within a Children’s Community Mental Health Program.