Borderline Personality Disorder (BPD) is characterized by emotional dysregulation, unstable self-identity and interpersonal relationships, and self-injury. A vast majority will attempt suicide, with 1 in 10 completing suicide. Adverse Childhood Experiences (ACEs) are prevalent in those with BPD – between 30-90% have experienced trauma. Due to these factors, there is a dire need for a trauma-informed, primary prevention intervention for patients with BPD. Through targeting pre-adolescent aged children who have experienced ACEs and their parents, a comprehensive-modal DBT program adapted for children will be implemented at a Philadelphia-based clinic. Trauma-informed care trainings will take place throughout the hospital system in which the clinic is housed.
The DBT-C intervention seeks to utilize a dedicated public health framework as a guide to mitigate the effects of ACEs and reduce the incidence of BPD among participants, that being a general social ecological model. This intervention qualifies as primary prevention of BPD as the project activities seek to reduce the incidence of BPD in the target population; the intervention qualifies as secondary prevention of ACEs as the project activities seek to reduce the impact of trauma in participants with ACEs. The intervention will address these issues with an understanding of the impact that the social determinants of health has on the target population, one that is largely people of color and of low socio-economic status, since trauma does not occur in a vacuum.
Within the individual level of Bronfenbrenner’s Social Ecological Model, the intervention teaches each participant necessary coping and resilience skills, as well as fundamentally addressing trauma through DBT. Within the microsystem, the intervention addresses family of the participants with trauma-informed parenting skills and targeted counseling. Within the mesosystem, skills group sessions are completed with both participants and family, to connect the interactions between the two. In addition, the peer mentoring component adds depth, as it expands the relationship levels within the mesosystem. Within the exosystem, the clinic and the hospital system in which is it housed will participate in trauma-informed training to expand to a trauma-informed systems of care. Within the macrosystem, this trauma-informed systems of care framework deconstructs the shame associated with trauma, creating a safe environment throughout the hospital system and employees, reworking the ways the system functions, trickling down to lower levels of the model. Within the chronosystem, each of these facets of the intervention work to ameliorate historical trauma’s impact, thus over time reducing the suffering experienced.
Through the planned intervention, trauma-informed principles are incorporated to ensure safety and empowerment for every participant. The planned intervention requires time and effort on the part of the participant, so ensuring the participants feel empowered in treatment and feels safe with the providers is imperative. The principle of peer support will be incorporated into the intervention through peer mentoring. Another principle is cultural, historical, and gender issues, which will be incorporated into the intervention by implementing racial concordance. Racial concordance is when services are delivered by a person of the same race as the participant. The final principle, safety, will be incorporated. Within DBT, safety planning is a major component of therapy. With a trauma-informed lens, safety plans will be created at the individual level and the group level, to ensure all participants have ways to stay and feel safe, specifically feeling as though their needs can and will be met, throughout the intervention whether on their own, in individual therapy, or in skills group sessions.
Through addressing each level of the social ecological model, aiming to decrease the incidence of the development of BPD in participants, and educating an entire hospital system on trauma-informed care, this intervention serves as a catalyst to begin trauma-informed systems of care within the Philadelphia area.
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