The University Hospital of North Norway (UNN), in collaboration with CheckWare, has developed a digital version of the DBT Diary Card for youth struggling to manage their emotions. User-friendliness, security, and clinical utility have been key focus points in developing the digital solution, and UNN has already observed more frequent usage and updates of the cards by patients.
The program is an important part of Dialectical Behavior Therapy (DBT) to assist the treatment team in mapping problematic behaviors and contextualizing the youths' actions. DBT is a therapeutic approach designed to help both young people and adults find the balance between accepting difficult emotions and being able to change behavior. The treatment focuses on changing behavior and practices relational and interpersonal skills, naming emotions, regulating emotions, and coping with stress.
The goal of the therapy is for patients to be able to think clearly in situations where they usually feel overwhelmed. Suicidal youth are one of the main target groups.
Recording diary cards is a central part of DBT. The patient’s reporting is used to identify behavioral patterns, map problem behaviors, and help patients reflect on how their days have been. In therapy sessions, the diary card is used as a starting point to form hypotheses about what triggers and influences the patient’s problematic behavior, and to help patients find good alternative ways to act.
In close collaboration with CheckWare, the University Hospital of North Norway has developed a digital version of the diary card for youth. Digitizing the diary card opens new possibilities to evaluate important processes through aggregated reports based on the patient’s reporting. Priorities in developing the digital solution have been user-friendliness, security, and clinical usefulness.
Developing the diary card in digital format instead of paper completely aligns with feedback from patients who have undergone treatment. It gives therapists a unique opportunity to continuously understand the patients’ mental state and link it to actions and subsequent treatment.
Must make room for youth voices
Kamilla Sørensen has herself been treated with Dialectical Behavior Therapy and today represents the user group of youth aged 12-25. She sits on the Youth Council, an advisory body for UNN, as well as a consultative body for the clinics’ work on developing and maintaining good health services for youth.
Lately, she has been active as an advisor in the development of the digital diary card.
"It is essential that youth voices are given space in matters like this. I participate to ensure that the younger perspective is heard and taken seriously," she says.
"It has been very important that Kamilla has been involved from the Youth Council. She has participated as an advisor regarding the youth group, which is our target group, but has also contributed input on the design of the form and digitalization in general," says Vegard Slettli. He is a clinical psychologist specialist at the Child and Adolescent Psychiatry Section (UPS) at UNN Tromsø. Slettli is the team leader for the DBT team for youth and also sits on the board of the Norwegian Association for Dialectical Behavior Therapy (N-DBT).
One great thing about the diary cards is that you can dare a little more and put down in writing what you find difficult and very private to say in a regular conversation.
Digital forms lower the threshold for use
When Kamilla went through treatment eight years ago, she questioned why the process wasn’t digitalized. For her, this resulted in many cards piling up, some cards not being filled out, while others were forgotten to be brought to the session. It was hard to keep track.
"There was hardly any continuity. Digital cards make the entire process completely different. One issue I care about is finding a language that youth recognize. It must not include too many difficult terms. Another aspect is asking the right questions that actually capture the individual’s problems. The questions cannot be too open or abstract. They should be very direct," she says and believes youth generally appreciate health professionals raising difficult issues:
"It can be a bit tough at first, if you’re not used to being asked such questions. But one great thing about the diary cards is that you can dare a little more and write down what you find difficult and very private in a regular conversation," she says.
"We are experiencing that the program has been positively received. Now that more and more teams are adopting it, we expect the feedback from the youth to increase. That will give us a volume where we can say more about the perceived benefits of the diary cards," says Vegard Slettli, who adds that they originally considered creating an app.
"That proved too challenging, especially regarding privacy. The most important thing in this solution is user-friendliness and security for each young person. We have to make it as easy as possible for them to respond, but in a way that is still secure so that the information does not get lost or misused. That could easily happen if sensitive personal information were stored on each individual’s mobile phone. Furthermore, we must clearly define who will have access to the forms filled out," says Slettli.
Even something as trivial as the order of the questions matters quite a bit. Both say they have received a lot of feedback and opinions, but the most important thing is that the diary card actually gets filled out.
"It’s actually incredible that digital cards haven’t been made before. Many young people have been asking for this," says Slettli.
The most important thing in this solution is user-friendliness and security for each young person. We have to make it as easy as possible for them to respond, but in a way that is still secure so that the information does not get lost or misused.