Improving adolescent outcomes in residential care: preliminary outcomes of a dialectical behavior therapy-informed treatment model

• DBT-informed model was piloted in a residential youth care setting. • Caregivers reported significant reductions in externalizing behavior problems. • Adolescents reported moderate improvements in emotion regulation. • Therapists rated over 80 % of youth as much or very much improved. • Reliable change varied across informants and outcome domains. Adolescents in residential youth care (RYC) often present with complex mental health needs, including trauma symptoms, emotion dysregulation, and self-harm. Dialectical Behavior Therapy (DBT) has shown promise in addressing these challenges, yet evidence for its implementation in RYC remains limited. This pre-post pilot study examined preliminary outcomes of the Care and Development Model (CDM), a DBT-informed intervention adapted for RYC. Forty-two adolescents (Mage = 15.13, SDage = 1.41; 47.6 % female), along with caregivers and milieu staff, participated. CDM included skills-training group, individual sessions, milieu-based coaching, and staff consultation team meetings. Assessment included pre-intervention trauma symptoms, and pre- and post-intervention assessments of emotion regulation, DBT skill use, suicidality/self-harm, and internalizing/externalizing problems. Post-hoc analyses included reliable change indices and shifts in clinical range. At admission, adolescents reported elevated PTSD symptoms, with significantly higher scores among females (d = –1.48). Improvements varied across domains. Caregiver reports showed clinically significant reductions in Total Problems (d = –0.98) and Externalizing problems (d = –1.11). Adolescents reported modest improvements in DBT-WCCL Blaming Others (d = –0.54) and reduced suicidal ideation. Nearly half (48 %) reported using DBT distress tolerance skills. Therapists rated 81.6 % of adolescents as “very much” or “much” improved, though correlations with adolescent-reported outcomes were modest. Findings suggest that DBT-informed care in RYC holds promise, particularly for addressing externalizing behavior and suicidality. However, variability across outcomes and informants highlights the complexity of implementation and the need for ongoing refinement of DBT adaptations in residential settings.