Modifying the Dialectical Behavior Therapy Mindfulness Curriculum Implemented with Transition-Age Youth and Young Adults in Foster Care

YTP’s DBT mindfulness modification process was conducted to understand: 

• The elements of DBT mindfulness that do not resonate with youth and may limit early engagement in YTP; 
• The elements of DBT mindfulness that are difficult for YTP coaches to facilitate; and
• Any differences observed by youth and coaches between the original and modified curriculum. 

Since YTP started, the Alameda County Social Services Agency, YTP program staff, and the evaluation team at Chapin Hall have tried to increase early engagement among program youth. After modifying the language and materials used in YTP so they are more relevant to racially and ethnically diverse youth, the YTP team decided to modify the mindfulness curriculum that is delivered during the first two weeks of each DBT module. They focused on this curriculum because (1) understanding mindfulness and related concepts is essential to meaningful engagement with the rest of the DBT curriculum, (2) mindfulness requires a new way of thinking which can be challenging for people new to it, and (3) participants may be more likely to persist in the program if they find the mindfulness content relevant during the first two weeks of DBT.   

The modification process started with delivering the original DBT mindfulness curriculum to youth and getting their feedback on it (Time 1). Then an advisory group comprised of subject matter experts like DBT practitioners, and mindfulness and meditation experts, reviewed the feedback and suggested changes. The YTP coaching team then used those suggestions to modify the curriculum and delivered it to youth again for feedback (Time 2). YTP coaches also provided feedback on their delivery of the modified curriculum and the advisory group reviewed all of the feedback to inform further updates to the curriculum. 

• YTP changed the cadence, framing, and structure of the mindfulness curriculum. The coaching team changed the cadence by introducing the concepts in the first two weeks, and provided more time for discussion and application of concepts. They changed the framing by talking about how mindfulness gives you a chance to reflect or focus your mind rather than trying to “control” your mind. And they changed the structure from a lecture format to an activity-based format. 
• Youth thought the modified curriculum was more interactive than the original and that it gave them more chances to reflect on their feelings. However, they thought additional engagement and small-group activities are needed so that they have more opportunity to apply and retain the information, especially when they are experiencing other life challenges.
• YTP coaches thought youth engaged more in the modified curriculum. Coaches reported that they were also trying to build their own skills by compiling a bank of mindfulness exercises that connect to specific skills or lessons so they feel more comfortable with spontaneously adjusting to youths’ needs. They emphasized using exercises that do not involve extensive focus on the body because it can be uncomfortable for youth with a history of trauma. 

This brief describes the process of modifying the DBT mindfulness curriculum for transition-age youth in YTP. The YTP evaluators at Chapin Hall conducted focus groups with youth to understand their perceptions of the curriculum before and after it was modified. An advisory group comprised of subject matter experts in DBT, and mindfulness and meditation experts, provided input into the modifications based on youths’ feedback. The YTP coaching team designed and implemented the changes. Feedback from YTP coaches informed recommendations for additional modifications in the future. 

Van Drunen, Molly, Amy Dworsky, and LaShaun Brooks (2024). Modifying the Dialectical Behavior Therapy Mindfulness Curriculum Implemented with Transition-Age Youth and Young Adults in Foster Care. OPRE Report # 2024-003, Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.