Abstract
This study examines therapeutic alliance (TA) over 2 years and the association with clinical outcomes for children and youth in a home and school-based behavioral health service characterized by innovative TA practices. Caregiver report of TA and functioning were collected monthly and discussed to inform service planning. Trajectory analysis was conducted to discern distinct patterns of TA ratings over time with linear mixed models to examine factors associated with the resulting TA patterns. We identified 1714 Medicaid-eligible youth and families. The majority of families (84%) reported high and steady ratings of TA, 5% reported lower but improving TA ratings, and 11% reported declining TA ratings over time. Average TA rating was associated with family and child functioning, yet all TA groups experienced improved functioning over time. Measurement of TA over time may help clinicians target and improve care for children and families.
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Acknowledgements
The authors gratefully acknowledge the contributions of Jeff Blau, Joel Brecht, Dr. Judy Dogin, Dr. Gail Edelsohn, James Gavin, Wendy Luckenbill, Diane Lyle, Kate Nicholson, and Kelly Perales, Community Care Behavioral Health Organization, Dr. Jane Kogan of the UPMC Center for High-Value Health Care, Dr. Bradley Stein of RAND Corporation, Pittsburgh, PA, and Advocates for Human Potential, Inc., Sudbury, MA for edits to this manuscript and commitment to improving children’s services and the therapeutic experience.
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Data gathering and use of information were approved as quality improvement activities by the University of Pittsburgh Medical Center’s Total Quality Council. Thus, this article does not contain any research studies with human participants performed by any of the authors. The authors certify responsibility for the content contained in this manuscript.
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Hutchison, S.L., Karpov, I., Crisan, A.B. et al. Association of Therapeutic Alliance with Outcomes Over Two Years in Youth and Family Service. Community Ment Health J 54, 935–943 (2018). https://doi.org/10.1007/s10597-018-0275-3
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DOI: https://doi.org/10.1007/s10597-018-0275-3