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Clinician Racial Biases: Preliminary Investigation on Predictors of Poor Therapeutic Alliance and Retention in Home Visiting Intervention Program

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Abstract

Background

Home visiting programs are effective in improving maternal-child health, and higher therapeutic alliance is associated with improved program retention and outcomes. Black, single, low-income mothers have a higher risk for poorer health outcomes in pregnancy and postpartum and for early termination of therapeutic services.

Objective

To examine associations between clinician and client alliance and social, economic, and racial demographics.

Methods

Mothers (N = 71) who were pregnant or had an infant (age < 24 m) receiving Infant Mental Health (IMH) services through community health service agencies and their clinicians (N = 50) completed the Scale to Assess Therapeutic Relationships (clinicians: STAR-C, clients: STAR-P) at 3-, 6-, 9-, and 12 months, and provided demographic information.

Results

Survival analysis showed those with higher alliance ratings, both client and clinician ratings, at the 3-month time-point were more likely to remain in treatment longer (for clients est = -1.67, p = .0017; for clinician est = -.75, p = .031). Controlling for clinician experience and frequency of reflective supervision, Black clinicians had higher alliance ratings than white clinicians, (b = 3.1 (1.6), p = .049). Neither clinician-client racial match nor client marital status predicted alliance. Black clinicians’ ratings of alliance did not vary by client race, but white clinicians reported weaker alliance with their Black, relative to white, clients (β = .40, p = .045).

Conclusions

Weaker alliance reported by white clinicians with Black clients, coupled with a lack of client-race related differences for Black clinicians, suggests white clinician racial bias may be important to consider in regards to program retention and health disparities.

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Data Availability

Not applicable.

Code Availability

Not Applicable.

Abbreviations

IMH-HV:

Infant Mental Health-Home Visiting Program

Alliance:

Therapeutic alliance

TA:

Therapeutic alliance

STAR:

Scale to assess therapeutic relationships

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Funding

The authors gratefully acknowledge that this research was made possible through the financial support provided by the Centers for Medicaid and Medicare through the Michigan Department of Health and Human Services, the Ethel and James Flinn Foundation, the Gerstacker Foundation, the University of Michigan’s Women and Infants Mental Health Program, and the Michigan Department of Health and Human Services Community Mental Health Services Block Grant (K. Rosenblum and M. Muzik, PIs). This work was also funded by the National Institute of Child Health and Development (NICHD) [Grant # 5T32HD079350], which made it possible to conceptualize and write this manuscript.

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Authors and Affiliations

  1. Department of Pediatrics, University of Michigan Medical School, 1540 E Hospital Dr, Ann Arbor, MI, 48109, USA

    Chioma Torres

  2. Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA

    Katherine L. Rosenblum, Jennifer M. Jester, Megan M. Julian & Maria Muzik

  3. Center for Children, Families, and Communities, Central Michigan University, 2480 West Campus Drive, Suite B100, Mount Pleasant, MI, 48858, USA

    Larissa N. Niec

  4. Department of Obstetrics & Gynecology, University of Michigan Medical School, 1540 E Hospital Dr, Ann Arbor, MI, 48109, USA

    Katherine L. Rosenblum & Maria Muzik

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  1. Chioma Torres
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  2. Katherine L. Rosenblum
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  3. Jennifer M. Jester
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  4. Megan M. Julian
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Michigan Collaborative for Infant Mental Health Research

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Correspondence to Chioma Torres.

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The study was approved by the University of Michigan Review Board (ID no. HUM00096040).

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Torres, C., Rosenblum, K.L., Jester, J.M. et al. Clinician Racial Biases: Preliminary Investigation on Predictors of Poor Therapeutic Alliance and Retention in Home Visiting Intervention Program. Matern Child Health J 26, 953–961 (2022). https://doi.org/10.1007/s10995-021-03369-z

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  • DOI: https://doi.org/10.1007/s10995-021-03369-z

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