Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA.
J Dev Behav Pediatr. 2010 Feb-Mar;31(2):83-91. doi: 10.1097/DBP.0b013e3181cda770.
Studies in pediatric primary care suggest that interactions between parents and providers may have therapeutic impact on children's mental health problems. Methods to measure interactions specific to mental health outcomes have been developed in psychotherapy but are only beginning to be applied in primary care. We tested an adaptation of the Vanderbilt Therapeutic Alliance Scale (VTAS) for rating parent-provider interactions in pediatric primary care.
Recoding, using the VTAS, of 50 previously collected audiotapes of visits to a pediatric residents' continuity clinic. Concurrent validity of VTAS coding was measured by comparing it to independent coding using the Roter Interaction Analysis System. Predictive validity was tested by comparing VTAS scores to parent ratings of the residents' behavior in the domains of interpersonal sensitivity, partnership, and informativeness.
The VTAS demonstrated a factor structure very similar to the structure observed when it has been used to rate mental health visits. VTAS patient and provider subscale scores correlated with corresponding Roter Interaction Analysis System measures of parent and resident participation. Total VTAS scores correlated most strongly with Roter Interaction Analysis System scores indicating emotion and rapport-building statements from the resident. Total VTAS scores predicted parents' ratings of residents' interpersonal sensitivity but not ratings of partnership or informativeness.
It appears possible to use therapeutic alliance to rate interactions in primary care. Measuring alliance may bring greater efficiency to primary care mental health studies because of its potential specificity as a marker of mental health-related outcomes.
儿科初级保健研究表明，父母与提供者之间的互动可能对儿童的心理健康问题产生治疗影响。已经开发出用于测量特定于心理健康结果的互动的方法，但这些方法仅开始在初级保健中应用。我们测试了一种用于评估儿科初级保健中父母与提供者互动的范德比尔特治疗联盟量表（VTAS）的改编版。
使用 VTAS 对以前收集的 50 个儿科住院医生连续诊所就诊的录音带进行重新编码。通过将 VTAS 编码与使用 Roter 互动分析系统进行的独立编码进行比较来衡量 VTAS 编码的同时效度。通过将 VTAS 评分与父母对居民在人际敏感性、伙伴关系和信息提供方面的行为的评分进行比较来测试预测有效性。
VTAS 表现出的因子结构与用于评估心理健康就诊的结构非常相似。VTAS 患者和提供者子量表评分与 Roter 互动分析系统中父母和居民参与的相应测量值相关。VTAS 总分与 Roter 互动分析系统评分最相关，该评分表示居民的情感和建立融洽关系的陈述。VTAS 总分预测了父母对居民人际敏感性的评分，但不能预测对伙伴关系或信息提供的评分。
似乎可以使用治疗联盟来评估初级保健中的互动。由于其作为心理健康相关结果的标记物的潜在特异性，测量联盟可能会为初级保健心理健康研究带来更高的效率。
