Hutchison Shari L, Karpov Irina, Crisan Alina Bodea, Hulsey Eric, Dan David
Community Care Behavioral Health Organization, UPMC Insurance Services Division, 339 Sixth Avenue, Suite 1300, Pittsburgh, PA, 15222, USA.
Allegheny County Office of Behavioral Health, Data Analysis, Research, and Evaluation, Pittsburgh, PA, USA.
Community Ment Health J. 2018 Oct;54(7):935-943. doi: 10.1007/s10597-018-0275-3. Epub 2018 Apr 26.
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.
本研究考察了以创新治疗联盟（TA）实践为特征的家庭和学校行为健康服务中，儿童和青少年在两年期间的治疗联盟情况及其与临床结果的关联。每月收集照顾者关于治疗联盟和功能状况的报告，并进行讨论以指导服务规划。采用轨迹分析，通过线性混合模型识别治疗联盟评分随时间变化的不同模式，以检验与所产生的治疗联盟模式相关的因素。我们确定了1714名符合医疗补助条件的青少年及其家庭。大多数家庭（84%）报告治疗联盟评分高且稳定，5%报告评分较低但呈上升趋势，11%报告评分随时间下降。平均治疗联盟评分与家庭和儿童功能状况相关，但所有治疗联盟组的功能状况都随时间有所改善。对治疗联盟随时间的测量可能有助于临床医生针对儿童和家庭进行精准治疗并改善护理。
