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.
Keywords: Behavioral health; Community mental health; Managed care; Medicaid; School psychiatry; Therapeutic alliance.