Therapeutic alliance and treatment outcome in the primary care behavioral health model.

Abstract

The current study investigated therapeutic alliance and clinical improvement within an integrated primary care behavioral health model. Participants included 542 primary care patients seen in two large family medicine clinics. Mental health symptoms and functioning were assessed using the 20-item Behavioral Health Measure (Kopta & Lowery, 2002) at the beginning of each patient appointment. Therapeutic alliance was measured with the Therapeutic Bond Scale (CelestHealth Solutions, 2008) following an initial appointment with one of 22 behavioral health consultants (BHCs). Primary care patients rated their therapeutic alliance following a first appointment with a BHC as statistically stronger than alliance ratings from a previously reported sample of outpatient psychotherapy patients after the second, third, and fourth psychotherapy sessions (Kopta, Saunders, Lutz, Kadison, & Hirsch, 2009). Results of a bootstrapped linear regression analysis indicated that therapeutic alliance assessed after the first primary care behavioral health appointment was not associated with eventual clinical change in mental health symptoms and functioning. A strong therapeutic alliance was able to be formed in a primary care behavioral health modality. This exceeded the magnitude found in outpatient psychotherapy alliance ratings. Early therapeutic alliance was unrelated to overall clinical improvement in primary care.

Does integrated behavioral health care reduce mental health disparities for Latinos? Initial findings.

“…With regard to therapeutic alliance, contrary to our expectations, we found Latino patients endorsed higher therapeutic alliance compared to non-Latino Whites, and both groups showed high alliance. This is also comparable to other research on alliance in IBHC models (Corso et al, 2012). …”

“…Furthermore, our follow-up rates were similar to those found in other IBHC models (Bryan et al, 2012; Corso et al, 2012). In particular, we found that approximately 28.0% of Latino patients and 34.7% of non-Latino White patients attended their scheduled follow-up sessions, which is similar to the 29.8% attendance rate found by Bryan and colleagues (2012) and the 28.4% found in Corso and colleagues (2012).…”

“…Still, much of this evidence has been obtained through Veterans’ Affairs or active military primary care clinics and in primarily non-Latino White samples (Corso et al, 2012) or samples with unknown ethnic distributions (Bryan et al, 2012). However, over the past decade, the Latino population is expanding into more rural regions of the United States with historically small Latino populations (Ennis, RiosVargas, & Albert, 2011).…”

Diagnoses, intervention strategies, and rates of functional improvement in integrated behavioral health care patients.

“…Medical providers will typically introduce BHCs using a “warm-handoff” that includes a brief description of presenting concerns and the role of the BHC on the medical team. BHCs tend to use brief assessment/screening tools and adapted versions of evidence-based interventions or intervention components, in particular, strategies and techniques based on cognitive–behavioral principles (Bridges et al, 2013; Bryan et al, 2012; Corso et al, 2012; Hunter, Goodie, Oordt, & Dobmeyer, 2009; Ray-Sannerud et al, 2012). …”

“…Preliminary findings estimate that a majority of patients—just over 70%—experience significant improvement when treated in IBHC settings (Bridges et al, 2013; Bryan et al, 2012; Corso et al, 2012). Patients with more severe initial impairment tend to improve more rapidly than patients with less severe initial impairment.…”