The Role of Therapeutic Alliance and Fidelity in Predicting Youth Outcomes During Therapeutic Residential Care

There is a gap in understanding how the treatment fidelity aspects of adherence and quality, along with common process factors such as therapeutic alliance, impact outcomes for youth. Few studies have examined both constructs of implementation and process factors simultaneously in regard to their relationship to client outcomes. This study examined the role of (a) youth ratings of implementation quality for a provider of therapeutic residential care, (b) the records of staff ratios of positive to negative statements to youth as reported for a token economy system, and (c) youth ratings of therapeutic alliance in relation to youth emotional and behavioral functioning at 6 months into therapeutic residential services. The study included data collection activities with 112 youth and staff at intake into residential group care through 6 months into residential services. Both youth ratings of therapeutic alliance and the ratio of positive to negative staff interactions with youth were related to improved youth emotional and behavioral functioning, as reported by staff using the Child Behavior Checklist. These findings suggest that it is important to consider both implementation and common process factors when looking to improve the quality of care for youth in therapeutic residential care.