Therapeutic alliance and outcome in a VA intensive case management program.
A total of 143 clients and their case managers in a Veterans Affairs (VA) intensive case management program modeled on the Program for Assertive Community Treatment rated their therapeutic alliance after two years in the program. Strong case-manager-rated alliance was associated with reduced symptom severity and improved global functioning as rated by independent assessors; it was also associated with higher client ratings of community living skills and more positive outcome as perceived by both clients and case managers. Strong client-rated alliance was associated only with more positive client-perceived outcome. Alliance ratings were not associated with use of inpatient psychiatric hospitalization. The case manager-client alliance appears to be a significant component of therapeutic effectiveness.
Neale
M S
MS
Northeast Program Evaluation Center, Veterans Affairs Medical Center, West Haven, CT 06516, USA.
Rosenheck
R A
RA
D000203:Activities of Daily Living / Q000523:psychology*; D000328:Adult; D000341:Affective Disorders, Psychotic / Q000523:psychology / Q000534:rehabilitation; D019090:Case Management; D003156:Community Mental Health Services / Q000592:standards*; D003237:Connecticut; D005260:Female; D005500:Follow-Up Studies; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000534:rehabilitation*; D008875:Middle Aged; D010348:Patient Care Team; D017060:Patient Satisfaction; D011369:Professional-Patient Relations; D011618:Psychotic Disorders / Q000523:psychology / Q000534:rehabilitation; D012559:Schizophrenia / Q000534:rehabilitation; D012565:Schizophrenic Psychology; D016896:Treatment Outcome; D014728:Veterans / Q000523:psychology*