title: Examining Change in Therapeutic Alliance to Predict Youth Mental Health Outcomes.
abstract: OBJECTIVE
  To examine the link between therapeutic alliance and youth outcomes.
  
  
  METHODS
  The study was conducted at a group-home with 112 youth with a disruptive-behavior diagnosis. Therapeutic alliance was collected routinely via youth and staff report. Outcome data were collected using youth and staff reports of externalizing behavior as well as behavioral incidents occurring during care. Outcome data were collected following intake into services and at 6 and 12 months of care. Data were analyzed to examine (1) if youth behavior problems at intake were predictive of therapeutic alliance and (2) if changes in alliance were predictive of subsequent youth outcomes. These were conducted with a 6-month service-delivery model and replicated with a 12-month model.
  
  
  RESULTS
  There was some support for the first hypothesis, that initial levels of youth externalizing behavior would be related to alliance ratings; however, most of the effects were marginally significant. The second hypothesis, that changes in therapeutic alliance would be related to subsequent youth outcomes, was supported for the 6-month model, but not the 12-month model.
  
  
  CONCLUSIONS
  Changes in therapeutic alliance may be predictive of youth outcomes during care. Additional research into examining therapeutic alliance trajectories is warranted to improve mental health services for youth.
authors.affiliation: University of Nebraska-Lincoln, 247 Barkley Memorial Center, University of Nebraska-Lincoln, Lincoln, NE 68583-0732, Kristin.Hurley@unl.edu.
authors.forename: Kristin
authors.initials: K
authors.lastname: Duppong Hurley
authors.affiliation: Oregon Social Learning Center, 10 Shelton McMurphey Blvd. Eugene, OR, 97401, MarkV@oslc.org.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Van Ryzin
authors.affiliation: University of Nebraska-Lincoln, University of Nebraska-Lincoln, 273 Barkley Memorial Center, University of Nebraska-Lincoln, Lincoln, NE, 68583-0732, Matt.Lambert@unl.edu.
authors.forename: Matthew
authors.initials: M
authors.lastname: Lambert
authors.affiliation: Father Flanagan's Boys Home, 14100 Crawford St. Boys Town, NE 68010, amy.stevens@boystown.org.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Stevens
keywords: adolescents; disruptive behavior; residential care; therapeutic alliance; youth outcomes