title: Longitudinal results of strengthening the parent-team alliance in child semi-residential psychiatry: does team investment make a difference?
abstract: BACKGROUND
  In a semi-residential setting where children switch daily between treatment and home, establishment of a strong parent-team alliance can be a challenge. The development of alliance with parents and the symptoms of the child might be strengthened by a structured investment of treatment team members.
  
  
  METHODS
  Participants were caregivers and treatment team members of 46 children (6-12 years) who received semi-residential psychiatric treatment. An A-B design was applied, in which the first 22 children were assigned to the comparison group receiving treatment as usual and the next 24 to the experimental group, where treatment team members used additional alliance-building strategies. Alliance and symptom questionnaires were filled out at three-month intervals during both treatment conditions. Parent-treatment team interactions, assessed on DVD, were coded according to members' adherence to these strategies.
  
  
  RESULTS
  Multilevel analyses (using MLwiN) showed that based on reports of primary caregivers and a case manager, the alliance-building strategies had a statistically significant effect on the strength of the therapeutic alliance between treatment team members and parents. In addition, primary caregivers in the experimental group reported significant less hyperactivity symptoms of their children.
  
  
  CONCLUSIONS
  Despite the methodological challenge of examining therapeutic processes in this complex treatment setting, this study supports the benefits of structured investment in the parent-team alliance.
authors.affiliation: Curium-LUMC, Centre of Child and Youth Psychiatry, Leiden University, Endegeesterstraatweg 27, 2342 Oegstgeest, The Netherlands.
authors.forename: Audri
authors.identifier: 0000-0001-9497-4196
authors.initials: A
authors.lastname: Lamers
authors.affiliation: GGzE Centre for Child and Adolescent Psychiatry, PO BOX 909 (DP 8001), 5600 Eindhoven, The Netherlands ; Tranzo, Scientific Centre for Care and Welfare, Tilburg University, PO BOX 90153, 5000 Tilburg, The Netherlands.
authors.forename: Chijs
authors.initials: C
authors.lastname: van Nieuwenhuizen
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, Vrije Universiteit Medical Centre, De Boelelaan 1118, 1081 Amsterdam, The Netherlands.
authors.forename: Jos
authors.initials: J
authors.lastname: Twisk
authors.affiliation: Curium-LUMC, Centre of Child and Youth Psychiatry, Leiden University, Endegeesterstraatweg 27, 2342 Oegstgeest, The Netherlands.
authors.forename: Erica
authors.initials: E
authors.lastname: de Koning
authors.affiliation: Curium-LUMC, Centre of Child and Youth Psychiatry, Leiden University, Endegeesterstraatweg 27, 2342 Oegstgeest, The Netherlands.
authors.forename: Robert
authors.initials: R
authors.lastname: Vermeiren
keywords: Children; Parents; Residential psychiatry; Therapeutic alliance