Parent-professional alliance and outcomes of child and family care: A systematic review

This presentation is based on a systematic review on the association between the parent-professional alliance and outcomes of youth and family care. In child and family social services, parents play an important role (Accurso, Hawley, & Garland, 2013; Chaffin & Bard, 2011). They are either the main target of service delivery (e.g., parenting support), are involved in child-focused care (e.g., residential care), or are involved in family- or multisystem-focused care (e.g., Multisystemic Therapy). Despite the important role of parents, empirical evidence that helps to optimize outcomes of care offered to parents is limited (Myers, 2008). Available studies investigating elements of effective care, often focus on effective intervention programs (Karver, Handelsman, Fields, & Bickman, 2006). Useful as these studies are, a broader focus is needed when investigating ingredients of effective care. Research in adult mental health shows that care effects are not only influenced by specific factors such as interventions or therapeutic techniques, but also by common factors, relating to care processes and outcomes, regardless of the therapeutic approaches (McLeod, 2011). One of these common factors is the alliance between clients and professionals (Grencavage & Norcross, 1990; Weinberger, 1995; Norcross, 2002). Recent meta-analyses indicated that alliance is a consistent predictor for outcomes of individual psychotherapy for adults (Norcross, 2011; Hubble, Duncan, Miller, & Wampold, 2010). Although alliance research in youth and family services has lagged behind in comparison to service delivery to adult clients, meta-analyses on the alliance-outcome association in youth psychotherapy (McLeod, 2011) and family therapy (Friedlander, Escudero, Heatherington, & Diamond, 2011) indicated that alliance plays an important role in realizing positive care outcomes. However, these studies offered no or limited information regarding the association between the parent-professional alliance and outcome, and potential moderators of this relationship. Furthermore, given the specific focus of these studies, information about other types of care involving parents (e.g., parenting support) is lacking. As a result, drawing general conclusions regarding the importance of the parent-professional alliance for outcomes in youth and family care presents a challenge. This knowledge gap limits our ability to understand how we can optimize youth and family care involving parents, and thereby promoting children’s well-being and psychosocial development. Since knowledge concerning the association between the parent-professional alliance and outcomes of youth and family care is limited and not yet aggregated, we have taken up this challenge and conducted a comprehensive systematic literature review. In accordance with the PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses (Moher, Liberati, Tetzlaff, & Alsman, 2009), we explored research examining the relationship between parent-professional alliance and outcomes. With respect to this association, we distinguished outcomes related to the behavioral impact of treatment (i.e., changes in child, parent, or family functioning), and outcomes associated with the treatment process (i.e., dropout/retention, treatment satisfaction). Furthermore, we investigated whether factors can be identified that moderate this alliance-outcome association. In line with previous meta-analyses (e.g., McLeod, 2011), we differentiated between methodological moderators (i.e., source and timing of alliance assessment), and moderators related to the context and content of care (i.e., referral source, target problem). In this presentation, following a brief introduction of the study design, we will present the results of this systematic review. In conclusion, we invite symposium participants to reflect on implications of our findings for professionals, researchers, educators and policy makers in the field of youth care, regarding the role of the parent-professional alliance in optimizing outcomes for children and families.