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Patient-Provider Therapeutic Alliance Contributes to Patient Activation in Community Mental Health Clinics

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Abstract

Patient activation, often conceptualized as an individual trait, contributes to mental health outcomes. This study assessed the relational contributors to activation by estimating the longitudinal association of patient-provider communication and two factors of therapeutic alliance (agreement on tasks/goals and bond), with patient activation. Participants were patients (n = 264) from 13 community-based mental health clinics across the United States. In multivariate models, controlling for patients’ individual and clinical characteristics, the task/goal factor of therapeutic alliance emerged as a significant and independent predictor of greater change in patient activation scores. Improving patient activation may require addressing patient-provider interactions such as coming to collaborative agreement on the tasks/goals of care.

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Acknowledgments

This study was supported by NIH Research Grant # P60 MD002261-03 funded by the National Institute of Minority Health and Health Disparities. Authors do not have any conflicts of interest to disclose. The DECIDE intervention is based upon the educational strategy developed by the non-profit organization, the Right Question™ Institute (formerly, the Right Question Project). Since 1991, the Right Question Institute (www.rightquestion.org) has been develo** and refining its innovative strategy for teaching question formulation and decision skills by learning from people in low-income communities around the country as they learned to advocate for their children’s education, and advocated for themselves and their families in their ordinary encounters with social services, health care, housing agencies, job training and other programs. RIGHT QUESTION™, QUESTION FORMULATION TECHNIQUE™ and FRAMEWORK FOR ACCOUNTABLE DECISION-MAKING™ are trademarks owned by the Right Question Institute and are being used by the Cambridge Health Alliance with the Right Question Institute’s permission. The Right Question Institute neither endorses nor is affiliated with this material and the associated research.

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Authors and Affiliations

  1. Department of Family Medicine and Community Health, Program in Health Disparities Research, University of Minnesota, 717 Delaware St. SE, Suite 166, 55414, Minneapolis, MN, USA

    Michele L Allen

  2. Center for Multicultural Mental Health Research, Cambridge Health Alliance, Somerville, USA

    Benjamin Lê Cook, Nicholas Carson & Margarita Alegría

  3. Department of Psychiatry, Harvard Medical School, Boston, USA

    Benjamin Lê Cook, Nicholas Carson, Martin La Roche & Margarita Alegría

  4. VA New Jersey Health Care System, Lyons, NJ, USA

    Alejandro Interian

  5. Boston Children’s Hospital, Boston, USA

    Martin La Roche

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  1. Michele L Allen
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  6. Margarita Alegría
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Correspondence to Michele L Allen.

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Allen, M.L., Cook, B.L., Carson, N. et al. Patient-Provider Therapeutic Alliance Contributes to Patient Activation in Community Mental Health Clinics. Adm Policy Ment Health 44, 431–440 (2017). https://doi.org/10.1007/s10488-015-0655-8

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