Measurement-based care (MBC) can improve mental health treatment outcomes and is a priority within the Department of Veterans Affairs (VA). However, to date, MBC efforts within the VA have focused on assessment of psychological symptoms to the exclusion of psychotherapy process variables such as the therapeutic alliance that may predict treatment response. This quality improvement project involved the implementation of routine monitoring of alliance within a VA substance use disorder (SUD) clinic predominantly serving veterans with serious mental illness. Alliance ratings were provided by 98 veterans following group therapy sessions. Low alliance ratings were used by the clinicians (n = 4) leading the groups (n = 9) as opportunities to discuss veterans' treatment experience and increase engagement. Using multilevel models that accounted for the nested nature of the data and veteran demographics, alliance ratings showed a small increase over time (B = 0.075, p < .001, f2 = 0.033). In addition, maximum alliance rating (i.e., patients' highest rating of alliance across all observations) was significantly but modestly associated with attendance at both MBC group sessions and all SUD-related visits in the 3 months following the initial alliance rating (Bs = 0.96 and 1.79; ps = .006 and .004; f2s = 0.079 and 0.088, respectively). Average alliance rating, however, was not associated with treatment attendance (ps > .050). Findings suggest that assessment of alliance is feasible within a VA SUD clinic and may provide information signaling risk for disengagement that could be used for increasing treatment engagement. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

中文翻译：

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例行监视治疗联盟，以预测退伍军人事务毒品使用失调诊所的治疗参与情况。

基于测量的护理（MBC）可以改善心理健康治疗的结果，并且是退伍军人事务部（VA）的优先事项。但是，迄今为止，VA内的MBC努力集中于评估心理症状，以排除心理治疗过程变量，例如可能预测治疗反应的治疗联盟。这个质量改善项目涉及在VA物质使用障碍（SUD）诊所内实施联盟常规监测，主要服务于患有严重精神疾病的退伍军人。小组治疗之后，由98位退伍军人提供了联盟等级。领导小组（n = 9）的临床医生（n = 4）使用较低的联盟评分作为讨论退伍军人的治疗经验和增加参与度的机会。使用考虑了数据和资深人口统计信息的嵌套性质的多层模型，联盟等级随时间推移显示出小幅增加（B = 0.075，p <.001，f2 = 0.033）。此外，最大联盟评分（即，所有观察结果中患者对联盟的最高评分）与初始联盟评分后的3个月内参加MBC组会议和与SUD相关的所有就诊的出席率显着但不相关（Bs = 0.96）和1.79； ps = 0.006和.004； f2s分别为0.079和0.088）。但是，平均联盟评分与治疗出勤率无关（ps> .050）。研究结果表明，在VA SUD诊所内对联盟的评估是可行的，并且可以提供信息表明脱离风险，可以用于增加治疗参与度。