Initial Score Reliability and Validity of an Observer-Rated Caregiver-Clinician Alliance Scale in Treatment for Youth Anxiety

Abstract

The caregiver-clinician alliance plays a vital role in youth psychosocial treatment. However, the psychometric properties of observer-rated instruments designed to assess the caregiver-clinician alliance have not been adequately assessed. To address this gap, this study examined the interrater reliability, item performance, and validity of scores on the Therapy Process Observational Coding System for Child Psychotherapy–Alliance Caregiver scale (TPOCS-A) used to assess the caregiver-clinician alliance in two independent samples of youth with primary anxiety problems who participated in randomized effectiveness trials. The first sample was comprised of 38 racially and ethnically diverse youth (M age = 10.83 years, SD = 2.11; 57.9% female), whereas the second sample was comprised of 55 racially and ethnically diverse youth (M age = 9.89 years, SD = 1.71; 54.5% female). Treatment sessions from both samples were coded by independent coders using the TPOCS-A along with observer-rated instruments of alliance, treatment adherence, and clinician competence. Across the samples, the interrater reliability, ICC(2,2), of the TPOCS-A Caregiver item scores ranged from −.04 to .78. TPOCS-A items were used to form two subscales (Bond & Task, Goal), and internal consistency ranged from .56 to .77 across the samples. Scores on the TPOCS-A Caregiver subscales (Bond & Task, Goal) evidenced convergent validity with scores on observer-report caregiver-clinician alliance instruments and discriminant validity with scores on adherence and competence instruments. Overall, the findings provide preliminary support for the reliability and validity of the TPOCS-A Caregiver scale and subscale scores.