Client-provider relationship and treatment outcome: A systematic review of substance abuse, child welfare, and mental health services researchedit
This systematic review reports on the association of the client-provider relationship with service outcomes across 3 service sectors: substance abuse, child welfare, and mental health. The review includes 60 research reports meeting inclusion criteria: 25 in substance abuse, 7 in child welfare, and 28 in mental health. For each social service sector, we analyze the association of the client-provider relationship to intermediate and ultimate outcomes. In addition, we examine potential moderating mechanisms of rater type (i.e., client, provider, and observer) and treatment setting (i.e., inpatient, outpatient, other). Social services research increasingly seeks to identify the active elements that affect outcomes common to all interventions. Results suggest the client-provider relationship is a consistent predictor of client retention in treatment and a somewhat less-consistent predictor of ultimate outcome across the 3 service sectors. These results contrast with recent findings from the psychotherapeutic literature in which the client-provider relationship demonstrated a weaker association with treatment retention (measured as drop out) than with other outcome measures. Findings indicate a clear need to refine the conceptualization and measurement of key service mechanisms and outcomes, particularly in the area of child welfare given that services research is less developed in that sector. The discussion includes recommendations for future research, including the use of selection criteria to enable researchers to conduct formal meta-analyses and expand the moderational framework with additional moderator variables relevant to social service delivery.