Abstract
Youth of color are disproportionately diagnosed with mental health disorders, but they are also at a much higher risk of treatment dropout and lower rates of treatment engagement. Though the strength of the therapeutic alliance has been shown to predict youth treatment engagement, youth of color tend to endorse weaker alliance ratings than White youth. Racial/ethnic matching (REM) between youth and providers has been proposed as a strategy to foster the therapeutic alliance early on, thereby increasing treatment engagement; however, the literature on its effectiveness remains mixed. Additionally, no studies to date have identified whether youth or caregiver respective alliance ratings are more important to youth treatment engagement. The present study sought to 1) understand the relationship between provider REM and treatment engagement for youth and the potential mediating role of alliance, 2) determine whether youth or caregiver alliance is more predictive of treatment engagement, and 3) determine whether these models are moderated by race/ethnicity (i.e., non-Hispanic, White versus clients of color). Results revealed no significant effects of REM on alliance ratings and treatment engagement but found several significant effects of alliance ratings on treatment engagement. Youth and caregiver alliance ratings had independent effects on treatment engagement. Caregiver alliance also had a negative indirect effect on the relationship between youth-provider REM and treatment retention. Race/ethnicity was not a significant moderator of any pathway. Simple slope analyses did reveal several significant relationships between alliance ratings and treatment engagement for youth of color, but the slopes were not significantly different from non-Hispanic, White youth.