L'alliance thérapeutique avec les adolescents de minorités ethnoculturelles en services de protection de la jeunesse

The disproportion of ethnocultural minority youth in child welfare services is well documented in the United States, in Canada and in Quebec. Among the solutions identified to address the over-representation of certain ethnocultural minority groups in child welfare services, the client-caseworker relationship has been found to be on of the best contributing factors towards change. The unique role of therapeutic alliance in intervention success, particularly in child welfare, and the lack of literature giving a voice to adolescents, who are at the heart of these interventions, increase the relevance of documenting their point of view regarding the relationship they have with their caseworker. To this end, two studies were conducted. The first theoretical study is a critical review of the literature regarding recommended clinical practices that promote therapeutic alliance in interventions conducted with ethnocultural minority adolescents in mandatory intervention settings, which include child welfare, juvenile justice and psychiatry. In total, 32 articles were reviewed to highlight clinical practices that are organized around knowledge, skills and dispositions. The methodological limits of the studies are addressed, and recommendations for future research and clinical practice are proposed. The second study, a phenomenological qualitative empirical study, was conducted to 1) better understand the perceived influence of ethnocultural background on the establishment of  therapeutic alliance between ethnocultural minority adolescents and their child welfare caseworker; 2) to understand, from a dyadic perspective, similarities, differences, points of agreement and points of disagreement in the adolescent-caseworker dyad. This study is part of a larger project that aims to explore the experiences of families from ethnocultural minority background receiving child welfare services (Lavergne and Dufour, 2015). Fifteen adolescents aged 12 to 17 and their thirteen caseworkers were met during semi-structured interviews. Thematic analyses were conducted. A second stage of analysis was then carried out, this one on adolescent-caseworker dyads, in order to better reflect the relational nature of therapeutic alliance. The results led to the identification of factors that influence specific therapeutic alliance parameters, including bond and agreement on goals and tasks. However, these influences seem to depend on the relative importance of the cultural parameter in each specific relationship, highlighting the importance of prior evaluation of that variable. The implications for clinical practice, training and research are discussed. The results of the two studies led to the identification of complementary clinical recommendations aimed at fostering therapeutic alliance with adolescents from ethnocultural minorities in child welfare services. Several considerations regarding barriers to applying these practices, optimizing caseworker training programs, and the need for further empirical support of the practices in future research are further addressed.

Keyphrases: adolescents, Therapeutic alliance, adolescents, ethnocultural minority, mandatory intervention, child welfare