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PubMed1995

A multisite study of client outcomes in assertive community treatment.

OBJECTIVE: This study examined outcomes of clients admitted to assertive community treatment programs simultaneously implemented at six sites in northeastern Indiana. METHODS: A total of 212 clients at risk for psychiatric rehospitalization were assessed at baseline and at six-month intervals for 18 months after admission to assertive community treatment programs. Data on rehospitalization, quality of life, and level of functioning were compared using t tests. Progressive improvement was also examined by linear trend analysis. RESULTS: Frequency of psychiatric hospitalization was reduced by one-third and the number of inpatient days by 50 percent after admission to the program. Improvements were progressive, with continued reductions over the 18-month period. Progressive improvements also occurred in quality of life as measured by both client and staff ratings. Case managers rated clients as having improved family and social support, increased self-reliance and independence, and improved daily living skills. Clients reported significantly more legal problems, which may have been an artifact of increased monitoring during treatment. A key element of the programs' success was the position of clinical coordinator, important functions of which are described. CONCLUSIONS: Results of this study provide support for wide-scale dissemination of assertive community treatment as an effective form of community care for persons with serious mental illness.

Activities of Daily Living↗
PubMed1999

Measuring client satisfaction with assertive community treatment.

OBJECTIVE: A mailed survey was used to measure satisfaction of seriously mentally ill clients with services provided by an assertive community treatment team. METHODS: A detailed 35-item questionnaire was mailed in 1995 to all 174 clients of the Brockville (Ontario) Psychiatric Hospital's assertive community rehabilitation program. RESULTS: The rate of return was 51 percent. Compared with clients who did not return the survey, the respondent group had significantly fewer males and fewer clients with a diagnosis of schizophrenia; respondents had been associated with the program for less time. Factor analysis of the survey responses revealed three principal components accounting for 46 percent of the total variance in responses. The factors were interpersonal aspects of care, client involvement in treatment, and medication and treatment issues. Respondents were generally satisfied with service from the program, but they were dissatisfied with side effects of medication and the amount of medication they were taking. CONCLUSIONS: A mailed survey appears to be an efficient and nonintrusive way to collect satisfaction data anonymously from persons with serious mental illness who are clients of an assertive community treatment team. The results highlight areas of need that the team can address.

Adult↗
PubMed2007

Assertive rehabilitation for intracapsular fracture of the proximal femur.

OBJECTIVE: To study the impact of assertive conservative therapy on walking in frail elderly patients with intracapsular fracture of the proximal femaur. DESIGN: Prospective non-randomized controlled trial. SETTING: Two private geriatric rehabilitation hospitals. SUBJECTS: From October 1997 to December 2004, 20 patients, not indicated for surgery, were treated with conservative therapy. There were 18 women and 2 men, and their ages were 87.1+/-4.2 (mean +/-SD) years. All of them could walk before hip fracture. INTERVENTIONS: Thirteen patients accepted our assertive therapy, which consisted of standing on the fractured limb and walking in parallel bars as soon as possible. Seven patients refused our methods and were conventionally treated; the injured limb was immobilized under skin traction, and then they gradually tried to use a wheelchair for pain reduction. MAIN MEASURES: We used the following measures before therapy and six months after: Merle d'Aubigné & Postel's Hip Score, Functional Independence Measure (FIM) and face pain scale. RESULTS: The two groups were similar demographically. All patients except one (n = 12) responded to our method and could walk. However, the patients treated with the conventional method (n = 7) did not recover the ability to walk. The mean FIM (transfer and locomotion, five items) was 18.2 +/-7.9 points in the former and 9.4 +/- 4.3 points in the latter. CONCLUSION: Assertive rehabilitation was more effective at restoring the ambulatory ability of frail elderly patients with intracapsular fracture of the hip than the conventional method.

Aged↗
PubMed2003

Assessing the value of assertive outreach. Qualitative study of process and outcome generation in the UK700 trial.

BACKGROUND: It is unclear why intensive case management (ICM) failed to reduce hospitalisation in the UK700 trial. AIMS: To investigate outcome generation in the UK700 trial. METHOD: A qualitative investigation was undertaken in one UK700 centre. RESULTS: Both intensive and standard case management practised individual casework, employed assertive outreach with comparable frequency, and performed similarly in the out-patient management of emergencies and in-patient discharge. However, ICM was advantaged in managing some non-compliance and undertaking casework that prevented psychiatric emergencies. Absence of team-based management and bureaucratised access to social care limited the impact of these differences on outcomes and the effective practice of assertive outreach, although this was relevant to only a sub-population of patients. CONCLUSIONS: The impact of ICM was undermined by organisational factors. Sensitive anticipatory casework, which prevents psychiatric emergencies, may make ICM more effective than an exclusive focus on assertive outreach. Our findings demonstrate the value of qualitative research in evaluating complex interventions.

Adolescent↗
PubMed1984

The development of an Assertiveness Self-Report Inventory.

The development of a self-report measure of assertiveness is described. The Assertiveness Self-Report Inventory (ASRI) was devised with concern for endorsement frequency, internal consistency, and independence from social desirability response bias. The scale's reliability and convergent and discriminant validity are adequate. Further tests of validity support the use of the scale as a measure that taps behavior related to the construct of assertiveness.

Journal Article↗
PubMed1977

Teaching assertive skills to a passive homosexual adolescent: an illustrative case study.

Social skills training was used to alter the socially inappropriate and ineffectual behavior of a 17-year old homosexual male. Target behaviors selected for treatment were the subject's effeminate mannerisms and lack of assertiveness in conflict situations, especially those involving other persons making derisive comments to him. A multiple baseline design was used to increase the patient's (a) eye contact, (b) rate of making appropriate requests for behavior change in others, and (c) general level of assertive affect. Six training and six generalization role-played interpersonal scenes were used. Results indicated significant improvement on trained social skills components with generalization to nontrained scenes as well. Implications of these findings are discussed, particularly with respect to social skills and assertion training for effeminate homosexuals.

Adolescent↗
PubMed2004

Client outcomes and the working alliance in assertive community treatment programs.

This study examined the relationship between outcomes and the working alliance in clients who were receiving assertive community treatment only or integrated assertive community treatment (assertive community treatment plus substance abuse treatment). All 98 participants had a severe mental illness and a substance use disorder. The Working Alliance Inventory assessed the alliance from the perspective of both the client and the case manager at 3 and 15 months into treatment. The six outcome measures were stable housing, client rating of psychiatric distress, interviewer rating of psychiatric symptoms, self-report of days used alcohol or drugs, and interviewer rating of substance use. Only 4 of 24 correlations were significant, indicating little relationship between the strength of the working alliance and client outcome.

Adult↗
PubMed1998

[Group psychotherapeutic factors in a self-assertive group].

The technique of group psychotherapy has recently been introduced to the practice in self-assertiveness training group. This study aims to assess various group factors that are hypothesized to be effective in the group process in a self-assertive group. Subjects of the study were participants in a 13-member self-assertiveness training group, with 4 female nurses and 8 male employees and 1 male student. The average age of this group was 35.2 years. Assessment of the group was based on Yalom's concept of twelve therapeutic factors in the group process. The results showed that 'identification', 'The existential factor' and 'interpersonal learning-input' were the three most important factors demonstrated during the group process. There were no significant age and gender differences in the above 'identification' and 'existential' factors. However, different beneficial factors were found for each group: for subjects aged 40 and above and males, it was 'interpersonal learning-output'; while in those with aged under 40 and females, 'universality' was more important than 'interpersonal learning-input'. Comparison of therapeutic factors among different groups was attempted. The above results were found different from patient groups, or the groups of university students. The discrepancy is due to different composition and tasks of each group.

Adult↗
PubMed1980

Trends in assertion training research and practice: a content analysis of the published literature.

Investigated historical trends in the assertion training literature by content analyzing 344 documents published between January 1942 and December 1977. Documents were collected through standard literature and search procedures and were content-coded according to their primary methods (e.g., case study, experimental research) and major foci (e.g., assessment, treatment). The results of four separate descriptive analyses performed on the coded reports revealed that although the assertion training literature has shown a very rapid acceleration of growth over the past five years, empirical documentation of the effects of a few important parameters of training and treatment is lacking. Future research needs that clearly emerged from the analyses were discussed.

Assertiveness↗
PubMed1980

Effect of sex of therapist and client on therapists' attitudes toward assertiveness problems.

Four hypothetical cases that contained descriptions of various assertiveness problems of male and female pseudo clients were presented to 57 male and 88 female mental health professionals. In two out of the four cases presented, female therapists found the client more in need of counseling than did male therapists, independent of the sex of the client. All therapists perceived a female client with a conflict between sexual assertiveness and negative judgments from peers to be more in need of counseling than a male client. All therapist preferred working with a female client in one of the cases. Thus, the effect of sex of therapist and client was not consistent across cases.

Adult↗
PubMed1981

Relationship between contrived in vivo and role-play assertive behavior.

Used a 2 (High or Low Assertive) x 2 (Role-Play or Contrived In Vivo) design to investigate the external validity of role-play (N = 32). The Conflict Resolution Inventory was used as the selection device. Results indicated a positive relationship between self-report scores and role-play behavior. They also indicated that self-report scores were not predictive of behavior in the contrived in vivo condition; moreover, assertion was enhanced in the role-play condition, while the converse occurred in the contrived in vivo condition. The results indicate that generalizations to more naturalistic settings based upon role-play or self-report scores must be made with caution.

Affect↗
PubMed1981

Expression of anger as a function of assertiveness and sex.

Examined differences between asserters and nonasserters and between the sexes on anger expression. Thirty-seven male and 53 female college students were administered the College Self-Expression Scale, the Buss Durkee Hostility Inventory, and the Anger Self-Report. As hypothesized, asserters and males expressed more anger and aggression, and nonasserters experienced more covert anger. The clinical/treatment implications of these findings were discussed. A finding discrepant with previous research and the present researchers' expectations, that men scored higher than women on guilt and condemnation of anger, was thought to reflect this study's sample rather than an actual population difference.

Aggression↗
PubMed1985

An assertiveness scale for adolescents.

This study developed a situation-specific instrument that measures assertiveness of adolescents. The Assertiveness Scale for Adolescents (ASA), which contains 33 items, was constructed using a multiple-choice format with three response alternatives. Based on data from 682 elementary and secondary school students, adequate reliability and validity of the ASA were obtained when tested against several variables about which predictions could be made. Potential use of the instrument in clinical diagnosis and research was discussed.

Adolescent↗
PubMed1992

The effect of two kinds of role playing on self-evaluation of improved assertiveness.

The study investigated the "differential effect of role-playing enactments" hypothesis through self-evaluations of improvement in assertiveness by participants in an assertive training program. Twenty-two nonassertive Israeli students were trained in two groups: mimetic-replications (action modeling, n = 12) and spontaneous (self-produced action, n = 10) role-playing interventions. Comparisons of their scores on the Self-Expression College Scale (CSES) before and after the training showed that both groups significantly improved their self-evaluations, but the mimetic-replication group did better. In particular, this group scored significantly higher on the CSES first factor (the willingness to take risks in situations that involved other, significant persons).

Adult↗
PubMed1993

Comparison of eating disorders and other dietary/weight groups on measures of perceived control, assertiveness, self-esteem, and self-directed hostility.

Anorexic and bulimic patients were compared to obese dieters, nonobese dieters, and normal controls on measures of perceived control, assertiveness, self-esteem, self-directed hostility, and psychiatric caseness. The anorexic and bulimic groups both scored significantly differently in the expected direction from the other three groups on all measures. There were no significant differences between the anorexic and bulimic groups and in turn, no significant differences among the obese, nonobese dieters, and normal controls. Results are in keeping with the notion that perceived control, low assertiveness, low self-esteem, and self-directed hostility are characteristics of eating disorder patients that differentiate them from individuals who display dietary/weight features, as well as from normal controls.

Adult↗
PubMed1987

Effects of assertion training and first aid instruction on children's autonomy and self-care agency.

Strategies for promoting autonomy and a self-care agency in children were investigated in this study. Ninety-two fifth grade students were randomly assigned to one of four learning groups: assertion training; first aid instruction; assertion/first aid; and control. Results showed mixed support for autonomy being higher where either or both assertion training and first aid instruction had occurred, and support for self-care agency being higher where first aid instruction had occurred.

Assertiveness↗
PubMed1991

Assertiveness and problem-solving training for mildly mentally retarded persons with dual diagnoses.

This study investigated the differential effectiveness of assertiveness and problem-solving training on dually diagnosed patients' adaptive social behavior, distress and psychiatric symptoms, anger control, and problem-solving coping skills using a counterbalanced design. Assessments were conducted at pretreatment, midphase, posttreatment, and a 3-month follow-up examination. A combined assertiveness and problem-solving training package was effective for treatment of individuals with mild mental retardation with dual psychiatric diagnoses. Specifically, improvements occurred regarding both self-report measures of distress and caregiver ratings of adaptive functioning; however, no essential differences were found between these two treatment protocols. The importance of using self-regulatory models of therapy with this population is highlighted, and recommendations were made for future research.

Adaptation, Psychological↗
PubMed2006

ASymptomatic atrial fibrillation and Stroke Evaluation in pacemaker patients and the atrial fibrillation Reduction atrial pacing Trial (ASSERT).

Asymptomatic atrial fibrillation (AF) is common and may have the same prognostic implications as symptomatic AF. Among patients receiving dual-chamber pacemakers, it is now possible to quantify asymptomatic AF accurately. Most of these episodes are of short duration, often lasting only seconds to minutes and are called atrial high-rate episodes (AHRE) to distinguish them from the longer episodes of overt AF. To understand properly the clinical importance of asymptomatic AF, a large study of pacemaker patients without clinically overt AF is required. ASSERT is a multicenter, cohort follow-up, and single-blinded randomized trial in elderly hypertensive patients with a pacemaker recently implanted for sinus or atrioventricular node disease. The goals of this trial are to evaluate whether the detection of AHRE with pacemaker telemetry predicts an increased risk of stroke and other vascular events and to evaluate if atrial overdrive pacing reduces symptomatic AF. ASSERT is evaluating the hypothesis that among pacemaker patients without a previous history of AF, detection of AHRE predicts an increased risk of stroke and systemic embolism. The second hypothesis to be tested is that overdrive atrial pacing will reduce the risk of symptomatic AF in pacemaker patients without a previous history of AF. Finally, a 400-patient substudy will use the noninvasive testing capabilities of the patients' pacemaker to evaluate changes in atrial electrophysiology over 2 years. This substudy will determine if atrial electrical remodeling is detectable in pacemaker patients and if it is associated with the development of AF.

Aged↗