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PubMed2005

How do people who receive assertive community treatment experience this service?

Using a participatory research approach this study examined Assertive Community Treatment as experienced by service recipients. Overall participants were positive about their involvement with ACT and their experiences reflected critical ingredients of the model. The analysis revealed seven ways the ACT promoted community adjustment. Unhelpful aspects of the experience included staff requiring more training in particular service areas, conflicts over money and medications, stigmatizing aspects of the service, and authoritative practices of individual staff. Services promoting community participation were less well-developed than clinical approaches. Tensions inherent in receiving ACT services were related to the participants' negotiation of personal and social consequences of mental illness while striving for autonomy, community participation and inclusion.

Activities of Daily Living↗
PubMed1991

[The advantage of active conformity as a communication strategy for compatibility between self assertion and smooth interpersonal relationship].

When a consensus is sought but no compromise seems to be obtainable among opposing opinions, people are often forced to choose one of them. This experiment investigated the effects of giving way and agreeing with the group under topics of either a high or low degree of importance. The results were as follows: 1) Those who have given way to others before perceived that their opinions would be accepted more easily in the next time than those who have insisted their own opinions. This tendency was greater under the condition of topics with higher importance. 2) Consequently, those who wish to assert oneself next time dared to give way and agree to others in the group. 3) Those who have stuck to their own opinions were much more regretful than what those who have given way would guess. From these results, it was suggested that people actively select conformity on a long view.

Adult↗
PubMedDate not supplied

Assertiveness, power and influence.

This article describes how nurses can use the concepts of assertiveness, power and influence to maximise their effectiveness in delivering care and bringing about change.

Assertiveness↗
PubMed2004

Challenges faced by service providers in the delivery of Assertive Community Treatment.

This qualitative study examined the delivery of Assertive Community Treatment from the perspective of service providers of 4 ACT teams in southeastern Ontario. Overall, providers were positive about their involvement with ACT. Eight tensions experienced in the context of delivering services emerged: negotiating governance structures; providing 24-hour coverage; balancing the clinical-administrative responsibilities of team leaders; accessing hospital beds; meeting local population needs; integrating treatment and rehabilitation; changing services to meet changes in the population being served; and implementing ambiguous ACT standards. Framing these challenges in the context of ACT structures and the broader community mental health system, the study suggests possibilities for the ongoing development of the model to facilitate the realization of the ACT vision.

Assertiveness↗
PubMed1987

Assertiveness and the medical administrator.

The ability of a medical record professional to deal successfully with other professionals in the health care system is an important measure of individual success as well as the success of the medical record service he/she manages. Assertion is usually a most successful technique in dealing with difficult interpersonal situations.

Aggression↗
PubMed2004

[Nurses' assertiveness training and cognitive therapy experiences with an outpatient suffering from low self-esteem].

The experiences during nine meetings with a psychotherapy outpatient suffering from low self-esteem between 1/1/02 to 4/10/02. Using comprehensive nursing assessment practices for guidance, two conclusions were arrived at regarding the patient's mental health: a) an imbalance in individual response ability, and b) long-term problems with low self-esteem. This assessment was used to help the authors practice appropriate nursing skills associated with assertiveness training and cognitive therapy and to establish a trusting, caring, and accepting relationship with the client. The treatment plan included attempts to increase personal confidence and to promote suitable skills for improving living functions, enhancing relationships, and practicing social behavior.

Adult↗
PubMed2005

[Assertive medicine: a proposal against defensive medicine].

More than ever the physician-patient relationship is deteriorated by diverse factors, among these liability complaints stand out, and have propitiated the practice of defensive medicine, an attitude considered in many countries as inappropriate, expensive and unethical. Defensive medicine widens the distance between a physician and his patient. To revert this vice and its noxious effects which corrupt the patient-physician relationship in our country, we propose that physicians put to practice actions which permit the renewal of the essence of humanistic medicine in their daily practice and the restoration of the relationship. These changes in attitude sum up to a proposition of professional practice which we have denominated assertive medicine. This offer is resumed in four points: 1) Maintain a proper verbal and non verbal communication with each patient, 2) Keep continuously up to date skills, knowledge and abilities, 3) Respect the patient's rights and 4) Defend their own rights as physicians.

Assertiveness↗
PubMed1990

Big fish in a big pool empowerment, assertiveness, and risk taking among nurses.

1. Although nursing is in a position to greatly affect health care, it lacks the personal skills of assertiveness, empowerment, and risk taking. 2. Empowerment is comprised of responsibility acceptance, accountability, and risk taking. Powerlessness is the direct result of an unwillingness to accept responsibility. 3. Accountability is the retrospective analysis to determine if work has been done appropriately. To take a risk is to exceed one's limits in reaching for a goal.

Assertiveness↗
PubMed1986

Further examination of the reliability of the Modified Rathus Assertiveness Schedule.

The reliability of the 30-item Modified Rathus Assertiveness Schedule (MRAS) was examined using the test-retest method over a three-week period. The MRAS, which was administered to 103 white middle-class seventh graders, yielded correlations of .74 using the Pearson product and Spearman Brown correlation coefficient. The correlations for males yielded .77 and .72 using the Pearson Product and Spearman Brown techniques, respectively. For females the correlations for both tests were .72. Paired t tests by sex indicated no significant change in MRAS scores between test administrations. These findings add to the existing information on the reliability of the MRAS.

Adolescent↗
PubMed1984

Assertion training with adolescents.

A month-long assertion training program for adolescents was instituted and evaluated in a middle-school setting. A group of 23 adolescents who received the treatment was compared to a group of 23 adolescents who did not receive the treatment. Although there were no significant differences between the groups prior to the program, the group who received the training significantly improved their scores on the Piers -Harris Children's Self-Concept Scale and the Intellectual Achievement Responsibility Questionnaire by the termination of the program. The group who did not receive any special program showed no change in their scores on these scales. These differences were still present at a seven-week follow-up.

Achievement↗
PubMed1993

The role of negative affect and positive affect in stress, depression, self-esteem, assertiveness, Type A behaviors, psychological health, and physical health.

Dua (1989) constructed the Thoughts and Real-Life Experiences Scale (THARL) to assess the degree of positive and negative affect experienced by people as a result of their thoughts and day-to-day experiences. This monograph reports on a number of studies designed to investigate the relationship between negative and positive affect caused by thoughts and day-to-day experiences and psychological health, psychological problems, and physical health. Results showed that a preponderance of self-reported negative affect was related to higher levels of stress, depression, poor psychological well-being, poor psychological health, lower self-esteem and poor self-reported retrospective physical health. A preponderance of negative affect was associated with only one of the two measures of prospective physical health, namely, the number of visits to doctors for medical problems over a period of 4 weeks. Positive affect was not associated with either self-esteem or physical health. Assertiveness and Type A/B behaviors were not associated with either negative or positive affect. Also, of the two measures of negative affect, that caused by thoughts seemed to be a better predictor of health, well-being, and psychological problems than that caused by day-to-day experiences.

Adaptation, Psychological↗
PubMedDate not supplied

Basic tools for the orthopaedic staff nurse. Part I: Assertiveness.

Organizational restructuring and expanded settings of health care delivery provide opportunities for the orthopaedic staff nurse to review basic communication tools that are useful with clients and families, managers, and other health care providers. It is critical for the staff nurse to build a repertoire of skills that support leadership and encourage enlightened followers. This two-part article addresses assertiveness, conflict management, and negotiation skills that are basic to providing professional care with confidence and competence in a changing health care environment.

Assertiveness↗
PubMed1997

A randomized trial of assertive community treatment for homeless persons with severe mental illness.

BACKGROUND: This experiment evaluated the effectiveness of an innovative program of assertive community treatment (ACT) for homeless persons with severe and persistent mental illnesses. METHODS: One hundred fifty-two homeless persons with severe and persistent mental illness were randomized to either the experimental ACT program or to usual community services. Baseline assessments included the Structured Clinical Interview for DSM-III-R, Quality-of-Life Interview, Colorado Symptom Index, and the Medical Outcomes Study 36-Item Short Form Health Survey. All assessments (except the Structured Clinical Interview) were repeated at the 2-, 6-, and 12-month follow-up evaluations. RESULTS: Subjects in the ACT program used significantly fewer psychiatric inpatient days, fewer emergency department visits, and more psychiatric outpatient visits than the comparison subjects. The ACT subjects also spent significantly more days in stable community housing, and they experienced significantly greater improvements in symptoms, life satisfaction, and perceived health status. CONCLUSIONS: Relative to usual community care, the ACT program for homeless persons with severe and persistent mental illness shifts the locus of care from crisis-oriented services to ongoing outpatient care and produces better housing, clinical, and life satisfaction outcomes.

Activities of Daily Living↗
PubMed2001

Time-limited assertive community treatment for homeless persons with severe mental illness.

BACKGROUND: The assertive community treatment (ACT) model for people with severe mental illness was originally designed to be provided continuously without termination. This study evaluated postdischarge changes in health status and service use associated with the time-limited provision of ACT to homeless people with severe mental illness. METHODS: Clients in the fourth annual cohort of the Access to Community Care and Effective Services and Supports (ACCESS) program (N = 1617) were assessed at entry into ACT and 3, 12, and 18 months later. Random effects models were used to compare outcomes and service use among clients who terminated ACT and clients who remained in ACT, controlling for potentially confounding factors. RESULTS: Altogether, of clients who participated in follow-up, 8.7% participated for less than 3 months; 40.6%, for 3 to 10 months; 15.3%, for 11-13 months; and 35.3%, for 14 months or more. Controlling for potentially confounding factors, mental health, substance abuse, and housing outcomes did not significantly differ between clients who had been discharged at the time of follow-up as compared with those who had not. Those who had been discharged had worked significantly more days than those who had not (t(1794) = 3.24, P<.001), and they reported significantly less outpatient health service use though there was no decline in hospital days or receipt of public support payments. CONCLUSION: Homeless clients who have severe mental illness can be selectively discharged or transferred from ACT to other services without subsequent loss of gains in mental health status, substance abuse, housing, or employment.

Adult↗
PubMed2003

Evaluation of a mental health treatment court with assertive community treatment.

Without active engagement, many adults with serious mental illnesses remain untreated in the community and commit criminal offenses, resulting in their placement in the jails rather than mental health facilities. A mental health treatment court (MHTC) with an assertive community treatment (ACT) model of case management was developed through the cooperative efforts of the criminal justice and mental health systems. Participants were 235 adults with a serious mental illness who were booked into the county jail, and who volunteered for the study. An experimental design was used, with participants randomly assigned to MHTC or treatment as usual (TAU), consisting of adversarial criminal processing and less intensive mental health treatment. Results were reported for 6 and 12 month follow-up periods. Clients in both conditions improved in life satisfaction, distress, and independent living, while participants in the MHTC also showed reductions in substance abuse and new criminal activity. Outcomes are interpreted within the context of changes brought about in the community subsequent to implementation of the MHTC.

Adult↗
PubMed2005

Efficacy of a Mental Health Treatment Court with assertive community treatment.

This study examined the efficacy of a Mental Health Treatment Court (MHTC) with diversion to treatment supported by an assertive community treatment (ACT) model of case management. A total of 235 participants were randomly assigned to either MHTC or treatment as usual (TAU) and assessed over a 2 year period. It was hypothesized that participants in the MHTC would decrease their criminal activity and improve their psychosocial functioning relative to participants receiving TAU. While there were offenders for whom neither treatment was effective, a majority in both groups decreased jail days and improved psychosocial functioning, with MHTC participants demonstrating greater gains in most areas. The impact of implementing the MHTC on community practices, and the value of integrating criminal justice and mental health systems, is discussed.

Adult↗
PubMed1997

The Program of Assertive Community Treatment (PACT): the model and its replication.

The Program of Assertive Community Treatment (PACT) has been investigated in Madison and at other replication sites, and the positive results for clients have led to more widespread dissemination of the PACT model. This chapter presents a basic introduction to the model of care, research findings, and views on PACT model replication.

Community Mental Health Services↗