Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Assertiveness”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 343 records · Page 19Linked to original sources
PubMed1997

Financing assertive community treatment.

Assertive community treatment (ACT) is a widely-used intervention for the most severely impaired persons with mental illness. Because it differs from traditional treatment approaches in its philosophy, its organization, and in the clients it serves, financing strategies that are appropriate for standard services may not be optimal for ACT. In developing new payment systems, policymakers must choose between targeted strategies that attempt to influence the treatment process directly and those that establish broad goals for effectiveness, access, and efficiency while allowing providers more latitude in the treatment process. These choices profoundly influence how and to whom ACT is available.

Community Mental Health Services↗
PubMed1997

Impact of assertive community treatment on homeless persons with co-occurring severe psychiatric and substance use disorders.

This study evaluated the impact of an integrated (mental health/substance abuse) assertive community treatment program on homeless persons with serious mental and substance use disorders. High rates of retention in treatment, housing stability, and community tenure were attained, and all but the most severe substance users appeared to gain these benefits. While the intervention appears to be an effective means of retaining in services and monitoring such difficult-to-treat and costly populations, it did not yield high rates of abstinence and social benefits in severe users.

Adult↗
PubMed2003

Survey of consumer and non-consumer mental health service providers on assertive community treatment teams in Ontario.

Reflecting the increasing trend of consumers as providers in mental health services, the standards for Assertive Community Treatment (ACT) teams in Ontario, Canada require the hiring of at least 0.5 full-time equivalent consumer as a service provider. Through a mail-out survey, we explored how the consumer position has been integrated into these ACT teams. It was found that despite some variation in the roles and degree of integration of the consumers on these teams, consumers were generally well-incorporated team members with equal or better job satisfaction as compared to other employees.

Attitude of Health Personnel↗
PubMed1989

Asserting scientific authority. Cognitive development and adolescent legal rights.

The APA uses amicus briefs to communicate scientific knowledge to the legal system. There can be tension, however, between promoting the social good through law and the disinterested reporting of scientific data. This article examines this conflict by discussing two APA amicus briefs filed in the United States Supreme Court in cases involving adolescents' abortion rights. The Court has restricted adolescents' rights to make important life decisions in part because adolescents have been presumed to lack competence and maturity. The briefs argued that developmental theory and data confirm that adolescents and adults have equivalent decision-making capacities. The scientific arguments in the briefs, however, do not justify this assertion. Analysis of the briefs illuminates some dimensions describing the role of a scientific statement in a legal brief. These dimensions identify ways to limit scientific claims about the evidence at hand to avoid overstatement. The primary danger of overstatement is that it undermines psychology's claim to expert authority in assisting in the formation of law and the shaping of social institutions.

Abortion, Induced↗
PubMed1998

Assertive community treatment for patients with co-occurring severe mental illness and substance use disorder: a clinical trial.

Integrated mental health and substance abuse treatment within an assertive community treatment (ACT) approach was compared to that within a standard case management approach for 223 patients with dual disorders over three years. ACT patients showed greater improvements on some measures of substance abuse and quality of life, but the groups were equivalent on most measures, including stable community days, hospital days, psychiatric symptoms, and remission of substance use disorder.

Adult↗
PubMed1998

Program fidelity in assertive community treatment: development and use of a measure.

Assertive community treatment (ACT) is a complex community-based service approach to helping people with severe mental disorders live successfully in the community. Effective replication of the model and research on critical elements require explicit criteria and measurement. A measure of program fidelity to ACT and the results of its application to fifty diverse programs are presented.

Community Mental Health Services↗
PubMed2002

Perceived stigma and community integration among clients of assertive community treatment.

Facilitating the integration of persons with psychiatric disabilities is an important goal of community programs. In addition to limitations such as inadequate housing, poverty, and unemployment, a common barrier to community adjustment identified by people with psychiatric disabilities is their perception of being stigmatized. This study examined the relationships between perceived stigma and community integration in 95 clients of assertive community treatment (ACT) teams, using sequential multiple regression procedures. Findings indicate that despite their physical presence in the community and the intensive support they receive, ACT clients believe other community members will reject them. Moreover, this perception appears to interfere with their sense of belonging, particularly among those who also perceive less social support and who have greater psychosocial skill deficits. In the context of the present study, global self-esteem did not mediate this relationship. In addition to community focused antistigma campaigns, stigma-related issues should also be addressed with ACT clients themselves.

Adolescent↗
PubMed2002

Assertive community treatment: development of the team, selection of clients, and impact on length of hospital stay.

Mental health services have been criticized for the lack of focus and response to people suffering from a serious mental illness (SMI). Assertive community treatment (ACT) offers the potential for greater partnership working between the user and provider of mental health services. The author describes one approach in developing ACT in the UK. Four criteria were developed to identify the most appropriate service users for ACT: those with SMI, illness instability, illness disability and risk to self or others. Fifty-five clients were identified using these criteria and tracked for their length of hospital stay and frequency of admission 2 years before acceptance to an ACT team and for 12 months after. Duration of hospital stay was unchanged although both the frequency and total numbers of bed days were reduced.

Adult↗
PubMed2002

Implementing assertive community care for patients with schizophrenia. A case study of co-operation and collaboration between mental health care and social services.

The aim of this study was to describe the personal experiences of collaboration and co-operation between staff from the community mental health and social services programmes in their daily work with schizophrenic patients. An additional aim was to generate the first step in a theory of how staff in the field of health care and social services manages to integrate their efforts on an individual and organizational level. The study group consisted of five members of a multidisciplinary team who had been working for 2 years with assertive outreach intensive clinical case management. Verbatim-transcribed thematic interviews were analysed according to the comparative method for grounded theory. The analysis was focused on quality of interpersonal interaction between practitioners, representing different professions in community-based mental health care, as well as the professional relationship to the patients/clients and their relatives. In the light of an individual and organizational perspective, different typologies of interpersonal interactions appeared. Three main variables were identified: collaborative relationship, co-operative partnership and professional-amateurism. Our findings on these qualitative differences in interpersonal relations should be taken into account in the continuing reorganization of the community health care services. This knowledge can also help in overcoming barriers between patients, professionals and organizations in the mental health services.

Adult↗
PubMed2006

Assertive outreach: an effective strategy for engaging homeless persons with substance use disorders into treatment.

The purpose of this study was to examine substance abuse treatment referrals that were made by outreach workers in a homeless outreach project. Ten outreach workers completed questionnaires on each of their clients who they had referred to a substance abuse treatment program over the previous year. Additional data was collected on the client's motivation level at the point the referral was made, which agencies the client was referred to, and if the client was rejected from any of the treatment programs. Bivariate correlation analyses were used to examine relationships between the variables. Of 73 project clients who were referred to substance abuse treatment in a one-year period of time, 41% successfully entered treatment. As might be expected, there was a statistically significant relationship between clients' motivation level and completed referral, and between referrals made and program acceptance. This study provides evidence that assertive outreach is effective in engaging and linking homeless persons with substance use disorders to substance abuse treatment services.

Adolescent↗
PubMedDate not supplied

Factors associated with residential placement in an assertive community treatment program.

Assertive community treatment (ACT) programs originated to meet the needs of the severely mentally ill (SMI) for multiple psychosocial supports necessary for community living. Housing has been prominent among these needs and research to date on ACT programs has addressed residential outcomes, principally reduced homelessness and maintenance in some form of stable housing. However, limited studies have examined variables that might predict particular types of residential placements, which range from unsupervised to highly structured environments. The purpose of this study was to identify factors related to residential placement for the subjects in a model ACT program. Of multiple variables assessed, two were significantly related to residential placement. Chronic respiratory illness was strongly associated with placement in supervised group homes. Team assignment was associated with placement, with clients in one of three teams significantly more likely to live more independently. Clients assigned to this team showed higher psychosocial functioning than others in terms of functional ratings on the Multnomah Community Ability Scale. However, higher function alone was not significantly associated with placement, suggesting a role for clinical judgement and a need for future research in this area.

Adult↗
PubMedDate not supplied

Assertive Community Treatment for patients with chronic and severe mental illness who abuse drugs.

The Assertive Community Treatment model of mental health service delivery has been extensively studied and has undergone various modifications over the past twenty years. This article describes a modified ACT Team approach to the treatment of individuals who suffer from severe comorbid mental illness and substance abuse. Demographics of patients who are chosen to receive these intensive services, service utilization patterns, and elements of team treatment are discussed. Comparisons with less severely ill dual diagnosis patients who receive more traditional case management services are reviewed.

Adult↗
PubMed2004

Implementing integrated treatment for co-existing substance use and severe mental health problems in assertive outreach teams: training issues.

This study sought to evaluate systematically training and implementation of a specific integrated treatment approach for co-occurring problem substance use and mental health within existing assertive outreach (AO) teams. The AO team was treated as a whole unit rather than as individual clinicians. They were provided with training and supervision to deliver a cognitive--behavioural integrated treatment approach. In a quasi-experimental time-lag design three teams were trained immediately and two others after an 18-month delay. There was evidence that teams acquired confidence and skills relevant to working with combined problems and that these gains were maintained over time. These results were replicated in the two teams trained after the delay. This study suggests that training mental health staff to use an integrated treatment approach is well received and produces lasting changes in confidence and skills. However, there are a number of issues related to staff training, shifting attitudes and implementation of integrated approaches into routine mental health practice. These issues are considered and suggestions made for staff training.

Attitude of Health Personnel↗
PubMed2005

Assertive outreach teams: their roles and functions.

This critical evaluation considers research literature on Assertive Outreach Teams (AOTs). The extensive examination of this multi-professional service configuration is contrasted with the under-defined and untested nature of the service interventions that are provided by these teams. An audit of crisis management work in an AOT is reported and twelve areas of "life difficulties" are identified. An attempt to measure these life difficulties is then described. The use of this measurement for prioritizing referrals, managing workloads, agreeing care plans and measuring outcomes is discussed. Finally, the inadequacy of existing research approaches and associated problems in the separation of management and clinical practices are considered.

Community Mental Health Services↗
PubMed2004

Employment outcomes for hard-to-reach persons with chronic and severe substance use disorders receiving assertive community treatment.

Many persons with chronic and severe substance use disorders (SUDs) enter and exit public substance dependence treatment systems with limited benefit, but continue overuse of high-cost health and human services. Less than a third holds jobs, earning income below U.S. federal poverty levels. Long-term integrated substance dependency treatment, rehabilitation, and support services will be essential to resolve substance dependence and employment problems. This single-group program evaluation reports adaptation of Assertive Community Treatment (ACT), a multi-component, team-based service model originally designed for persons with severe mental illnesses and multiple disabilities, for effectiveness with persons with severe SUDs. The ACT model delivers an integrated package of treatment, rehabilitation, and support to reduce substance misuse and increase employment. Of the 35 clients admitted 12 months prior to conclusion of this 2-year service demonstration, only one left treatment prematurely. Generally, clients modestly reduced substance misuse and increased employment. However, the evaluation design and small sample limit inferences of causation and generalizability of these promising outcomes. Persuading states to adopt expensive team-based approaches for this population will require firm evidence of favorable cost-benefit ratios.

Adult↗
PubMed1978

Assertiveness training for nurses in a general hospital.

This article describes the first stage of an assertiveness training program for staff and managerial nurses in a general hospital. Special problems were raied in the group and their origins discussed. The group focused on the role of the professional nurse and the relationships between doctors, nurses, and patients.

Aggression↗
PubMed1995

Assertive community treatment and case management for schizophrenia.

This review examines the impact of assertive community treatment (ACT) and case management models on the use of inpatient hospitalization and other community mental health services, costs, and other clinical and social outcomes. ACT programs have been found to reduce hospitalization and increase use of community mental health services at an equivalent or reduced cost. Greater fidelity to the ACT model produced better outcomes. The impact of case management models is less consistent, but intensive case management programs also have been found to reduce hospitalization. We discuss limitations in past research and recommend future directions.

Case Management↗
PubMed2005

Randomized trial of supported employment integrated with assertive community treatment for rural adults with severe mental illness.

Urban-based randomized clinical trials of integrated supported employment (SE) and mental health services in the United States on average have doubled the employment rates of adults with severe mental illness (SMI) compared to traditional vocational rehabilitation. However, studies have not yet explored if the service integrative functions of SE will be effective in coordinating rural-based services that are limited, loosely linked, and geographically dispersed. In addition, SE's ability to replicate the work outcomes of urban programs in rural economies with scarce and less diverse job opportunities remains unknown. In a rural South Carolina county, we designed and implemented a program blending Assertive Community Treatment (ACT) with an SE model, Individual Placement and Support (IPS). The ACT-IPS program operated with ACT and IPS subteams that tightly integrated vocational with mental health services within each self-contained team. In a 24-month randomized clinical trial, we compared ACT-IPS to a traditional program providing parallel vocational and mental health services on competitive work outcomes for adults with SMI (N = 143; 69% schizophrenia, 77% African American). More ACT-IPS participants held competitive jobs (64 versus 26%; p < .001, effect size [ES] = 0.38) and earned more income (median [Mdn] = 549 US dollars, interquartile range [IQR] = 0-5,145 US dollars, versus Mdn = 0 US dollars, IQR = 0-40 US dollars; p < .001, ES = 0.70) than comparison participants. The competitive work outcomes of this rural ACT-IPS program closely resemble those of urban SE programs. However, achieving economic self-sufficiently and developing careers probably require increasing access to higher education and jobs imparting marketable technical skills.

Adolescent↗