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PubMed2003

Maternal power assertion in discipline and moral discourse contexts: commonalities, differences, and implications for children's moral conduct and cognition.

Parental power assertion is traditionally studied in the behavioral domain--discipline triggered by the child's immediate misbehavior--but rarely in the cognitive domain--parent-child discussions of the child's past misbehavior. Maternal power assertion was observed in "do" and 'don't" discipline contexts from 14 to 45 months and in the context of mother-child discourse about a recent misbehavior at 56 months. Mothers' use of power cohered across the "do," 'don't," and discourse contexts, but its implications were domain specific. Power assertion in the 'don't" discipline context predicted behavioral outcomes (more moral conduct at 56 and 73 months, less antisocial conduct at 73 months) but not cognitive outcomes (moral cognition at 56 and 73 months). Power assertion in the discourse context predicted less mature moral cognition but not moral or antisocial conduct. Mothers' high Neuroticism predicted more power assertion in all three contexts. Child effects were examined.

Adult↗
PubMed1976

The relationship of extraversion and neuroticism to two measures of assertive behavior.

One hundred forty-four college students completed the Eysenck Personality Inventory and the Rathus Assertiveness Schedule (RAS) and wrote their behavioral reactions to five scenarios in which an assertive behavior was an appropriate response. Extraversion showed a significant positive correlation with the RAS in both males and females. Neuroticism was negatively correlated with RAS in both sexes. Extraversion and RAS correlated significantly with rated Assertiveness in the scenarios only in the male sample. The RAS predicted variance in Assertiveness beyond that predicted by Extraversion. Overall low correlations of the measures with rated Assertiveness were discussed in terms of the low internal consistency reliability of that scale.

Aggression↗
PubMed2005

Towards quality indicators for assertive outreach programmes for severely impaired substance abusers: concept mapping with Dutch experts.

OBJECTIVE: We investigated the concept of 'quality of assertive outreach programmes for severely impaired substance abusers' with the aim of developing a conceptual framework as the basis for an assessment instrument. DESIGN: We held a concept-mapping session with 13 experts in 2003. Fifty measurable elements of quality were mentioned and rated in terms of relative importance on a Likert-type response scale. Subsequently, the experts grouped the statements that were similar in content. The resulting concept map and additional interpretation made up the final quality framework. SETTING/STUDY PARTICIPANTS: Theoretical sampling was used to select Dutch managers, team leaders, and service providers from different assertive outreach delivery systems for substance abusers. Variation in both perspective and region was reflected in the sample. RESULTS: Nine aspects of quality were formulated: preconditions for care, preconditions for service providers' work, relationship to regular care, service providers' activities and goals, service providers' skills, the role of repression, optimal care for the client, goals of assertive outreach, and nuisance reduction to society. Each aspect was presented using a selection of measurable elements. CONCLUSIONS: According to the experts, optimal assertive outreach depends on a broad range of aspects that were later classified in three regions: structure, process, and outcomes. Saturation of the elements has not been proved so far. Nevertheless, it is promising that the framework's regions are supported by theory and that it is largely in accordance with clients' perspectives on assertive community treatment.

Administrative Personnel↗
PubMed2002

A comparison of experts' perspectives on assertive community treatment and intensive case management.

This study compared experts' views on the critical ingredients of assertive community treatment and intensive case management. Twenty experts on assertive community treatment and 22 experts on intensive case management rated the importance of 40 elements common to each treatment approach. The assertive community treatment experts gave higher importance ratings than the intensive case management experts to 37 of the 40 items; for 21 of these items, the ratings were significantly higher. Differences in importance ratings were greatest for organizational and structural elements and smallest for treatment goals. The results of this study indicate that although intensive case management resembles assertive community treatment in most respects, assertive community treatment may be a more clearly articulated model overall.

Attitude of Health Personnel↗
PubMed2003

Case managers' perspectives on critical ingredients of assertive community treatment and on its implementation.

OBJECTIVE: The authors sought to identify case managers' perspectives on the critical ingredients, therapeutic mechanisms of action, and gaps in implementation of the critical ingredients of assertive community treatment. METHODS: Seventy-three assertive community treatment teams that attended the 1997 National Assertive Community Treatment Conference rated the degree to which 16 clinical activities were beneficial to clients and rated the importance of 27 possible critical ingredients of the ideal team as well as the extent to which each ingredient characterized their team. RESULTS: At least 50 percent of the teams rated 24 of the 27 critical ingredients as "very important." Having a full-time nurse on the team was rated as the most important ingredient, and medication management was rated as the most beneficial clinical activity. The ratings of teams from urban and rural settings were highly correlated. Critical elements that the teams reported as being the most underimplemented included the presence of a full-time substance abuse specialist, a psychiatrist's involvement on the team, team involvement with hospital discharge, and working with a client support system. CONCLUSIONS: Case managers strongly endorsed the team approach as well as medical aspects of assertive community treatment. Despite broad consensus on the critical ingredients of the ideal assertive community treatment team, several important ingredients appear to be consistently underimplemented.

Attitude of Health Personnel↗
PubMed2005

Community tenure of people with serious mental illness in assertive community treatment in Canada.

OBJECTIVE: This study followed consumers after admission to an assertive community treatment program to determine when the first hospital admission was more likely to occur, which variables predicted community tenure, and, more specifically, whether the availability of within-program hospital beds predicted community tenure. METHODS: Data were gathered from three assertive community treatment programs in southeastern Ontario--the psychosocial rehabilitation program, the community integration program, and the assertive community treatment team program. Only the psychosocial rehabilitation program provided within-program beds. Hospital records of consumers who entered a program between July 1, 1990, and December 1, 1999, were examined prospectively until January 1, 2000, in order to record time to the first admission. Survival analysis based on the life-tables method was used to estimate the probability of remaining out of the hospital at 90-day intervals. Factors associated with time to admission were identified by using the Cox proportional hazards model. RESULTS: A total of 333 consumers were followed: 117 consumers in the psychosocial rehabilitation program, 105 in the community integration program, and 111 in the assertive community treatment team program. Findings indicated that consumers were most likely to be admitted to a hospital in the nine months after entering an assertive community treatment program. A diagnosis of substance use disorder, higher past hospital use, and the availability of within-program beds were associated with an increased risk of admission. CONCLUSIONS: Studies have shown that hospitalization remains a reality for many consumers and therefore warrants further study. The survival model proved advantageous by allowing a more complete and comparable description of consumers' hospitalization patterns that cannot be achieved with previously used methods, and it offered the power of regression analysis.

Acute Disease↗
PubMed1995

Assertive community treatment: an update of randomized trials.

OBJECTIVE: Results of randomized clinical trials of assertive community treatment for seriously mentally ill patients published between 1990 and 1994 are reviewed to synthesize the state of knowledge about this research and to clarify continuing research directions. METHODS: Randomized trials of interventions that used treatment principles and practices consistent with the Program for Assertive Community Treatment model or close adaptations whose results were published since 1990 were identified by literature searches using MEDLINE and PsychLit and by contact with investigators of ongoing trials. RESULTS: Controlled clinical trials have been conducted with a wide range of severely mentally ill populations, including patients in Great Britain, patients with recent-onset schizophrenia, veterans, dually diagnosed clients, and homeless persons. Methodological improvements in some studies include increased attention to monitoring the experimental and comparison interventions, as well as larger sample sizes and longer duration of the clinical trials than in earlier efficacy trials. Strong positive effects of assertive community treatment on hospital days and on patient and family satisfaction were found. Gains in functional outcomes, such as employment, may require interventions specifically targeted to these outcomes. CONCLUSIONS: Questions about the role of assertive community treatment as time-limited treatment, as an adjunct to other services and treatment, or as a comprehensive and continuous service system for adults with severe mental illness require further research. The growing research base should provide valuable information on costs, outcomes, and indications for assertive community treatment that can be evaluated by policy-makers.

Adult↗
PubMed1997

Assertive community treatment versus usual care in engaging and retaining clients with severe mental illness.

OBJECTIVE: Two assertive community treatment teams were compared with a usual-care control condition based on their ability to engage and retain clients with serious and persistent mental illness in community-based mental health services. METHODS: Clients were randomly assigned to one of two assertive community treatment teams (N = 116) or to usual care (N = 58). Survival analysis was used to compare clients' length of engagement and retention in service in the two treatment conditions and in usual care. Cox regression analyses were conducted to determine whether demographic, program, or client variables were significantly associated with length of retention in treatment. Data on these baseline variables were collected after clients made initial contact with their community mental health provider. Clients were observed for up to 870 days. RESULTS: By the end of the observation period, the assertive community treatment teams retained 68 percent of their clients, compared with 43 percent in usual care. In both types of treatment, clients were at greatest risk of dropping out of services during the first nine months. The risk of dropout was associated with the type of treatment. Usual-care clients were more than twice as likely as assertive community treatment clients to drop out for reasons related to dissatisfaction with treatment. Each additional night homeless during the six months before enrollment in the study resulted in a 14 percent increase in the probability of dropout. CONCLUSIONS: Assertive community treatment clearly demonstrated a greater ability than usual care services to engage and retain clients in community mental health care.

Adult↗
PubMed1999

Fidelity to assertive community treatment and client outcomes in the New Hampshire dual disorders study.

OBJECTIVE: The study examined the association between fidelity of programs to the assertive community treatment model and client outcomes in dual disorders programs. METHODS: Assertive community treatment programs in the New Hampshire dual disorders study were classified as low-fidelity programs (three programs) or high-fidelity programs (four programs) based on extensive longitudinal process data. The study included 87 clients with a dual diagnosis of severe mental illness and a comorbid substance use disorder. Sixty-one clients were in the high-fidelity programs, and 26 were in the low-fidelity programs. Client outcomes were examined in the domains of substance abuse, housing, psychiatric symptoms, functional status, and quality of life, based on interviews conducted every six months for three years. RESULTS: Clients in the high-fidelity assertive community treatment programs showed greater reductions in alcohol and drug use and attained higher rates of remission from substance use disorders than clients in the low-fidelity programs. Clients in high-fidelity programs had higher rates of retention in treatment and fewer hospital admissions than those in low-fidelity programs. No differences between groups were found in length of hospital stays and other residential measures, psychiatric symptoms, family and social relations, satisfaction with services, and overall life satisfaction. CONCLUSIONS: Faithful implementation of, and adherence to, the assertive community treatment model for persons with dual disorders was associated with superior outcomes in the substance use domain. The findings underscore the value of measures of model fidelity, and they suggest that local modifications of the assertive community treatment model or failure to comply with it may jeopardize program success.

Adult↗
PubMed2005

MachineProse: an ontological framework for scientific assertions.

OBJECTIVE: The idea of testing a hypothesis is central to the practice of biomedical research. However, the results of testing a hypothesis are published mainly in the form of prose articles. Encoding the results as scientific assertions that are both human and machine readable would greatly enhance the synergistic growth and dissemination of knowledge. DESIGN: We have developed MachineProse (MP), an ontological framework for the concise specification of scientific assertions. MP is based on the idea of an assertion constituting a fundamental unit of knowledge. This is in contrast to current approaches that use discrete concept terms from domain ontologies for annotation and assertions are only inferred heuristically. MEASUREMENTS: We use illustrative examples to highlight the advantages of MP over the use of the Medical Subject Headings (MeSH) system and keywords in indexing scientific articles. RESULTS: We show how MP makes it possible to carry out semantic annotation of publications that is machine readable and allows for precise search capabilities. In addition, when used by itself, MP serves as a knowledge repository for emerging discoveries. A prototype for proof of concept has been developed that demonstrates the feasibility and novel benefits of MP. As part of the MP framework, we have created an ontology of relationship types with about 100 terms optimized for the representation of scientific assertions. CONCLUSION: MachineProse is a novel semantic framework that we believe may be used to summarize research findings, annotate biomedical publications, and support sophisticated searches.

Artificial Intelligence↗
PubMed1978

The assessment and training of assertive skills with drug addicts: a preliminary study.

The effects of a short-term behaviorally-oriented assertion training program were evaluated with a sample of drug-abuse patients concurrently involved in an ongoing inpatient program. Assertion questionnaire and verbal performance data were obtained from both a treatment and a no-treatment group prior to and following 3 weeks of assertion training. The results indicated consistent and significant group differences on the verbal behavior variables, but not on the questionnaire data. The results also suggested that the assessment of assertion by situationally defined problem areas may be more accurate and sensitive to change than a more general definition and assessment of assertive behavior.

Adult↗
PubMed1978

[Assertive training: techniques and clinical applications].

This paper successively examines the components of assertive behavior, its measurement instruments and the different techniques used to teach patients how to become more assertive. The therapeutic applications of assertive training are also summarized. The discussion emphasises the need for comparative studies with long term follow-ups and considers the problems of generalization outside the experimental setting. The use of anger is questioned because assertive training serves neither to eliminate nor exaggerate aggression but to control it. The authors conclude that a good assertive training technique should include simple and clearcut instuctions, behavior rehearsal and modeling.

Aggression↗
PubMed1980

Effects of assertion training on depression.

This was a non-analogue study of the effects of assertion training on depression. Twenty-six moderately depressed females (X = 21.3 years) were assigned randomly to assertion training or delay-control groups. Results partially supported the effectiveness of treatment. Experimental Ss became significantly more assertive and engaged in significantly more activities than controls, and effects of treatment continued after treatment ended. Eight weeks after treatment, the experimental Ss' scores indicated significantly less depression than at posttesting. Both experimental Ss and delya controls reported a significant decrease in depression from pre- to posttest. The two groups were not significantly different in reported depression at posttesting. Other findings included: (1) significant negative correlations between measures of depression and assertiveness; (2) no significant interactions between S type (client and volunteer) and outcome; and (3) no significant interactions between length of time depressed and outcome.

Adult↗
PubMed1983

Self assessment of relapse risk and assertiveness in relation to treatment outcome of female alcoholics.

Prior to and following social-skills training during a three months inpatient treatment, 145 female alcoholics indicated for various situations involving social pressure to drink alcohol (a) how difficult it would be for them not to drink (Relapse Risk) and (b) the degree of discomfort they expected (Specific Assertiveness). In addition, General Assertiveness situations, not related to alcohol, were evaluated. Patients who relapsed three months after treatment evaluated the situations more difficult to deal with and creating more discomfort than abstaining patients, although the groups did not differ in their self-rated assertiveness in non-alcohol-related situations. All ratings improved throughout the training, but the differences between outcome groups were similar before and after. When patients were excluded who had relapsed already during treatment, Relapse Risk but not Specific Assertiveness still discriminated between outcome groups. The prognostic power of the Risk rating seems to reflect a general efficacy expectation evident in a strong relation to patients' conviction of being able to stay abstinent, stated already at admission.

Alcoholism↗
PubMed1990

Effects of in vivo behavioral rehearsal on the learning of assertive behaviors with a substance abusing population.

Forty-three residents of a substance abuse treatment center were randomly assigned to (a) Assertiveness Training with Behavioral Practice (ATBP); (b) Assertiveness Training with Journal (ATJ), or (c) Waiting List Control (WLC). Using the Behavioral Assertiveness Test and the Gambrill-Richey Assertion Inventory, subjects in the ATBP group showed greater gains than the ATJ group on one behavioral measure, while both the ATBP and ATJ groups changed more than the WLC group on the Gambrill-Richey Response Likelihood scale. Behavioral rehearsal (homework compliance) was not consistently related to outcome, calling into question the value of the widespread use of homework assignments in behavioral treatments.

Adult↗
PubMed1999

Assessment of a cooperative-creative program of assertive behavior and self-concept.

This study examined the effects of a game program of assertive behavior, helpful behavior, and self-concept in children aged 8 to 10. A pretest-intervention-posttest design was used with a sample of 126 experimental and 28 control subjects. Three instruments were administered before and after intervention: the Children's Assertive Behavior Scale, Sensitivity Scale, and the Adjective Check List. Assertive behavior, helpful behavior, and self-concept were the dependent variables. Intervention consisted of a group play-session carried out once a week during the whole academic year. The program's games encourage children to cooperate and share, as well as to develop creative play. The program included presentation, communication, help, cooperation, creativity, and emotional expression games. Results of multiple variance analyses suggest that the program caused significant improvement in assertive behavior (p < .001) and self-concept (p < .01). This paper reveals empirical evidence of the positive contribution of cooperative-creative play to child development.

Assertiveness↗
PubMed1990

Effectiveness of booster sessions in the maintenance and enhancement of treatment gains following assertion training.

Forty-six unassertive Ss were randomly assigned to assertion training (AT) or waiting-list control conditions. Ss receiving AT showed significantly greater improvements from pretreatment to post-treatment on 8 out of 10 questionnaire measures of assertiveness and 3 out of 5 direct behavioral observation measures compared with the waiting-list group. 27 Ss who had completed the AT program were then randomly assigned to 1 of 3 booster conditions, namely, monthly assertion training boosters (ATB), monthly attention placebo boosters (APB), or no boosters (NB). At the 3-month follow-up there was minimal difference between booster conditions. By the 6-month follow-up the results favored the ATB condition. Although the APB procedure was effective in preventing the relapse shown by the NB subjects, the ATB group actually showed further improvements on some measures of assertiveness during the 6-month follow-up period.

Adult↗
PubMed1998

Increasing assertiveness skills to reduce HIV risk among women living with a severe and persistent mental illness.

This study examined whether training women living with a severe mental illness to be assertive in sexual situations would decrease their risk for HIV infection. Twenty female outpatients were randomly assigned to either a 10-session assertiveness training intervention or a waiting-list control condition. All participants completed measures of HIV-related information, motivation, skills, and sexual risk behavior pre- and postintervention and at 2- and 4-month follow-ups. Compared with controls, women in the intervention group increased their assertiveness skill, HIV knowledge, and frequency of condom-protected intercourse. It is concluded that assertiveness training for women living with a severe mental illness can serve as 1 part of a comprehensive HIV-risk-reduction program for this vulnerable population.

Adult↗