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PubMed1994

Appropriateness of assertive case management for drug-involved prison releasees.

Assertive case management models have been used successfully in both social work and mental health settings and, most recently, in the substance abuse field. This article reports on the application of an assertive case management model with drug-involved parolees in Delaware. Because of a variety of factors, the evaluation proved to be less than an ideal test of the effectiveness of the case management approach. Although there were some modest effects on reducing relapse to drug use, it appears that assertive case management is of limited value for clients who are not merely unable to access services, but who are often quite assertive in their unwillingness to make use of these services.

Assertiveness↗
PubMed1995

[Disorders of assertiveness and social anxiety].

Assertiveness is a multidimensional concept use to describe individual's social functioning, from normal adaptation to pathological worries of social inefficacy. Several psychological impairments are evoked in assertiveness disorders, leading to the discussion of cognitive and emotional functioning in such pathology. These pathologies are represented by the social anxiety spectrum, an heterogeneous syndrome from shyness to social phobia in which functional dysregulation are discussed to explain the missadaptation. Experimental approach are developed to test the cognitive hypothesis proposed in assertiveness and social anxiety, and to discuss the clinical and psychopathological status of assertiveness disorders.

Adaptation, Psychological↗
PubMed1995

Assertive outreach for frequent users of psychiatric hospitals: a meta-analysis.

A meta-analysis was conducted on nine studies of an assertive outreach model for frequent users of psychiatric hospitals. Four studies used experimental or quasi-experimental designs and five used pre-post designs. Findings at one-year follow-up were examined for retention in community mental health services, psychiatric inpatient days, quality of life, and client level of functioning. Eighty-four percent of assertive outreach clients were still receiving mental health services after one year, compared to 54% of controls. In two thirds of the programs, the mean annual rate of inpatient days declined by 50% or more. The overall experimental effect size for quality of life was negligible, although changes over time for assertive outreach clients were more encouraging. Similarly, improvement in level of functioning was found for assertive outreach clients. The study examining experimental differences in level of functioning obtained a nonsignificant moderate effect.

Chicago↗
PubMed2005

North Birmingham assertive outreach evaluation. Patient characteristics and clinical outcomes.

BACKGROUND: Given the adoption of assertive outreach teams into UK mental health policy, it is important to assess whether gains identified in efficacy studies can be replicated in ordinary clinical settings. AIM: The aim of the study was to assess patient characteristics and clinical outcomes in routine assertive outreach services in the UK. METHODS: Patients (N=250), newly taken onto five assertive outreach teams, were followed up over 2 years. Baseline characteristics and outcome measures were compared. RESULTS: Most patients had an International Statistical Classification of Diseases and Related Health Problems, 10th Revision, diagnosis of schizophrenia, schizotypal or delusional disorder and long-standing involvement with psychiatric services. Around a half had a history of substance abuse and violence. At follow-up, the majority had ongoing input from the teams and there was a significant decrease in the use of in-patient care. There was no improvement in symptoms, risk behaviours or social functioning. CONCLUSION: Patients on assertive outreach teams remain in contact with services and spend less time in hospital yet show little change with respect to clinical outcomes.

Adult↗
PubMed1997

Project ASSERT: an ED-based intervention to increase access to primary care, preventive services, and the substance abuse treatment system.

STUDY OBJECTIVE: To test the feasibility and effectiveness of Project ASSERT, an innovative program developed by us to facilitate access to the substance abuse treatment system and to primary care and preventive services for emergency department patients with drug- and alcohol-related health problems. METHOD: Multicultural health promotion advocates (HPAs) were trained by ED personnel to screen patients using a health needs history, to administer a brief negotiated interview based on readiness-to-change principles, and to use an active referral process to capture the marginal capacity of the substance abuse treatment system. Outcome measures included (1) number of referrals to the substance abuse treatment system, (2) patient self-report of satisfaction with services received from Project ASSERT and utilization of treatment resources, and (3) changes in self-reported frequency of drug and alcohol use and in Drug Abuse Screening Test scores between enrollment and follow-up at 60 to 90 days. RESULTS: Between March 1, 1995, and February 29, 1996, 7,118 adult ED patients were screened. Substance abuse was detected among 2,931 patients (41%), and 1,096 (37% of detected patients) were enrolled. A total of 8,848 referrals were made: 3,189 to primary care, 2,018 to a variety of substance abuse treatment services, 2,253 for smoking cessation, 339 for mammography, and 689 to other support services (eg, psychiatric nurse, social worker, battered women's advocate or shelter). Comparison of enrollment and follow-up scores for the 245 enrollees who kept a follow-up appointment demonstrated significant reductions, including a 45% reduction in severity of drug problem, a 56% reduction in alcohol use, and a 64% reduction in the frequency of drinking six or more drinks at one sitting. At follow-up, patients expressed satisfaction with Project ASSERT: 91% were satisfied with their referrals; 93% thought the HPAs explained things well; and 99% thought the HPAs respected them as individuals. Among the follow-up group, 50% self-reported that they had kept an appointment for treatment. CONCLUSION: Project ASSERT is an innovative approach to link ED patients with the substance abuse treatment system and with primary care and other preventive services. Its success is further demonstrated by its adoption by Boston Medical Center as a funded ED value-added service.

Adult↗
PubMed2005

Randomized controlled trial of assertive community treatment in intellectual disability: the TACTILD study.

BACKGROUND: There has been a policy shift away from hospital to community in the services of all those with psychiatric disorders, including those with intellectual disability (ID), in the last 50 years. This has been accompanied recently by the growth of assertive outreach services, but these have not been evaluated in ID services. METHOD: In a randomized controlled trial we compared assertive outreach with 'standard' community care, using global assessment of function (GAF) as the primary outcome measure, and burden and quality of life as secondary measures. RESULTS: We recruited 30 patients, considerably less than expected; no significant differences were found between the primary and secondary outcomes in the two groups. The differences were so small that a Type II error was unlikely. CONCLUSIONS: Reasons for this lack of specific efficacy of the assertive approach are discussed and it is suggested that there is a blurring of the differences between standard and assertive approaches in practice.

Adolescent↗
PubMed1997

Assertive community treatment and medication compliance in the homeless mentally ill.

OBJECTIVE: This study describes medication compliance rates among a group of homeless mentally ill subjects who received assertive community treatment. METHOD: The medication compliance of 77 homeless persons who had been referred to an assertive community treatment program was prospectively evaluated at baseline and quarterly for 1 year. RESULTS: A minority of the cohort (29%) was compliant at entry into the assertive community treatment program. Compliance significantly increased after 3 months (57%) and remained high through the year. Medication compliance was associated with fewer psychiatric symptoms but not with better housing placements or fewer days in the hospital. CONCLUSIONS: Medication compliance rates among a cohort of homeless persons with severe mental illness were markedly higher after they entered a program of assertive community treatment.

Adolescent↗
PubMed2004

Forensic assertive community treatment: preventing incarceration of adults with severe mental illness.

OBJECTIVE: Persons with severe mental illness are overrepresented in jails and prisons in the United States. A national survey was conducted to identify assertive community treatment programs that have been modified to prevent arrest and incarceration of adults with severe mental illness who have been involved with the criminal justice system. METHODS: Members of the National Association of County Behavioral Health Directors (NACBHD) were surveyed to identify assertive community treatment programs serving persons with criminal justice histories and working closely with criminal justice agencies. Programs were identified that met three study criteria: all enrollees had a history of involvement with the criminal justice system, a criminal justice agency was the primary referral source, and a close partnership existed with a criminal justice agency to perform jail diversion. Senior representatives of each program were subsequently contacted, and a telephone survey was administered to gather information about the design and operation of the programs. RESULTS: A total of 291 of 314 NACBHD members (93 percent) responded to the survey. Sixteen programs that met the study criteria were identified in nine states. The primary referral sources for 13 of these programs (81 percent) were local jails. Eleven programs (69 percent) incorporated probation officers as members of their assertive community treatment teams. Eight programs (50 percent) had a supervised residential component, with five providing residentially based addiction treatment. Eleven of the 16 programs have begun operating since 1999. Only three programs have published outcome data on program effectiveness. CONCLUSIONS: Forensic assertive community treatment is an emerging model for preventing arrest and incarceration of adults with severe mental illness who have substantial histories of involvement with the criminal justice system. Further research is needed to establish the structure, function, and effectiveness of this developing model of service delivery.

Adult↗
PubMed1995

Dissemination of assertive community treatment programs.

OBJECTIVE: The study sought to estimate the number of programs in the U.S. for severely mentally ill adults that used the assertive community treatment model and to describe variations in characteristics of the intervention across programs. METHODS: Assertive community treatment programs identified by state mental health authorities completed a 12-item survey. The survey included questions on caseload, composition of the treatment team, nature of services, and structure of service provision. RESULTS: A total of 303 of 340 programs (89 percent) identified by states responded to the survey. More than 75 percent provided most of their services in the field, delivered medications, included medical staff on the assertive community treatment team, and had caseload ratios of less than 20 consumers for each provider. CONCLUSIONS: Assertive community treatment programs have disseminated quite unevenly across 33 states, with the highest concentrations of programs in midwestern and eastern states.

Adult↗
PubMed1978

The measurement of assertiveness and aggressiveness.

The Bakker Assertiveness-Aggressiveness Inventory is a 36-item self-report inventory designed to measure two separate aspects of what has previously been subsumed under the rubric "assertiveness", namely, (a) defensive, responsive behaviors which protect territory and privileges, and (b) initiating behaviors which augment the person's territory or status. Assertiveness scores increases significantly above aggressiveness scores in a class which focused on the defensive, responsive aspects of behavior. Aggressiveness was found to correlate with occupation level and amount of schooling sought, while assertiveness did not correlate with either of these. Normative, reliability and validity data are presented.

Aggression↗
PubMed1979

Covert modeling vs. Behavior rehearsal in the training and generalization of assertive behaviors: a crossover design.

Twenty-four underassertive individuals from the community were assigned randomly to two treatment orders that included covert modeling and behavior rehearsal in a crossover design. Dependent measures included two self-report inventories and a behavioral assertiveness test. This test included a self-rating scale, two nonverbal measures, and eight measures of speech content. No measurable differences between treatments were found, and both significantly improved assertive skills on 10 of the 13 measures. However, Ss had greater expectations of improvement from behavior rehearsal both during and after treatment. Generalization of assertive skills from trained to untrained situations occurred on 8 of the 11 behavioral measures. Suggestions were made for exploring the use of covert modeling as a personal coping procedure capable of enhancing generalization and maintenance.

Adolescent↗
PubMed1982

A self-report measure of assertiveness in young adolescents.

Reported a self-report measure of adolescents' assertiveness. Items for this scale were presented to young adolescents (N = 78) and subsequently were subjected to a factor analysis that revealed factors of submissiveness, aggressiveness, and assertiveness. Teacher ratings and behavioral responses during a role-play test also were obtained and provide additional validational evidence in support of the scale. After the validational study, a small assertiveness training program was conducted to evaluate the efficacy of standard treatment procedures with this population. Results indicated that training effects were obtained and that the effects generalized to situations that had not been employed during training.

Adolescent↗
PubMed1980

Assertion training: effectiveness in the treatment of depression.

Assigned depressed outpatients (N = 32) to either group assertion training or "traditional" group psychotherapy. The results showed that over a relatively short period of time, assertion training was more effective than traditional psychotherapy in increasing self-reported assertiveness and in alleviating depression.

Assertiveness↗
PubMed1980

Concurrent validity of three self-report measures of assertiveness.

The relative validity of three self-report measures of assertiveness was assessed by correlating the scored obtained by 88 student nurses with peer and faculty ratings of assertiveness. Self-reported assertiveness failed to predict frequency of class participation within a subsample of 48 students. Type of instructional setting, however, did exert a significant effect on class participation.

Adult↗
PubMed1993

Refusal assertion versus conversational skill role-play competence: relevance to prevention of tobacco use.

Conversational and refusal assertion skills of 768 seventh grade youth were assessed through ratings of global (for example, effectiveness) and non-verbal (for example, eye contact) behaviour performed in two role-play scenarios. The ratings were completed after each scenario by the subjects themselves, as well as by classmate and trained adult observers. Use of the Hays and Hayashi multitrait scaling method to interpret these data revealed two results. First, the items used to measure role-play behaviour did not achieve sufficient internal consistency to create global and non-verbal composites. Second, inter-rater agreement and discriminant validity were obtained only for ratings of the global effectiveness of each of the two social skills. Next, a series of multiple regression analyses indicated that an index of the global effectiveness of refusal assertion skill, but not of conversational skill, was predictive of intention to use tobacco. Those who were relatively unskillful at refusing offers were more likely to intend to use tobacco. Analyses exploring relations of trained observer ratings of the effectiveness of both role-play types, trained observer ratings of the other global and non-verbal items, and subjects' intention to use tobacco indicated that only a hesitant voice pattern was both negatively predictive of effective refusal assertion and positively predictive of intention to use tobacco in the future. In other words, those who are hesitant when they refuse a tobacco offer are the ones most likely to report an intention to use tobacco in the future. The consistency of this last finding in the tobacco use prevention literature is discussed.

Assertiveness↗
PubMed1992

Assertiveness training for disabled adults in wheelchairs: self-report, role-play, and activity pattern outcomes.

Thirty-four physically disabled adults participated in an 11-week assertiveness training (AT) program. Ss were randomly assigned to either AT or a waiting-list (WL) condition. Each was asked to complete three self-report measures, a role-play test, and a social and recreational activity diary. The AT Ss showed significant improvements on both self-reported assertiveness and role-play performance from pre- to posttreatment, whereas WL controls showed no changes on these measures. No significant changes in frequency of social or recreational activities were found at posttest for either AT or control Ss. A mixed pattern of results was shown at 6-month follow-up. Posttest gains were maintained across all self-report measures of assertiveness and acceptance of disability, whereas role-play performance approached baseline levels at 6-month follow-up. Overall results support the use of AT in enhancing perceived social efficacy and interpersonal skill of physically disabled adults in wheelchairs.

Activities of Daily Living↗
PubMed2002

Depression, automatic thoughts, alexithymia, and assertiveness in patients with tension-type headache.

OBJECTIVE: The role of psychological factors related to headache has long been a focus of investigation. The aim of this study was to evaluate depression, automatic thoughts, alexithymia, and assertiveness in persons with tension-type headache and to compare the results with those from healthy controls. METHODS: One hundred five subjects with tension-type headache (according to the criteria of the International Headache Society classification) and 70 controls were studied. The Beck Depression Inventory, Automatic Thoughts Scale, Toronto Alexithymia Scale, and Rathus Assertiveness Schedule were administered to both groups. Sociodemographic variables and headache features were evaluated via a semistructured scale. RESULTS: Compared with healthy controls, the subjects with headache had significantly higher scores on measures of depression, automatic thoughts, and alexithymia and lower scores on assertiveness. Subjects with chronic tension-type headache had higher depression and automatic thoughts scores than those with episodic tension-type headache. CONCLUSIONS: These findings suggested that persons with tension-type headache have high depression scores and also may have difficulty with expression of their emotions. Headache frequency appears to influence the likelihood of coexisting depression.

Adult↗
PubMed1985

The need for power and fear of assertiveness in English-speaking South African female graduates.

The present study demonstrated that Winter's (1973) power arousal procedure and scoring system for the need for power, which were developed in the United States, are valid for English-speaking South African female graduates. Subjects in whom the need for power had been aroused by a prerecorded inspirational speech (n = 20) had significantly higher n Power scores than matched nonaroused subjects (n = 20), T2(8, 31) = 56.17, p less than .01. Further, it was argued that the fear of assertiveness is a component of the need for power, and a scoring system for measuring this motive was suggested. Fear of assertiveness was shown to correlate significantly with various behavioral and dispositional measures of assertiveness, relating especially to a dependency pattern of behavior.

Adult↗