Assertive Approach Research Articles

Recovery Prevalence and Health Profile of People in Recovery: Results of a Southeastern Pennsylvania Survey on the Resolution of Alcohol and Other Drug Problems

The emergence of recovery as an organizing construct for behavioral health public policy and the resulting push to increase the recovery orientation of addiction treatment have sparked renewed questions about the prevalence of substance use disorder (SUD) remission/recovery within the general population. The present study reports findings on recovery-related questions imbedded within a public health survey conducted in Philadelphia and four adjacent counties in Southeastern Pennsylvania. The results reveal an adult recovery prevalence rate (9.4%) comparable to rates found in national surveys, but key measures of physical, emotional, and social health of adults in recovery suggest the need for assertive, sustained, and community-based approaches to recovery management that transcend brief episodes of professional intervention.

Evaluation of three assertive outreach teams

Aims and methodTo evaluate outcomes for service users during their first year of treatment in three English assertive outreach teams. Changes in health and social functioning, engagement with services, service use and need (rated by staff and service users) were evaluated.ResultsIn 49 service users we found a significant increase in mean staff-rated met needs up to 6 months of treatment. There were no significant changes in ratings of engagement or Health of the Nation Outcome Scales (HoNOS) scores at 6 and 12 months. Unmet needs rated by service users and staff showed a non-significant trend for improvement across a range of individual health and social domains. Duration of hospital admission reduced significantly between the 12 months before the evaluation and the 12 months of the evaluation. Formal and informal admission and levels of contact with crisis teams reduced over the study period.Clinical implicationsAlthough these results offer some support to the assertive outreach approach, further research in larger samples is needed to identify which changes in health and social functioning are associated with transfer to assertive outreach teams.

Effectiveness of Assertive Community Management in Singapore

Assertive Community Treatment (ACT) was introduced in the 1970s as a comprehensive and assertive approach to community-based case management of patients with chronic and serious mental illness. Launched in Singapore in 2003, the Assertive Community Management (ACM) was modelled after the ACT, but with the main difference of 24 hour availability for the latter only. In line with the move towards de-institutionalisation of psychiatric patients, ACM was introduced to provide a mobile community-based multidisciplinary team approach to manage patients with severe chronic psychiatric illness. This article aims to evaluate and provide an update on this service programme in Singapore following an earlier study by Fam Johnson in 2007. A naturalistic and retrospective study was conducted. One hundred and fifty-five patients recruited into ACM from 1 September 2008 to 1 September 2009 and had completed 1 year of ACM were included in our study. Outcomes were defined as number of admissions (NOA) and length of stay (LOS) one year before and one year following induction into the programme. Baseline socio-demographic factors were also investigated to see if they predicted outcome with ACM. The mean NOA was 1.9 pre-ACM and 0.6 post-ACM, with mean reduction in NOA of 1.3 (P <0.01). The mean LOS was 72.2 days pre-ACM and 17.1 days post ACM, mean reduction in LOS 55.1 days (P <0.01). In addition, it was found that gender, diagnoses and ethnicity were not predictive of the outcome measures of NOA or LOS. ACM in Singapore had been well established since its inception and continued to show effectiveness in reducing inpatient hospitalisation among the chronically mentally ill.

Emotional work: students realising, negotiating and overcoming barriers

PurposeThe purpose of the research is to explore Foundation degree students’ experience of an innovative curriculum, designed to enable pathway choices and widen access to Honour's degree programmes in a wide range of health professions and Social Work.Design/methodology/approachA longitudinal, cohort design followed three years’ of entrants through their degree and in some cases beyond. Semi‐structured, in‐depth interviews were carried out by a dedicated researcher at approximately yearly intervals.FindingsSocial networks and friendship groups emerged as pivotal to participants’ well‐being and persistence. Institutional barriers included communication problems and a lack of information about timetables and other practical issues. Over time participants came to assert their needs and confront problems, individually and collectively, describing a more questioning and assertive approach to their study and work lives.Research limitations/implicationsThe experiences over time of students who leave university are needed to explore the role of social group membership and the effect of practical problems. A limitation of the study is that their views are not captured.Practical implicationsThe importance of naturally‐occurring social groups in creating persistence at university has implications for curriculum design and resources (time/space) to support this activity.Social implicationsWidening access to HE brings with it new responsibilities to support students over time as transitions occur through programmes of study and during vacation periods.Originality/valueFlexible approaches to education are generally seen to benefit mature students but can be stressful and require good and timely information.

Interlending and document supply: a review of the recent literature: 79

PurposeThe purpose of this paper is to provide a review of the literature concerning interlending and document supply and related matters.Design/methodology/approachThe paper is based on the reading of over 150 journals, as well as monographs, reports and websites.FindingsThis study finds that the prices of the big deals are under greater attack than ever. Alternatives are being actively explored. A more assertive approach is being adopted to expand the role of open access and both national and international newspapers as well as magazines such as The Economist have given it much favourable coverage in the last quarter. Resistance is growing, particularly in the UK, to the publishers' ability to override copyright law in their contracts with libraries.Originality/valueThis is the only regular literature review that focuses on document supply and related issues.

Therapeutic Assessment With an Adolescent: Choosing Connections Over Substances

This case study provides an in-depth example of a comprehensive therapeutic assessment with an adolescent (TA–A) and his parents. The TA–A addressed parental concerns about their son's drug experimentation as well as the adolescent's own private questions about his distinctiveness from others, all set against a backdrop of ongoing parental conflict and poor communication. The TA–A process and how it is specifically tailored to balance the needs of adolescents and their parents is discussed. Subsequently, each step of TA–A is illustrated through the case study. Research findings at the conclusion of the assessment and at follow-up indicated significant decreases in internalizing symptomology and school problems, increases in self-esteem and self-reliance, and improved family functioning as reported by the adolescent. At follow-up, the father spoke of developing a more assertive parenting approach and successful follow-through on recommendations. This case study provides a template for clinicians interested in conducting TA–A.

India as a democracy promoter? New Delhi's involvement in Nepal's return to democracy

According to the theory of ‘democratic peace’, India, as the largest democracy in the world and as South Asia's predominant regional power, should be expected to promote democracy in neighbouring countries. However, New Delhi lacks any kind of official democracy-promotion policy, and its past record on democracy promotion efforts in the region is mixed at best. Against this background, the article analyses the substantial role India has come to play in the peace and democratization process in Nepal in the years 2005–2008, asking whether this constitutes a departure from New Delhi's traditional policy of non-interference in its neighbours' internal affairs and a move towards a more assertive approach to democracy promotion. However, the analysis shows that India's involvement in Nepal was the product of short-term stability concerns rather than being an indicator of a long-term change in strategy with the intention of becoming an active player in international democracy promotion.

Interlending and document supply: a review of the recent literature: 77

PurposeThe purpose of this paper is to review the current LIS literature for document supply and related topics.Design/methodology/approachThe paper is based on the reading of about 150 journals, reports and web sites.FindingsThis study finds that the prices of the big deals are under greater attack than ever. Alternatives are being actively explored. A more assertive approach is being adopted to expand the role of open access. Resistance is growing, particularly in the UK, to the publishers' ability to override copyright law in their contracts with libraries.Originality/valueThis is the only regular literature review that focuses on document supply.

OSCE electoral assistance and the role of election commissions

AbstractElection commissions that serve the partisan interests of the authorities are key to the manipulation of election processes in OSCE participating states and beyond. Despite the importance of impartial election administration, OSCE/ODIHR, in its reviews of election laws or in its reports of election observation missions, has so far declined to put forward a comprehensive view on what constitutes best practices regarding the composition and functioning of election commissions. Drawing from a comparative study of the manipulation of rules for the composition and functioning of election commissions, this article develops insights, and formulates recommendations, that could inform a more assertive ODIHR approach to the issue of partisan election commissions..

Outreach and Support in South London (OASIS). Outcomes of non-attenders to a service for people at high risk of psychosis: the case for a more assertive approach to assessment

Outreach and Support in South London (OASIS). Outcomes of non-attenders to a service for people at high risk of psychosis: the case for a more assertive approach to assessment

Treatment of first-episode psychosis patient, psychosocial aspects

Two large randomised clinical trials, the OPUS and the LEO trials, investigating specialised assertive intensive treatment in early phases of psychosis have been shown to have positive effects on clinical symptoms, substance abuse, and user satisfaction although only some of these positive effects are sustainable over time. At a five-year follow-up, there were no clinical differences between the specialised assertive intervention group and standard care, but significantly more intervention patients were able to live independently and spent significantly fewer days in hospital. As a consequence of these outcomes, a comparison of five years and two years of specialised assertive treatment is currently being undertaken. Crucial elements in specialised assertive intensive treatment are the assertive approach and family involvement, and there is also some evidence supporting the inclusion of cognitive behavioural therapy, supported employment and weight management.

Subcontracting, Posted Migrants and Labour Market Segmentation in Finland

AbstractUsing evidence from the shipbuilding and construction industries in Finland, this article shows how trade union responses to the introduction of migrant workers can be conditioned by product markets. Growing numbers of ‘posted workers’, or intra‐European Union work migrants employed via transnational subcontractors, are segmenting the labour market, by competing with domestically domiciled workers whose employment is more tightly regulated. In Finland, the construction worker's union has had a far more assertive and successful approach to enforcing wage norms than the union in shipbuilding. This appears to be related to the greater exposure of shipbuilding to international product market competition.

Recruitment into a guided internet based CBT (iCBT) intervention for depression: Lesson learnt from the failure of a prevalence recruitment strategy

Introduction Internet based Cognitive Behavioural Therapy (iCBT) represents a significant development in the way psychological interventions are delivered. Studies tend to recruit via common media channels leading to criticisms of biased sample sizes and limited generalisability to primary care settings. Aim To evaluate the use of a prevalence recruitment strategy within primary care to recruit into an RCT examining a free to use iCBT intervention. Methods Fully randomised controlled trial (RCT), utilising a prevalence based recruitment strategy, comparing the iCBT intervention with telephone support provided by NHS Direct Health Advisors with treatment-as-usual (TAU) control. Results Recruitment rates were low with only 7 participants recruited over 8 months. Overall only 14% of expected study invitations were sent, with only 1% undertaking the consent and initial screening process. Discussion Key differences with successful prevalence recruitment strategies highlight four main issues to consider when recruiting participants from primary care into iCBT studies — lack of equipoise, a need for an assertive approach, coding of depression in GP databases and help seeking behaviour in depression which can all act as potential contributors to failure to recruit. However other non-primary care recruitment methods, such as the use of media channels, which are already shown to be effective in non-primary care settings should be considered if these methods more accurately target the population who would be willing to adopt iCBT more generally.

P03-201 - The krapellenian dicotomy in terms of employment outcomes

BackgroundWe decided to examine the employment status of all patients with Schizophrenia actively treated by the Bedford East CMHT and compare this to the employment status of all those in the team who suffered from Bipolar Affective Disorder.MethodsCases of Schizophrenia and Bipolar Disorder were anonymously identified from a database held by the team and their employment status was established.Results124 patients were identified with schizophrenia, 24 with Schizoaffective disorder, and 60 with Bipolar Disorder.Of the Schizophrenia patients, 91 (73.38%) were unemployed, 15(12%) were employed, 10 (8%) were in voluntary employment and 8 (6.45%) were labelled ‘other’ [housewife, student etc].Of the Bipolar patients, 32 (53.33%) were unemployed, 14(23%) were employed, 5 (8.3%) were in voluntary employment and 9 (15%) were labelled ‘other’Of the Schizoaffective patients, 15 (62.5%) were unemployed, 4 (16.66%) were employed, 2 (8.33%) were in voluntary employment and 3 (12.5%) were labelled ‘other’.DiscussionEmployment Outcomes for serious mental illness were poor, however Schizophrenia patients had a lower chance of returning to employment, partly due to the heterogeneity of the condition. Bipolar patients had twice the chance of gainful employment as Schizophrenic ones.ConclusionIt is particularly difficult to achieve employment for patients with serious mental illness. This adds to the recently made argument for a more assertive approach by the creation of ad hoc chronic psychosis teams who could give ongoing support to aid patients to return to social inclusion and possibly work.

China’s new foreign policy strategy and Russia’s concerns

The recent trends in Beijing?s foreign policy have become a broadly discussed topic throughout the world. China?s economic success over the last ten years has led Beijing to take a more assertive approach to China?s relationship with the outside world. This shift has manifested itself in a more hard-line approach to China?s relationship with her partners, less inclination toward compromise, and a tendency to respond to the external pressure with more pressure, to the external bumps with harder bumps. The new assertiveness of China can be understood. After all, it is merely the natural urge of a new, large, and successful regime to actively pursue its interests. At the same time, it is true that the successful economic development of the last ten years has led to the growth of nationalism among the elite. If the nationalist tendency prevails in the Chinese foreign policy, China?s neighbors, including Russia, will have to do some serious rethinking of their approach to the growing giant.

Security issues during Lula's administration: from the reactive to the assertive approach

Brazil's security agenda during Lula's administration was not homogeneous through the two mandates: the first tenure (2002-2006) revealed a reactive approach towards security topics, while the second one (2006-2010) was more assertive. More specifically, the shift occurred in terms of both its geographical scope - once it incorporated global issues in a more systematic way -, and instruments through which the security agenda was exercised, given the multilateral initiative of Unasur's CDS

India and China eye each other warily

When Chinese Premier Wen Jiabao visits New Delhi on 15–17 December he will find the political mood quite different from when he was last there nearly five years ago. While it is often claimed that Asia is large enough to accommodate the simultaneous emergence of both China and India as rising powers, India is visibly concerned over Beijing's growing attention to South Asia, and especially over China's more assertive approach to a longstanding border dispute. Prime Minister Manmohan Singh said in September that ‘China would like to have a foothold in South Asia and we have to reflect on this reality… It's important to be prepared.’

A Regional Power Promoting Democracy? India’s Involvement in Nepal (2005–2008)

According to the theory of “democratic peace,” India, as the largest democracy in the world and as South Asia’s predominant regional power, should be expected to promote democracy in neighboring countries. However, New Delhi lacks any official democracypromotion policy, and its past record on democracy in the region is mixed at best. Against this background, the paper analyzes the substantial role India came to play in the peace and democratization process in Nepal in the years 2005–2008, asking whether this constitutes a departure from New Delhi’s traditional policy of noninterference in its neighbors’ internal affairs and a move towards a more assertive approach to democracy promotion. The analysis shows that India’s involvement in Nepal was the product of short‐term stability concerns rather than being an indicator of a long‐term change in strategy with the intention of becoming an active player in international democracy promotion. Als groste Demokratie der Welt und gleichzeitig als dominierende Regionalmacht in Sudasien, konnte man erwarten, dass Indien in seinen Nachbarstaaten Demokratieforderung betreibt. Die Theorie des demokratischen Friedens geht davon aus, dass es im Interesse einer Demokratie wie Indien liegt, von Demokratien umgeben zu sein, da somit die Wahrscheinlichkeit von Kriegen sinkt. Dies ist jedoch bei Indien nicht der Fall: Neu‐Delhi geht pragmatisch mit autoritaren Staaten um und hat keine offizielle Politik der Demokratieforderung. Das Papier geht der Frage nach, inwieweit Indiens substanzielles Engagement im Friedens‐ und Demokratisierungsprozess in Nepal in den Jahren 2005‐2008 eine Abkehr von Neu‐Delhis traditioneller Ablehnung von Demokratieforderung darstellt. Die Untersuchung ideeller und zielorientierter Grundlagen in Indiens Ausenpolitik und die Analyse des indischen Engagements in Nepal fuhren zu dem Schluss, dass wir es mit keinem radikalen Wandel zu tun haben. Indiens Bemuhungen in Nepal sind nicht als langfristiger Strategiewandel, sondern als reaktiver, kurzfristiger Politikwechsel zu verstehen, der primar auf die Stabilisierung des Nachbarstaats abzielte.

Outreach and Support in South London (OASIS). Outcomes of non-attenders to a service for people at high risk of psychosis: the case for a more assertive approach to assessment

International agreement dictates that clients must be help-seeking before any assessment or intervention can be implemented by an 'at-risk service'. Little is known about individuals who decline input. This study aimed to define the size of the unengaged population of an 'at-risk service', to compare this group to those who did engage in terms of sociodemographic and clinical features and to assess the clinical outcomes of those who did not engage with the service. Groups were compared using data collected routinely as part of the service's clinical protocol. Data on service use and psychopathology since referral to Outreach and Support in South London (OASIS) were collected indirectly from clients' general practitioners (GPs) and by screening electronic patient notes held by the local Mental Health Trust. Over one-fifth (n=91, 21.2%) of those referred did not attend or engage with the service. Approximately half of this group subsequently received a diagnosis of mental illness. A diagnosis of psychosis was given to 22.6%. Nearly 70% presented to other mental health services. There were no demographic differences, except that those who engaged with the service were more likely to be employed. Over one-fifth of those referred to services for people at high risk of psychosis do not attend or engage. However, many of this group require mental health care, and a substantial proportion has, or will later develop, psychosis. A more assertive approach to assessing individuals who are at high risk of psychosis but fail to engage may be indicated.

Is it time to trial vitamin D supplements for the prevention of schizophrenia?

Is it time to trial vitamin D supplements for the prevention of schizophrenia?