Assertive Treatment Research Articles

Protocol for a prospective multicentre registry cohort study on suicide attempters given the assertive case management intervention after admission to an emergency department in Japan: post-ACTION-J Study (PACS)

IntroductionSuicide attempt is the most important risk factor for later suicide. A randomised-controlled, multicentre trial of postsuicide attempt case management for the prevention of further suicide attempts in Japan, named...

Hyperspectral Imaging: A Review on UAV-Based Sensors, Data Processing and Applications for Agriculture and Forestry

Traditional imagery—provided, for example, by RGB and/or NIR sensors—has proven to be useful in many agroforestry applications. However, it lacks the spectral range and precision to profile materials and organisms that only hyperspectral sensors can provide. This kind of high-resolution spectroscopy was firstly used in satellites and later in manned aircraft, which are significantly expensive platforms and extremely restrictive due to availability limitations and/or complex logistics. More recently, UAS have emerged as a very popular and cost-effective remote sensing technology, composed of aerial platforms capable of carrying small-sized and lightweight sensors. Meanwhile, hyperspectral technology developments have been consistently resulting in smaller and lighter sensors that can currently be integrated in UAS for either scientific or commercial purposes. The hyperspectral sensors’ ability for measuring hundreds of bands raises complexity when considering the sheer quantity of acquired data, whose usefulness depends on both calibration and corrective tasks occurring in pre- and post-flight stages. Further steps regarding hyperspectral data processing must be performed towards the retrieval of relevant information, which provides the true benefits for assertive interventions in agricultural crops and forested areas. Considering the aforementioned topics and the goal of providing a global view focused on hyperspectral-based remote sensing supported by UAV platforms, a survey including hyperspectral sensors, inherent data processing and applications focusing both on agriculture and forestry—wherein the combination of UAV and hyperspectral sensors plays a center role—is presented in this paper. Firstly, the advantages of hyperspectral data over RGB imagery and multispectral data are highlighted. Then, hyperspectral acquisition devices are addressed, including sensor types, acquisition modes and UAV-compatible sensors that can be used for both research and commercial purposes. Pre-flight operations and post-flight pre-processing are pointed out as necessary to ensure the usefulness of hyperspectral data for further processing towards the retrieval of conclusive information. With the goal of simplifying hyperspectral data processing—by isolating the common user from the processes’ mathematical complexity—several available toolboxes that allow a direct access to level-one hyperspectral data are presented. Moreover, research works focusing the symbiosis between UAV-hyperspectral for agriculture and forestry applications are reviewed, just before the paper’s conclusions.

A capability framework to develop leadership for evidence-informed therapies in publicly-funded mental health services

PurposeIt is difficult to replicate evidence-informed models of psychosocial and assertive care interventions in non-research settings, and means to determine workforce capability for psychosocial therapies have not been readily available. The purpose of this paper is to describe and provide a rationale for the Therapy Capability Framework (TCF) which aims to enhance access to, and quality of, evidence-informed practice for consumers of mental health services (MHSs) by strengthening workforce capabilities and leadership for psychosocial therapies.Design/methodology/approachGuided by literature regarding the inadequacies and inconsistencies of evidence-informed practice provided by publicly-funded MHSs, this descriptive paper details the TCF and its application to enhance leadership and provision of evidence-informed psychosocial therapies within multi-disciplinary teams.FindingsThe TCF affords both individual and strategic workforce development opportunities. Applying the TCF as a service-wide workforce strategy may assist publicly-funded mental health leaders, and other speciality health services, establish a culture that values leadership, efficiency, and evidence-informed practice.Originality/valueThis paper introduces the TCF as an innovation to assist publicly-funded mental health leaders to transform standard case management roles to provide more evidence-informed psychosocial therapies. This may have clinical and cost-effective outcomes for public MHSs, the consumers, carers, and family members.

Assertive interventions for first episode psychoses: The Danish experience

Early Intervention services with team-based intensive case management and family involvement are superior to standard treatment in reducing psychotic and negative symptoms and comorbid substance abuse and improving social functioning and user satisfaction. The results of the OPUS-trial will be presented together with meta-analyses based on similar trials. The implementation of OPUS all over Denmark will be presented together with the Danish OPUS-fidelity study. Specialized elements are being are being developed such as inclusion of new methods in CBT for psychotic and negative symptoms, neurocognitive and social cognitive training programs, interventions for supported employment and focus on physical health. Results of long term follow-up studies indicate that the prognosis of first episode psychosis is very diverse with the extremes represented by one group being well functioning and able to quit medication without relapse; and another group having a long term chronic course of illness with a need for support to maintain daily activities. The Danish TAILOR-trial–testing dose reduction versus maintenance therapy will be presented. It will be of immense value to be able to intervene in risk groups identified in the premorbid phase, and there are few examples of ongoing trial for children of parent with schizophrenia and bipolar disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Assertive interventions for first episode psychoses: The Italian experience

In Italy, despite the favourable conditions created by the 1978 reform law and the community psychiatry, at the end of the past century there were no culture or initiatives oriented to innovative and evidence-based founded interventions in early psychosis. The watershed was the setting up in the MHD of Niguarda (Milan) of Programma 2000, addressed to FEP and HR mostly inspired by the knowledge of existing studies and experiences and with the recommended characteristics of specificity, multicomponentiality, assertiveness and doctrinal orientation. From the very start, one fundamental aim was to disseminate information, training, supervision, and to raise consensus and initiatives throughout Italy, as well as to improve international links. In many ways, the consequences have been extremely positive. In 2005, Angelo Cocchi and Programma 2000 team founded the AIPP (Italian Association for Early Intervention in Psychosis), now named Italian Association for Prevention and Early Intervention in Mental Health. Over the years, the Association has organized conferences, scientific days, working network, two national surveys on EIS and produced a document to favour their development. The results of the second survey are the more updated and articulated about the number of early interventions services, their characteristics and distribution in the different Italian regions. The survey conclusion is that EI Services implementation in Italy has been proceeding, albeit slowly. Nevertheless, there is still a great variability of therapeutic strategies and further efforts are then necessary to stimulate resources allocation as well as to assess and address adherence and fidelity to guidelines recommendations.Disclosure of interestThe author has not supplied his declaration of competing interest.

A family-based intervention of adolescents with eating disorders: The role of assertiveness

IntroductionOne of the key profile features of adolescents with Eating Disorders (ED) is a difficulty with assertiveness. Indeed, current research points to the importance of these patients’ perception of excessive control exerted by their families. Because these adolescents generally live with their families of origin, family-based variables may impact the development and evolution of psychosocial risk factors associated with this psychiatric disorder.ObjectiveTo investigate whether adolescents with ED improve on assertive communication as a result of parental assertiveness training.MethodsThe sample was comprised of 50 female adolescents with ED receiving group therapy treatment at Niño Jesús hospital in Madrid. Out of the 77 parents participating in the study, 36 were part of the experimental group and subjected to training in assertive skills (8-week sessions for about 2 hours). In addition, 41 parents formed the control group (with no assertiveness training). Before and after this training (or the same amount of time for the control group), adolescents were administered the psychometric test known as the Rathus Assertiveness Schedule (RAS).ResultsA significant increase in RAS scores was found in adolescents whose parents were subjected to the assertiveness training. Moreover, there was a significant decrease in self-restriction scores in patients with ED after their parental assertiveness intervention. No significant changes were observed, however, in the control group.ConclusionsOur results indicate that providing families with educational tools that aim at developing assertive communication may boost the level of assertiveness in adolescents and, thereby, presumably help in the prognosis of ED.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Parental Stress and Social Support of Caregivers of Children With Cerebral Palsy

Abstract Stress and social support are relevant variables for understanding the impact of disability on the care relationship. Thus, this study investigates the association between the parental stress index, social support indicators, and the sociodemographic variables of caregivers of children with cerebral palsy in a capital city of the Eastern Amazon. The following instruments were applied to 100 caregivers: the Sociodemographic Inventory, the Gross Motor Function Classification System, the Parenting Stress Index, and the Medical Outcomes Study Social Support Survey. For data analysis, descriptive statistics were used, in addition to techniques of multivariate analysis. It was found that most participants had high parental stress and a high perception of social support. Specific aspects of the perception of social support and sociodemographic indicators were associated with stress. This knowledge favors the design of more assertive interventions because it outlines the aspects of these variables that appear to have a more effective impact on parental stress.

Local Protest and Federal Policy: The Impact of the Civil Rights Movement on the 1964 Civil Rights Act

When and how do movements influence policy change? We examine the dynamics leading up to Kennedy's decision to pursue major civil rights legislation in 1963. This marked a key turning point in shifting the executive branch from a timid and gradualist approach. Although it is widely taken for granted that the civil rights movement propelled this shift, how the movement mattered is less clear. While most protest targeted local economic actors, movement influence was exerted at the national level on political actors. Thus, movement influence was indirect. We focus on the relationship between local movement efforts to desegregate public accommodations (restaurants, movie theaters, hotels, etc.) and federal responses to movement demands. Although exchanges between movement actors and the federal government took place throughout the period, the logic of federal response evolved as political actors sought strategies to minimize racial conflict. Specifically, the Kennedy administration shifted to a dual strategy. First, the Department of Justice attempted to promote “voluntary” desegregation by working with executives of national companies and civic groups. Second, administration officials worked with these same groups to build support for major legislation among key interest groups. This shift toward a more assertive and proactive intervention in civil rights stands in contrast to the pessimism regarding the prospects for federal policy only a few months earlier. We examine the logic of this response including the impact of civil rights protest on the administration's policy proposals.

Specialised assertive intervention in early psychosis

Specialised assertive intervention in early psychosis

How successful are first episode programs? A review of the evidence for specialized assertive early intervention

It has been hypothesized that the first 5 years after first episode of psychosis are a critical period with opportunities for ameliorating the course of illness. On the basis of this rationale, specialized assertive early intervention services were developed. We wanted to investigate the evidence basis for such interventions. The evidence for the effectiveness of specialized assertive early intervention services is mainly based on one large randomized clinical trial, the OPUS trial, but it is supported by the findings in smaller trials, such as the Lambeth Early Onset trial, the Croydon Outreach and Assertive Support Team trial and the Norwegian site of Optimal Treatment trial. There are positive effects on psychotic and negative symptoms, on substance abuse and user satisfaction, but the clinical effects are not sustainable when patients are transferred to standard treatment. However, the positive effects on service use and ability to live independently seem to be durable. Implementation of specialized assertive early intervention services is recommended, but the evidence basis needs to be strengthened through replication in large high-quality trials. Recommendation regarding the duration of treatment must await results of ongoing trials comparing 2 years of intervention with extended treatment periods.

The rise of assertive community interventions in South Africa: a randomized control trial assessing the impact of a modified assertive intervention on readmission rates; a three year follow-up

BackgroundMany countries have over the last few years incorporated mental health assertive interventions in an attempt to address the repercussions of deinstitutionalization. Recent publications have failed to duplicate the positive outcomes reported initially which has cast doubt on the future of these interventions. We previously reported on 29 patients from a developing country who completed 12 months in an assertive intervention which was a modified version of the international assertive community treatment model. We demonstrated reduction in readmission rates as well as improvements in social functioning compared to patients from the control group. The obvious question was, however, if these outcomes could be sustained for longer periods of time. This study aims to determine if modified assertive interventions in an under-resourced setting can successfully maintain reductions in hospitalizations.MethodsPatients suffering from schizophrenia who met a modified version of Weidens’ high frequency criteria were randomized into two groups. One group received a modified assertive intervention based on the international assertive community treatment model. The other group received standard care according to the model of service delivery in this region. Data was collected after 36 months, comparing readmissions and days spent in hospital.ResultsThe results demonstrated significant differences between the groups. Patients in the intervention group had significantly less readmissions (p = 0.007) and spent less days in hospital compared to the patients in the control group (p = 0.013).ConclusionModified assertive interventions may be successful in reducing readmissions and days spent in hospital in developing countries where standard care services are less comprehensive. These interventions can be tailored in such a way to meet service needs and still remain affordable and feasible within the context of an under-resourced setting.

EPA-1816 - Intervention in First Episode Psychosis

Purpose of review It has been hypothesized that the first five years after first episode of psychosis constitutes a critical period in with opportunities for ameliorating the course of illness. Based on this rationale, specialized assertive early intervention services were developed. We wanted to investigate the evidence basis for such interventions. Recent findings The evidence for the effectiveness of specialized assertive early intervention services is mainly based on one large randomized clinical trial, the OPUS trial, but it is supported by the findings in smaller trials such as the Lambeth Early Onset (LEO) trial, the Croydon Outreach and Assertive Support Team COAST trial and the Norwegian site of Optimal Treatment (OTP) trial. There are positive effects on psychotic and negative symptoms, on substance abuse and user satisfaction, but the clinical effects are not sustainable when patients are transferred back to standard treatment. However the positive effects on service use and ability to live independently seem to be durable. Summary Implementation of specialized assertive early intervention services is recommended, but the evidence basis needs to be strengthened through replication in large high quality trials. Recommendation regarding the duration of treatment must await results of ongoing trials comparing two years of intervention with extended treatment periods. Two-year follow-up N=369 OPUS (N=205) ST (N=164) P Cohen’s d Psychotic dimension 1.06 (1.26) 1.27 (1.40) 0.02 0.16 Negative dimension 1.41 (1.15) 1.82 (1.23) 0.34 GAF function 55.16 (15.15) 51.13 (15.92) 0.03 0.26 User satisfaction 26.1 (3.7) 22.9 (5.2) 0.67

A solution to the ossification of community psychiatry

SummaryThe aim for seamless care that has long been the ultimate goal of good community psychiatry in the UK has disappeared, and there is now much needless argument over models of delivering care that ignore its main philosophy. It is argued that this ossification of care has not only made it ineffective, but has also promoted demoralisation and burn-out in the workforce, as the locus of control has shifted from clinician to managerial imperative. An initiative that can break up the opaque structures that hinder continuity of care is now available and a suggestion is made for a flexible, invigorated community care team system based on smaller catchment areas that allows a single team to combine the elements of assertive outreach, crisis resolution and early intervention with in-patient care.

HIV-Related Risk Among Female Migrants Working in Entertainment Venues in China

China has experienced a surge in internal migration during the past decade, and migrant populations have been identified as a high-risk group for HIV and other sexually transmitted infections (STIs). Young female migrants often find employment in entertainment venues (bars, karaoke parlors, and massage parlors) located in metropolitan cities, and sex work transactions frequently occur in these venues. We examined factors associated with risk for HIV, other STIs, and reproductive health challenges in a cross-sectional study of 358 young female migrants, ages 18-29, working in entertainment venues in a rapidly growing urban city in China. Results indicate high levels of behavioral risk for HIV and other STIs, low rates of HIV testing, and high prevalence of problem drinking and mental health problems, including recent depression symptoms and suicidal ideation. Factors associated with increased STIs and genitourinary tract infections included commercial sex work, early sexual debut, abortion history, illicit drug use, and anxiety. Factors associated with increased HIV testing included employment in an affluent entertainment venue, education level, knowledge about where to obtain free HIV tests, condom use, and general HIV/AIDS knowledge. Findings of this study highlight the insufficient coverage of current public health services to female migrants working in entertainment venues and call for more assertive prevention interventions to mitigate risk for sexual, reproductive, behavioral, and mental health problems in this mobile population.

A Social Work Contribution to Suicide Prevention Through Assertive Brief Psychotherapy and Community Linkage: Use of the Manchester Short Assessment of Quality of Life (MANSA)

There is a striking absence of literature articulating and evaluating clinical social work contributions to suicide prevention, despite considerable practice in this important field. This article reports on a model of assertive brief psychotherapeutic intervention and facilitated linkage to community services utilized in a prospective cohort study of emergency department suicide attempt aftercare. A key outcome measure, the Manchester Short Assessment of Quality of Life (MANSA), was used with 65 patients to assess psychosocial domains at initial presentation, 4-weeks, 3-months, and 6-months. There were significant improvements in the domains of work, finance, leisure, social life, living situation, personal safety and health by 3 months. There were highly significant correlations between psychosocial improvements and improved depression scores.

An assertive outreach intervention does not reduce repeat suicide attempts compared with usual care

An assertive outreach intervention does not reduce repeat suicide attempts compared with usual care

Early detection, early symptom progression and symptomatic remission after ten years in a first episode of psychosis study

BackgroundPoor symptom outcome remains a challenge in psychosis: At least 50% of first-episode patients continue to have positive and/or negative symptoms after ten years. ObjectiveTo investigate rates, early predictors and early symptom progression of long-term non-remitted psychosis in an early detection study. MethodsSymptomatic remission according to new international criteria was assessed in 174 patients at ten-year follow-up. Remitted and non-remitted patients were compared on early symptom progression, and logistic regression was applied to predict non-remission. ResultsAt ten years, 50% of patients were in symptomatic remission. Non-remission was predicted by positive symptoms at inclusion and during the first year of treatment. Of individual symptoms only hallucinations were significantly predictive of ten-year non-remission. Early symptom differences were not reflected by differences in treatment. ConclusionsLong-term symptomatic non-remission is associated with early positive symptoms. More assertive intervention may be needed in patients who do not respond robustly in the first year of treatment, whether or not they have been detected “early”.

Effect of assertive outreach after suicide attempt in the AID (assertive intervention for deliberate self harm) trial: randomised controlled trial

Objective To assess whether an assertive outreach intervention after suicide attempt could reduce the frequency of subsequent suicidal acts, compared with standard treatment.Design Randomised, parallel group, superiority trial with blinded...

Suicide Attempt Presentations at the Emergency Department: Outcomes From a Pilot Study Examining Precipitating Factors in Deliberate Self-Harm and Issues in Primary Care Physician Management

The aim of this study was to examine the psychosocial precipitating factors of people presenting to the emergency department (ED) due to attempted suicide. Demographic, diagnostic and service use data were collected for a 6-week period. All patients were referred for primary care physician (PCP) management, with a sample followed up for secondary analysis of precipitants to self-harm and follow-up outcomes. Results of the study showed that key psychosocial stressors that triggered suicidality were relationship issues and recent unemployment, with depression present in 92% of cases. While 83% of patients followed attended their first PCP appointment, 50% discontinued by 3 months. The conclusion of this study is that psychosocial crises and depression are key factors in suicide attempts. Assertive crisis intervention, facilitated linkage to community services, and greater monitoring are recommended.

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.