Evaluation of a mental health treatment court with assertive community treatment

Without active engagement, many adults with serious mental illnesses remain untreated in the community and commit criminal offenses, resulting in their placement in the jails rather than mental health facilities. A mental health treatment court (MHTC) with an assertive community treatment (ACT) model of case management was developed through the cooperative efforts of the criminal justice and mental health systems. Participants were 235 adults with a serious mental illness who were booked into the county jail, and who volunteered for the study. An experimental design was used, with participants randomly assigned to MHTC or treatment as usual (TAU), consisting of adversarial criminal processing and less intensive mental health treatment. Results were reported for 6 and 12 month follow-up periods. Clients in both conditions improved in life satisfaction, distress, and independent living, while participants in the MHTC also showed reductions in substance abuse and new criminal activity. Outcomes are interpreted within the context of changes brought about in the community subsequent to implementation of the MHTC.     

Efficacy of a Mental Health Treatment Court with assertive community treatment

This study examined the efficacy of a Mental Health Treatment Court (MHTC) with diversion to treatment supported by an assertive community treatment (ACT) model of case management. A total of 235 participants were randomly assigned to either MHTC or treatment as usual (TAU) and assessed over a 2 year period. It was hypothesized that participants in the MHTC would decrease their criminal activity and improve their psychosocial functioning relative to participants receiving TAU. While there were offenders for whom neither treatment was effective, a majority in both groups decreased jail days and improved psychosocial functioning, with MHTC participants demonstrating greater gains in most areas. The impact of implementing the MHTC on community practices, and the value of integrating criminal justice and mental health systems, is discussed.     

Prediction of outcome from cognitive-behavioral treatment of irritable bowel syndrome

The presence of a diagnosable Axis I psychiatric disorder predicted significantly (P < 0.001) lower likelihood of significant improvement among 90 irritable bowel syndrome patients given cognitive and behavioral treatments to help the disorder. Other psychological tests, including the MMPI, BDI, STAI, as well as demographic variables, failed to yield significant prediction.     

Prediction of outcome in the behavioural treatment of panic disorder with agoraphobia

Outcome was predicted from pre-treatment characteristics for 62 patients with a primary diagnosis of panic disorder with agoraphobia of moderate to severe magnitude who were treated with 16 sessions of behavioural therapy. Two approaches to the task of prediction was compared: (i) predicting class membership as clinically significantly improved at post-test and at 1-year follow-up on a composite score; and (ii) predicting individual change from the same variable. Agoraphobic severity was found to be a significant predictor of clinically significant improvement at both post-treatment and follow-up. It was also found to be a significant predictor of change at post-treatment, but not at follow-up. Instead the duration of the disorder was found to be a significant predictor of change at follow-up. Perceived treatment credibility, motivation, anxious cluster personality disorder or trait anxiety were not identified as significant predictors of outcome.     

Predicting outcome of chronic pain treatment via a modified self-efficacy scale

This study utilized a modified self-efficacy scale and examined the relationship of perceived self-efficacy to treatment outcome in a chronic, intractable, benign pain population (N = 62). In two separate studies a self-efficacy scale was given to inpatients in a combined cognitive-behavioral and medical treatment program. The scale categories consisted of (1) walking distance, (2) lifting ability, (3) pain coping, (4) working ability, and (5) social and recreational engagement. Self-efficacy beliefs were found to be associated with the level of functioning of these patients and their response to treatment. Patients with higher self-efficacy scores following treatment rated themselves as more improved and demonstrated better overall functioning with greater reductions in chronic illness behavior at followup. These observations support the merits of self-efficacy measures as predictors of treatment outcome in chronic pain patients.     

Prediction of treatment outcome in social phobia: a cross-validation.

This study was a replication of a study on the prediction of treatment outcome in social phobic patients [Chambless, D. L., Tran, G. Q. Glass, C.R. (1997). Predictors of response to cognitive-behavioral group therapy for social phobia. Journal of Anxiety Disorders, 11 221-240]. Results at the posttest and the 18-months follow-up were analyzed for DSM-III-R social phobic patients, with either a generalized social phobia (n = 50) or a nongeneralized fear, i.e. fear of blushing, trembling or sweating in social situations (n = 26). Predictors were pretreatment depression, personality disorder traits, clinician rated severity of impairment and frequency of negative self-statements during social interactions. The criterium variable was (the residual gain score of) self-reported avoidance of social situations. In line with Chambless et al., pretreatment depression showed some predictive value, but smaller and only at the posttest. Change in the frequency of negative self-statements paralleled, but did not predict, change in social phobia symptoms. In contrast with Chambless et al., clinician rated severity was (slightly) predictive for treatment outcome, whereas avoidant personality traits had reverse correlations with outcome in both subgroups. The results are discussed and directions for further research are given.     

Covert and overt rehearsal and elaboration during treatment in the development of assertive behavior

The present investigation examined the effects of covert and overt rehearsal and client elaboration of situations designed to train assertive behavior. Nonassertive clients (n = 61) received one of four treatments resulting from the 2 × 2 factorial combination of Modality of Rehearsal (covert vs overt) and Elaboration (elaboration vs no elaboration of training situations). A delayed-treatment group was included in the design to serve as a no-treatment control condition before subjects were assigned randomly to one of the above treatments. Treatment led to significant improvements on self-report and behavioral measures of assertiveness and self-efficacy. Covert and overt rehearsal were equally effective. However, elaboration of training situations significantly enhanced the effects of covert and overt rehearsal. Treatment effects were maintained up to a 6-month follow-up, transferred to novel role-playing situations, and brought clients within the range of other subjects (n = 45) who regarded themselves as adept in social situations requiring assertive behavior and who had not sought treatment.     

resilience and unemployment: exploring risk and protective influences for the outcome variables of depression and assertive job searching

This study examined adult resilience in the context of the adversity of unemployment. Seventy‐seven unemployed job seekers completed a self‐report survey containing the Resilience Scale (G. M. Wagnild & H. M. Young, 1993), Centre for Epidemiologic Studies–Depressed Mood Scale (L. S. Radloff, 1977), and the Assertive Job Hunting Survey (H. A. Becker, 1980). Product–term regression indicated that for those unemployed persons who had resilient qualities, less depression resulted even though they had been job searching for a long time (beta = ‐.359, p < .001). Length of time job searching was positively associated with depression (beta = .41, p < .01). When the outcome variable was job search assertiveness, only the main effect of resilience (beta = .492, p < .001) was significant, accounting for 25.8% of the variance. The inclusion of psychological interventions to foster resilience, along with standard job search training provided by job network services, is advocated.     

Predicting outcome of insanity acquittees released to the community

This research developed a model for forensic release decisions that incorporated actuarial and psychiatric predictors. The model was based on research that compared 127 insanity acquittees in the State of Maryland with a matched control group of 127 convicted felons and a comparison group of 135 mentally disordered prison transfers. The three cohorts were followed for an average of 10 years after release from hospital or prison. Findings on two outcome indicators are reported in this article: rearrests within 5 years after release and overall functioning in the community during 2½ years after release. Discriminant analysis was performed on the outcome variable of rearrest; it was found to accurately predict the outcome of 75% of the subjects with the following six variables: adjustment in hospital, clinical assessment of hospital staff, Global Assessment Scale score at release, functioning prior to instant offense, heroin addiction, and birth order. A second discriminant analysis identified seven variables that accurately predicted the overall functioning of 80.4% of the insanity acquittees.     

Demoralization and living alone: outcome from an urban community study.

The purpose of the present study was to investigate differences in demoralization between those who live in single-person households and those who live in households with others in a random sample of 8,634 urban adults. Responses to the 26-item Psychiatric Epidemiologic Research Interview did not substantiate that adults who live alone are more likely to be demoralized than those who live with others, until age and gender are considered. Men who live alone scored higher on demoralization than men who live with others, yet women who live with others scored higher on demoralization than those who live alone. An interaction for living arrangement and age group on demoralization was also observed.     

Prediction of treatment outcome among patients with irritable bowel syndrome treated with group cognitive therapy

Using a sample of over 125 patients with irritable bowel syndrome (IBS) who were treated with cognitive therapy administered in small groups, we sought to predict end of treatment and 3-month follow-up improvement in two changes indices of gastrointestinal (GI) symptoms (Pain/Discomfort Index which assessed change in abdominal pain, abdominal tenderness and bloating and Bowel Regularity Index which assessed change in diarrhea and constipation). We also sought to predict scores on IBS specific quality of life (QOL) and overall level of psychological distress using the Global Severity Index (GSI) of the Brief Symptom Inventory (BSI). Significant, but modest, levels of prediction were found for prediction of improvement in GI symptoms (4-15% of variance). Stronger significant prediction was obtained for the QOL and global psychological distress measure with R(2)'s ranging from 0.36 to 0.50. A wide variety of demographic, GI symptom, psychological status and psychiatric status variables entered the final prediction equations.