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Therapeutic limit setting in an assertive community treatment program.

M S Neale1, R A Rosenheck

  • 1Veterans Affairs Northeast Program Evaluation Center, VA Connecticut Healthcare System, Campbell Avenue, West Haven, Connecticut, 06156, USA. michael.neale@med.va.gov

Psychiatric Services (Washington, D.C.)
|March 29, 2000
PubMed
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Assertive community treatment case managers frequently use verbal guidance and other strategies for therapeutic limit-setting with clients who have serious mental illness. These limit-setting approaches are important for treatment and comparing team assertiveness.

Area of Science:

  • Psychiatry
  • Clinical Psychology
  • Social Work

Background:

  • Assertive Community Treatment (ACT) is a model of intensive community-based psychiatric care.
  • Effective limit-setting is crucial for managing serious mental illness (SMI) within ACT.
  • Understanding the specific limit-setting strategies employed by ACT teams is essential for optimizing client care.

Purpose of the Study:

  • To examine the range and frequency of therapeutic limit-setting activities used by ACT team members with clients diagnosed with SMI.
  • To identify factors influencing the use of limit-setting strategies in ACT.
  • To analyze the psychometric properties of the Therapeutic Limit Setting (TLS) scale.

Main Methods:

  • Case managers (N=1564) from 40 Veterans Affairs ACT teams reported their use of 25 limit-setting activities.

Related Experiment Videos

  • A 25-item measurement scale was factor analyzed to develop the TLS scale.
  • Standard multiple regression analyzed the relationship between limit-setting scores and client characteristics, treatment process variables, and therapeutic alliance.

    • Main Results:

    • Case managers most frequently used informal verbal approaches and least often formal legal restrictions for limit-setting.
    • Factor analysis yielded a 20-item TLS scale with five factors: verbal guidance, money management, contingent withholding of services, enforced hospitalization, and invocation of external authorities.
    • Limit setting was more common with clients exhibiting more severe symptoms, greater hospitalization history, recent substance use, arrests, and those with a representative payee.

    Conclusions:

    • ACT case managers utilize diverse limit-setting strategies.
    • Limit setting is a common and significant component of ACT.
    • The TLS scale and its factors offer a valuable tool for assessing assertiveness in ACT teams and other community-based services.