Clients engagement with assertive outreach services : a comparison of client and staff perceptions of engagement and its effect on later engagement
Volume I of the thesis comprises the research component, which consists of two papers: a
review paper and a main empirical paper.
The review paper explores to what extent engaging with services may be beneficial or
detrimental to people with severe and enduring mental health problems. The paper examines
the impact of therapeutic alliance, duration of untreated psychosis and assertive outreach
services. The potential negative impact of engagement with services is also addressed by
reviewing studies looking at stigma, labelling and racial discrimination. The paper concludes
that engaging with services has the potential to be beneficial to people with severe and
enduring mental health problems, once barriers such as stigma and racial discrimination have
been addressed, and services are acceptable to the people using them.
The main empirical paper explores clients' engagement with assertive outreach services,
comparing client and staff perceptions of engagement and its impact on later engagement.
The study's findings highlight differences and similarities between client and statT
perceptions of engagement and suggest possible reasons for these. The clinical implications
of these findings are discussed and future directions for research are suggested The final section of Volume I consists of a set of appendices. Appendix 1 is a public domain
briefing paper that summarises the review paper and the main empirical paper. The
remaining appendices contain information relevant to the main paper but not recorded within
it. This information includes copies of questionnaire measures, demographic and clinical
characteristics, information and consent forms, ethical approval and instructions to authors
for journal submission.
Volume II of the thesis consists of the five clinical practice reports completed during the
course, which reflect work carried out on clinical placement. These reports include: a case
study of a three and a half year old girl with a phobia of opening her bowels, formulated
from three different theoretical perspectives; a study investigating community mental health
team users' views on assertive outreach and services; a case study using exposure therapy to
treat a man with a learning disability, who had a fear of visiting his G.P.; a single case
experimental design of a staff intervention for an older adult with challenging behaviour; and
a presentation of a shared formulation of a client with delusional beliefs in an assertive