Pressure and perceived coerciveness in an assertive community treatment program: an exploratory study
Bibliographic record
Abstract
Limited evidence suggests that Assertive Community Treatment (ACT) teams may in some cases be unnecessarily coercive. The study aimed to adapt or develop measures of client-perceived coerciveness, and of actual pressure or coercion, in an ACT setting. It also aimed to examine the association between these two constructs, as well as their associations with client sociodemographic and clinical characteristics. Uses of pressure or coercion in a high-fidelity ACT team in Montreal, Canada were observed over an eight-week period. Based on these observations, the MacArthur Admission Experience Interview and Survey were adapted to the ACT setting to measure coercion perceived by clients. A new measure of pressure actually applied to clients, based on client self-reports, was also developed. Both measures were administered to a sample of 38 consenting clients. Sociodemographic and clinical measures, symptoms and level of functioning were also measured and correlated with the coercion measures. Most clients report having been subject to relatively low levels of pressure by ACT team members, and perceived coerciveness also appears low. The two constructs, however, are not correlated. Clients who function at a lower level and those who are more symptomatic report being subject to more pressure; among these, only the former also perceive the team as more coercive. Actual and perceived coerciveness appear to represent two different constructs. Their levels in a mature, high-fidelity ACT program were low but not negligible. Separate monitoring of pressure applied to clients, and of perceived coerciveness, may be needed.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".