AB1421 Assisted Outpatient Treatment Training Power Point

What is AB1421? Passed in 2002 – Allows for local Board of Supervisors to adopt Assisted Outpatient Treatment in their respective counties. AOT provides court ordered outpatient treatment for adults with serious mental illness who are experiencing repeated crisis events and who are not engaging in treatment on a voluntary basis. AOT is a civil matter and heard in civil court AB1421 specifies the eligibility criteria, referral process and services provided

Who can request AOT? Immediate Adult family members Person 18 years of age or older residing with the individual Director of treating agency, charitable organization, licensed residential care facility or hospital Treating licensed mental health professional Peace Officer, parole or probation officer supervising the individual

Criteria for an AOT Referral County resident, minimum 18 years of age. Person is suffering from a mental illness as defined in paragraphs (2) and (3) of subdivision (b) of Section 5600.3 of the California W&I code. There has been a clinical determination that the person is unlikely to survive safely in the community without supervision.

Criteria for an AOT Referral The person has a history of lack of compliance with treatment for his or her mental illness, in that at least one of the following is true: The person’s mental illness has, at least twice within the last 36 months, has been substantial factor in necessitating hospitalization or receipt of services in a forensic or other mental health unit of a state correctional facility or local correctional facility, not including any period in which the person was hospitalized or incarcerated immediately preceding the filing of the petition. OR B. The person’s mental illness has resulted in one or more acts of serious and violent behavior toward himself or herself or another within the last 48 months, not including any period in which the person was hospitalized or incarcerated immediately preceding the filing of the petition.

Criteria for an AOT Referral The person has been offered an opportunity to participate in a treatment plan by Behavioral Wellness Department director, or his designee, provided the treatment plan includes all of the services described in Section 5348, and the person continues to fail to engage in treatment. (Section 5348 handout available). The person’s condition is substantially deteriorating. Participation in AOT Program would be the least restrictive placement necessary to ensure the person’s recovery and stability. In view of the person’s treatment history and current behavior, the person is I need of assisted outpatient treatment in order to prevent a relapse or deterioration that would be likely to result in grave disability or serious harm to himself or herself, or to others, as defined in Section 5150. It’s likely that the person will benefit from assisted outpatient treatment.

Phone 888-868-1649 OR Fax 805-681-5117 AOT Referral Number This office will be responsible receiving AOT referrals and conducting a brief screening of eligibility criteria. Once verified, this office will assist in facilitating the referral to the AOT Program for commencement of outreach and engagement activities.

Assisted Outpatient Treatment Referral Form and Eligibility Check List To initiate referral, call Behavioral Wellness Access Team at 1-888-868-1649 or FAX Referral Form to 888-681-5117 Date of request: ______________ Referral source: Name of person making the referral: ________________________________________________ Relationship to client: ____________________________________________________________ Name of agency (if applicable): ____________________________________________________ Phone number: ____________________ E-mail address: ___________________________ Client information: Client’s name: ______________________________________ Date of birth: ________ _______ Address: ______________________________________________________________________ Gender:  M  F Homeless:  Yes  No Language:  Spanish  English  Other: ___________________________________________ Phone number: ______________________ Insurance:  MediCal  Medicare  None  Other: __________________________________ Mental health and substance use history: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

AOT Eligibility Checklist Yes No Unknown 1) The person is 18 years of age or older.    2) The person is suffering from a mental illness. [See paragraphs (2) and (3) of 5600.3(b). [This excludes dementia and organic brain damage.]      3) There has been a clinical determination that the person is unlikely to survive safely in the community without supervision. 4) The person has a history of lack of compliance with treatment for his or her mental illness in that at least one of the following is true: i. The person’s mental illness has, at least twice within the last 36 months, been a substantial factor in necessitating hospitalization, or receipt of services in a forensic or other mental health unit of a state correctional    facility or local correctional facility, not including any period during which the person was hospitalized or incarcerated immediately preceding the filing of the petition. OR   ii. The person’s mental illness has resulted in one or more acts of serious and violent behavior toward himself or herself or another, or threats, or attempted to cause serious physical harm to himself or herself or another within the last 48 months, not including any period during which the person    was hospitalized or incarcerated immediately preceding the filing of the petition.

AOT Eligibility Checklist Cont’d Yes No Maybe 5) The person has been offered an opportunity to participate in a treatment plan by the director of the local mental health department, or his or her designee, provided the    treatment plan includes all of the services described in Section 5348, and the person continues to fail to engage in treatment. 6) The person’s condition is substantially deteriorating.    7) Participation in the assisted outpatient treatment program would be the least restrictive placement, that is appropriate and feasible, and necessary to ensure the    person’s recovery and stability. 8) In view of the person’s treatment history and current behavior, the person is in need of assisted outpatient treatment in order to prevent a relapse or deterioration that would be likely to result in grave disability or serious harm to himself or herself, or    to others, as defined in Section 5150. 9) It is likely that the person will benefit from assisted outpatient treatment.   

AOT Process AOT referrals will be screened face to face by County Outreach and Engagement Team. The team will respond and make all efforts to engage referred candidate and offer voluntary services. If services are accepted, referred candidate will be linked to appropriate provider and process will stop here. If AOT candidate refuses services but is open to engagement, the team will continue to see clients as they gather supporting evidence of criteria and continue to offer/facilitate linkage to services (building relationship) for a period of up to 90 days. The AOT Outreach and engagement team will continue to engage candidate until such time that it is determined that candidate does not meet AOT eligibility criteria, will not engage or accept services voluntarily, or determines that AOT is best course of action and that all criteria can be substantiated in court.

Petition Process (Pre-Hearing) Petition filed with County Counsel. County Counsel will file petition with court and notify Public Defender and Patient Rights. Candidate will be offered settlement prior to proceedings. Petition will only be granted if criteria can be proven by clear and convincing evidence. If Candidate Refuses, “Court may order that the person consent to a clinical assessment”. If person refuses, court may order person be taken to hospital for the assessment. Detention of the Candidate: under the order my not exceed 72 hours and Candidate must meet WIC Section 5150 criteria. Purpose of assessment is to determine if an individual meets AOT clinical necessity criteria. An order for assessment under this section is not an order for treatment

AOT Hearing Process Subject of AOT Petition has a right to legal counsel Court hears testimony and recommendation If the court finds that the person meets the criteria for AOT, and there is no appropriate and feasible less restrictive alternative, the court may order AOT Hearing may be conducted in absence of person ONLY if: County has personally served a copy of the petition to candidate AND Candidate was given written notice and can show that appropriate attempts to elicit the attendance of the person have failed

AOT Petition Granted If granted in court, the treatment plan development may not exceed six (6) Months Candidate will be linked to full Service Partnership Program for treatment plan implementation If person refused to comply with the ordered treatment, there is strong belief that criteria for AOT is still present and efforts ere made for voluntary compliance, the treatment provider may request that the person be transported for assessment pursuant to WIC section 5150 Failure to comply with AOT order alone may not be grounds for involuntary commitment or hospitalization or a finding that the person is in contempt of court. There are no civil or criminal penalties for violation of AOT Order and treatment plan.

A sample of AOT provisions Recovery-focused, strength-based services Small case loads (10 to 1 ratio) Intensive case management/wrap-around-services Co-occurring disorder treatment 24/7 on-call staff response if needed Field-based services Peer coaching and support Educational/Vocational assistance Housing assistance

AOT Treatment- Full Service Partnership Program All-encompassing continuum of services available just as in regular Assertive Community Treatment (ACT) programs Carefully tailored treatment plan Assistance with entitlements (Social Security, Medi-Cal) Integrated Person focus (substance use disorders, Psychiatric, Medical) Like Skills training Community Integration

AOT Outcomes State requirements: 1. Reducing homelessness and hospitalization of persons in the program. Reducing involvement with local law enforcement by persons in the program. The evaluation and report will also include other measures identified by the department regarding the person in the program and all of the following, based on information that is available: The number of persons referred to the program The number of referrals that met criteria for AOT vs other The number of outreach attempts made per AOT Candidate

AOT Outcomes 6. The number of outreach contacts made per AOT Candidate The number of AOT Candidates/Clients accepting voluntary treatment The number of AOT Candidates entered into a settlement agreement The number of AOT Clients “court mandated to treatment The number of Emergency Room Visits per AOT Client 11. The number of people who were able to maintain housing 12. The number of people who maintained contact with the treatment system 13. Other indicators of success as identified by the AOT team