1. Developing an Effective Assisted Outpatient Treatment Program
What We’ve Learned

2. What is assisted outpatient treatment (AOT)?
Specified in Texas Health & Safety Code
Court ordered and Court monitored services
Serves individuals with severe and persistent mental illness with a history of non-compliance with outpatient services
For high end users of resources such as psychiatric and medical emergency centers, jails, and psychiatric inpatient admissions

3. Who Is It For?
Those with multiple inpatient admissions with minimal participation in outpatient services (“revolving door”)
Clients who have demonstrated a lack of consistent treatment which contributes to increased time in institutions such as jails, emergency rooms, or psychiatric hospitals
Represents less than .05% of a state’s population

4. Common Characteristics
Majority have schizophrenia, schizoaffective, or severe bipolar disorder diagnoses
47% had co-occurring substance abuse disorders
47% did not comply with medications prior to AOT
Most at risk of being homeless or incarcerated

5. Participant A: Before AOT
Adult male, history of schizophrenia diagnosis and amphetamine dependence; homeless; unemployed; strained family relationships; chronic non-compliance with outpatient treatment
835 days incarcerated
32 crisis assessments
19 inpatient admissions
2 known nearly lethal suicide attempts

6. Participant A: Post AOT
Living with family members
Employed part-time
Compliant with all outpatient appointments and medications (monthly injections)
100 days in jail
Intermittent drug use
0 crisis presentations
0 inpatient admissions

7. Participant B: Before AOT
Adult female; doctoral degree; diagnosed with bipolar type 1, severe, with psychotic features; no income & no benefits; strained family relationships; chronic non-compliance with outpatient treatment
115 days in county jail
1,052 days of inpatient psychiatric admissions
Repeated court involvement through inpatient commitments

8. Participant B: Post AOT
Period of outpatient treatment compliance due to “black robe” effect which has decreased over time
0 days in jail; 0 arrests
Obtained disability and insurance benefits
Period of improvement in community activities (social events)
Decrease is hospitalizations

9. Participant C: Before AOT
Adult male; Veteran; diagnosed with schizoaffective disorder; chronic non-compliance with outpatient treatment that commonly led to threats of violence against public officials
251 days in state or private psychiatric facility
247 days in jail
Multiple contacts with court system after being found incompetent to stand trial for criminal offenses

10. Participant C: Post AOT
0 days in jail
0 days in state or private psychiatric facility
Significant improvement with family relationships, recreational activities, & community involvement
Compliant with outpatient services
Compliant with medications (injections every 2 weeks)
Limited insight into mental illness but willing to comply with court order (“black robe” effect)

11. 7 Core Elements of an Effective AOT Program
Program must have buy-in from key leadership
Representatives of key stakeholders must meet regularly
Agreed upon written policies, procedures, and developed forms
Assigned professional serving as liaison between treatment teams and court
AOT education provided to stakeholders & community members
Patient outcomes, individual/family satisfaction, & gaps in resources are tracked for program evaluation purposes
Established methods for identifying & addressing gaps in resources & areas for improvement

12. What We Found Buy-in from leadership is a must!
Regular status hearings should occur and help serve as reminders/check-ins for everyone involved
AOT served as a catalyst for bringing stakeholders to the table while improving agency cooperation and communication
Tracking and data collection should occur throughout the process

13. What We Learned
“Success” in the program may look different from one person to the next
Treatment providers must redefine engagement efforts for court-ordered outpatient clients
Education for stakeholders should be ongoing
The AOT program is not for everyone
Clients often need additional support after court dates

14. Limitations
Does not adequately address co-occurring diagnoses of mental health and substance abuse
Does not provide clear legal consequences for those who do not abide by court orders
Requires court time for participating psychiatrists
Funding is an issue
The court can petition for LMHA participation with an AOT candidate

15. Benefits Reduction in crisis presentations
Reduction of inpatient admissions
Reduction in days incarcerated
Reduction in ER visits
Increased resources made available
Better communication between agencies
Improvement in family relationships
Improvement in overall quality of life

16. The Treatment Advocacy Center
For more information about Assisted Outpatient Treatment (AOT), go to

17. Questions?

18. Presenters
Beth Dalman, M.Ed., LPC-Intern supervised by J. Spillman, LPC-S
Coordinator of Outpatient Crisis Services
Matthew LaVoie
PETC Utilization Review

19. References
Reference Material for Developing an Effective Assisted Outpatient Treatment Program (2017). Treatment Advocacy Center.