1. AGHPS
November 9th 2012

2. Environmental Scan Ontario Charter Challenge
Oxford CTO Evaluation Trial

3. Do CTOs Work? What type of CTO? For what type of patient?
Work in what way?
Work to deliver what type of treatment?
Work when used for how long?
O’Reilly R. Research on community treatment orders. In Vingilis E, State S. Eds Applied Research and evaluation in community mental health services. Pages McGill-Queens University Press 2011

4. Are there best practices with CTOs?
Geller JL. Clinical Guidelines for the use of involuntary outpatient treatment. Hospital and Community Psychiatry 41:749-55, 1990.
O’Reilly R, Dawson J, Burns B. Best Practices in the Use of Involuntary Outpatient Treatment. Psychiatric Services 2012;63:421-3.

5. Purpose of CTOs Least restrictive alternative
To stop the revolving door
Reduce community violence
Increase the potential for recovery

6. For what type of patients?
Diagnostically - schizophrenia spectrum illnesses and some manic depressive patients
Patients who are refusing treatment or have a history of non-adherence to treatment
Patients who are incapable of consenting to their own psychiatric treatment
Patients who without treatment will predictably deteriorate and pose a risk to themselves or to others.
Patients who will accept and follow the CTO

7. Work in what way? Outcome measure Reduction of bed utilization
Increase follow-up with mental health service
Reduce violence and arrests
Reduce victimization
Reduce mortality
Improve quality of life

8. Work with what type of treatment?
Follow-up with psychiatrist and case manager
Take psychotropic medication
Long-acting injections of antipsychotic medication
Live in a specific type of residence
Will reside in a group home or residential setting, which by program design supports the development of life skills and promotes treatment adherence

9. How long does a CTO take to work?
North Carolina RCT - a minimum of 6 months
Qualitative research suggests that “real” change takes about a year
For how long should a CTO continue in place?