Article

Assessing outcomes for consumers in New York's assisted outpatient treatment program.

Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 238 Civitan Bldg., Box 3173, Durham, NC 27710, USA.
Psychiatric services (Washington, D.C.) (Impact Factor: 2.81). 10/2010; 61(10):976-81. DOI: 10.1176/appi.ps.61.10.976
Source: PubMed

ABSTRACT This study examined whether New York State's assisted outpatient treatment (AOT) program, a form of involuntary outpatient commitment, improves a range of policy-relevant outcomes for court-ordered individuals.
Administrative data from New York State's Office of Mental Health and Medicaid claims between 1999 and 2007 were linked to examine whether consumers under a court order for AOT experienced reduced rates of hospitalization, shorter hospital stays, and improvements in other outcomes. Multivariable analyses controlling for relevant covariates were used to examine the likelihood that AOT produced these effects.
On the basis of Medicaid claims and state reports for 3,576 AOT consumers, the likelihood of psychiatric hospital admission was significantly reduced by approximately 25% during the initial six-month court order (odds ratio [OR]=.77, 95% confidence interval [CI]=.72-.82) and by over one-third during a subsequent six-month renewal of the order (OR=.59, CI=.54-.65) compared with the period before initiation of the court order. Similar significant reductions in days of hospitalization were evident during initial court orders and subsequent renewals (OR=.80, CI=.78-.82, and OR=.84, CI=.81-.86, respectively). Improvements were also evident in receipt of psychotropic medications and intensive case management services. Analysis of data from case manager reports showed similar reductions in hospital admissions and improved engagement in services.
Consumers who received court orders for AOT appeared to experience a number of improved outcomes: reduced hospitalization and length of stay, increased receipt of psychotropic medication and intensive case management services, and greater engagement in outpatient services.

0 Bookmarks
 · 
134 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE Jail diversion programs strive to divert offenders with mental illness from prosecution and into mental health treatment. Participants sometimes spend a short time in jail after arraignment, either because treatment resources are not immediately available or because judges want to increase their motivation for treatment. This study explored the effects of short jail stays before jail diversion ("jail first") on participants' postdiversion service use and reoffending. METHODS The data were merged administrative records from public behavioral health and criminal justice systems in Connecticut for 712 adults with serious mental illness who participated in the jail diversion program during fiscal years 2005-2007. The effects on treatment receipt, crisis-driven service use, and reoffending during the six months postdiversion among jail first participants (N=102) versus a propensity-matched sample of participants who were diverted immediately (N=102) were estimated. RESULTS Jail first participants had greater improvements in receipt of psychotropic medication during the follow-up compared with their counterparts who were diverted immediately. However, compared with participants who were immediately diverted, they did not have greater reductions in crisis-driven service use or reoffending and the time to reincarceration was shorter. CONCLUSIONS Short stays in jail before diversion did not appear to be associated with improved mental health and reoffending outcomes, even though they appeared to improve receipt of psychotropic medication. Further research is needed to better understand the relationships between jail first, receipt of psychotropic medication, and broader health and offending outcomes, with a focus on identifying missing links that address criminogenic risks and participants' more intensive social service needs.
    Psychiatric services (Washington, D.C.) 05/2014; · 2.81 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This Open Forum reviews research findings on outpatient commitment and alternative approaches, such as conditional hospital release and guardianship. Despite the accumulating evidence in favor of these practices, many questions remain about their essential elements and comparative effectiveness. The authors describe the strengths and shortcomings in existing studies and propose a research strategy that would take advantage of advances in methodologies, such as instrumental variables and propensity weighting, to design studies with a level of rigor comparable to that of randomized controlled trials. The Affordable Care Act (ACA) introduces many opportunities and resources to improve care; studies should also be undertaken to investigate use of outpatient commitment and alternative approaches in the post-ACA health care environment.
    Psychiatric services (Washington, D.C.) 06/2014; 65(6):812-5. · 2.81 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: After nearly three decades of studies evaluating the legal practice of involuntary outpatient commitment, there is yet little consensus about its effectiveness and only limited implementation. Debate continues over how best to assist adults with serious mental illnesses who are unable or unwilling to participate in prescribed community treatment and as a result experience repeated involuntary hospitalizations or involvement with the criminal justice system. The authors comment on the Oxford Community Treatment Order Evaluation Trial (OCTET), a recently conducted randomized trial of outpatient commitment, and discuss the limitations of the study's design for resolving the persistent question of whether compulsory treatment is more effective than purely voluntary treatment for this difficult-to-reach target population. The authors conclude that the search for a definitive and generalizable randomized trial of outpatient commitment may be a quixotic quest; the field should, rather, welcome the results of well-conducted, large-scale, quasi-experimental and naturalistic studies with rigorous multivariable statistical controls.
    Psychiatric services (Washington, D.C.) 06/2014; 65(6):808-11. · 2.81 Impact Factor

Full-text

Download
0 Downloads
Available from
Feb 17, 2015