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The state of Wyoming Department of Health proposes Project REACH, a comprehensive Assisted Outpatient Treatment (AOT) program in Natrona County for 75 adults annually [300 adults over the life of the project] who may be safely deflected from restrictive placements and served in a community-based program. This program is intended to demonstrate best practices and influence assisted outpatient treatment infrastructure development throughout the state of Wyoming. The target population will include persons, defined under Wyoming law as having severe and persistent mental illness [SPMI], experiencing psychiatric crises who are currently placed on inpatient psychiatric holds, sometimes for 3 months or longer. Expected demographic profile of participants will reflect Natrona County, so approximately 87% will be European- American, 8% Latino, and 2.3% non-native born. Most participants will live in poverty and a subpopulation will experience episodic homelessness and incarceration. The goals of Project REACH are to assist persons with SPMI achieve recovery by reducing placement in restrictive institutional settings and implementing a continuum of evidence-based community interventions, residential alternatives, and engagement strategies, including Assisted Outpatient Treatment. Objectives include: developing formal AOT agreements and training to facilitate deflection to appropriate levels of care, implementation of a Mobile Crisis Outreach Team, development of new Supportive Housing resources, training and implementation of evidence-based practices, developing a customized quality improvement system and sharing findings and future funding recommendations through the sustainability planning process. Evidence-based practices will be: AOT, Mobile Crisis Response, Crisis Stabilization, Supportive Housing, Supportive Employment, Motivational Interviewing, and Wellness Action Recovery Planning.

Utah will develop and implement the Utah Assisted Outpatient Treatment Program (U-AOT) in two Local Mental Health Authorities, by developing a system of coordination and communication across community services, and the provision of a combination of Evidence Based treatment and support services. The population of focus will be adults with serious mental illness who are on civil commitment, with poor treatment compliance, and a history of multiple hospitalizations and/or incarcerations. Goal 1: Demonstrate that AOT will result in improvement of treatment outcomes for adults with SMI, under civil commitment, with a history of treatment non-compliance. Individuals receiving AOT will decrease service/system utilization. Goal 2: Establish and implement Assisted Outpatient Treatment in two communities (Davis Behavioral Health and Weber Human Services) within Utah. The AOT Program will be characterized by the enhanced relationships, communication, and coordination for in-person, legal, electronic and functional exchanges with the courts, police, hospitals and other community partners. Staff will be trained in each community in the AOT model of treatment. Nationally recognized training curricula for EBPs will be integrated into target communities. Goal 3: Establish and strengthen the necessary infrastructure to maintain and expand AOT throughout Utah, and to increase the number of individuals with serious mental illness who receive sufficient services and supports to remain in the community. An Assisted Outpatient Treatment Steering Committee (AOTSC) will be established at the State Level and the AOTSC will create a Strategic Plan for ongoing community AOT services. Goal 4: Collection and analysis of program data, with results used to modify program and maximize effective strategies. Program data will be collected and analyzed in target communities with intent to generalize data collection process and lessons learned state-wide.

Tropical Texas Behavioral Health (TTBH) is located in deep South Texas just ten miles from the Texas Mexico border in the Rio Grande Valley (RGV), a culturally rich region that has a predominately Hispanic population and faces cyclical poverty. A third of the region's population live below the poverty line and many residents are Limited English Proficiency (LEP). Access to treatment for serious mental illness is limited in the Rio Grande Valley, designated as a 2016 Health Professional Shortage Area. More than one third of residents did not have health insurance in 2011, the third-highest rate in the country. In the face of these many challenges, TTBH served 22,253 (22,041 Hispanic) seriously mentally ill people in 2015 with gold standard person-centered care with a culturally appropriate service delivery system. However, there is no assisted outpatient treatment for the seriously mentally ill with criminal justice issues in the area. TTBH and its partners propose the Valley AOT Care Program to serve Cameron and Hidalgo Counties. TTBH will rigorously apply the protocols and standards of the Evidenced Based Practices of AOT, as a court-ordered treatment. The Valley AOT Care Team will screen at least 200 referrals annually and serve at least 125 clients annually, for a total of 500 over the life of the grant cycle. The program will offer a variety of comprehensive services including Cognitive Behavioral Therapy, Case Management, Psychiatric Services, Crisis Intervention, Supported Employment and Housing Services, and Skills Training and Development. By the end of the grant cycle, at least 90% clients will participate in person centered recovery planning (PCRP) and 75% of clients will be compliant with their PCRP. Other expected outcomes are the reduction of the incidence and duration of hospitalization, reduction of arrests and incarcerations.

Pine Belt Mental Healthcare Resources (PBMHR) is a community mental health center in southern Mississippi serving a 9-county catchment area. PBMHR is proposing to implement an AOT program in order to benefit adult individuals with SMI who are in need of continual psychiatric care in order to prevent relapse, hospitalization, and/or dangerous behavior and who have difficulty complying with treatment without assistance. The typical candidate for AOT will have a history on non-adherence to their medical regimen due to a neurological syndrome, anosognosia. This syndrome impairs the individual's ability to recognize his/her mental health symptoms, leading to a rejection of the need for treatment. The candidate for AOT will have refused voluntary treatment; is experiencing a health detriment due to this decision; and will be able to function appropriately in the community when compliant with AOT services. Additionally, Mississippi law requires that at least one or both standards be met: 1) the individual demonstrates himself to be an immediate physical danger to self or others; and/or 2) or is gravely disabled and unable to care for himself by virtue of mental illness. The purpose of the Pine Belt AOT Program is to establish and implement a routine, systematic response to outpatient commitments (OPC) in two counties in southern Mississippi in order to reduce the negative consequences associated with untreated serious mental illness and inform knowledge regarding assisted Table 3 links the goals and objectives we intend to achieve.

Oklahoma's (OK's) Path to Recovery Assisted Outpatient Treatment (PTR AOT) program will provide a strengths-based, non-threatening process for ensuring that our most vulnerable citizens, adults with serious mental illness (SMI), who do not yet recognize the need for treatment, access and participate in effective treatment in order to achieve an independent life in the community of their choice, safely and successfully, with hope for the future. OK's PTR AOT program will be implemented in our two most heavily populated counties, Oklahoma (OK) and Tulsa, and in four rural counties in NE OK, Rogers, Washington, Ottawa, and Delaware. The total population of the six counties is 1,687,862. These counties are home to a diverse population and array of languages. There is a more diverse population in OK and Tulsa counties, while in the four NE OK counties, only 1.4% of the population identifies as Black, 17% American Indian, 1.2 % as Asian, and more than 7% as two or more races. The PTR AOT program will be designed to offer maximum treatment and support to prevent these negative outcomes and result in recovery that means living an independent life in the community. A high priority will be placed on preventing a need for psychiatric hospitalization or incarceration due to SMI. The PTR AOT program will serve as a model for the rest of the state, not funded through this SAMHSA opportunity, as AOT develops statewide. OK will serve 100 individuals yearly, with 75 served in the eight service months of year one, with services beginning by the fourth month of funding. Goals for outcomes include: 1) reduce hospitalizations by 25%; 2) reduce homelessness by 15%; 3) reduce arrests by 25%; and 4) increase treatment adherence by 75%.

Currently an Assisted Outpatient Treatment program does not exist in Northern Nevada; as a result, this proposal includes requests for infrastructure (not to exceed 60% of the requested budget). Based upon the proposed Assertive Community Team (ACT) structure, the total number of clients able to be served will be 85. The Case Managers will carry caseloads of 15 clients each. Their role is to engage the clients in service, motivate them to engage in treatment, attend court ordered and non-court ordered activities, monitor their mental status and ability to meet their activities of daily living, and help them schedule and organize their lives to successfully graduate from the AOT program. The goal of successful graduation from the AOT Program is that the graduate will have sufficient insight into his/her emotional states and behaviors that he/she either can manage them sufficiently to recognize early signs of decompensation and seek appropriate help, or accept feedback from a trusted person (family member, friend or mental health professional) to seek additional help and avoid hospitalization or incarceration. In addition to the services provided by the program staff, AOT clients will have full access to all appropriate services provided by NNAMHS, including an array of mental health and co-occurring groups, a Medicaid approved Day Treatment Program run by a community partner, Intensive Outpatient Programs offered by community partners, psychoeducational groups focused on better living, and occasional outings and celebrations sponsored by NNAMHS and the Nevada Alliance for the Mentally Ill (NAMI).

Mountain Comprehensive Care Center (MCCC) will implement the Big Sandy Assisted Outpatient Treatment Program in partnership with the Floyd, Johnson, Magoffin, Martin and Pike County Kentucky District Courts, the criminal justice system, and community-based resource providers. The project will provide age, gender, culturally and linguistically competent, person-centered, evidence-based treatment to persons with Serious Mental Illness, as well as connect them to a variety of recovery and peer-based supports. MCCC will ensure an array of trauma informed, community-based services have been offered prior to petitioning to AOT. The project will target adults ages 18 and over with an SMI or co-occurring SMI and substance use diagnosis. This program is designed to work with families and courts to allow these individuals to obtain treatment while continuing to live in the community and their homes. The project will utilize the evidence-based practices of Illness Management and Recovery, Cognitive Behavioral Therapy, and Motivational Interviewing, which are effective for outreach, retention and outpatient behavioral health treatment for persons with SMI or co-occurring mental and substance use disorders, along with peer support services to further promote recovery. All interventions will be conducted through a trauma- informed care approach. Treatment will be integrated with health care, case management, peer and recovery-oriented supportive services and follow-up for up to 3 months post discharge. MCCC will serve 75 persons annually and 300 over the four year project period. Goals include: 1) Increase coordination with the criminal justice system, including the courts, and other community entities to implement an AOT Program; 2) Increase access to and utilization of an AOT Program for persons with SMI; and 3) Ensure that project implementation and evaluation adhere to targeted goals, objectives, outcomes and facilitate CQI.

MHMR Tarrant proposes to partner with John Peter Smith (JPS) Hospital and the Tarrant County Probate Courts to provide assisted outpatient treatment (AOT) to individuals with serious mental illness in Tarrant County, Texas. The proposed project will form partnerships between the area's largest behavioral health providers and the probate court system, leverage existing community-based crisis and recovery services, and implement and evaluate a new AOT program. Tarrant County has a population of over 1.9 million and includes the cities of Fort Worth and Arlington. MHMR and JPS will partner to provide seamless services meeting all of the RFP required and allowable activities in a stepped-care model. Clients will be identified in JPS' inpatient behavioral health unit, which provides the assessments for Temporary Mental Health Commitment Hearings in Tarrant County. In AOT, MHMR will provide person-centered treatment plans, case management, medication management, and wraparound services. MHMR will use the Assertive Community Treatment (ACT) model to directly provide these intensive services. MHMR staff will coordinate with the courts and the District Attorney to communicate clients' court-ordered treatment compliance and provide appropriate interventions to address non-compliance. After the 90-day court order, clients will be transitioned to nine months of peer support aftercare services using the Illness Management Recovery (IMR) model to maintain their progress. The proposed program will leverage existing MHMR and JPS services including, benefits assistance, housing assistance, co-occurring psychiatric and substance use disorder (COPSD) treatment, and integrated behavioral and primary healthcare. Project AOT will serve 400 individuals over the grant period (100 per year).

The proposed Puerto Rico Assisted Outpatient Treatment (AOT) Project is directed to implementing and evaluating a new AOT program in partnership with behavioral health entities that provide an array of evidence-based treatment and the criminal justice system, including the mental health courts. The principal purpose of the project is to provide access to Individuals with Serious Mental Illness residents of the Western Region of Puerto Rico to evidence based services that reduce the incidence and duration of psychiatric hospitalizations, homelessness and interactions with the criminal justice system while improving their health and social outcomes. By improving the quality and effectiveness of outpatient treatment services, the proposed project will be directed to accomplishing the following goals: (1) Improve the quality and effectiveness of assisted outpatient treatment services through the implementation of two strategies: a) implement EBPs for individuals with SMI who are processed by Mayaguez MH Court as a pilot project; and b) develop a wraparound services system to ensure a comprehensive MH services delivery; (2) Reduce the incidence and duration of psychiatric hospitalization, homelessness, incarcerations and interactions with criminal justice system of individuals with SMI; (3) Improve the PR -AOT participant's health and social outcomes through their participation in an array of services provided by multiple agencies, including the MH court of the PR Courts Administration, the MHAASA Mayaguez Services Center, substance abuse treatment providers, primary health care providers, temporary and permanent shelter and permanent housing providers, public and private social services providers, training and employment services providers, and entities offering family and peer supports. MHAASA will serve 75 individuals with SMI and their families for the first year and 300 individuals through the lifetime of the project.

LifeStream Behavioral Center proposes to implement an assisted outpatient treatment team program according to Florida statute which allows for involuntary outpatient commitment of persons with serious mental illness who have been unable to benefit from treatment provided through traditional programs. Assisted Outpatient Treatment, an evidence-based practice listed in the National Registry of Evidence-based Programs and Practices, will be complemented by Critical Time Intervention, a case management program in three phases. Critical Time Intervention improves engagement, establishes and strengthens social and community supports and helps individuals sustain recovery. Care coordination will facilitate referral and transition into and out of the program. Cognitive enhancement therapy will be provided as an adjunct service in order to improve the individual's ability to benefit from the program by rehabilitating cognitive functioning according to this evidence based practice. Seventy-five individuals will be served annually with a total of 300 individuals served in this program over the four year lifetime of the project. Project goals 1) Establish a Program for Assisted Outpatient Treatment to serve adults with serious mental illness residing in Lake and Sumter Counties who meet the statutory requirement for involuntary outpatient placement according to Florida's Baker Act; 2) Improve the mental and physical health and quality of life of individual's enrolled in AOT attending to the "four major dimensions that support a life in recovery" -health- home- purpose- community and 3) Monitor and evaluate the AOT to insure that the program provides evidence-based practices and interventions that lead to reductions in episodes of acute illness, hospitalizations, incarceration, homelessness and other adverse events that result from untreated mental illness.

The Hinds County Mental Health Commission (d.b.a. Hinds Behavioral Health Services), court and community providers will implement and evaluate the Assisted Outpatient Treatment program delivering evidence-based practices to reduce the incidence and duration of psychiatric hospitalization, homelessness, incarcerations, and interaction with the criminal justice system, while improving the health and social outcomes of individuals with serious mental illness (SMI) and their families. Project Name: Assisted Outpatient Treatment. Population(s) served: Adults (18 years and older) and their families, who reside in Hinds County, are diagnosed with SMI and in need of court-ordered outpatient treatment. Evidence-based services: AOT, Motivational Interviewing, Stages of Change, Person-Centered Treatment, Seeking Safety, Wraparound/Full Service Partnership, peer/family supports, recovery coaching, Crisis Intervention Training, cultural competency cross-systems training and Mental Health First Aid training. Project Goal: Implement culturally competent, trauma-informed, multi-disciplinary community-based outpatient mental health treatment team services to individuals with SMI and their families with a flexible, continuous quality improvement approach utilizing court intervention, person-centered case management, systems navigation and evidence-based practices and programs delivered in the most fully-integrated and least restrictive environment. Number to be served. 75 per year, 300 across four-years.

Summary: The Cuyahoga County Assisted Outpatient Treatment pilot project is designed to reduce the incidence and duration of inpatient psychiatric hospitalization, homelessness, and interactions with the criminal justice system among persons with Severe Mental Illness (SMI); and to improve the health and social outcomes of persons with SMI. Project Name: Cuyahoga County, Ohio Assisted Outpatient Treatment Pilot Project. Population to be Served: Persons with SMI who are civilly committed to the public mental health system are the population of focus they are individuals who are considered to be a danger to self or others, and will have been sent to the hospital for treatment. These are clients who have severe symptoms and impairments that are not effectively remedied by available treatment, or who resist or avoid involvement with behavioral health treatment. Most are indigent and eligible for Medicaid; approximately half are women, and approximately half are African American. The Board and its partners will endeavor to serve I 00 persons each year, or 400 throughout the life of the project. Goals: 1) Create awareness among jurists, hospitals, treatment agencies and the community of the availability of AOT and the requirements of Ohio law. 2) Build the infrastructure to monitor the progress of all clients in the AOT pilot program and facilitate communication among the Board, hospitals, clients, families, and the Court. 3) Expand treatment services to ensure a comprehensive, evidence-based continuum of treatment, wraparound recovery supports, monitoring and reporting to provide persons with SMI with the greatest opportunity to remain in the least restrictive setting.

Assist Ventura County (Assist) was designed by Ventura County Behavioral Health Department (VCBH) to implement Assisted Outpatient Treatment (AOT) using Assertive Community Treatment (ACT) in the least restrictive environment to a minimum of 60 persons with SMI annually (240 total), curb the cycle of hospital and jail/prison commitments that commonly result from resistance to mental health treatment, and promote wellness and recovery. Given that Ventura County includes a large (41.2%) Latino population, Assist will conduct targeted efforts to reach that community through culturally informed outreach, engagement and rehabilitation strategies that utilizes bilingual/bicultural staff. VCBH offers a full continuum of care in the Adult Division for persons suffering from SMI through six adult outpatient clinics countywide. Services include: individualized treatment planning, medication management, social rehabilitation, group/individual psychotherapy, and collateral contacts. In addition, VCBH has built an assertive cluster of programs directed at those resistant to treatment, including Rapid Integrated Support and Engagement (RISE), VISTA/XP for incarcerated individuals, VOICE/AB109 for probationers, and the Latino Outreach Program. VCBH will contract with an AOT-experienced external evaluator, Resource Development Associates to measure outcomes. Services include: medication management, case management, rehabilitation, substance treatment, housing, employment/vocational services, peer services, and assistance with natural supports. The goal is to increase the number of persons with SMI receiving outpatient treatment; to promote health, wellness, and recovery; and allow previously untreated persons to live a self-directed life while striving to reach their full potential. Objectives include decreasing rates of hospitalizations, homelessness, jail days by at least 50%; increasing to 95% the clients' ability to be self-supporting through benefits or gainful employment.

The proposed Puerto Rico Assisted Outpatient Treatment (AOT) Project is directed to implementing and evaluating a new AOT program in partnership with behavioral health entities that provide an array of evidence-based treatment and the criminal justice system, including the mental health courts. The principal purpose of the project is to provide access to Individuals with Serious Mental Illness residents of the Western Region of Puerto Rico to evidence based services that reduce the incidence and duration of psychiatric hospitalizations, homelessness and interactions with the criminal justice system while improving their health and social outcomes. By improving the quality and effectiveness of outpatient treatment services, the proposed project will be directed to accomplishing the following goals: (1) Improve the quality and effectiveness of assisted outpatient treatment services through the implementation of two strategies: a) implement EBPs for individuals with SMI who are processed by Mayaguez MH Court as a pilot project; and b) develop a wraparound services system to ensure a comprehensive MH services delivery; (2) Reduce the incidence and duration of psychiatric hospitalization, homelessness, incarcerations and interactions with criminal justice system of individuals with SMI; (3) Improve the PR -AOT participant's health and social outcomes through their participation in an array of services provided by multiple agencies, including the MH court of the PR Courts Administration, the MHAASA Mayaguez Services Center, substance abuse treatment providers, primary health care providers, temporary and permanent shelter and permanent housing providers, public and private social services providers, training and employment services providers, and entities offering family and peer supports. MHAASA will serve 75 individuals with SMI and their families for the first year and 300 individuals through the lifetime of the project.

Behavioral Health System Baltimore will implement Outpatient Civil Commitment in Maryland for 75 clients with serious mental illness per year. Clients will have had two or more involuntary inpatient commitments within the preceding 12 months and a specific history of unsuccessful community treatment. OCC will support clients in their communities through person-centered treatment planning and services, reducing the negative consequences of repeat inpatient care. Behavioral Health System Baltimore (BHSB) is the local behavioral health authority for Baltimore, Maryland and oversees a network of predominately private non-profit providers that deliver a range of services to 65,000 Baltimore City residents each year. BHSB is the lead applicant as they have the authority to implement, monitor and oversee the components of this grant application. For purposes of this application, Assisted Outpatient Treatment is called Outpatient Civil Commitment (OCC), defined as involuntary outpatient treatment as a condition of release from inpatient civil commitment. Core elements of this OCC pilot include assertive, persistent outreach and engagement conducted by peers, consumer driven services, system accountability for timely and effective service delivery, and the use of data for continuous quality improvement. Baltimore City, an urban environment with a well-developed PBHS and a full continuum of services, is an optimal venue to pilot this program. While Baltimore City is 11% of Maryland's population, 53,370 residents received mental health services in FY 15, which represents 29% of those served state-wide. Baltimore spends disproportionately on inpatient care: 25% of all PBHS expenditures are for inpatient care for 9% of consumers served. Bon Secours Baltimore Health Systems, Inc. will serve as the primary provider for this grant.

The Assisted Outpatient Treatment Program (AOT) is designed to provide increased support and services to at least 75 adult individuals with a serious mental illness per year in Baldwin County, Alabama. The target population is individuals who have a history of multiple involuntary psychiatric hospitalizations, frequent encounters with law enforcement which include arrests, limited social support, limited insight into their diagnosis, homelessness, poor physical healthcare access, and a history of failed treatment compliance with traditional outpatient services. Individual's enrolled in the AOT program will have a treatment team to closely monitor treatment compliance, provide extended hours service delivery, utilize existing services such as the Assertive Community Treatment (ACT) Team and Intensive Day Treatment, provide diagnosis and medication education, teach appropriate daily living skills, and link them to appropriate community resources. The goals of the AOT program are to 1.) Reduce the incidence and duration of psychiatric hospitalizations. Individuals enrolled will meet regularly with their treatment team, who will monitor symptoms, and teach effective symptom management. 2.) Reduce the interactions with the criminal justice system and maintain treatment within the least restrictive environment. By encouraging and monitoring treatment compliance and providing psycho-education, individuals enrolled in AOT will be less likely to have encounters with law enforcement. 3.) Reduce the incidence of homelessness for individuals with a serious mental illness. Individuals, who are identified as homeless will be linked to supportive housing services. 4.) Improve access and compliance with healthcare. Individuals involved in AOT will meet with a benefits specialist to assist in obtaining healthcare benefits, and be linked to an affordable local healthcare provider. 5.) Improve social outcomes for all participants.