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The Sangamon County Illinois Assisted Outpatient Treatment Program (SCI-AOT) is a comprehensive collaboration of Southern Illinois University School of Medicine (SIU SOM), Memorial Behavioral Health, Sangamon County Circuit Court and State's Attorney, Springfield Police Department, behavioral health care, and community providers. The overall program goal is to deliver 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/or substance use disorder (SUD). Families will be included in care, though not counted in the service estimate. Ongoing community partnership is ready to begin robust implementation, continuation, and evaluation of the SCI-AOT program. A peer support specialist, care coordinator, and other navigation assistant personnel will engage and link participants with appropriate needed healthcare services, including SIU SOM Center for Family Medicine, Department of Psychiatry clinic, and Office of Community Initiatives and Complex Care.

The Milwaukee County Behavioral Health Division (BHD) submits this application for $3,996,143 (over four years) to enhance crisis treatment services by implementing a new Assisted Outpatient Treatment (AOT) program using the Assertive Community Treatment (ACT) model for individuals with severe mental illness (SMI), high utilization rates of acute adult inpatient services (AIS), and under involuntary commitment for treatment. Services will be delivered in the geographic catchment area of Milwaukee County with a population of 952,085 and encompassing areas of extreme poverty and high racial segregation. The projected number of unique consumers to be served through the AOT program are 30 consumers per year; 120 consumers throughout the lifetime of the project. The focus population is predominantly African American with diagnoses of Schizophrenia and Other Psychotic Disorders, unemployed, undereducated, on Medicare or Medicaid, and requiring four times longer average lengths of stay than their national counterparts. Strategies and interventions include: the implementation of an AOT program that provides access to, and continuity of care with, a full fidelity ACT team for civilly committed SMI consumers; full fidelity ACT Team staffing and services; training for ACT team members, AOT Implementation Team, ACT Stakeholder Advisory Board, and consumer advocates in AOT and ACT evidence-based practices (EBP) such as Enhanced Illness Management and Recovery (psychosocial rehabilitation intervention that combines Illness Management and Recovery and Integrated Dual Disorder Treatment, Social/Natural Supports), Family Psychoeducation, and Cognitive Behavioral Therapy; rigorous AOT program evaluation and ACT model fidelity; and sustainable funding streams and the role of Managed Care, Medicaid, and other insurance programs to ensure AOT program continuation when federal funding ends. Project goals: enhance crisis treatment services for individuals unable to adhere to treatment and who cycle repeatedly from tenuous stability to psychiatric crisis; provide more effective and comprehensive EBP services for individuals with complex clinical and social needs; and sustain the AOT program through ongoing EBP training for the ACT Team, third party revenue, and mentorship. Measurable objectives are to: create the foundation for AOT Program implementation using a full fidelity ACT Team Model; establish and operate a formal AOT program to motivate and engage individuals with SMI who struggle with voluntary treatment adherence; train in core ACT services and educate stakeholders and community on the AOT process the ACT model; admit 4 consumers with an AOT Court Order to the full fidelity ACT Team per month; monitor and assess ACT fidelity; provide ongoing training and consultation in intensive skills (secondary ACT services) and complementary EBPs; and build access to core ACT and secondary services for individuals with SMI in Milwaukee County. Anticipated outcomes include fewer psychiatric hospitalizations, increase in medication adherence, cost savings from less readmissions, decrease in harmful behaviors, reduced likelihood to perpetrate violence, and fewer arrests and incarceration among AOT participants.

Oklahoma’s (OK’s) Pathway to Recovery Assisted Outpatient Treatment (PTR) program will provide trauma-informed outreach and evidence-based, strengths-based, non-threatening AOT for adults with serious mental illness (SMI). A high priority will be placed on decreasing psychiatric hospitalizations, incarceration, and homelessness. The PTR program will be the first of its kind in each of the counties selected for the project: Canadian, Pottawatomie, Mayes, Payne, and Kay. Persons with SMI are the most likely to be unemployed and living in poverty, without safe and stable housing or homeless, and to experience incarceration. The PTR 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. Two certified community behavioral health clinics (CCBHCs) in these counties, Red Rock Behavioral Health Services, and Grand Lake Community Mental Health Center, are experienced in operating within an AOT process in other counties. They bring the know-how with them to implement quickly. Important goals will be to: 1) Create local AOT processes with involvement of law enforcement, court system, and other key community partners; 2) Implement a local AOT process maximizing use of OK AOT law; 3) Locate, assist and engage individuals through innovative, intensive outreach approaches utilizing motivational interviewing and critical time intervention techniques; 4) Meet immediate support and treatment needs; 5) Complete a comprehensive assessment that includes psychiatric, social and primary care needs; 6) Complete an integrated care/treatment plan; 7) Maintain a “never give up” approach - keep changing the plan until a person is meaningfully engaged in long-term outpatient treatment; 8) Track outcomes each step of the way; and 9) Implement a continuous quality improvement process; and 10) Utilize evidence based practices such as Critical Time Intervention (CTI), Motivational Interviewing (MI), Independent Placements and Supports (IPS), and Programs of Assertive Community Treatment (PACT), Enhanced Illness Management Recovery (E-IMR), Collaborative Assessment and Management of Suicidality (CAMs), Housing First, Moral Reconation Therapy (MRT). All services will be built upon trauma-informed principles focusing on hope and resilience. Objectives include training 20+ staff annually, serving 45 in the first year, 75 in the second year, and 100 in years three and four, for a total of 320. The goals for participants include reducing the following by the twelve-month update: 1) reduce hospitalizations by 60%; 2) Reduce number admitted to psychiatric hospitals by 50%; 3) Reduce nights spent in emergency rooms for mental health care by 25%; 4) Reduce the number of arrests by 45%; and 5) Reduce the number of days spent in jail by 50%.

The Kentucky Assisted Outpatient Treatment (AOT) Program will close a gap in the behavioral health service continuum for a small but extremely costly percentage of Kentucky's population of individuals with a serious mental illness. While the majority of individuals with SMI who receive treatment do so voluntarily, a very small percentage have difficulty following through with ongoing, voluntary, outpatient care. These individuals frequently cycle in and out of jails, hospitals, and homelessness resulting in high treatment costs and low quality of life. The population of focus for the Kentucky AOT Program is individuals with a SMI who meet criteria set forth in Tim's Law and who are being discharged from a state psychiatric hospital or a psychiatric unit of a community hospital. In 2017, the Kentucky General Assembly passed Tim's Law, Kentucky's enabling legislation for Assisted Outpatient Treatment (AOT). Tim's Law authorizes state district courts to order AOT for individuals who have been involuntarily hospitalized at least twice in the past twelve months, who are diagnosed with a serious mental illness, who are unlikely to adequately adhere to outpatient treatment on a voluntary basis, and for whom court-ordered AOT is the least restrictive alternative mode of treatment available and appropriate. To date, Kentucky has been unable to make AOT a viable option for those who could benefit, with no operational AOT programs in the state and only one instance of Tim's Law being invoked. Funds from this grant will afford Kentucky the opportunity to design, implement, evaluate, and sustain local AOT programs in four (4) behavioral health regions of the state and serve 192 individuals over the course of the project period. These regions, which are served by Kentucky's only two state-owned and -operated psychiatric hospitals (Western State and Central State), were selected based on indicators of need (e.g., high hospital readmission rates) as well as implementation readiness (e.g., stakeholder interest and engagement). Implementation will stagger across the project period. Regions served by Centerstone and Communicare, Inc. will serve as Cohort 1 (Yrs 1 & 2), while regions served by River Valley Behavioral Health and Pennyroyal Center will serve as Cohort 2 (Yrs 3 & 4). Cohort 1 will continue implementation in Years 3 and 4 and move into a sustainability phase. During the grant, 30 of Kentucky's 120 counties will be impacted, comprising areas in which about 38% of the estimated SMI state population reside. The Kentucky AOT Program proposes to improve outcomes for the population of focus, demonstrate cost savings, and create a sustainable AOT model for statewide implementation through the realization of three overarching goals: Goal 1: Build a centralized infrastructure to support AOT programs in four regional catchment areas of the state and eventual statewide implementation; Goal 2: Implement AOT programs with fidelity in four regional catchment areas of the state; and Goal 3: Develop state and local capacity to evaluate, improve, and sustain AOT programming. AOT has a strong evidence base for reducing the incidence and duration of psychiatric hospitalizations, homeless, incarcerations and criminal justice involvement for those with a serious mental illness. Through Kentucky's implementation of the Kentucky AOT Program, a percentage of our most vulnerable citizens, will be able to obtain treatment while continuing to live in the community and their homes with a much higher quality of life and at a much lower cost.

The Twenty-Second Judicial District Court ("the Court") requests funds to develop an assisted outpatient treatment ("AOT") program in partnership with Florida Parishes Human Services Authority ("FPHSA") and NAMI, St. Tammany. This program will be known as the Northshore Outpatient Assistance and Holistic Services ("NOAHS") Program and will facilitate prompt access to mental health services for eligible adults (male and female) with severe mental illness. NOAHS will be able to serve 35-50 participants per grant year and will serve as the basis of a sustainable program within the Court's jurisdiction. NOAHS will provide qualified participants with individualized integrated mental health and substance use treatment including medically assisted treatment, prescription medication management, peer support, life skills resources, transportation, and supportive housing. Additionally, NOAHS will develop, implement and maintain a mobile response team to deliver these services where necessary. To be a successful program, NOAHS will meet the following goals 1) increase access to and utilization of adult evidence-based practices among the target population in the service area, 2) reduce barriers to care for the target population, 3) improve participant well-being, 4) improve connectivity with support and 5) improve participant integration. Collectively, these goals comprise the larger objective of improving the stability and self-sustainability of the target population through reducing incidences of substance abuse, trauma, hospitalization, homelessness, and criminal conduct.

The Successful Recovery-Assisted Community Treatment (SR-AOT) program will provide AOT services in six counties in North Carolina. No less than 300 persons with Serious Mental Illness (SMI), averaging 75/year, that have not been treated and at risk for harm and poor quality of life will be served over the course of the grant. A Care Management Team (CM Team) will ensure a comprehensive evaluation and access to evidence-based practices (EBP). The grantee, Partners Behavioral Health Management (PBHM), will use a comprehensive Theory of Change based evaluation and performance management evaluation model. Persons served will be 18-years or older, have a SMI with emphasis on schizophrenia and schizoaffective disorders, and will found to need services that require judicial support to ensure adherence via referral, evaluation and decision by court judge or magistrate. An integrated and individualized system of care via CM Teams that include licensed professionals, trained Care Managers, Peer Supports and SOAR workers will be offered to each consumer. Assessment will determine which community provider(s) are most likely to be clinically successful and the consumer will be supported by the CM Team to participate in court-mandated, but evaluation determined treatments. At all times the consumer will be supported, their choices honored whenever possible, and methods to reduce feelings of coercion and stigma used. The SR-AOT will blend several EBPs. The CM Team will provide services consistent with the Critical Time Intervention model, consistently use Motivational Interviewing, and support each SR-AOT consumer to complete a Psychiatric Advanced Directive as a ward against future periods of instability. Other EBPs that PBHM can access via a network of over 500 providers includes, but is not limited to, Assertive Community Treatment Teams (ACTT), Community Support Teams (CST), Psychosocial Rehabilitation, Transitions to Community Living, and the Club House Model. A strength of the SR-AOT is the ability of PBHM as a health plan to match consumers with a breadth of participating providers on an individualized basis. Five overall goals, each with 2-4 objectives, and several evaluation outcomes will be used to determine program impact. The goals of the program are to (1) Lower use of and high cost/ineffective services while engaging with appropriate EBPs to limit harm to self or others; (2) Improve treatment adherence while lowering perceived coercion; (3) Improve disruptive symptoms and community/social engagement; (4) Implement the SR-AOT with fidelity; and, (5) Engage community programs and services in an AOT sustainable network.

The Houston AOT Program will reduce the incidence and duration of psychiatric hospitalization, emergency healthcare service usage, homelessness, incarceration, and other interactions with the criminal justice system by improving sustained treatment engagement, treatment adherence, and functional outcomes for adults age 18 years and older with serious mental illness (SMI) in Harris County, Texas; thus, decreasing taxpayer burden and repeat emergency healthcare service usage. With one of the largest, most diverse and rapidly growing populations in the U.S., Harris County's mental healthcare services have been struggling to keep pace with the expanding demand for services, particularly for those who are high need/service consumers originating from historically underrepresented racial, ethnic, and cultural backgrounds and underserved communities. During the course of this 4-year project, The Houston AOT Program will serve a total of 110 (20 in year 1, 30 or more in years 2-4) unique uninsured/underinsured English and Spanish speaking residents in Harris County with SMI who have consistently demonstrated significant barriers to sustained voluntary treatment engagement and medical and mental health treatment adherence. The Houston AOT Program will leverage existing relationships between The Harris Center for Mental Health and IDD (The Harris Center), the UTHealth Harris County Psychiatric Center (HCPC), and Harris County Probate Court 3 to build a coalition of stakeholders involved in the civil commitment process, thereby expanding existing collaborations between behavioral health entities and the criminal justice system to develop and fully implement and adult AOT program that holistically addresses the health and behavioral health needs of individuals with SMI in the greater Houston area. Potential candidates for The Houston AOT Program will be identified from individuals diagnosed with SMI admitted to HCPC. Also, The Houston AOT Program's Hospital Liaison will identify additional potential program candidates by reviewing HCPC admissions in conjunction with The Harris Center's list of patients who struggle with adherence to outpatient services and have frequent use of emergency psychiatric services. Individuals civilly committed to The Houston AOT Program will receive individualized treatment planning based on assessment of substance misuse and trauma, in addition to their existing mental health issues. Furthermore, comprehensive health, behavioral health, and psychosocial services will be provided through evidence-based interventions, such as case management, motivational interviewing (MI), psychosocial rehabilitation, cognitive processing therapy (CPT), cognitive behavioral therapy (CBT), and trauma-informed Illness Management and Recovery (IMR) curriculum, as indicated. Implementation and outcomes of The Houston AOT Program will be evaluated by an independent, university-based evaluation team through formative and summative evaluation components to ensure its congruence with program participants' needs, state law, and program goals, and to inform continual program improvement and quality assurance efforts.

The proposed project would develop an Assisted Outpatient Treatment (AOT) program to bridge the gap between inpatient and outpatient mental health services, improve treatment outcomes and reduce incidence of inpatient psychiatric and reduce criminal justice involvement. The Austin AOT program presents a practice and evidence-based intervention designed to promote treatment adherence, empower client engagement in managing their care, reduce inpatient bed stays, and involvement with the criminal justice system. The population of focus for proposed program is comprised of adult clients in Travis County who are persistently non-adherence with needed treatment for their mental illness and meet criteria for AOT under Texas state law. Clients much qualify for Assertive Community Treatment as defined by Texas State Utilization Management Guidelines (Texas Health and Human Services Commission, 2017) and meet criteria for Outpatient Commitment as defined by Health and Safety Code Section 574.035. Austin's AOT Program will bring together Integral Care, Travis County Probate Court, Travis County Clerk's Office and Dell Medical School at the University of Texas at Austin to establish a framework for identification, referral and the care and treatment of clients living with SMIs. Other community partners include NAMI Central Texas, Austin State Hospital, and Travis County Sheriff's office. All client treatment plans will employ a recovery-oriented approach. Specifically, plans will include motivational interviewing strategies, psychiatric advanced directives, and collaborative, individually tailed plans of recovery. In order to develop plans for each client, we will use data obtained from the initial ANSA and a corresponding psychosocial narrative assessment to identify clients' goals, strengths, and barriers to recovery. Across treatment plans, clients are offered evidence-based treatment, including Assertive Community Treatment, Illness Management and Recovery, Integrated Treatment for Co-Occurring Disorders, as well as practical assistance with basic needs, such as food, shelter and clothing. A peer specialist will regularly engage clients to develop trust in the program. By including a recovery-oriented approach and tools for shared decision making for future care such as psychiatric advance directives, our AOT program aims to improve therapeutic alliances and client' participation in their care. Integral Care proposes to serve a minimum of 55 unduplicated clients in the first year and a minimum of 220 unduplicated clients over the four-year project period. Project goals include increasing engagement in ongoing mental health care (measurable objectives: [1] beginning in year 2, 50% of program enrollees will have a Psychiatric Advance Directive, [2] following 1 year of services, clients will demonstrate increased empowerment in managing mental health); reducing inpatient psychiatric bed days by providing continuity of care (measurable objectives: [1] following one year of AOT services, clients will demonstrate reduction in risk behaviors and improved functioning), and reducing criminal justice involvement (measurable objectives: [1] following one year of AOT services, clients served will experience reduction in the number of jail bookings).

Abstract The Greater Mobile Assisted Outpatient Treatment Program (GMAOT) was designed by AltaPointe Health to address the growing number of involuntary commitments, increased number of individuals with serious mental illness in Mobile Metro Jail, and a large number of homeless individuals in the community living with mental illness. The program will provide increased support and services to at least 140 adults with a serious mental illness per year in Mobile County, Alabama. The target population is individuals with a history of multiple involuntary psychiatric hospitalizations, frequent encounters with law enforcement, including 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. The Mobile County Probate Court Judge, working in conjunction with AltaPointe Health, is committed to finding a solution to enhance outcomes and quality of life for individuals living with mental illness in Mobile County. Individuals enrolled in the GMAOT program will have a designated treatment team closely monitoring treatment compliance with their court order, providing extended service delivery hours, utilizing existing services such as the Assertive Community Treatment (ACT) Team and Intensive Day Treatment, providing diagnosis and medication education, teaching daily living skills, and linking them to community resources and supports. The addition of a court of order for outpatient treatment will be used only as the least restrictive option. The goals of the AOT program are to 1) Reduce the incidence and duration of psychiatric hospitalizations by delivery of multi-disciplinary in-home services from the AOT Team multiple times per week, depending on need. 2) Reduce the interactions with the criminal justice system and maintain treatment within the least restrictive environment through monitoring treatment compliance and providing psycho-education. 3) Reduce the incidence of homelessness for individuals with a serious mental illness by linking participants to supportive housing services and resources needed to sustain community living. 4.) Improve access and compliance with healthcare assisting participants in obtaining healthcare benefits and linking them to an affordable local healthcare provider. 5.) Improve social outcomes for all participants by providing education, family support, and linkage to community resources. Qualitative and quantitative data will be collected, for the 12 months prior to enrollment, throughout enrollment, and for 12 months following enrollment, in order to measure outcomes and program effectiveness. Evidence-based practices such as AOT, ACT, Motivational Interviewing, and Trauma-Informed Care will be utilized to insure the highest quality of service delivery. Evidence-based Quality Improvement (EBQI) will provide timely feedback to make adjustments in real-time to maintain program fidelity.

A partnership led by the Mental health Center of Denver (MHCD) proposes to improve health and social outcomes and reduce criminal justice system involvement and incarcerations among Denver residents with a serious mental illness. The Denver Court-Ordered Assisted Community Treatment (CO-ACT) project will implement and evaluate an Assisted Outpatient Treatment (AOT) program which will identify, engage and deliver case management, services and support to justice-involved adults who are court-ordered into treatment. MHCD has a successful history of collaboration to provide behavioral health services for justice-involved individuals in Colorado's 2nd Judicial District. Current partnerships encompass the Denver Police Department; Denver District, Probate and County Courts; the Denver Sheriff's Department; probation and parole; county and district attorney's; the Public Defender's Office; Denver Health, the city's principal safety net healthcare provider; and the Denver Crime Prevention and Control Commission. Through these partnerships, persons with serious behavioral health disorders are now linked with targeted services at many points of involvement with the justice system, from pre-adjudication and diversion to probation and parole. Despite this success, Denver does not have an AOT program in place, nor a comprehensive service program exclusively for justice-involved individuals with a serious mental illness. SAMHSA funding would create a multi-disciplinary team of behavioral health specialists with the skills and experience to serve 75-125 people annually and a total of 450 people over the four-year project period. The CO-ACT team would deliver services tailored to the specific needs of each person enrolled. These could include intensive case management, mobile crisis services, medication management, treatment for mental health/substance use disorders, short- and long-term housing and supports, wellness/recovery, rehabilitation/supported employment, linkages with family and other natural supports, and other services/supports as needed. CO-ACT's target population will be adult offenders with a serious mental illness, including those with co-occurring substance use disorder, who are in the pre-trial phase in Denver District or County Court. These persons would be court-ordered into the program as an alternative to trial and potential incarceration. Participants will be able to access a full array of case management and other evidence-based care through the dedicated, multi-disciplinary team. The CO-ACT project will incorporate a robust evaluation to measure the program's success in improving health and wellness for program participants, and in reducing further interactions with the justice system, incarcerations, psychiatric hospitalizations and homelessness. This evaluation will use the nationally-known Recovery Inventory System, a high-level utilization management and outcomes system developed with the participation of persons we serve in its design, selection and ongoing data collection. We will also conduct a comprehensive evaluation of the process of implementing AOT in Denver, aimed at facilitating replication in other jurisdictions.

The Massachusetts Administrative Office of the Trial Court (AOTC) in partnership with Boston Medical Center (BMC) is applying for a $4 million SAMHSA Grant over the course of 4 years to design, develop, implement and evaluate a new program in the Boston Municipal Court to provide the first demonstration of Assisted Outpatient Treatment (AOT) in MA with seriously mentally ill (SMI) and criminally involved patients in need of more comprehensive and intensified services than are currently available. The population of focus includes patients who refuse to participate in our three mental health courts (MHCs), those who are ineligible for MHC due to the nature of their offenses, and those who have been involved with the MHC who have relapsed or require aftercare—patients frequently caught in a “revolving door” of repeated psychiatric hospitalizations. We expect BOAT patients to resemble clients of the MHCs—who are 48% Black and 17% Latinx. Their main diagnoses are psychotic disorders (40%), major depression (34%), and anxiety (15%). More than two-thirds reside with family members (36%) or on the street (35%). More than half (53%) have co-occurring SUDs, and (72%) are male. Our geographic service area is Boston Massachusetts, home to 694,583 residents in 2018. Although Massachusetts does not provide for AOT by way of legislation that allows for a civil involuntary commitment order, judges do have legal authority to order a person with SMI to participate in mental health treatment and maintain their recovery on an outpatient basis within the community. M.G.L. c. 276 sec. 87 provides for the imposition of terms of probation that enable a criminal defendant to remain in the community under the supervision of the court with conditions that he or she adhere to prescribed mental health and /or substance disorder treatment services. The goals and objectives of AOT are thereby satisfied. The BOAT Program will serve 75 patients in Year 1 and 100 each year thereafter, for a total of 375 patients over four years. BOAT patients will be assessed and treated by a multidisciplinary care team—the BOAT psychiatrist and a mental health clinician, case manager, peer specialist, recovery coach, and employment specialist. In addition, all patients will be referred to fully integrated primary care practices within BMC or one of the hospital’s 14 affiliated community health centers (CHCs), all of which offer master’s level counseling, psychiatric clinic sessions, and medication for addiction treatment. Within BMC, care coordination will be facilitated through our electronic health record and existing relationships with the CHCs. After a 90-day period of intensive outpatient services, patients will be transitioned to a “stepdown” outpatient program, and thereafter, to one of our integrated primary care practices. Monitoring, case management and support services will continue for an average 12-18 months. BOAT staff will maintain a REDCap database for the purposes of monitoring, case management and evaluation. Outcomes of interest include pre/post health-related quality of life, homelessness, arrests, psychiatric hospitalizations, employment and utilization and cost of acute care services.

Project Abstract Summary Summary. The North Mississippi Commission on MI/MR (d.b.a. Communicare/Region 2 Mental Health), an established, accredited political subdivision with 50 years of experience, robust infrastructure and proven track record, in partnership with the 18th Chancery Court, and stakeholders involved in the civil commitment process 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 interactions 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 Lafayette County, are diagnosed with SMI and in need of court-ordered outpatient treatment. Strategies: (1) develop strategies to eliminate disparities and improve social determinants of health reducing inpatient hospitalization, substance abuse, criminal justice involvement, homelessness, suicide fatalities and limited family and social connectedness; (2) develop, implement and sustain civil court commitment process and community-based mental health treatment with oversight from an AOT Coalition; (3) promote flexible, 24/7 on-call, community-based, multi-disciplinary team and in-home mental health services resources; and (4) implement cross-sector workforce training. Evidence-based: Trauma-informed, culturally competent and linguistically appropriate AOT, MI, ACT, EMDR, IMR, Wraparound/Full-Service Partnership, peer/family supports and Crisis Intervention Training/MHFA community trainings. 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. Objectives: 1) Establish and equip new intercept point for centralized intakes including assessment, referral and linkage coordination for eligible SMI adults with 80% or more stakeholders attending AOT Coalition meetings; 2) Family Advisory Committee meets quarterly and two new family supports are trained in advocacy each year; 3) Ensure 80 % of participants receive GPRA/NOMS assessments at intake, 6-months post-intake, every 6-months thereafter and at discharge; 4) Hire, train and certify clinical team on EBPs and train community providers on mental health and recovery practices with 85% of attendance at each training and 80% demonstrating adherence to the model; and 5) Evaluate and monitor improvements in health and social outcomes of individuals with a SMI and reductions in the incidence and duration of psychiatric hospitalization, homelessness, incarcerations, and interactions with the criminal justice and document AOT cost-savings. Number to be served. 50 per year, 200 across 4-years.

Centerstone Assisted Outpatient Treatment (C-AOT) will implement and evaluate a new AOT program, reducing the incidence and duration of psychiatric hospitalizations, homelessness, incarcerations, and interactions with the criminal justice system, while improving health/social outcomes for 275 adults with serious mental illness (SMI) involved in the civil commitment process in Lee County, Florida (Year 1: 50; Year 2-4: 75 annually). C-AOT’s focus population is expected to mirror catchment area Centerstone clients with SMI, including 56% male, 44% female, 69% white, 23% African American, and 3% Hispanic/Latino individuals. An estimated 21,000+ catchment area adults are expected to have SMI; of those, an estimated 5,200+ are expected to have co-occurring substance use disorder (COD). Adjusting for age, from 2010-2018, hospitalizations for mental disorders increased by 80.5% in Lee County. In 2018, Lee County jails served an average daily inmate population of 1,772, including 16% with SMI. Forty-five percent of individuals experiencing homeless in Lee County have a developmental/mental health condition or substance use addiction. In the 2017-2018 fiscal year, 4,850 adults from Lee County received an involuntary commitment examination. C-AOT will be faithfully implemented according to Florida civil commitment statute, including strict adherence to client due process rights specified in Florida statute. C-AOT will ensure treatment provision for persons from Lee County who are court ordered to receive involuntary outpatient treatment. C-AOT will provide evidence-based intensive outpatient mental and substance use disorder treatment and recovery support services using SAMHSA’s Assertive Community Treatment model within a Recovery Oriented System of Care. Clients with COD will also receive relapse prevention services and Medication Assisted Treatment (MAT), as appropriate. Project goals include: (1) Implement and evaluate a new AOT program in collaboration with local stakeholders to provide evidence-based/multidisciplinary treatment and recovery services; (2) Develop infrastructure and community capacity to implement AOT program/services; (3) Improve the health/social status and outcomes among clients ordered to involuntary outpatient treatment; and (4) Develop/disseminate a replicable service model. C-AOT will achieve the following measurable objectives: Reduce mental health symptomatology by 50%; Reduce substance use by 65%; Provide 100% in need with resources to identify/secure stable housing and employment; Reduce costly service use (e.g., hospitalization) by 40%; Reduce past 30-day criminal justice system involvement by 60%; Increase social connectedness by 70%; and Achieve 80% participant retention. C-AOT has commitments from partners dedicated to the project’s success, including local courts and other stakeholders involved in the civil commitment process (e.g., Trial Court Administrator, State Attorney’s Office, and Public Defender from the 20th Judicial Circuit), as well as community-based providers who will support wraparound care/recovery among C-AOT participants.

ABSTRACT Calhoun County Assisted Outpatient Treatment Program Calhoun County Community Mental Health Authority (also known as Summit Pointe), endorsed by the State of Michigan, will coordinate and implement the Calhoun County Assisted Outpatient Treatment Program (CC-AOT). The new system will centralize processes and communications while provide monitoring of individuals on an AOT or Deferral in the county through increased coordination with its civil partners and community service providers. The population of focus will be adults (18+) with serious mental illness (SMI) who are on a civil order. The new CC-AOT team, will intensively serve 75 of the highest need individuals annually, 300 individuals on AOTs over four years in total. The program will utilize and promote evidence-based practices which include Motivational Interviewing, Seeking Safety, Peer/family supports, Assertive Community Treatment (ACT), Illness Management and Recovery (IMR), Crisis Intervention Training, and Mental Health First Aid training; as well as cultural competency cross-systems training. The program will strive 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 SMI and their families for those serve in the coordinated program. Goal 1: Coordinate and centralize oversight of AOTs. We will develop a centralized database and establish procedures and appropriate staffing for oversight of AOTs. Data collected will inform on disparities, challenges, successes and outcomes which will assist in program modifications. Goal 2: Establish and implement AOT policy/process in Calhoun County by enhancing relationships, coordination and communication with legal system, courts, police, hospitals and other community partners. We will formalize partnerships through policies/MOUs and monthly partner meetings to evaluate processes. Goal 3: Develop an AOT hearing process with Probate Court to serve 75 of the most severe AOT population within grant year one. We will establish a procedure to have hearings when individuals on AOTs are non-compliant and provide prevention strategies to decrease recidivism. Goal 4: Expand treatment services to ensure a comprehensive, evidence-based continuum of treatment, wraparound recovery supports, monitoring and reporting to provide persons with SMI the best opportunity to remain in the least restrictive setting and ultimately decrease service/system utilization. Removing barriers and gaps in services, enhancing monitoring capabilities, increasing staffing and supports, along with training partners on the new AOT system as well as nationally recognized evidence based practices will provide the necessary foundation to support individuals on AOTs and help them remain successful living in our community.

The Genesee Health System Specialized AOT Program will serve residents of Genesee County, Michigan with Severe Mental Illness (SMI) who do not voluntarily engage in treatment and are in need of, or placed on AOT court orders. Key aims of the program are to increase education and collaboration of key community partners specific to this population, increase engagement of the individual and their support persons in treatment, and reduce hospital recidivism. To lay the foundation for a successful community wide program, Genesee Health System’s (GHS) Project Director will leverage existing relationships with community partners to create a network of key partners that will meet regularly as an AOT Community Collaborative and receive specialized training in addition to discussing unique challenges to Genesee County. An AOT monitor will oversee the AOT population within Genesee County and serve as an important liaison across multiple social service, treatment, legal, and judicial entities. To better review trends and challenges of serving this population, a Project Evaluator will assist in establishing community wide data collection procedures to monitor effectiveness of community wide interventions. Quality improvement plans will be tasked to the AOT Community Collaborative. Each participant will be engaged in person-centered treatment planning through the use of Motivational Interviewing techniques following a comprehensive bio-psycho-social assessment process that has identified needs and recommended treatment; to include best practices and/or evidence based practice treatments. Each program participant will be assigned to a specialized care manager who will be specifically trained and certified to work with this challenging and vulnerable population. Judicial review hearings will take place for those on an AOT at sooner intervals than the expiration of the order to monitor and encourage AOT adherence prior to crisis situations or end of the court ordered period. Clinical outcome goals would include increased engagement in behavioral health care treatment services as evidenced by adherence to the recommended treatment plan, increased engagement of the natural support system through Family Psychoeducational Group offerings, and reduced inpatient psychiatric hospital recidivism within 30 days of admission (< 15%).

Ozark Center, a comprehensive behavioral healthcare provider with 55 years of experience, respectfully submits this proposal to implement Recovery Up to expand community-based, trauma-informed, culturally and linguistically SMI and/or related COD treatment services and peer recovery support services for 100 adults over the 4-year grant period; thereby, doubling existing treatment capacity. Recovery Up addresses a statewide/county need to strengthen CJ systems coordination in partnership with Jasper County Courts and University of Missouri-St. Louis-Missouri Institute of Mental Health. Project name: Recovery Up. Population to be served: Adults (18+) who have SMI and/or COD treatment needs based on DSM criteria; 100% trauma involved; at high risk for recidivism; 40% COD; 5% homeless; 9% veteran; 7% Hispanic/ Latino; 3% Multi-racial; 2% African American; 100% CJ involved. Strategies: The underserved adult CJ involved population will be served through expanded treatment and community-based CJ systems collaboration and coordination: 1) BHDIS within first 60 days; 2) Expanded MOUs/ MOAs with crisis, housing, employment/education, peer supports, primary and behavioral healthcare, CJ. EBPs: ACT, MRT, MI, Seeking Safety, E-IMR, CBT, EMDR, and MAT. Goals: 1) Ensure CJ systems coordination/collaboration to increase access/availability; 2) improve SMI diagnosis for COD, MAT, and trauma and increase recovery; 3) improve SMI/ COD signs/symptoms and medication adherence and increase recovery; 4) increase recruitment, access, engagement, and retention and improve recovery; 5) improve employment/ education stability; 6) improve housing stability; 7) decrease CJ involvement; 8) decrease psychiatric hospitalizations; 9) improve social connectedness; 10) improve access/availability and reduce behavioral disparities. Objectives: Years 1-4 to 06/30/24: 1) 100% will receive AOT; 2) 100% will be screened/assessed for trauma, COD, and MAT; 3) 100% will be screened/assessed for psychiatric medication management; 4) 54% will increase recruitment, access, engagement, and retention; 5) 54% will improve employment/education status; 6) 54% will improve housing stability; 7) 54% will reduce CJ involvement; 8) 54% will reduce psychiatric hospitalizations; 9) 54% will improve social connectedness; 10) 12% will be racial and/or ethnic populations. # served: 25 Years 1-4, totaling 100 in 4 years.

Pecan Valley Centers' Assisted Outpatient Treatment program will significantly improve the lives of the individuals involved by increasing treatment adherence and treatment outcomes for those who have a serious mental illness and have been historically non-adherent. Pecan Valley Centers will identify individuals with a history of non-compliance with treatment, history of incarcerations and arrests, and history of multiple inpatient psychiatric hospitalizations. With these individuals, Pecan Valley Centers will provide medication management, case management, skills training, and psychosocial rehabilitation, as well as specific evidence-based practices, such as Assertive Community Treatment (ACT), Illness Management and Recovery (IMR), Permanent Supportive Housing (PSH), Supported Employment (SE), Seeking Safety, and the Matrix Substance Abuse Treatment. The specific evidence-based practices are tailored for individuals who have a serious mental illness. Pecan Valley Centers anticipates serving 30 unduplicated individuals annually in the proposed Assisted Outpatient Treatment program. This totals to 120 unduplicated individuals over the entire grant term. Pecan Valley Centers has identified the following goals; 1) increased use of outpatient mental health treatment for "revolving door patients", 2) increased community tenure, 3) decreased rates of homelessness, and 4) decreased rates of arrests and/or incarcerations. Pecan Valley Centers estimated that 100 individuals will receive Assisted Outpatient Services over the lifetime of the grant. Pecan Valley Centers estimated that 72 individuals will experience a reduced rate of psychiatric hospitalizations over the lifetime of the grant. Pecan Valley Centers estimates that 96 individuals will have secure, safe, and affordable housing over the lifetime of the grant. Pecan Valley Centers estimates that 90 individuals will experience less criminal justice involvement (arrest and/or incarceration) over the lifetime of the grant.