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


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Swartz
Marvin S
MS
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 238 Civitan Bldg., Box 3173, Durham, NC 27710, USA. marvin.swartz@duke.edu
Wilder
Christine M
CM
Swanson
Jeffrey W
JW
Van Dorn
Richard A
RA
Robbins
Pamela Clark
PC
Steadman
Henry J
HJ
Moser
Lorna L
LL
Gilbert
Allison R
AR
Monahan
John
J
D000328:Adult; D000553:Ambulatory Care / Q000592:standards*; D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review; D007902:Length of Stay; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D028642:Persons with Psychiatric Disorders; D008875:Middle Aged; D015999:Multivariate Analysis; D009518:New York; D017063:Outcome Assessment, Health Care