AOT court orders have increased rapidly since the program began, but appear to be stabilizing in recent years. This trend may be due to the supply of capacity in AOT programmes and the lack of new programme funding. Across the state, the largest number of AOT prescriptions tends to be in areas where the concentration of adults with severe mental illness is higher. New York City and its surroundings account for the majority of AOT orders in the state. We found regional differences between the different elements of AOT implementation and management, including the greater use of the EVS First model in New York State before resorting to the court-ordered AOT. Lower New York programs use AOT First almost exclusively, rarely voluntary agreements as a transition from AOT. While a large portion of AOT recipients are Black, there is no obvious racial bias in the program when the factors of the target audience are taken into account. Nationally, the use of EVS First is much less common, as the majority of AOT orders are made in New York City, where voluntary agreements are usually made as termination of the AOT trial. Since regions where these two very different approaches to voluntary agreements differ so much in their population characteristics and in the availability of treatment services, it is not possible to directly compare their relative effectiveness. The available data allow only a limited assessment of whether voluntary agreements are effective alternatives to the initiation or continuation of the AOT. There are relatively few voluntary agreements and they usually occur in counties that use the “EFD First” model. However, we found evidence that AOT recipients have a lower risk of arrest than their counterparts in extended volunteer services.
We also found evidence in case managers` data that receiving AOTs in combination with ACT services significantly reduces the risk of hospitalisation compared to receiving ACT alone. The procedure for initiating voluntary agreements and creating extended service plans are not legal elements of the Kendra Act. However, they are used by many AOT programs in the county, either before the launch of the AOT or after a period of AOT. Some counties have introduced formal procedures for voluntary agreements (i.e. legal documents), and other counties use less formal written or oral agreements. Although OMH counties do not report individual or identifying data on individuals served under these voluntary agreements, the number of voluntary agreements has been recognized and reported in previous program reports. Kendra`s law requires that the written treatment plan include case management services, usually ICM or ACT services, while the person is under court order. These extended services are also provided to individuals under EVS agreements. Act teams and intensive case management services are the cornerstones of the AOT treatment plan and have received the majority of AOT parallel funding nationally. A review of the distribution of treatment type among all individuals who received AOT prescriptions between 1999 and mid-2007 (N = 14,127) shows that 20% of cases received CWT and 74% received MHI. The remaining 6% may also have received an MHI as part of a joint case management team5 or less intensive supportive case management.
According to aggregate data provided by counties, the rate per 100,000 EVS agreements was initially much higher than the AOT order rate, as shown in Figure 1.6. However, AOT orders eventually outperformed EVS orders – especially in the inner city counties – so the AOT order rate in 2006 was much higher than that of EVS orders. Lifetime arrest records were obtained for 181 people who received an AOT or EVS in six counties. AOT programs identified individuals who received EVS as part of their programs and indicated the periods during which they received EVS. EVS beneficiaries are individuals who would have qualified for AOT orders, but have signed voluntary agreements to receive intensive services as an alternative to a court order. An important difference between regions was the use of voluntary agreements instead of a formal AOT court order. The AOT is essentially a tripartite agreement between a transferor (usually the initiator of the underlying mortgages), an assignee (the investor) and a broker or broker. The assignor shall endeavour to remove the mortgages from the books in order to eliminate the threat of factors such as interest rate risk, prepayment risk and default risk. In other counties, largely outside of New York City, voluntary agreements are more often used as a trial period before an AOT court order is initiated before a formal AOT order is initiated. If the test phase fails, an AOT procedure is initiated. A psychiatrist in the northern county discussed this approach to providing EFD in the following ways: Study 1A New York State Assisted Outpatient Care (AOT) assessment by Gilbert and colleagues (2010) examined whether individuals had lower arrest rates when receiving extensive AOT or voluntary services than before starting either.
Study participants were selected from AOT`s lists of mental health care recipients in six New York City boroughs. Based on structured interviews, 181 individuals were identified for the study who had received a court-ordered AOT (n=139) or signed a volunteer service contract (n=42) at some point during the study period. The sample was 60% male, with an average age of about 34 years. The sample consisted of about 46% white, 35% African American, 11% Hispanic, and 7% Asian/Pacific Islander or other. There were no significant differences between groups in terms of age, sex, race or ethnicity, and educational attainment. People who made voluntary agreements were more likely to have a primary diagnosis of major depressive disorder (17%) than people who received an AOT (4%), and were also more likely to live in areas outside of New York City (98% of the voluntary agreement group, compared with 60% of the AOT group). The main result of the interest was arrest rates. The arrest records of the 181 participants from 1 November 1999 to 28 February 2008 were obtained from the New York State Division of Criminal Justice Services. Demographic information was collected during interviews and diagnostic data was extracted from the corresponding Medicaid rights files. .