AOT Program Planning: Designing for Success and Resolving Unexpected Challenges

Assisted Outpatient Treatment (AOT) is a civil court mandate requiring individuals to participate in community-based mental health services. Research shows us that people in well-run AOT programs are more likely to participate in treatment, are less likely to be hospitalized, and are less likely to be arrested. Evidence also tells us that planning is key to creating an AOT program that accomplishes those goals.

The Importance of Planning

“AOT itself is not complicated, but you have to have the appropriate set of services that can meet the needs of people who are under an AOT order – the ‘treatment’ part of AOT is critical,” says Hank Steadman, founder of Policy Research Associates (PRA) and a pioneer in the field of translating AOT research into practical implementation.

“Before issuing AOT court orders, you need to have the resources in place to meet the needs of people who will be placed under an AOT order,” Steadman says. “PRA has the ability – in terms of both research and technical assistance – to assist states in identifying the necessary services and resources to implement a successful AOT program and how to set them up.”

“Communities often don’t fully understand the scope of the public services necessary to successfully implement an AOT program,” says Lisa Callahan, an AOT expert with decades of experience as both a researcher and consultant. “And without adequate resources for those services, AOT programs simply won’t work. PRA can help communities assess their existing services and identify areas that require additional investment to support an AOT program that makes a difference.”

Frequent Questions in AOT Program Planning

Jurisdictions planning to implement AOT programs face a host of questions. Decades of research tell us which questions are most important – and how to answer them.

Some of these questions apply to every AOT program: What types of services will be needed to implement a successful AOT program? How should we prioritize these services? What characteristics make someone a good candidate for AOT programs? How do you evaluate AOT programs in a way that is actually meaningful to local vested partners?

And some questions are specific to jurisdictions that have received grant funding: How do you demonstrate progress to funding agencies and administrators? What do your funders need to know? How do you collect that information?

The good news is that these questions are well-studied, and experts are available to help jurisdictions answer them and apply those answers to their specific circumstances.

“We work with jurisdictions to identify their needs, assess the available resources, and help them develop a detailed roadmap for implementation,” says Melissa Stein, a senior project associate at PRA with experience working on AOT programs.

“PRA has both research expertise and years of experience working with clinicians, case managers, civil court judges, administrators, and funding agencies,” says Callahan. “This combination of expertise and experience puts PRA in a unique position to help jurisdictions develop and implement AOT programs so that the programs have the best chance of success.”

“That expertise and experience also mean PRA can help AOT programs navigate unexpected challenges as they arise,” says Callahan. “It has an excellent track record in this area.”

Navigating Unexpected Challenges

Even well-planned programs can run into problems. Being able to tap into a network with decades of experience and expertise can help jurisdictions navigate those unforeseen obstacles.

“For example, there can be unexpected challenges in getting legal and clinical stakeholders to see eye to eye,” says Callahan. “Sometimes one party doesn’t understand the perspective of the other, or the limitations they’re facing. This can lead to unrealistic expectations regarding everything from what can be required of people enrolled in AOT programs to the timeframe involved in mental health treatment. Helping communities navigate that tension is one of the things PRA does really well.”

“The type of technical assistance PRA provides can serve as a catalyst for helping jurisdictions move past sticking points or provide a third-party perspective that draws on our extensive experience to help resolve problems and determine how to move forward,” says Chanson Noether, a vice president at PRA with decades of experience working with AOT programs.

“Another challenge that crops up fairly often with AOT programs is a lack of dedicated funding to support the services necessary to make a program successful,” Noether says. “Our technical assistance work often focuses on helping jurisdictions identify both those needs and possible partnerships that can help to address those needs.”

“Jurisdictions are focused on addressing their day-to-day challenges, which is understandable,” says Stein. “PRA not only provides expertise, but can help program personnel think about the big picture. We also connect AOT program staff with other organizations around the country who have navigated these challenges – and help stakeholders identify paths forward when they are at an impasse.”

“AOT programs are not new,” Steadman says. “We know what services are needed. The research done at PRA and elsewhere offers insights into the nature of these programs and services.”

“One of the things that makes PRA stand out is that it integrates research into technical assistance, allowing us to work directly – and effectively – with the agencies responsible for addressing these pressing social issues.”

PRA’s Expertise in AOT

PRA is the national leader in designing and implementing AOT programs. Our team brings decades of experience delivering evidence-based AOT technical assistance that helps communities, courts, and treatment providers realize the full potential of AOT: improving outcomes for both individuals and communities.

We provide comprehensive support across all stages of AOT programming, from initial design and implementation to data-informed strategies for strengthening established programs. Our approach to AOT technical assistance is tailored, practical, and grounded in both data and field experience.

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