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Assisted Outpatient Treatment (AOT)

Assisted Outpatient Treatment team picture.

(left to right: Charles Houston, Angelica Almeida)

Introduction to AOT

This webpage is designed to provide additional information about Assisted Outpatient Treatment (AOT). This program, which is often referred to as Laura’s Law, is a new intervention tool that allows a clinical team to outreach and engage individuals with known mental illness, who are not engaged in care, and are on a downward spiral. San Francisco’s implementation of this program has a particular focus on community-based services that allow multiple opportunities for an individual to engage in voluntary treatment. The ultimate goal of this program is to provide intensive outpatient services to these individuals in an effort to improve their quality of life, as well as prevent decompensation and cycling through acute services (e.g., psychiatric hospitalization) and incarceration. 

If this is a psychiatric or medical emergency, dial 9-1-1

History of Assisted Outpatient Treatment (AOT)?

Assisted Outpatient Treatment, also known as "Laura's Law," was passed by the California Legislature in 2002 as AB1421. This law allows for court ordered outpatient treatment for individuals with a mental illness who meet strict legal criteria (More information about the law).

What will Assisted Outpatient Treatment look like in San Francisco?

In July 2014 the San Francisco Board of Supervisors adopted AOT with added conditions to make sure that the law is used to engage individuals in voluntary treatment (More information about the Health Code). This includes having individuals work with a "Care Team," of:

  1. a forensic psychologist,
  2. a peer specialist, and
  3. a family liasion.

The San Francisco AOT Program will start on November 2, 2015.

How many people will meet criteria for Assisted Outpatient Treatment?

Based on national data, it is expected that less than 100 individuals in San Francisco will meet criteria for the program.

What is the goal of Assisted Outpatient Treatment?

The goal of this program is to provide intensive outpatient services to referred individuals to improve their quality of life, as well as prevent mental health crises and cycling through emergency services or incarceration.

If you have any questions, feel free to contact Angelica Almeida, Ph.D. (Director of Assisted Outpatient Treatment) at (415) 255-3722.

Please see the Assisted Outpatient Treatment Fact Sheet (English | Chinese | Russian | Spanish | Tagalog | Vietnamese) for additional details on the referral and engagement process as well as frequently asked questions (FAQ's).

Who is eligible?

Generally, Assisted Outpatient Treatment (AOT) is a program that is designed to outreach individuals with a known mental illness, who are not engaged in care, and are on a downward spiral.

If you are unsure if an individual qualifies for the program, please contact the AOT Care Team at (415) 255-3936 or the toll free number (844) 255-4097 to discuss the case with a team member.

The law requires that an individual must meet all of the following criteria to qualify for Assisted Outpatient Treatment (AOT):

  1. 18 years of age or older;
  2. Suffering from a mental illness (Welfare and Institutions Code §5600.3 (b)(2) and (3));
  3. Clinical determination that the person is unlikely to survive safely in the community without supervision, per clinical determination;
  4. History of lack of compliance with treatment for his or her mental illness, in that at least one of the following is true:
    a) The person's mental illness has, at least twice within the last 36 months, been a substantial factor in necessitating hospitalization or receipt of services in a forensic or other mental health unit of a state correctional facility or local correctional facility, not including any period during which the person was hospitalized or incarcerated immediately preceding the filing of the petition; or
    b) The person's mental illness has resulted in one or more acts of serious and violent behavior toward himself or herself or another within the last 48 months not including any period during which the person was hospitalized or incarcerated immediately preceding the filing of the petition;
  5. Been offered an opportunity to participate in treatment and continues to fail to engage in treatment;
  6. Substantially deteriorating;
  7. Participation in AOT would be the least restrictive placement needed to ensure the person's recovery and stability;
  8. In need of AOT in order to prevent a relapse or deterioration that would be likely to result in grave disability or serious harm to himself or herself, or to others; and
  9. Likely to benefit from AOT

Who can refer?

A request for Assisted Outpatient Treatment can be made by the following adults (age 18+):

  1. Any adult who lives with the individual with mental illness;
  2. A parent, spouse, sibling, or adult child of the individual with mental illness;
  3. The director of a mental health institution in which the individual with mental illness lives;
  4. The director of a hospital where the individual with mental illness is hospitalized;
  5. A licensed mental health provider supervising the treatment of the individual; or
  6. A peace, parole, or probation officer assigned to supervise the individual.

How do I refer?

If you would like to refer an individual to the Assisted Outpatient Treatment (AOT) program, please:

  1. Complete the referral form (English | Chinese | Russian | Spanish | Tagalog | Vietnamese) and fax it to (415) 255-3798 or email it to AOT-SF@sfdph.org

  2. OR

  3. Call (415) 255-3936, the toll free number (844) 255-4097, or the TDD at (888) 484-7200 and leave a clear message and number where you can be reached.

Please note that email is not a secure form of communication. If you choose to email the referral form, your information will be reviewed and a member of the AOT Care Team will contact you via phone to discuss the case further.

A member of the AOT Care Team will contact you within one business day of receiving the referral. The AOT Care Team works standard business hours Monday through Friday; however, may not be available to answer incoming phone calls.

Please see the Intake Flow Chart (English | Chinese | Russian | Spanish | Tagalog | Vietnamese) for an overview of the process.


Care Team

Angelica Almeida
Angelica Almeida, Ph.D. (Director)

Dr. Almeida is excited to be heading the Assisted Outpatient Treatment (AOT) Care Team. She joins the Department of Public Health with a wealth of information and experience working with individuals with severe mental illness. In her previous role as the Deputy Director of Jail Health Reentry Services in the San Francisco County Jail, Dr. Almeida worked closely with the community and courts (including Behavioral Health Court) to ensure continuity of care between the forensic and community systems of care. Additionally, she has experience working with families and is an adjunct professor at a local university.


Charles Houston
Charles Houston (Team Member)

Charles Houston enthusiastically joins the AOT Care Team with a great deal of experience working at a local outpatient mental health center as a peer educator, systems navigator, and health and safety associate. He is well versed in working with drug treatment programs and has participated in committees to promote recovery and wellness within the San Francisco Department of Public Health. Mr. Houston is passionate about supporting families and working with community programs to ensure that individuals are receiving the support needed.





Additional Information

Between April and October of this year Dr. Almeida provided numerous trainings on San Francisco's Implementation of Assisted Outpatient Treatment to interested stakeholders. Please review the PowerPoint presentation for additional information.

Annual Report

The Department of Public Health is required to provide an annual report to the Board of Supervisors and the State of California on the effectiveness and cost of the Assisted Outpatient Treatment program. This report will be provided by an external evaluator and will provide quantitative (e.g., numbers of people served, demographics of population) and qualitative (e.g., family and participant satisfaction with services provided). The Board of Supervisors have also required a more in depth analysis (including cost analysis) to be provided by an external evaluator after a three year period.

San Francisco Annual AOT Full Report 2015-2016

Executive Summary

On November 2, 2015, San Francisco Department of Public Health’s (SFDPH) Behavioral Health Services (BHS) Division launched the Assisted Outpatient Treatment (AOT) program (www.sfdph.org/aot). The program seeks to:

  • improve the quality of life of participants and support them on their path to recovery and wellness,
  • prevent decompensation, and
  • prevent cycling through acute services (e.g., psychiatric hospitalization) and incarceration.

The program, authorized by San Francisco’s Board of Supervisors in 2014, is one of a handful of County led programs in California to support the primary intent and purpose of the Assisted Outpatient Treatment (AOT) Demonstration Project Act of 2002 (Welfare and Institutions Code (WIC) §§ 5345-5349.5)—otherwise known as “Laura’s Law”—to (a) identify persons with serious mental illness who are not engaged in treatment, (b) assess if there is substantial risk for deterioration and/or involuntary detention (under WIC § 5150) which could be mitigated by provision of appropriate services, and (c) petition the court to order participation in such services if the individual is not able to be successfully engaged by other means.

The San Francisco AOT Model is utilized as an intervention and engagement tool designed to assist and support individuals with serious mental illness. San Francisco’s AOT program places an emphasis on promoting voluntary engagement in services by utilizing a strength-based and client-centered approach, as well as accessing an individual’s natural support system (i.e., family and friends). The program has been constructed to employ principles of recovery and wellness, and has a particular focus on community-based services and multiple opportunities for an individual to engage in voluntary treatment before a court order is requested. This is the first annual report for the AOT program in San Francisco and covers a five-month period from November 2, 2015 through March 26, 2016.

The AOT Care Team

Core program services are provided by the AOT Care Team, in accordance with San Francisco Health Code §§ 4111-4119, which is comprised of the AOT Director, a Peer Specialist, and a Family Liaison. The AOT Care Team conducts extensive outreach to:

  • locate and engage Referred Individuals with local mental health resources,
  • encourage voluntary participation in treatment and engagement among Referred Individuals, and
  • petition the court to order individuals into outpatient treatment when indicated.

The Care Team works with Zuckerberg San Francisco General Hospital’s Division of Citywide Case Management to coordinate treatment for individuals that are court ordered into treatment and support individuals who have voluntarily agreed to services in linking to long term care.

Data Snapshot

Service

WIC § 5348(d) requests information on the “number of persons served by the program and, of those, the number who are able to maintain housing and the number who maintain contact with the treatment system.”

During the first five months of program implementation, the AOT Care Team received 113 calls. Specifically, between November 2, 2015 and March 26, 2016 the San Francisco AOT program:

  • Received 113 calls:
    •  59 calls for referrals—most of these (53 percent) were from family members.
    •  54 requests for information.
  • Conducted outreach to 25 individuals who met initial eligibility criteria.
  • Supported 75 percent of individuals who accepted housing assistance.
  • Supported connection and/or connected 79 percent of individuals to clinical case management services.
  • Petitioned the court to order outpatient treatment for one individual which resulted in a Settlement Agreement.

Individuals served by the AOT Care Team have an extensive history of lack of engagement in services, psychiatric hospitalizations, contact with the criminal justice system, and homelessness. In the 36 months (3-years) prior to being referred to the program:

  • 84 percent had at least one known inpatient psychiatric hospitalization in San Francisco.
  • 60 percent had at least one known incarceration in San Francisco.
  • 64 percent had been homeless at some point.

Given the early stages of the implementation of AOT in San Francisco, data regarding WIC §§ 5348(d)(2)- 5348(d)(14) is incomplete or not yet available. Detailed information on these WIC sections will be analyzed and presented in future reports. The remainder of this report will focus on the successful outreach and engagement of individuals referred to the program—for whom we use the term, Referred Individuals.

Engagement and Satisfaction

Among the 25 Referred Individuals who met criteria for outreach:

  • 48 percent have accepted treatment (i.e., are in the early stages of being or have been successfully connected to a provider).
  • 75 percent have accepted housing assistance.
  • 35 percent are living independently and 26 percent are in residential treatment or supportive facilities.

The AOT Care Team also engaged members of individuals’ support networks through activities such as:

  • Referrals to resources and support groups such as the National Alliance on Mental Illness (NAMI).
  • Support and guidance in coping with challenges associated with caring for a loved one who has a serious mental illness.

In surveys with Referred Individuals and interviews with members of their support networks, respondents expressed a high degree of satisfaction with the program. Findings include the following:

  • Referred Individuals reported feeling “hopeful” about their future.
  • The majority of Referred Individuals and support network members reported positive perspectives on the approach to engagement from the AOT Care Team.
  • The majority of support network members and Referred Individuals felt supported by the AOT Care Team.
  • AOT participation was associated with increasing awareness of and access to effective resources for Referred Individuals and family members in and out of California.

Looking Ahead

As the AOT program progresses into its second year of implementation, we intend to expand evaluation components to include the following:

  • Rates of and influences on successful treatment adherence among AOT participants.
  • Social functioning and independent living among current and former AOT participants.
  • Strategies to expand family support and to achieve acceptable balance between family expectations and program goals.
  • AOT impact on substance use by AOT participants and substance use disorders.
  • Use and results of employment service programs by AOT participants.
  • Victimization and violence reduction effects of AOT.
  • Best practices for engagement and intervention efforts.

Treatment Resources

If this is a psychiatric or medical emergency, dial 9-1-1

San Francisco Suicide Prevention, 415-781-0500

Resources in a Mental Health Crisis

Treatment Access Programs:

Mental Health and Substance Abuse Treatment
Behavioral Health Access Center (BHAC) and Treatment Access Program (TAP)
1380 Howard Street, 1st Floor
415-255-3737
8:00 am- 5:00 pm (Monday – Friday)
* provides assessment for treatment
* 24 hour hotline available at 415-255-3737 or 888-246-3333 (TDD: 888-484-7200)

Community Behavioral Health Provider List

Call 2-1-1 or visit 211.org for additional local resources.


Family and Peer Support:

National Alliance on Mental Illness (NAMI)
415-905-6264
www.namisf.org

Warm Line
855-845-7415
11:00 AM - 11:00 PM Monday - Friday;
11:00 AM - 7:00 PM Saturday


Printable Resource List (English | Chinese | Russian | Spanish | Tagalog | Vietnamese)

Mental Health Board of San Francisco