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RESEARCH WEEKLY: Upcoming evaluation of New York assisted outpatient treatment
By Elizabeth Sinclair Hancq
(August 16, 2023) New York’s 2009 evaluation of their assisted outpatient treatment program (AOT) is the cornerstone of the existing research literature on AOT. Much of what we know about AOT is from that evaluation, including how AOT programs can be cost-effective through the significant reductions in inpatient hospitalizations seen among AOT participants.
New York has always prioritized data collection and evaluation of their statewide AOT programs. When AOT was first established in statute in 1999, known as Kendra’s Law in New York, included was a requirement for the NY Office of Mental Health to monitor the implementation of AOT statewide and the requirement to submit a report evaluating program participant outcomes. New York Office of Mental Health also hosts a real-time publicly available data dashboard about program operations, characteristics of AOT participants, and outcomes.
In July 2023, NY Office of Mental Health released a request for proposals for another evaluation of AOT in New York State. Up to $1,000,000 will be awarded and the applications are due next week. New York’s prioritization of data collection and evaluation of their statewide AOT program can serve as a blueprint for other states moving towards statewide implementation, for oversight and accountability by the Governor and legislature after adoption of new statutes, and/or to see any return on investment after implementation of a new program.
Key aspects of upcoming NY AOT evaluation
There are several research questions that the evaluation aims to address, according to the evaluation RFP:
- What does AOT accomplish, and where are its points of impact?
- How do treatment outcomes compare between individuals receiving court-ordered community-based services and those receiving comprehensive, voluntary services?
- How does the compulsory aspect of AOT mediate outcomes, relative to outcomes (including engagement and attendance) among individuals receiving comprehensive, voluntary services?
- Do participants get the services they need (including needs as defined clinically and by participants)?
The RFP explicitly states how comparing outcomes of individuals enrolled in AOT to those receiving voluntary services is challenging because a randomized control trial, the gold standard research methodology for evaluation, is not possible in the context of this evaluation. In recognition of this, the applicants for the AOT evaluation grant must include the following in their proposed evaluations:
- The number of individuals who received each type of service and where they were located in NYS;
- The disparity of services in consideration of the geographic location in NYS;
- Type of services received by race, age, and gender, and socioeconomic status;
- The rate of hospitalization, homelessness, contacts with law enforcement and incarceration;
- Housing status;
- Employment history and ability to obtain and maintain employment; and
- New investments to create and expand said services.
- Evidence that court-ordered services were offered as a last resort and in the least restrictive setting.
A blueprint for other states
This RFP signifies that new research is coming on the effectiveness of AOT in New York State and that we will soon have more and updated information about how the AOT program is being implemented, if it is serving the right individuals, and if it is still showing positive outcomes for participants enrolled. This RFP and New York’s prioritization for data collection and evaluation, and the accountability that comes with that, can serve as a blueprint for other states moving towards statewide implementation of AOT.
References
New York State Assisted Outpatient Treatment Program Evaluation. (2009). New York Office of Mental Health.
Evaluation of the New York State Assisted Outpatient Treatment Program: Request for Proposals. (2023). New York Office of Mental Health
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