Client Outreach in Los Angeles County’s Assisted Outpatient Treatment Program: Strategies and Barriers to Engagement

Purpose: Assisted outpatient treatment (AOT) programs can compel treatment-refusing individuals to participate in mental health treatment via civil court order. In California’s AOT programs, individuals first must be offered 30 days of outreach services and can accept services voluntarily. This study examines the use of outreach strategies in an AOT program with the potential for voluntary or involuntary enrollment. Methods: Outreach staff completed a survey in which they reported and rated outreach strategies and barriers to treatment for 487 AOT-referred individuals. Results: Outreach staff reported using a broad array of strategies to persuade and engage clients. Supportive and persuasive strategies were most common. More coercive strategies, including court order, were used when needed. More clients enrolled voluntarily (39.4%) than involuntarily (7.2%). Conclusions: Outreach, coupled with the strategic use of potential court involvement, can lead to voluntary enrollment of treatment-refusing individuals with many, often severe, barriers to engaging in outpatient treatment.

Adults with Serious Mental Illness

The clinician’s goal for every adult with serious mental illness should be recovery, moving beyond symptom control toward the promotion of an individual’s functioning, autonomy, and sense of purpose. This chapter highlights some of the nonpharmacological, evidence-based practices that have been shown to further recovery for adults with serious mental illness. The case-based discussion highlights illness management, supported employment, supported housing, assertive community treatment, mobile crisis teams, cognitive–behavioral therapy for psychosis, peer support, and clubhouses as best practice models of care. Strategies to enhance medication adherence are discussed. The use of court-ordered assisted outpatient treatment as a strategy to prevent hospitalizations is also explored.