• AOT Implementers
• Start Out Right
• Build a Stable Infrastructure Before Launch
• Keep the Momentum Going

Hold regular stakeholder meetings

Once an AOT program is launched, a group representing all of the stakeholder organizations comprising the planning team -- but not necessarily the same top leaders -- should continue to meet periodically for purposes of program improvement and evaluation. Each meeting agenda should focus on ensuring that appropriate individuals are being referred to AOT and identifying gaps in services, with ongoing discussion of ways to improve the program.

Print materials to inform participants of rights and responsibilities

Participants are sometimes committed to AOT during a psychiatric crisis or with great anxiety and confusion about their rights and responsibilities. Some AOT programs have found it helpful to provide participants with a standardized pamphlet or handbook when they join the program. The materials should:

• be written simply;
• be offered in all languages commonly spoken in the jurisdiction;
• provide a basic explanation of the program and the legal implications of the court order;
• assure participants of their rights to due process and high-quality treatment in conjunction with their responsibilities to adhere, and provide guidance on how to seek redress for perceived rights violations;
• list contact information for key members of the program team.

A customizable example is available in our document archive.

Educate stakeholders and the community at large

Community engagement regarding the potential benefits and the process of AOT should be initiated prior to program launch and repeated periodically. This will deepen stakeholder investment in the success of the program and facilitate identification of proper AOT candidates from all referral sources. Target audiences include:

• Staff at health care facilities and agencies serving potential AOT participants
• Family, caregivers
• National Alliance on Mental Illness (NAMI) affiliates and other advocacy groups
• Law enforcement
• Peer-support services
• Psychiatrists in private practice

Track data for purposes of program evaluation and improvement

Tracking tools can assist with measuring success, identifying opportunities for improvement, and performing program cost/benefit analysis. Teams should consider data tracking capacity during the planning stages. It is recommended that participant data continue to be tracked after AOT graduation to measure the sustainability of gains achieved under the program. Key data include:

• Hospitalizations and emergency room / crisis center visits (psychiatric and otherwise)
• Civil commitments
• Criminal justice interactions
• Housing maintenance
• Employment
• Treatment costs

Evaluation of participant and family satisfaction is also important in sustaining the program in the long term. A neutral third party should be engaged to conduct an analysis of program feedback. Areas of evaluation may include:

• Interactions during court proceedings
• Interactions during treatment team meetings
• Quality of information about the program provided to participants
• Perceptions as to whether the program upheld standards of participant dignity/privacy
• Perceptions of coercion
• Perceived benefits of participation
• Suggestions for improvement

AOT programs must not only collect information, but also use it. The tracking and surveys called for above should be utilized to identify deficiencies in the program and should lead to the development and execution of improvements. Developing improvement strategies is a primary purpose of regular stakeholder meetings.

Participant and community needs change over time. Programs must expect to adapt continually to maintain good outcomes.

Mentor neighboring communities

Given that AOT requires considerable effort to initiate at the program level, successful AOT programs should assist their neighboring communities in developing their own AOT programs. Having a regional network of linked AOT programs will facilitate continuity of care for participants who relocate while still under court order.

Building this network will take time, as successful early adopters help and serve as models to their nearby counterparts. The goal should not be for each new program to be a carbon-copy of the neighboring jurisdictions. For participants who relocate and transition between AOT programs, the important constant is for court-ordered care to yield maximum treatment engagement.

Possible strategies for mentorship include:

• Presentations to stakeholder groups in neighboring counties;
• Inviting teams from neighboring counties to visit and observe the program in action;
• Publishing reports touting the program’s clinical and fiscal successes;
• Seeking local media coverage of the AOT program;
• Freely sharing court forms, policy documents, budgets, staffing models, etc.

New York State’s AOT data collection provides a good example of such a system.