Assisted outpatient treatment (AOT)

About AOT

AOT is a community-based behavioral health treatment that is available under civil court commitment. Early intervention through a program like AOT can make a strong impact on the lives of individuals struggling with behavioral health conditions.

Ordered by the civil court

If legal criteria are met, AOT may be ordered as a form of less restrictive alternative (LRA) treatment:

• To involuntary inpatient treatment.
• Upon discharge from an involuntary inpatient commitment.

An AOT order may be for up to 18 months.

A court may supervise an individual on an AOT, requiring appearance in court for periodic reviews. A court may modify the order after considering input from the agency or facility designated to provide or facilitate services.

Who does AOT serve?

AOT is designed for individuals who have historically struggled with adhering to their voluntary treatment. They must meet specific criteria, like a history of hospitalization or a refusal to participate in treatment in the past.

The aim of AOT is to better motivate individuals to fully engage with their treatment plan. Providers focus on effective treatment and work diligently to keep them actively involved.

By connecting participants to the treatment that they need earlier via court order, AOT is especially helpful to people facing social and economic consequences of living with an untreated mental health or substance use disorder.

What is the criteria?

Specific criteria governs when a court may order AOT for an individual. The following are some of the criteria, but not a comprehensive list. For a complete breakdown of criteria, see RCW 71.05.248.

Individual is diagnosed a behavioral health disorder

• An individual has a behavioral health disorder.
• Based on a clinical determination and in view of the individual's treatment history and current behavior, at least one of the following is true.
  • The individual is unlikely to survive safely in the community without supervision and the individual's condition is substantially deteriorating
  • The individual needs assisted outpatient treatment to prevent a relapse or deterioration that would be likely to result in grave disability or a likelihood of serious harm to themselves or to others.

Individual has a history of lack of compliance with treatment

Noncompliance has been a significant factor in:

• Necessitating hospitalization.
• Receipt of services in a forensic or other mental health unit of a state correctional facility or local correctional facility.

• Necessitating emergency medical care or hospitalization for behavioral health-related medical conditions.

Noncompliance has resulted in:

• One or more violent acts, threats, or attempts to cause serious physical harm to the individual or another individual.

LRA treatment is deemed necessary or beneficial

• Participation in an assisted outpatient treatment program would be the least restrictive alternative necessary to ensure the individual 's recovery and stability
• The individual will benefit from assisted outpatient treatment.

Who can file a petition for AOT?

The following individuals may directly file an AOT petition:

• The director or the director's designee of a hospital where the individual is hospitalized
• The director of a behavioral health service provider providing behavioral health care or residential services to the individual or the director's designee
• The individual's treating mental health professional or substance use disorder professional or one who has evaluated the individual
• A designated crisis responder
• A release planner from a corrections facility
• An emergency room physician

What are the requirements for treatment?

The law requires that assisted outpatient treatment include:

• Assignment of a care coordinator
• An intake evaluation with the treatment provider of the least restrictive alternative treatment
• A psychiatric evaluation
• A schedule of regular contacts with the provider of the less restrictive alternative treatment services for the duration of the order
• A transition plan addressing access to continued services at the expiration of the order
• An individual crisis plan
• Notification to the care coordinator if reasonable efforts to engage the client fail to produce substantial adherence with court-ordered treatment conditions

AOT may also require:

• Medication management
• Psychotherapy
• Nursing
• Substance use counseling
• Residential treatment
• Support for housing, benefits, education, and employment
• Peer support services

What are the rights of AOT clients?

Under AOT, community members are protected by the patient rights outlined by RCW 71.05.360 and 71.05.217.

• A list of these rights must be prominently displayed in all facilities providing these services.
• An individual loses their federal gun rights and is not allowed to possess or purchase firearms permanently if, due to a mental disorder, they are committed to an AOT order.
• Individuals under an AOT order cannot be directly placed into involuntary inpatient treatment. If there are concerns about grave disability or imminent risk, the individual may be referred to a Designated Crisis Responder (DCR) for evaluation and investigation. The DCR may file a petition and detain the individual for involuntary inpatient treatment for up to five days. At the end of five days, the individual will go to court and the court will decide if the individual meets criteria for continued inpatient treatment.

Background

Between 2015 and 2023, several behavioral health administrative services organizations (BH-ASOs) participated in implementation of AOT pilot programs. As of 2023, all BH-ASOs are working to implement AOT programs in each region.

Historical context

In 2015, the Legislature adopted E2SHB 1450 establishing Assisted Outpatient Mental Health Treatment (AOMHT) in Washington. AOMHT is based on Kendra's Law, an assisted outpatient treatment law originally from New York in 1999. AOMHT is part of RCW 71.05.

On April 1, 2018, ESSB 6491 expanded AOMHT to include a need for treatment related to a substance use disorder and was renamed Assisted Outpatient Behavioral Health Treatment (AOBHT).

In 2022, AOBHT was renamed Assisted Outpatient Treatment (AOT) and included three changes:

• The law governing involuntary behavioral health treatment for minors was amended to allow a petition for LRA treatment for adolescents who are 13 to 17 years old on the basis that the adolescent is in need of AOT, under the same criteria and standards that apply for adults in need of AOT.
• Behavioral health administrative services organizations (BH-ASOs) must employ an AOT program coordinator to oversee system coordination and legal compliance for AOT.
• The development of an individualized discharge plan for a person committed to a state hospital for 90 or 180 days must include consideration of whether a petition should be filed for LRA treatment on the basis the person is in need of AOT.