Did New York’s assisted outpatient treatment (AOT) program improve outcomes?
Last week, the Human Services Research Institute & University of Pittsburgh released their final evaluation report on assisted outpatient treatment (AOT) in New York state. TAC is grateful for the research team’s detailed report and for their emphasis on including the perspectives of people with lived experience throughout this process.
The evaluation showed that AOT participants improved on nearly every key outcome, including reduced hospitalization rates, housing stability, independent living, risk of harm to others, and reduction in arrests. Increased access to services was the primary factor behind these improvements. In most areas, outcomes for AOT participants matched or exceeded those of people receiving voluntary assertive community treatment (ACT) services.
Interviews with participants offered meaningful insights for reform, especially regarding quality of care and due process. While interviews were limited only to AOT participants with capacity to participate in research, findings largely reinforce long-standing TAC recommendations related to AOT implementation. TAC recommends that states:
- Create and distribute accessible educational materials about AOT process for people receiving AOT services and their families.
- Ensure AOT is only used for individuals who are unlikely to engage in voluntary services and who are likely to experience harm if left untreated, based on a clinical determination.
- Ensure intensive community services are available voluntarily to people with SMI whose needs are comparable to those of AOT participants.
- Provide oversight to guarantee that AOT participants receive person-centered care and that the order is dismissed when it is no longer needed.
- Prioritize the use of nonpolice transportation options when involuntary transportation to a hospital becomes necessary to protect the safety of the AOT participant or others.
Equivalent outcomes are often cited as evidence that voluntary services are sufficient. However, findings must be interpreted in light of the population AOT is intended to serve:
- AOT serves a distinct group of people with SMI who are unlikely to engage in voluntary services because of impaired decision-making capacity or limited insight and who face a risk of harm if left untreated.
- Although the study matched participants on many factors, unmeasured differences in insight and decision-making capacity may have masked important distinctions between the AOT and voluntary service groups.
The findings must be interpreted in light of the population AOT is intended to serve. To meet criteria for AOT in New York, a person must be found unlikely to engage in voluntary treatment, unlikely to survive in the community without supervision, and have a history of treatment non-adherence that has led to documented adverse outcomes. A person with the same medical needs who is likely to engage in treatment and does not have documented adverse outcomes related to treatment non-adherence could not legally be placed on an AOT order in the state of New York.
Viewed in this context, the finding that AOT participants achieved outcomes comparable to or better than voluntary ACT participants reinforces the value of AOT as a targeted intervention for individuals at risk of serious deterioration while also underscoring the importance of ensuring robust voluntary services are available for those able to engage in care voluntarily.
Read the report in its entirety here. For questions or comments on the 2026 New York State AOT Evaluation report or TAC’s response, contact our team at press@tac.org.
