SMI Research Digest: Assisted Outpatient Treatment

SMI Research Digest is a monthly publication from TAC’s Public Education and Research (PER) team that summarizes recently published research on topics related to severe mental illness (SMI). This month we feature three studies published in 2025 that highlight the effectiveness and impact of assisted outpatient treatment (AOT). AOT is outpatient treatment under a civil court order primarily for individuals with serious mental illness who are unlikely to adhere to voluntary services and have a demonstrated history of negative outcomes caused by treatment nonadherence.

Kentucky’s AOT program improves outcomes for people with SMI. In this study published in Journal of Evidence-Based Social Work, researchers used Medicaid data to evaluate the impact of AOT on service utilization and cost savings for the 67 participants who were enrolled in Kentucky’s AOT program from 2018 to 2024. The average number of encounters with the healthcare system decreased by 38% during AOT and 48% after completing AOT. Hospitalizations also decreased by 53% during AOT and 67% after AOT. Lastly, data revealed that average Medicaid expenditures per participant decreased by $1,326.22 per month during AOT and $1,105.34 after AOT. These positive findings suggest that AOT may be a useful tool for both improving quality of life for people with serious mental illness and reducing system-level costs. The authors also stress the importance of implementing AOT in a recovery-oriented way that protects participants’ due process rights and autonomy.

Participants’ clinical and social functioning improves during AOT across multiple study sites. This multisite study published in Psychiatric Research and Clinical Practice used data from 392 participants across six AOT programs. Results suggested that participating in AOT was associated with significant improvements in appointment adherence, medication adherence, symptom severity, and life satisfaction. The study also found significant reductions in violence, suicidal ideation, inpatient hospitalizations, arrests, substance use, and homelessness. Improvements were greatest for people who were on an AOT order for at least six months.

The importance of program monitoring in Houston’s AOT program. The 175 participants served by Houston, Texas’ AOT program have experienced positive outcomes, including, but not limited to, significant improvements in housing stability, medication adherence, and the number of participants pursuing education and job training. Participants also experienced significant reductions in psychological distress, incidences of domestic violence, psychiatric hospitalizations, and time spent in jail or prison. In this paper, published in Social Work, researchers highlight the role of AOT liaisons, also sometimes called AOT monitors or coordinators, in the program’s success. Key responsibilities of these multisystem liaisons included evaluating the appropriateness of referrals, ensuring client treatment preferences were taken into consideration, developing court status hearing procedures, communicating with outpatient providers, and assisting participants in applying for benefits, among others. All liaisons met monthly through a larger collaborator meeting and maintained weekly communication with each other to promote successful multisystem coordination.

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