Ashlea Emery

ASSISTED OUTPATIENT TREATMENT

 Program: a civil legal procedure whereby a judge can order an

individual with a serious mental illness to follow a court-ordered treatment plan in the community. AOT is intended for adults diagnosed with a serious mental illness who are unlikely to live safely in the community without supervision and treatment, and who also are unlikely to voluntarily participate in treatment

Program goal: to improve access and adherence to intensive behavioral health services in order to avert relapse, repeated hospitalizations, arrest, incarceration, suicide, property destruction, and violent behavior

ASSISTED OUTPATIENT THERAPY

Study 1Gilbert, All ison R., Lorna L. Moser, Richard A. Van Dorn, Jeff rey W. Swanson, Christine M. Wilder, Pamela Clark Robbins, Karl i J . Keator, Henry J. Steadman, and Marvin S. Swartz. 2010. “Reductions in Arrest Under Assisted Outpatient Treatment in New York.” Psychiatric Services61(10):1–4.

Study 2Link, Bruce G., Matthew W. Epperson, Brian E. Perron, Dorothy M. Casti l le, and Lawrence H. Yang. 2011. “Arrest Outcomes Associated With Outpatient Commitment in New York State.” Psychiatric Services  62(5):504–08.

Study 3Swanson, Jeff rey W., Marvin S. Swartz, Randy Borum, Virginia A. Hiday, H. Ryan Wagner, and Barbara J. Burns. 2000. “Involuntary Outpatient Commitment and Reduction of Violent Behavior in Persons With Severe Mental I l lness.” Brit ish Journal of Psychiatry  176:324–31.

STUDIES

VIOLENCE SCALE

COMMUNITY NEED

2005 2006 2007 2008 20090

20

40

60

80

100

120 110 107103

99 98

Violent Crimes, 2005-2009

USNew York State Onondaga County*Syracuse

Year

Offenses per 10,000 people

COMMUNITY NEED CHART DATA: CNY VITALS

http://cnyvitals.org/onondaga/public-safety/violent-crimes

CNY VITALS

LOGIC MODEL

PROBLEM OR ISSUE RESOURCES ACTIVITIES OUTPUTS SHORT- TERM OUTCOMES LONG-TERM OUTCOMES IMPACT

The Community Need In order to accomplish In order to address our We expect that once We expect that if accomplished We expect that if accomplished We expect that if accomplished

This is the problem we our set of activities we problem or asset we will accomplished these these activities these activities these activities

are trying to solve will need the following: accomplish the following activities will produce will lead to the following will lead to the following will lead to the following

    activities: the following evidence changes in 1–3 changes in 4–6 changes in 7–10 years:

      or service delivery: years: years:  

In our community there are too many individuals being arrested for violent behavior. The rate is currently 98 per 10,000 people. It would be much better to be closer to 20 per 10,000 people. This problem is a result of adults diagnosed with a serious mental illness who are unlikely to voluntarily participate in treatment. (http://cnyvitals.org/onondaga/public-safety/violent-crimes)

Executive Director, Accountant, Manager, County Administrators, Caseworker, Counselor, Therapist, Parole officer, Transportation, Therapy, Medication, Wellness center, Doctor's office, Pharmacy, Computers.

mentally ill offenders aged 18 and older will participate in Assisted Outpatient Treatment, a program that establishes a court-ordered treatment plan within the community

the outputs will be a monthly count of how many mentally ill offenders aged 18 and older sign up for and participate in the program

The percent of individuals with mental illness who engage in violent behavior will be lower for those participating in the program as compared to those not participating.

The percent of individuals with mental illness being incarcerated will be lower for those participating in the program as compared to those not participating.

The community problem of individuals being arrested for violent behavior will decline from the current amount of 98 per 10,000 people closer to the desired lower level of 20 per 10,000 people.

“Cont inuity of care makes a s ignifi cant d iff erence in prevent ing mental health re lapse.”

A growing body of ev idence indicates that prevent ing mental health re lapse a lso protects against cr iminal recid iv ism.”

“There is a strong relat ionship between psychiatr ic d isorders and disabi l i ty in socia l , economic, and cognit ive domains, refl ect ing the eff ects of psychiatr ic d isorders on mot ivat ion, thought, and behavior. In th is sense, d isabi l i ty may be related to the diffi cult ies of re integrat ion insofar as both involve the inabi l i ty to assume normal socia l ro les.”

“Vio lence among indiv iduals with severe mental i l lness is re lated to mult ip le var iables with compounded eff ects over the l i fe span.”

“ Mult ivar iate analyses revealed that severe mental i l lness a lone did not predict future v io lence; i t was associated instead with histor ica l (past v io lence, juveni le detent ion, physical abuse, parental arrest record) , c l in ical (substance abuse, perceived threats) , d isposi t ional (age, sex, income), and contextual ( recent divorce, unemployment, v ict imizat ion) factors. Most of these factors were endorsed more often by subjects with severe mental i l lness.”

LITERATURE REVIEW

Dieleman, C. (2014). Mapping Community Capacity: Identifying Existing Community Assets for Supporting People with Mental Health Problems who Have Been Involved with the Criminal Justice System. Canadian Journal Of Community Mental Health , 33(3), 29-42. doi:10.7870/cjcmh-2014-021

Schnittker, J., Massoglia, M., & Uggen, C. (2012). Out and Down: Incarceration and Psychiatric Disorders.  Journal Of Health & Social Behavior , 53(4), 448-464. doi:10.1177/0022146512453928

Swanson, J. W., Swartz, M. S., Essock, S. M., Osher, F. C., Wagner, H. R., Goodman, L. A., & ... Meador, K. G. (2002). The Social-Environmental Context of Violent Behavior in Persons Treated for Severe Mental Il lness. American Journal Of Public Health , 92(9), 1523-1531.

Arch Gen Psychiatry. 2009 Feb;66(2):152-61. doi: 10.1001/archgenpsychiatry.2008.537.

WORKS CITED

DATA ANALYSIS: CROSSTABS & CHI-SQUARE

REGRESSION

SUSTAINABILITY

   

Parameters for Assisted Outpatient Treatment Draft Budget for Years (2014-2015)

   

Assumptions:  

   

   

   

People Served:  Number of mentally ill offenders aged 18 and older served this year. 1500

   

Staffing Costs- Administrative:  

Executive Director 80000

Accountant 70000

Manager 65000

County Administrators 90000

   

Staffing Costs- Programming Staff:  

Caseworker 35000

Counselor 30000

Parole officer 35000

   

Fringe Benefits (be sure to withold these in compliance with federal law) Social Security (%) 7.15%

Unemp/Disability (%) 8.00%

Health insurance ($/month) $200

Dental insurance ($/month) $14.70

Pension (%) 3.53333333%

   

Materials Costs (do these on a per client served basis)Transportation 400

Therapy 1000

Medication 200

   

   

Office Space (Rental costs etc.)  

Wellness center 25000

Doctor's office 20000

Pharmacy 30000

   

Revenues (Be sure to aspire to revenues appropriate to your project)Psychological Associates 999000

Wegmans Pharmacy 950000

Kellogg Foundation 900000