The Kentucky Assisted Outpatient Treatment (AOT) Program will close a gap in the behavioral health service continuum for a small but extremely costly percentage of Kentucky's population of individuals with a serious mental illness. While the majority of individuals with SMI who receive treatment do so voluntarily, a very small percentage have difficulty following through with ongoing, voluntary, outpatient care. These individuals frequently cycle in and out of jails, hospitals, and homelessness resulting in high treatment costs and low quality of life. The population of focus for the Kentucky AOT Program is individuals with a SMI who meet criteria set forth in Tim's Law and who are being discharged from a state psychiatric hospital or a psychiatric unit of a community hospital. In 2017, the Kentucky General Assembly passed Tim's Law, Kentucky's enabling legislation for Assisted Outpatient Treatment (AOT). Tim's Law authorizes state district courts to order AOT for individuals who have been involuntarily hospitalized at least twice in the past twelve months, who are diagnosed with a serious mental illness, who are unlikely to adequately adhere to outpatient treatment on a voluntary basis, and for whom court-ordered AOT is the least restrictive alternative mode of treatment available and appropriate. To date, Kentucky has been unable to make AOT a viable option for those who could benefit, with no operational AOT programs in the state and only one instance of Tim's Law being invoked. Funds from this grant will afford Kentucky the opportunity to design, implement, evaluate, and sustain local AOT programs in four (4) behavioral health regions of the state and serve 192 individuals over the course of the project period. These regions, which are served by Kentucky's only two state-owned and -operated psychiatric hospitals (Western State and Central State), were selected based on indicators of need (e.g., high hospital readmission rates) as well as implementation readiness (e.g., stakeholder interest and engagement). Implementation will stagger across the project period. Regions served by Centerstone and Communicare, Inc. will serve as Cohort 1 (Yrs 1 & 2), while regions served by River Valley Behavioral Health and Pennyroyal Center will serve as Cohort 2 (Yrs 3 & 4). Cohort 1 will continue implementation in Years 3 and 4 and move into a sustainability phase. During the grant, 30 of Kentucky's 120 counties will be impacted, comprising areas in which about 38% of the estimated SMI state population reside. The Kentucky AOT Program proposes to improve outcomes for the population of focus, demonstrate cost savings, and create a sustainable AOT model for statewide implementation through the realization of three overarching goals: Goal 1: Build a centralized infrastructure to support AOT programs in four regional catchment areas of the state and eventual statewide implementation; Goal 2: Implement AOT programs with fidelity in four regional catchment areas of the state; and Goal 3: Develop state and local capacity to evaluate, improve, and sustain AOT programming. AOT has a strong evidence base for reducing the incidence and duration of psychiatric hospitalizations, homeless, incarcerations and criminal justice involvement for those with a serious mental illness. Through Kentucky's implementation of the Kentucky AOT Program, a percentage of our most vulnerable citizens, will be able to obtain treatment while continuing to live in the community and their homes with a much higher quality of life and at a much lower cost.