Implementing Assisted Outpatient Treatment for Adults with Severe Mental Illness in Dallas County, Texas - Introduction: Metrocare’s Assisted Outpatient Treatment (AOT) Program’s population of focus is adults with severe mental illness (SMI) under civil court commitment in Dallas County, Texas. The following describes the demographic profile of the population of focus, the types of AOT available in Texas, the challenges faced in providing AOT services, partnerships established to address these challenges, and the comprehensive screening, assessment, and treatment processes implemented by Metrocare. Demographic Profile: The population of focus is comprised 47% African American, 40% White, 3% Asian, and 10% other racial backgrounds. Hispanic or Latino individuals constituted 17% of the population, with a male-to-female ratio of 57% to 43%. The average age of female clients was 46, and male clients was 41. English was the primary language for 93% of clients, while 4% spoke Spanish. Approximately 36% of participants identified as low-income, with 64% utilizing Medicaid. Types of AOT in Texas: AOT in Texas is categorized as Temporary, Extended, or By Modification, each with specific criteria and durations. Temporary AOT lasts up to 90 days, Extended AOT up to a year, and By Modification allows modification from inpatient commitment to AOT. Challenges and Disparities: Dallas County faces significant challenges in mental health care access. Underserved populations, including low-income individuals and people of color, lack access to mental health services. Limited hospitalization resources exacerbate the problem, with Texas failing to meet the recommended bed-to-population ratio. High incarceration rates, particularly among the African American population, and homelessness due to untreated mental illness further compound the challenges. Partnerships: Partner organizations, including Dallas County Probate Court #3/Mental Illness Court (MIC), the South Dallas Employment Project (SDEP), AIDS Services of Dallas (ASD), Dallas Police Department (DPD), Terrell State Hospital (TSH), and the University of Texas (UT) Southwestern, will collaborate with Metrocare. MIC will provide staffing and referrals, SDEP offers employment and wrap-around services, ASD serves as a referral source and community resource, DPD provides referrals, TSH acts as a primary referral source, and UT Southwestern will work on AOT utilization with Metrocare and the probate court. Screening, Assessment, and Treatment Processes: Metrocare conducts thorough screening and assessment upon entry into the AOT program, covering financial, mental health, and diagnostic aspects. This process involves evidence-based assessments and a diagnostic interview by a licensed practitioner. Individualized treatment plans are developed through person-centered recovery planning. Participants receive comprehensive care, including primary care screening, targeted case management, psychiatric rehabilitation, peer and counselor support, family assistance, and 24/7 access to team members. The program adopts Assertive Community Treatment (ACT) as its primary model, offering flexible services in natural settings. Integrated treatment for co-occurring disorders, along with evidence-based interventions like Seeking Safety, Motivational Interviewing, Cognitive Behavioral Therapy, and Illness Management and Recovery, are essential components of the program's approach. Impact: The program intends to serve 225 unduplicated individuals from the population of focus in Dallas County over four years as follows: year one, 51 individuals, year two, 55 individuals, year three, 59 individuals, and year four, 60 individuals. Conclusion: The implementation of AOT services in Dallas County fills a vital gap in services. Metrocare’s initiative, in partnership with various organizations, aims to reduce the incidence and duration of psychiatric hospitalization, homelessness, incarcerations, and interactions with the criminal justice system while improving the health and social outcomes of the population of focus.
