Regional Differences in New York’s Assisted Outpatient Treatment Program

Pamela Clark Robbins, B.A., Karli J. Keator, B.A., Henry J. Steadman, Ph.D., Jeffrey W. Swanson, Ph.D., Christine M. Wilder, M.D., Marvin S. Swartz, M.D.

(Editors note: Opponents of AOT said there were regional differences in AOT. This study shows that is true. One difference the authors found is that some counties saved money and stress on patients, by allowing them to “stipulate” to a psychiatrists findings, thereby obviating the need for the psychiatrist to be present at the actual hearings. The authors found other differences but did not reach any conclusion as to whether they were an appropriate recognition of urban versus rural health care systems, or an issue should be remedied. Since the other studies show AOT has beneficial impact, presumably the changes would be to increase utilization in all regions. Download PDF of the complete study: Regional Differences in New York’s Assisted Outpatient Treatment Program)


This study sought to describe the implementation of “Kendra’s Law” in New York State and examine regional differences in the application of the program. Methods: Between February 2007 and April 2008, interviews were conducted with 50 key informants across New York State. Key informants included assisted outpatient treatment (AOT) county coordinators, county directors of community services, judges, attorneys from the Mental Hygiene Legal Service (MHLS), psychiatrists, treatment providers, peer advocates, family members, and other referred individuals. Additional analyses were conducted using AOT program administrative and evaluation databases and client history data.


From program inception in 1999 through 2007, a total of 8,752 initial AOT orders and 5,684 renewals were granted. Notable regional differences were found in the use of two distinct models of AOT: AOT First and Enhanced Voluntary Services First. Regional differences were also found in how the AOT program was implemented and administered. Other variations stemmed from the court proceedings themselves, the continuity and interest of the presiding judge, and the attitudes of the MHLS attorneys.


Many regional adaptations of the AOT program were found. Many were the result of lack of guidance in implementing Kendra’s Law. Policy makers may want to consider whether the law should change to allow for these differences or whether additional support from a central source is warranted to ensure more uniformity in the implementation of AOT and thus the fairness of its application across the state.

(Psychiatric Services)

Download PDF of the complete study: Regional Differences in New York’s Assisted Outpatient Treatment Program)