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Commission hears first‑year outcomes for Assisted Outpatient Treatment program
Summary
The commission reviewed the first year of San Francisco’s Assisted Outpatient Treatment (AOT) program (implemented 11/02/2015): 214 calls, 108 referrals, 53 contacts, seven court petitions (five individuals), outcomes including settlements and court orders, and reported housing and service linkages; staff to submit the required annual state report in May.
The Health Commission received a comprehensive first‑year report on San Francisco’s Assisted Outpatient Treatment program from Angelica Halmeida, director of AOT, detailing operations and preliminary outcomes from the program’s launch on Nov. 2, 2015 through Nov. 1, 2016.
Halmeida described implementation steps taken before rollout — 63 stakeholder trainings to hospitals, jails, peer organizations and family groups — and outlined the San Francisco care‑team model, which includes a psychologist director, a peer specialist and a family liaison and emphasizes extended engagement (commonly ~60 days before filing court petitions, though the program allows at least 30 days).
In the first year the program fielded 214 calls (106 for information only and 108 referrals), made contact with 53 referred individuals, and filed seven court petitions (two were extensions). Five unique individuals were petitioned; three resulted in settlement agreements, three resulted in court orders for outpatient services and one petition was withdrawn because the individual could not be located. Halmeida reported that 60 percent of contacted individuals accepted voluntary services.
Halmeida also reported participant characteristics and early outcomes: referrals skewed male and concentrated in the 26–45 age group, with court petitions skewing 36–45; 40 percent of individuals reported a history of homelessness in the three years prior to contact, and 65 percent were housed at discharge. At discharge, 62 percent of individuals were connected to long‑term case management. The program reported statistically significant reductions in psychiatric emergency services (PES) contacts comparing pre‑ and post‑implementation periods (significance levels cited at p≤0.05 and p≤0.01 for different analyses); incarceration and hospitalization trends showed non‑significant trends toward improvement.
On funding and resources, Halmeida said the program is supported primarily by Mental Health Services Act (MHSA) funds with complementary billing to Medi‑Cal for certain services and some flexible spending on housing supports and engagement. Staff estimated program and flexible spending at roughly $1 million annually and noted a staff‑to‑client ratio requirement of 1:10 under the law; Halmeida said she would confirm per‑client steady‑state cost, which commissioners estimated informally at about $20,000 per touched client.
Next steps include hiring an additional senior behavioral health clinician, filing the required annual report to the State Department of Mental Health in May 2017, and preparing a three‑year evaluation to assess efficacy and any cost savings. Halmeida emphasized that while early results are encouraging, the program cannot be said to cause all observed changes and that ongoing evaluation is planned.
