Assisted Outpatient Treatment (AOT)

What is Assisted Outpatient Treatment (AOT)?

AOT is a form of court mandated, outpatient, behavioral health treatment order designed as an alternative to involuntary hospitalization for high needs individuals who struggle with adhering to voluntary treatment. Instead, it provides them with involuntary, community-based, intensive, outpatient treatment and monitoring. To receive these services, a petition illustrating the recipient’s need of them is presented to a court which then holds a hearing on whether to place them on an AOT order. In the North Sound Region of Snohomish, Island, Skagit, Whatcom, and San Juan counties, currently only Snohomish County provides these services.

What type of services does AOT provide?

Unlike other forms of Less Restrictive Alternatives, AOT places an emphasis on intensive, comprehensive treatment as well as compliance monitoring. In Snohomish County, AOT orders are monitored and administered by Conquer Clinics. Conquer provides AOT clients with all of their AOT services unless they should wish to receive some from another willing provider in which case Conquer will coordinate with said provider to assure all service requirements are met. Conquer’s website can be found here . AOT services include:

• An intake evaluation with the provider of the less restrictive alternative treatment.
• A psychiatric evaluation, a substance use disorder evaluation, or both.
• A schedule of regular contacts with the provider of the treatment services for the duration of the order.
• Development of an individual crisis plan.
• Consultation about the formation of a mental health advance directive under chapter 71.32 RCW.
• Monitoring of and Notification to appropriate stakeholders of non-compliance.
• Facilitation of the client’s required appearances in court.
• Efforts to eliminate barriers to obtain prescriptions medications where applicable.
• Development of whole person treatment plans with individuals that includes personal goals as well as those ordered by the court.
• Ongoing and consistent individual therapy for the duration of the AOT order.
• Ongoing and consistent peer support services for the duration of the AOT order.
• Ongoing and consistent case management for the duration of the AOT order.
• Ongoing and consistent medication management for all psychiatric medication needs for the duration of the AOT order.
• Providing services to the client wherever they are required including in the home and the community.
• Transportation for the client as required to facilitate the delivery of services.
• Utilization of telehealth services as required to facilitate the delivery of services.
• Close collaboration with any relevant past or present treatment providers for the client including other BHAs.
• Facilitation of connection to resources such as housing assistance, job applications, and medical appointments.
• Assistance preparing for and attending required court appearances, as well as attending and supporting the client during said appearances.
• Access to 24/7 crisis response services.
• Adhering to state-wide AOT best practice guidelines as they develop.

Who is AOT a good fit for?

AOT is designed to aid individuals with high behavioral health needs who have historically struggled with voluntary treatment compliance and are unable to be properly served by less restrictive forms of treatment but for whom involuntary hospitalization may not be necessary. It can be used as an early intervention to prevent the need of a hospitalization or as a condition of one’s release. Someone who qualifies for AOT:

• Has a behavioral health disorder.
• Is unlikely to survive safely or avoid serious disability or harm to themselves or others without supervision.
• Has a history of lack of compliance with treatment that has caused, within the last 36 months, hospitalization, emergency medical care treatment, or incarceration, or, in the last 48 months, violent acts. This includes individuals currently hospitalized but deemed capable of receiving less restrictive treatment.
• Could not be properly treated by any less restrictive treatment.
• And would benefit from Assisted Outpatient Therapy.

How does someone receive an AOT order?

AOT is a court ordered form of involuntary treatment. To be admitted to an AOT program and receive AOT services, an individual must first receive a court order for said treatment. The first step in this process is for a qualified individual or individuals (see “Who can complete an AOT petition”) to complete an AOT Petition (PDF) and Declaration (PDF).

The completed Petition and Declaration are then sent to the Snohomish County Prosecutor’s Office email (SPA-AOTProsecutors@snoco.org) who review it for legal sufficiency and reach out to the petitioner for any required changes. This hearing will be considered either contested or uncontested depending on the respondent’s response.

If the respondent chooses to contest it, the individual(s) who completed the Petition and Declaration, or their representatives, will be required to attend the hearing virtually. A copy of the petition and notice of the hearing will be served to all parties required to attend the hearing.

Who can complete an AOT petition?

Although other parties can advocate for an AOT petition to be filed for an individual they believe are in need of AOT services, only the following individuals may directly file a petition for AOT on the basis that a person is in need of it:

• The director of a hospital where the person is hospitalized or the director's designee.
• The director of a behavioral health service provider providing behavioral health care or residential services to the person or the director's designee.
• The person's treating mental health professional or substance use disorder professional or one who has evaluated the person.
• A designated crisis responder.
• A release planner from a corrections facility.
• An emergency room physician.

A Declaration must accompany the petition completed or cosigned by a physician, physician assistant, or advanced registered nurse practitioner who has examined or attempted to examine the respondent no more than 10 days prior. See the Petitioner Guide (PDF) for further details and requirements.

If you believe you know someone who may benefit from AOT but are not one of the above professionals, consider contacting the person’s behavioral health provider to discuss AOT as an option. If the person is not currently receiving behavioral health services, consider consulting this list of providers in the North Sound region to assist them in finding one: Find a Provider | North Sound BH-ASO.

If you believe the person is in crisis, contact 988 or VOA Regional Crisis Line to coordinate a mobile crisis response or to connect with the Snohomish County DCR office.