1. Using Court Ordered Outpatient Treatment
To Enhance Success with
Crisis Intervention Teams

2. Westchester County, New York Population: 976,396

3. CIT in New York State
In a 2013 report the Treatment Advocacy Center gave New York a C- in diversion for people with serious mental illness in contact with justice system. Largely due to a lack of CIT development.
NYS OMH and DCJS have worked with the NY Institute for Police Mental Health and Community Collaboration and at this point CIT exists in:
Westchester
Monroe
Rockland
Orange
Dutchess
Erie
Albany
Nassau
Broome
Cortland
Greene
Niagara
Cattaraugus
Madison
Rensselaer
Ulster
Putnam
Bronx
New York
Richmond
Queens
Kings
Oneida
Cayuga
Saint Lawrence
Essex
Orleans
44% or 27 of the 62 Counties that make up New York.

4. CIT in Westchester County
Westchester began to offer CIT training to officers in 2006
At this point, all officers coming through the Westchester County Police Academy receive 40 Hour CIT Basics Course.
CIT is offered twice per year for experienced officers.
There are formal teams in the cities of:
White Plains (co-response model)
New Rochelle (law enforcement only model)
Yonkers 4th Precinct (co-response model)
Many other Police Departments have trained officers but have not developed formalized teams.

5. Court Ordered Outpatient Treatment
With the exception of…
Connecticut,
Maryland,
Massachusetts
Tennessee
Every state and the District of Columbia have enacted laws to authorize the use of AOT.
The US DOJ, Office of Justice Programs and SAMHSA have deemed AOT to be an evidence-based practice.
AOT has been endorsed by…
The American Psychiatric Association
American College of Emergency Physicians
International Association of Chiefs of Police
National Sheriffs’ Association
National Alliance on Mental Illness

6. Overview of Assisted Outpatient Treatment
Assisted outpatient treatment (AOT) is a procedure by which seriously mentally ill individuals are placed under a court-ordered treatment plan while continuing to live in the community.
New York State’s version of AOT is known as “Kendra’s Law,” named in accordance with the 1999 legislation.
Since the legislation was introduced in 1999 there have been over 15,000 people put on Assisted Outpatient Treatment in the State of New York.
Despite the fact that the law has yet to become permanent, there are compelling arguments that it increases public safety and if done properly, promotes recovery.

7. History
1999: Kendra Webdale died after being pushed in front of a subway by a man suffering from mental illness, Andrew Goldstein.
: Mr. Goldstein received 199 days of inpatient & emergency room services on 15 different occasions, in 6 hospitals. He often did not follow-up with treatment & stopped taking medication.

8. Kendra’s Law
Court-ordered outpatient treatment (Assisted Outpatient Treatment or AOT)
NYS Mental Hygiene Law §9.60
Eligibility Criteria:
18 or older, and
Mentally ill, and
Unlikely to survive safely in the community without supervision, and

9. Kendra’s Law (cont.)
Have a history of lack of compliance that has resulted in:
2 inpatient admissions in the past 36 months OR
At least one act of serious violence toward self or others, or threats of, or attempts at, serious physical harm to self or others within the past 48 months,
AND

10. Kendra’s Law (cont.)
Be unlikely to voluntarily participate in treatment,
AND
Based on history & current behavior, be in need of Assisted Outpatient Treatment in order to prevent relapse or deterioration that would likely result in serious harm to the individual or others,
Be likely to benefit from Assisted Outpatient Treatment

11. Westchester County AOT Coordinator
Kendra’s Law (cont.)
A petition can be started by many people including:
-an adult roommate of the person
-the parent, spouse, adult child, or adult sibling
-the director of a hospital where the person is hospitalized
-the psychiatrist who is either treating or supervising the treatment
-the director of community services
Westchester County AOT Coordinator
Sara Servadio

12. Role of Police in AOT
Police may be directed to transport individual who has been noncompliant with court-order to hospital for evaluation (by physician via MHL §9.60).
Police may be directed to transport person who has not responded to requests for AOT evaluation to hospital for evaluation (by court-order via MHL §9.60).
Police may recommend family members get more information about Kendra’s Law from the County.

13. Nys data on the impact of
Assisted Outpatient Treatment

14. AOT and Incarceration in NYS
People incarcerated during their time in AOT compared with anytime in their life prior to AOT:
Prior to AOT 28%
During AOT 8%
Reduction 71%

15. AOT and Hospitalization in NYS
People hospitalized during their time on AOT compared with anytime in their life prior to AOT
Prior to AOT 97%
During AOT 36%
Reduction 63%

16. Increased Access to Services
456% increase in access to Care Coordination services
18% prior to AOT
100% during the period that the person was on AOT
204% increase in adherence to medication
28% prior to AOT
85% during the period that the person was on AOT

17. Increased Access to Services
273% increase in access to housing
11% prior to AOT
41% during the time that the person was on AOT
258% increase in access to alcohol and substance use services
12% prior to AOT
43% during the time that the person was on AOT

18. Notable Impact of AOT… 17% reduction in incidents of harmful behavior
50% reduction in incidents of public disturbance
50% reduction in incidents of harm towards others
57% reduction in incidents of suicide and self injury
55% reduction in suicidal threats

19. CIT and Co-Response teams
Westchester County

20. CIT In Westchester County
Westchester has 48 Law Enforcement Agencies
White Plains Police Department has trained CIT Officers as well as a Police Mental Health Co-Response Team
Yonkers Police Department has trained CIT Officers and a Police Mental Health Co-Response Team in the 4th Precinct
New Rochelle Police Department has a trained CIT Team
Most of the Law Enforcement Agencies have trained CIT officers but don’t have dedicated teams.

21. Collaboration at the County Level
The Westchester County Department of Public Safety and Department of Community Mental Health coordinate CIT training and development.
CIT BASICS – Is a 40 hour class that we have begun to offer to ALL police recruits at the academy level.
CIT CERTIFICATION – Is the 40 hour class offered to experienced officers.

22. Does Not End After Training
collaboration
Does Not End After Training

23. I am writing this to update you with the recent interactions and developments in regards to Mr. V.. 
Due to the Increase in the frequency and severity of the contacts, issues and complaints relating to Mr. V., we examined several options in attempting to get him some help.  Being that Mr. V. adamantly refused to seek or obtain assistance on his own, notifications were  made to Adult Protective and the Westchester County DCMH. 
After having communication with myself and Officer Forsythe, Mark Giuliano and Sara Servadio of Westchester County DCMH responded to Mount Kisco on 08/31/2016 to see if we could find and interview Mr. V.. After being unsuccessful in locating Mr. V., Mark and Sara stopped at the P11 Precinct and reviewed several past blotter narratives pertaining
to recent incidents with Mr. V.  Due to the detailed narratives that had been composed recently by Sgt. Robinson, Det. Fumuso, P.O. Reilly and P.O. Forsythe the DCMH representatives concluded that they had enough information to issue a signed Emergency Admission form under the Mental Hygiene Law for Mr. V. to be brought to Northern Westchester Hospital. 
Mr. V. was located about a half hour late and was transported to Northern Westchester Hospital by Westchester EMS where he was admitted and is receiving medical services that he urgently needed.
- Sgt. Steven Koehler #3030

24. All involved,
Good work on this, thank you.   Also, from outside the Department at County Mental Health, thank you to Mark Giuliano and Sara Servadio for actually getting something done on this.
- Captain Frank Donovan

25. Assisted Outpatient Treatment
Westchester County

26. Westchester County Current Snapshot
Clinical Information
84% are diagnosed with a psychotic disorder
16% with an affective disorder
40% had a co-occurring substance use disorder
Justice Involvement
54% had a history of incarceration in the local county DOC
7% had a history incarceration in the NYS prison system
Access to Housing
88% are housed
Of the 88% housed
54% live at home
46% live in NYS OMH funded housing
12% are currently homeless

27. Westchester County Current Snapshot
Access to Case Management prior to Assisted Outpatient Treatment
31% were connected to some level of service coordination
69% were not connected to service coordination
Access to CM or ACT with AOT Order
100% of the people on AOT have some level of service coordination
64% have case management
36% receive services through an ACT Team.

28. Coordination with NYS Police

29. Elements to Operationalize Collaboration
Have a Point Person
Dedicated Law Enforcement Point of Contact for mental health partners to reach out to.
Dedicated Mental Health Point of Contact for law enforcement partners to reach out to.
Forum for System Issues as well as Case Discussion
Trust
Follow Through

30. QUESTIONS?

31. WESTCHESTER COUNTY Sara Servadio, MA
Assisted Outpatient Treatment Coordinator
Mark Giuliano, MSW
Program Director Community Support
WESTCHESTER COUNTY
DEPARTMENT OF COMMUNITY MENTAL HEALTH