The Harris Center for Mental Health and IDD

Assisted Outpatient Treatment (AOT) is a court-mandated program intended to engage adults with serious mental illness who have challenges with voluntary treatment adherence. AOT programs are designed to promote outpatient treatment participation, reduce emergency care, and decrease justice involvement. Research has found AOT programs to be effective in reducing hospitalizations and justice involvement. Yet, concerns have been raised, including limiting individual autonomy and self-determination and overrepresentation of individuals from BIPOC backgrounds. This article describes the evolution the AOT Houston Model. Through applying the social work lens, this innovative model builds on AOT strengths and addresses limitations. The Houston AOT Model has five goals guided by the core tenets of client empowerment and self-determination. This Model prioritizes six elements including housing, employment, access to public benefits, transportation, service continuity, and care coordination/communication. Implications for practice and policy are presented with strategies for successful implementation of comprehensive AOT programs in other jurisdictions.

Young adults experiencing first-episode psychosis have historically been difficult to retain in mental health treatment. Communities across the United States are implementing Coordinated Specialty Care to improve outcomes for individuals experiencing first-episode psychosis. This mixed-methods research study examined the relationship between program services and treatment retention, operationalized as the likelihood of remaining in the program for 9months or more. In the adjusted analysis, male gender and participation in home-based cognitive behavioral therapy were associated with an increased likelihood of remaining in treatment. The key informant interview findings suggest the shared decision-making process and the breadth, flexibility, and focus on functional recovery of the home-based cognitive behavioral therapy intervention may have positively influenced treatment retention. These findings suggest the use of shared decision-making and improved access to home-based cognitive behavioral therapy for first-episode psychosis patients may improve outcomes for this vulnerable population.

This case report detailed the process of differential diagnosis and course of treatment for a 9-year-old male with Landau—Kleffner syndrome (LKS). He presented to a long-term inpatient psychiatric facility with primary complaints of physical aggression, property destruction, non-compliance, poor academic performance, and developmental regression. He had no history of seizures. Subsequent to several diagnoses and admits to the hospital, a neuropsychological evaluation was conducted. Findings revealed primary deficits in language (receptive and expressive). Observations during functional analysis indicated the possibility of seizure activity. EEG (electroencephalograph) confirmed this contention. The diagnosis of LKS was given and behavioral therapy was successfully used to extinguish the maladaptive behaviors associated with LKS. This complex case illustrated the necessity and utility of neuropsychological assessment, especially in cases where alternate diagnoses are feasible and also served as an informative case example of possible behavioral manifestations that can occur with LKS, and how to treat such.

36 geropsychiatric outpatients were administered a semistructured personality disorder interview derived from DSM-III criteria. Over half (58%) of this elderly sample met criteria for diagnoses of personality disorders, which have been shown to significantly affect treatment of Axis I symptomatology in young adults. Compared to a young adult outpatient sample of 298, older patients had significantly fewer disorders and multiple ones. The greater number of diagnoses yielded by the interview versus clinical evaluation approached statistical significance.

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