Back to Annual Meeting

Back to Annual Meeting

APHA Scientific Session and Event Listing

Bruce Link, PhD and Dorothy Castille, PhD. Epidemiology of Mental Disorders, New York State Psychiatric Institute, Columbia University, 172 W 168th Street, 16th Floor, New York, NY 10032, 212 305-4547, bgl1@columbia.edu

IIntensive case management is a key service provided to mental health care consumers who receive court orders to involuntary outpatient commitment known as Assisted Outpatient Treatment (AOT) in New York State. Case management services aim to engage previously treatment non-compliant people in treatment. The alliance between the case manager and the client may be a significant factor in treatment retention. Objective: This study examines the client's perspective on treatment engagement to understand the influence of AOT and coercion on the working alliance with a case manager and with retention in treatment. Methods: Persons receiving AOT orders (N= 73) and clients without AOT orders (N= 99) participating in this New York City study were interviewed at baseline and followed at 1, 3, 6, 9 and 12 months after the initial interview. Results: Although initially selected because of a history of disengagement from treatment, over time, AOT patients came to resemble other outpatients in their alliance with case managers. Moreover, when considered in the context of other factors, patients assigned to AOT were more likely to remain in treatment than other outpatients. At the same time the experience of coercion negatively influenced the alliance with a case manager and treatment retention for both AOT and other outpatients. Conclusion: Our preliminary analyses suggest that because feeling coerced harms treatment engagement, we must address the roots of perceived coercion both in people assigned to AOT and in people using outpatient services more generally. This is treated in Disentangling the roots of perceived coercion.

Learning Objectives: At the conclusion of this presentation, the participant will be able to

• define involuntary outpatient commitment,
• identify two factors associated with retention in treatment and describe the nature of the association,
• indicate where research and strategic intervention must focus to further enhance treatment engagement for difficult to engage persons.

Keywords: Mental Health, Treatment Outcomes

Presenting author's disclosure statement:

Any relevant financial relationships? No