Assisted outpatient treatment (AOT) is a legal alternative to involuntary inpatient commitment whereby the court may order the patient to participate in outpatient care. In the studies of AOT included in our analysis, patients could receive an AOT order if there was evidence that the person might not follow up with community outpatient care. In some locations, the AOT order allowed early release from the psychiatric hospital.

 

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the program impacts measured in the research literature (for example, impacts on crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases. See Estimating Program Effects Using Effect Sizes for additional information on how we estimate effect sizes.

The effect size may be adjusted from the unadjusted effect size estimated in the meta-analysis. Historically, WSIPP adjusted effect sizes to some programs based on the methodological characteristics of the study. For programs reviewed in 2024 or later, we do not make additional adjustments, and we use the unadjusted effect size whenever we run a benefit-cost analysis.

Research shows the magnitude of effects may change over time. For those effect sizes, we estimate outcome-based adjustments, which we apply between the first time ES is estimated and the second time ES is estimated. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured	Treatment age	Primary or secondary participant	No. of effect sizes	Treatment N	Effect sizes (ES) and standard errors (SE)			Unadjusted effect size (random effects model)
					ES	SE	Age	ES	p-value
Psychiatric symptoms Mental health symptoms (such as symptoms of psychosis) in individuals with serious mental illness, measured on a validated scale.	0	Primary	2	242	-0.004	0.088	45	-0.004	0.967
Hospitalization (psychiatric) Admission to a psychiatric ward or hospital.	0	Primary	6	9547	0.044	0.013	45	0.044	0.001
Psychiatric emergency services Emergency department visit related to a psychiatric condition.	0	Primary	1	78	0.181	0.164	45	0.181	0.268
Global functioning How well individuals (typically those who are developmentally disabled or seriously mentally ill) have adapted to activities of daily living.	0	Primary	1	166	-0.056	0.110	45	0.110	0.612
Crime Any criminal conviction according to court records, sometimes measured through charges, arrests, incarceration, or self-report.	0	Primary	1	172	0.013	0.169	45	0.013	0.941

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Castells-Aulet, L., Hernandez-Viadel, M., Jimenez-Marots, J., Canete-Nicolas, C., Bellido-Rodriguez. C., Calabuig-Crespo, R., Asensio-Pascual, P., Lera-Calatayud, G. (2014) Impact of involuntary out-patient commitment on reducing hospital services: 2-year follow-up. Psychiatric Bulletin, 38, 1-4.

Phelan, J.C., Sinkewicz, M., Castille, D.M., Huz, S., & Link, B.G. (2010). Effectiveness and outcomes of assisted outpatient treatment in New York State. Psychiatric Services, 61(2), 137-143.

Preston, N.J., Kisely, S., & Xiao, J. (2002). Assessing the outcome of compulsory psychiatric treatment in the community: epidemiological study in Western Australia. Bmj, 324, 7348.

Segal, S.P., & Burgess, P.M. (2006). Conditional release: a less restrictive alternative to hospitalization? Psychiatric Services, 57(11), 1600-6.

Steadman, H.J., Gounis, K., Dennis, D., Hopper, K., Roche, B., Swartz, M., & Robbins, P.C. (2001). Assessing the New York City involuntary outpatient treatment program. Psychiatric Services, 52(11), 1533.

Swanson, J.W. (2001). Can involuntary outpatient commitment reduce arrests among persons with severe mental illness? Violence & Abuse Abstracts, 7(4), 259-371.

Swartz, M.S., Swanson, J.W., Wagner, H.R., Burns, B.J., Hiday, V.A., & Borum, R. (1999). Can involuntary outpatient commitment reduce hospital recidivism? Findings from a randomized trial with severely mentally ill individuals. The American Journal of Psychiatry, 156(12), 1968-75.

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