Decreases in inpatient hospitalisations from a technology-based, integrated behavioural health crisis response system: an evaluation of the Grand Response Access Network on Demand (GRAND) Model

ABSTRACT

Objective:

In the US, there is a need for integrated behavioural health crisis programs that can offer alternatives to inpatient placements and improve client outcomes. In response, GRAND Mental Health in Oklahoma developed the Grand Response Access Network on Demand Model (GRAND Model) in 2016. The purpose of this research was to evaluate the GRAND Model’s outcomes and establish the evidence that it reduces inpatient placements.

Methodology:

A longitudinal research design using secondary data was used to assess outcomes before and after the GRAND Model implementation in 2016. Quantitative data-informed changes in the central outcome of interest: reductions in inpatient hospitalisations.

Results:

From 2015 to 2021, the number of inpatient hospitalisations among GRAND adult clients at any Oklahoma psychiatric hospital (excluding Wagoner) fell from 959 (2015) to 66 (2021), a reduction of 93.1%. Inpatient hospitalisations among GRAND adult clients at Wagoner Hospital fell from 841 (2015) to 0 (2021), a reduction of 100%.

Discussion:

The findings presented here suggest that the GRAND Model could be effective in reducing inpatient hospitalisations among adults. Replication of the model is encouraged by other communities, particularly those in rural areas.

KEYWORDS:

• Inpatient
• mental health crisis
• evidence base
• telehealth
• integrated care

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 In the United States there exists variation in crisis clinician models, to include the often employed approach where the ‘on call’ clinicians are at home and could be sleeping when they receive a crisis call.

2 Initially, these centres were called Intensive Outpatient Centres (IOCs). In 2019, Oklahoma statutes and standards related to Medicaid billing allowed for the certification of the IOCs as URCs. Since 2020, the three IOCs in the GRAND Model have been referred to as URCs.