This page is optimized for a taller screen. Please rotate your device or increase the size of your browser window.

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

Jennifer Bronson, Abt Global; Lance Washington National Association of State Mental Health Program Directors Research Institute


June 27, 2023

One in every five Americans over 18 struggles with mental health illness each year, and more than 54% of Americans with mental illnesses don’t receive treatment. Clearly, something needs to change to better engage people in treatment and provide access to it. To do this and ultimately improve outcomes, it is crucial that mental health care is provided in the least restrictive settings possible. However, in many communities, inpatient placements are the best or only option for people experienced a mental health crisis. This article outlines the need for more integrated behavioral health crisis programs, beyond just inpatient placements, so those struggling with mental health can access and benefit from treatment.

This article showcases the Grand Response Access Network on Demand Model (GRAND Model), developed in rural northeastern Oklahoma in 2016 to deliver behavioral health crisis services—particularly for those who could be better served in a lower level of care from inpatient. The GRAND Model aimed to improve the crisis response continuum, from de-escalation of circumstances to after-care and follow-up support. An evaluation of the GRAND Model was conducted to determine if the model decreased inpatient hospitalizations among adult clients.

Researchers used a longitudinal research design with secondary data to assess the outcomes of the GRAND Model both before and after its implementation in 2016. GRAND Mental Health was awarded a federal Certified Community Behavioral Health Clinic Planning Grant in 2015 to improve behavioral health outcomes. GRAND developed the GRAND Model to reduce inpatient hospitalizations and the model has three parts: urgent recovery centers that take voluntary admissions and drop-offs from law enforcement, the use of iPads with a special app that connects the client to their care team and 24/7 crisis services, and a team of clinicians working at the URC who answer all crisis calls. These components proved beneficial, as findings showed that the number of inpatient hospitalizations among GRAND adult clients at any Oklahoma psychiatric hospital fell 93.1% between 2015 and 2021. At one hospital, Wagoner, inpatient hospitalizations dropped from 841 in 2015 to 0 in 2021, a 100% reduction. These findings suggest that the GRAND Model is contributed to reducing inpatient hospitalizations. Other areas in Oklahoma and around the nation have been encouraged to replicate it for their own communities, especially in rural counties where distance and access to care plays a crucial factor for patients.

Learn more about the study’s methodologies, findings, and recommendations by clicking above!

North America