From research to reality: The transformation of Tulsa's mental health systems for children

May 31, 2023

After just a few months at the helm of Tulsa’s Parkside Psychiatric Hospital and Clinic, Jim Serratt saw it was time for dramatic change.

A high staff vacancy rate — 68% — stymied the hospital’s capacity, leaving little room for admissions, said Serratt, who joined Parkside as its CEO in summer 2022.

Parkside Psychiatric Hospital and Clinic. Photo credit: Parkside, Inc.

Equipped with data and guidance from Healthy Minds, Serratt focused on what Parkside was uniquely positioned to do in Tulsa: build capacity for kids to have a safe place for acute stabilization.

Now, after redefining Parkside’s company culture, raising wages, and focusing on workforce development, that vacancy rate is down to 6%. Total bed capacity has nearly doubled. Before, beds were split for use by adults and children, but now the hospital has prioritized using most of its bed capacity for children.

“One of the first documents I ever found was a report that Healthy Minds had done on the state of youth mental health in northeast Oklahoma,” Serratt said. “I used that as a guideline, and we began the assessment process of how we could be part of the development of a plan that would start to meet the needs of the kids that were entrusted to us.”  

Finding and filling gaps in the continuum of children’s mental health care has been a hallmark of Healthy Minds’ work since its inception in 2019.

Much of Healthy Minds' work centers on gaps in what is called the continuum of care. This graphic shows how a person might move through different stages of the continuum through their life, moving to higher or lower levels of care based on their need and risk. The foundation of the continuum, promotion and prevention, should be part of each step in the continuum, and comprehensive crisis care should also be accessible from any part of the continuum.

With Healthy Minds’ counsel and coordination, Tulsa-area mental health providers, health care executives, school districts, and local leaders have come together to dramatically improve how the city’s mental health systems work for children and young people.

Healthy Minds’ extensive research on children’s mental health showed how soaring mental health need among Oklahoma children in the wake of the COVID-19 pandemic exposed cracks in the continuum. The kids who fell through the cracks wound up in ERs in unprecedented numbers.

The research also uncovered a gap between the Tulsa area's share of beds for children and its youth population. While the Oklahoma City area still has the majority of the state’s beds, a total of 100 beds for children and adolescents at Parkside will bring the Tulsa area's share of the state’s bed count just over 15%, up from 12% in a previous Healthy Minds analysis. The Tulsa area is home to about 26% of the youth population in Oklahoma, and the Oklahoma City area has about 36%.

Expanding inpatient capacity is one of three key priorities Healthy Minds' research laid out for Tulsa, along with creating a crisis "front door" and expanding intensive home- and community-based services.

In response, community leaders in Tulsa have stepped up to meet the growing mental health needs of children and youth across the continuum of care.

In addition to expanded inpatient capacity at Parkside for children in crisis, Healthy Minds’ system coordination led to the launch of a 24/7 crisis stabilization center for children and a new program to ensure children get the ongoing support they need in school or at home after a mental health crisis.

A place to turn for families in crisis

Operated by Counseling & Recovery Services (CRS) of Oklahoma, YES Tulsa filled a missing piece in Tulsa’s mental health continuum for children. Families who aren’t sure how to help a child in crisis can now access crisis stabilization services, emergency mental health screenings and care coordination around the clock at YES Tulsa.

In addition to identifying the need for the facility through research, Healthy Minds helped to secure key funding at the state and local level for YES Tulsa, the city’s first 24/7 urgent recovery center for children and youth. Both the city and Tulsa County committed COVID-relief funding for the facility, and the state Department of Mental Health and Substance Abuse Services will fund its ongoing operations.  

“Healthy Minds jumped on board with us, because they also agreed that was a missing piece in the community,” said Andre Campbell, clinical director of CRS. “We wanted to be a part of the solution.”  

Before YES Tulsa, “the ER became the place to go,” Campbell said. When families didn’t know where else to turn, emergency rooms became de-facto crisis centers, though they’re often ill-equipped to help families with a behavioral health crisis.  

YES Tulsa aims to help children ages 5-17 stabilize after a crisis so they can be treated in the community rather than in an inpatient setting or other higher level of care.  

Of the 309 referrals to the YES program so far this year, 86% were able to be discharged to a lower level of care, Campbell said. YES Tulsa staff also directly connect those children and their families to ongoing community-based care.

“Not every child needs to go to a higher level of care,” he said. “Sometimes it’s just about having an opportunity to regulate.”

YES Tulsa provides around-the-clock evaluation and stabilization services for children in crisis.

Staying connected after a crisis

After a mental health crisis, it’s crucial to provide children with ongoing services to help them thrive at home and in school.

Through grant funding from the Substance Abuse and Mental Health Services Administration, Family & Children’s Services forges those connections with its Bridging the Gap program.

The Bridge program, which launched in 2022, is designed to improve the transition from inpatient or crisis-level behavioral health care to outpatient care for both children and adults.  

Schools and hospitals refer children for follow-up with the children’s Bridge program. Two mobile crisis teams — each including a therapist and a case manager — focus on responding to schools. A dedicated outreach team is the bridge from crisis stabilization to follow-up, connecting clients with Family & Children’s wraparound services.

When school staff and mental health providers join forces, they help meet students’ needs in a way they couldn’t without collaboration.

“Everyone can work at the highest level of their role,” said Stephanye Lewis, a senior program director with Family & Children’s Services who oversees SAMHSA grant projects for the organization.

In addition to participating in the early stages of forming the idea for the program, Healthy Minds serves as the program evaluator for the Bridge grant and is working to sustain and expand it with future funding. As the grant’s evaluator, Healthy Minds provides technical assistance and data analysis, assessing the success of the program against the grant’s goals and requirements.

In just six months of the Bridge program, Family & Children’s saw a significant drop in the number of children who spent nights in the hospital for psychiatric or emotional problems, Lewis said.

At the program’s baseline assessment, 11 children accounted for a combined 73 nights in the hospital in the previous month. At the six-month mark, none of the children had spent the night at the hospital in the previous month.  

Similarly, at baseline there were 9 ER visits among enrollees in the program. At six months, that number fell to zero.

Because of the program’s success in its initial partnership with Tulsa Public Schools, Lewis said Family & Children’s teams have now expanded their reach into Broken Arrow and Union Public Schools.

Pediatric behavioral health encounters at The Children's Hospital at Saint Francis, 2021

What’s next

Healthy Minds’ ongoing work on Tulsa's continuum of care for children is supported by a grant from the Tulsa Area United Way.

The Anne and Henry Zarrow Foundation also provides Healthy Minds with funding to focus on projects in Tulsa in addition to statewide work to improve Oklahoma's mental health systems.

Statewide, Healthy Minds is active in the implementation of 2022’s House Bill 4106. The law, born out of recommendations developed through Healthy Minds’ research, requires schools to work with community mental health providers to develop plans to respond to kids in crisis.

As part of efforts to strengthen intensive home- and community-based services in Tulsa, Healthy Minds has helped the city apply for a System of Care grant from SAMHSA. If the grant is received, multiple organizations across Tulsa would receive funding to build out comprehensive community mental health services for children.

Healthy Minds has also helped Tulsa Public Schools apply for a federal grant to build capacity around tiered mental health supports for students.

Multi-sector collaboration has driven key improvements in Oklahoma’s systems of mental health care for children and will be critical for future efforts to strengthen the continuum of care.

For Serratt and Parkside, the future of Tulsa’s continuum of care for children will depend on teamwork and communication. He wants to see the community identify and rally around the ideal providers for each step of the continuum, so that children who need help get the right level of care.

“My goal would be in the years to come that we help people identify who's the best provider in each one of those spaces of the continuum, and then all of us support them,” he said. “We'll all be stronger for it.”