Psychiatric Intake Response Center 2025 Annual Report

2025 ANNUAL REPORT Psychiatric Intake Response Center

THE PIRC TEAM

Ahmad Brewer, LICSW, PIP Mindy Cavender, LICSW Alex Faust, LPC Hannah Finley, ALC Matt Foster, LPC

Leah Johnson, LMFT Lee Knight, ALC

Shannon Messina, LICSW Susan Smith, LICSW, PIP Espy Soriano-Sanchez, ALC Justin Weatherly, LICSW Erica Wilson, LPC

Carmen Lambert, LICSW Naren Leopard LICSW, PIP

Ashley Loftis, LPC Faith Lowe, LICSW Leigh McKay, LPC

Sara Harbison, ALC Jalana Johnson, LPC

PIRC Administrators and Directors

Thomas “Tom” G. Shufflebarger, MBA, FACHE, President and Chief Executive Officer Andrew “Andy” Loehr, DNP, RN, CNML, CPNP, Senior Vice President and Chief Operations Officer Brandy Reeve, MSN, RN, CPN, CENP, Vice President, Behavioral Health Services

Jesse Tobias “Toby” C. Martinez Jr., MD, Medical Director, Psychiatric Intake Response Center, and Consultation-Liaison Psychiatry; Psychiatrist, Alabama Pediatric Psychiatry, LLC; Clinical Associate Professor, Department of Psychiatry & Behavioral Neurobiology, Heersink School of Medicine, Division of Child and Adolescent Psychiatry, UAB Cynthia “Cindy” M. Jones, MA, LPC-S, NCC, Director, Psychiatric Intake Response Center, and Partial Hospitalization Program (PHP)/Intensive Outpatient Program (IOP)

PIRC Advisory Committee Members

Brian Blakes, Fire Chaplain, City of Birmingham Fire and Rescue Service Margo Harwell, Director of Pediatric Access to Telemental Health Services (PATHS), Children’s of Alabama Gus Heard-Hughes, Vice President of Programs, Community Foundation of Greater Birmingham (CFGB) Cindy Jones, Director of Psychiatric Intake Response Center (PIRC), and Partial Hospitalization Program (PHP)/Intensive Outpatient Program (IOP), Children’s of Alabama Benny LaRussa, Jr., Chief Executive Officer, Sterling Capital Management Leigh Long, Social Worker, Mental Health Community Advocate Jennifer McCombs, School Counselor, Alabama School of Fine Arts (ASFA), and Founder of Over the Mountain Counseling Michelle McGlaughlin, Director of Grants and Contracts, Children’s Aid Society of Alabama Lisa Maloney, Director of Emergency Department and Trauma Services, Children’s of Alabama Kathy Marino, Mental Health Community Advocate Jesse Tobias “Toby” C. Martinez, Jr., MD, Medical Director, Psychiatric Intake Response Center (PIRC), and Consultation-Liaison Psychiatry, Children’s of Alabama; Medical Director, Alabama Pediatric Psychiatry, LLC.; Clinical Associate Professor, Department of Psychiatry & Behavioral Neurobiology, Heersink School of Medicine, Division of Child and Adolescent Psychiatry, UAB

Laurie Marzullo, MD, Medical Director, Urgent Care Services, Children’s of Alabama; Associate Professor, Pediatric Emergency Medicine, UAB Brian Massey, Vice President of Government Relations, Children’s of Alabama Artie Nelson, Child, Adolescent, and Family Psychiatrist, Private Practice Brandy Reeve, Vice President, Behavioral Health Services, Children’s of Alabama Charisse Rupert, Executive Director, Wings Across Alabama, and Board of Directors Member, NAMI Alabama Robin Sparks, Mental Health Initiative Director, Community Foundation of Greater Birmingham (CFGB) Garland Stansell, Chief Communications Officer, Children’s of Alabama John Stone, Director of Advancement, Children’s Aid Society of Alabama Camille Underwood, School Mental Health Coordinator, Midfield City Schools, and Founder of Camille Underwood Consulting Stacy White, Mental Health Community Advocate Erica Wilson, Licensed Professional Counselor, PIRC Therapist, and Founder of The Olive Branch Counseling Center

2 2025 PSYCHIATRIC INTAKE RESPONSE CENTER ANNUAL REPORT

A Letter from the PIRC Director

Dear Community Partners, Professionals, and Advocates:

As Alabama continues to face an ongoing youth mental health crisis, I want to highlight what members of Children’s Psychiatric Intake Response Center (PIRC)/Psychiatric Consult Teams think are children’s mental health challenges and solutions: Access and shortage of mental health providers. Statewide, this shortage, especially in rural Alabama has created crisis situations for patients and caregivers. This year, Children’s Emergency Department (ED) had the most psychiatric visits in its history at 4,730. PIRC Therapist Shannon Messina stated what we hear is there are, “long wait times to establish care,” that causes delayed intervention, keeping patients and caregivers in perpetual crisis. Social media and online chat rooms. These platforms play the greatest role in exposing kids to risky, unhealthy, and harmful people and situations. “You used to open a door into your home and knew who you invited in. Now, someone can come into your home (through online sites and social media), and you don’t know it,” said PIRC Therapist Susan Smith. Caregiver education. Certified Registered Nurse Practitioner Shaquenta Powe said caregivers are not aware of what mental health symptoms are and what influences children. PIRC Therapist Espy Soriano-Sanchez said she talks to caregivers and encourages them to, “Take advantage of all the tools and education provided. Be open and listen while being unconditionally supportive.” Stigma and shame. Many caregivers believe seeking mental health services reflects poorly on them or their child. “Early intervention is critical,” said the teams’ Medical Director and Psychiatrist Dr. Jesse Tobias “Toby” C. Martinez, Jr. Addressing mental health challenges during childhood leverages a unique window of high brain plasticity, where the mind is most adaptable and receptive to learning new coping mechanisms, according to International Journal of Mental Health Systems*. Solutions for mental health shortage. In July, the PIRC/Psychiatric Consult Teams began a monthly collaboration with UAB’s Pediatric Residency Program. Residents are assigned mental health day rotations in the ED, allowing them to shadow team members and be exposed to children, teens, and caregivers during a crisis. “This rotation has allowed me to improve my knowledge of mental health conditions, medications, and other resources that are available to these patients. It will serve me well in a future career of general pediatrics,” said Resident Dr. Sarah Hicks.

Solutions for caregivers and access. Our clinicians provide empathetic and non-judgmental support. They focus on patient and caregiver strengths to help them feel empowered to cope with what’s ahead. Caregivers learn that mental health concerns are chronic, but treatable conditions and with proper interventions have positive outcomes. Through the PIRC line or in the ED, we connect caregivers to services statewide that best fit their child’s needs. Children’s and communities statewide are fortunate to have highly trained and experienced mental health professionals who are on the frontline to intervene, educate, advocate, and support caregivers and patients.

Psychiatric Consult/PIRC Team Medical Directors PIRC Director

Nurse Practitioners (CRNP)

Dr. Tobias Martinez Dr. Vinita

Cindy Jones

Ashley Alspaugh Debra Bruns

Jennifer Crook

Tarra Love

Sharon Minyard

CRNP (cont.)

Yalamanchili

PIRC Therapists

Teresa Moore Shaquenta Powe Courtney Reeves Shirin Sewani Ahmad Brewer Mindy Cavender Alex Faust

With gratitude,

Hannah Finley

Matt Foster Sara Harbison Jalana Johnson

Leah Johnson

Lee Knight Carmen Lambert Naren Leopard

Ashley Loftis

Faith Lowe

Leigh McKay Shannon Messina Susan Smith Espy Soriano-Sanchez Justin Weatherly Erica Wilson

Cynthia “Cindy” M. Jones, MA, LPC-S, NCC PIRC Director, Children’s of Alabama

Pictured are the PIRC/Psychiatric Consult Teams members who work on the frontlines. Pictured from top left to right are Psychiatrists, Nurse Practitioners, Licensed Social Workers, Licensed Counselors, and a Licensed Marriage and Family Therapist.

*Int J Ment Health Syst. 2020 Mar 24;14:23. doi: 10.1186/s13033-020-00356-9. Prevention and early intervention in youth mental health: is it time for a multidisciplinary and trans-diagnostic model for care? Marco Colizzi 1,2, Antonio Lasalvia 1, Mirella Ruggeri 1

PIRC DATA

2025 Total PIRC Calls

250

219

201

198

200

179

174

172

170

152

146

150

118

109

109

100

50

0

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2025 Total Emergency Department Psychiatric Consults

358

294

Jan

62

Jul

96

243

147

428

424

96

120

Feb

Aug

282

254

411

500

Mar

Sept

97

104

257

319

496

481

Apr

115

Oct

116

308

318

311

411

May

Nov

81

121

206

239

264

332

98

106

Jun

Dec

118

189

2025 Total Psych Visits

COA Psych Admits

Psych D/C/AMA/Other

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PIRC IMPACT

PATHS sponsored PIRC to attend and exhibit at the 17th Annual Southeast Regional ADHD Conference. More than 230 people attended the conference. Pictured are PATHS Case Coordinator Casey Barnes, PATHS Director Margo Harwell, and PIRC Therapist Shannon Messina.

PIRC Therapist Carmen Lambert, left, talked about PIRC services with a play therapist attending the 3rd Annual Alabama Association for Play Therapy conference.

4,730 Emergency Department Psychiatric Consults, averaging 394 a month 39 Events statewide PIRC either exhibited, sponsored, or educated the community. 28 Alabama rural counties included in outreach. Rural counties are indicated by more than 50% of their population living in rural areas.

1,947 Calls, averaging 162 a month

12 out of 39 Events sponsored or supported by Children’s of Alabama PATHS program. 2,372 PIRC database providers statewide & surrounding states in the Southeast increased 10%* from 2024. 5,518 Total population impacted by outreach, 45% increase from 2024.

200 Hours of outreach

* Focused efforts were to include more ARC programs; autism, psychological, and neuropsychological testing providers; residential facilities; and certified adoption-competent and registered play therapists.

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PIRC COMMUNITY OUTREACH

PATHS sponsored the 24th Annual Alabama Autism Conference, including PIRC as an exhibitor. At the conference are, left to right: PATHS Director Margo Harwell; PATHS Care Coordinators Staci Smith and Casey Barnes; PATHS Project ECHO Coordinators Meghan Dreher and Kristin Adams; and PIRC Director Cindy Jones.

Minnesota Children’s Behavioral Health Team came to Children’s for a two-day site visit. Pictured are Minnesota’s Children’s and Children’s of Alabama’s Behavioral Health leadership teams.

Mental Health/Healthcare Providers

“The PIRC team has been essential to the care of behavioral health patients within the Emergency Department… The PIRC Therapists are both advocates and guides— bridging the gap between crisis and community, while supporting healthier outcomes for children and families.” Lisa Maloney, Emergency Department and Trauma Services Director, Children’s of Alabama

3rd Annual Alabama Association for Play Therapy Conference 17th Annual Southeast Regional ADHD Conference 24th Annual Alabama Autism Conference Alabama Academy of Family Physicians (AAFP) Conference

Alabama Chapter—American Academy of Pediatrics (AL-AAP) Fall Conference Alabama Chapter—American Academy of Pediatrics (AL-AAP) Spring Conference Alabama Rural Health Conference Children’s Aid Society’s Understanding & Addressing Complex Trauma and Loss in Childhood Conference Children’s of Alabama Mental Health Awareness Conference Children’s of Alabama 2nd Annual Pediatric Emergency Medicine Symposium Children’s of Alabama Practical Day of Pediatrics Conference Huntsville Hospital Nursing Administration Site Visit Minnesota Children’s Site Visit Parent-Child Interaction Therapy (PCIT) Training to Alabama Mental Health Therapists PATHS Project ECHO Presentation to Alabama Pediatricians on Navigating Mental Health Care and Assessing for Suicide VitAL Annual Conference Wellstone Emergency Services (WES) Pediatric Unit Site Visit

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PIRC COMMUNITY OUTREACH

Children’s of Alabama Health Education and Safety Center, CHIPS, and PIRC employees participated in Pickens County Schools’ 3rd Annual “Just Be” Well Pickens Back-to-School Rally. The teams met and educated 250 caregivers and their children about health and mental heatlh services available through Children’s of Alabama.

About 250 students attended Marshall County’s Kate Duncan Smith DAR High School “Day Without Hate” Mental Health Fair. School educators seen here provided education on mental health and PIRC services.

Schools Alabama Department of Early Childhood Education distributed PIRC flyers to every family participating in their program statewide. Birmingham City A. H. Parker and Ramsay High Schools’ 3rd Annual “Stop the Violence” event Hewitt-Trussville Middle School’s 2nd Annual Sunshine and Synergy Resource Fair Marshall County Kate Duncan Smith DAR High School’s “Day Without Hate” Mental Health Fair PATHS Alabama Board of Education statewide School Safety Coordinators Training Pelham Park Middle School Suicide Awareness Walk Pickens County Schools’ 3rd Annual “Just Be” Well Pickens Back-to-School Rally St. Clair County Schools’ Community Resource Fair

Children’s Behavioral Health Services Nurse Educator Tiffany Hutto, left, Alabama State Representative Kenneth Paschal, middle, and PIRC Director Cindy Jones, right, participated in Pelham Park Middle School’s Suicide Awareness Walk event. PIRC exhibited on its services to caregivers and students attending.

“I think a lot of the PIRC program. I find it very, very valuable.”

Dionne Stevens, Mental Health Services Coordinator, Pell City Schools, St. Clair County

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PIRC COMMUNITY OUTREACH

PIRC Therapist Susan Smith exhibited at the Black Women’s Mental Health Institute’s Mental Health Equity and Liberation Summit: Restorative Resilience - Advancing Mental Health Equity through Collective Advocacy.

PIRC Director Cindy Jones, far right, talked to families about PIRC services at the Resources at Railroad Community Mental Health and Wellness Fair.

Community Events Black Women’s Mental Health Institute’s Mental Health Equity and Liberation Summit Brewster Road Community Church Health and Wellness Fair Children’s of Alabama/Regional Autism Network Workshop series (3 events) City of Birmingham Mental Health Day End Addiction BHAM Walk Mujeres Ayudando a Mujeres (M@M) Latina women’s group at Hoover YWCA NAMI Birmingham Walk Public Affairs Research Council of Alabama (PARCA) Annual Forum on State of Mind: Navigating Alabama’s Mental Health Dilemma Refresh Family Church Fair Resources at Railroad Community Mental Health and Wellness Fair The Church at Brook Hills foster family support group

“Y’all were phenomenal. I needed to find resources for this child and you (PIRC Therapist) we’re terrific. Thank you!” Lori Wallace, Care Coordinator, My Care Alabama (Northwest, East, and Central Regions of Alabama)

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PIRC STATISTICS

Lauderdale 12

Limestone 5

Jackson 7

Madison 27

Colbert 3

PIRC Callers by County

Lawrence 2

DeKalb 6

Franklin 1

Morgan 11

Marshall 10

Total: 1,947 *

Cherokee 3

Marion 10

Winston 12

Cullman 20

Etowah 38

*373 calls did not identify county. 4 were out of state.

Blount 20

Walker 29

Cleburne

Calhoun 46

Lamar 2

Fayette 5

St. Clair 56

3

Jefferson 760

Talladega 35

Randolph 6

Clay 6

Tuscaloosa 64

Pickens 4

Shelby 153

Bibb 9

Coosa 2

Chambers 1

Tallapoosa 2

Chilton 30

Greene 1

Hale 4

Perry 4

Lee 18

Elmore 11

Autauga 22

Sumter 1

Macon 0

Dallas 6

Russell 1

Montgomery 34

Marengo 7

Lowndes 0

Bullock 2

Wilcox 3

Choctaw 2

Barbour 2

Crenshaw

Pike 2

Butler 1

Clarke 2

2

Monroe 1

Henry 0

Dale 2

Washington 0

Conecuh 0

Coffee 3

Covington 1

Houston 9

Escambia 4

Geneva 5

Mobile 10

Baldwin 14

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PIRC STATISTICS

Lauderdale 37

Limestone 18

Jackson 13

Madison 206

Colbert 14

PIRC-Identified Mental Health Providers by County

Lawrence 9

DeKalb 22

Franklin 11

Morgan 32

Marshall 22

Cherokee 9

Marion 9

Winston 15

Cullman 26

Etowah 59

Total: 2,372 *

Blount 10

Walker 49

Cleburne

Calhoun 60

Lamar 10

Fayette 10

St. Clair 15

7

*Totals indicate the number of mental health care providers in the PIRC database. Providers may have multiple specialists on staff. The database recognizes some practices as one listing. 88 of providers listed are represented by surrounding states.

Jefferson 553

Talladega 20

Randolph 8

Clay 6

Tuscaloosa 98

Pickens 8

Shelby 107

Bibb 13

Coosa 4

Chambers 9

Tallapoosa 15

Chilton 12

Greene 6

Hale 7

Perry 10

Lee 68

Elmore 16

Autauga 17

Sumter 6

Macon 9

Dallas 17

Russell 13

Montgomery 114

Marengo 14

Lowndes 6

Bullock 8

Wilcox 10

Choctaw 5

Barbour 9

Crenshaw

Pike 22

Butler 13

Clarke 8

7

Monroe 5

Henry 6

Dale 17

Washington 9

Conecuh 3

Coffee 16

Covington 11

Houston 59

Escambia 14

Geneva 5

Mobile 132

Baldwin 106

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PIRC STATISTICS

Caller’s Primary Concern*

Needs Community Resouces

962

Behavior Concern

576

Acting Out

248

ADHD

219

Imminent Danger to Self...

214

Anxiety

200

Anger

198

Suicidal Thoughts/Actions

177

Depression

166

Autism

128

Self-Injurious Behaviors

71

Experienced Trauma

67

64

Parent/Child Conflict

45

Stress

Mood Disorders

23

Bullying

19

Sexually Inappropriate/ Reactive Behaviors

13

4

Eating Disorder

*Multiple concerns are reflected.

Number of Caller’s Concerns by Ages

172 165 165

164 157

146

134 131

126

110 106

81 76

69

51

33

7 5

Ages

13 12 14 16 15 10

171198761854321

11 2025 PSYCHIATRIC INTAKE RESPONSE CENTER ANNUAL REPORT

PIRC STATISTICS

Top 10 Counties by Caller

Jefferson 61%

Shelby 12%

Tuscaloosa 5%

St.Clair 5%

Calhoun 4%

Etowah 3%

Talladega 3%

Montgomery 3%

Chilton 3%

Walker 2%

Caller’s Disposition Profile

Make Recommendation to NEW Provider 45%

Provide Education and Family Support 24%

Recommend to Emergency Department 16%

Recommend to COA Emergency Department 11%

Recommend to Existing/Treating Provider 4%

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PIRC STATISTICS

Caller’s Psychosocial Indicators

DHR Involvement 22%

Death 17%

Divorce 15%

Adoption 14%

Family Conflict 11%

Foster Child 7%

Sexual Abuse 7%

Physical Abuse 3%

Emotional Abuse 2%

Incarceration/Legal Trouble 2%

Verbal Abuse 1%

PIRC Growth Since 2018

5000

4730

4411

4235

4045

4025

4000

3679

3149

3006

2998

2932

3000

2436

2198

2132

1982

1947

2000

1177

1000

0

03/2018-12/2018 2019

2020

2021

2022

2023

2024

2025

PIRC Calls

ED Visits

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PIRC FUTURE PLANS

Behavioral Health department employees supported Mental Health Awareness month in May. PIRC team members represented are back left to right; PIRC, Psychiatric Consultation-Liaison, and Alabama Pediatric Psychiatry Medical Director Dr. Jesse Tobias “Toby” C. Martinez, Jr.; PIRC Therapists Susan Smith, Faith Lowe, Shannon Messina, and Leigh McKay; and PIRC Director Cindy Jones.

PIRC Therapist Ashley Loftis, right, with PIRC Director Cindy Jones, left, celebrated Loftis receiving three years of service award. Loftis also works full-time as the Director of Mental Health Programs for the Addiction Prevention Coalition. APC is a community partner whose aim is to eliminate addiction in Central Alabama.

There were many ways the PIRC/Psychiatric Consult teams impacted children’s mental health this year. We continued to reduce strain on Children’s Emergency Department by consulting on those in crisis. The PIRC remains an entry point for those looking for mental health services. Accessing our ever-growing database helped callers get one step closer to care. Community outreach focused more on rural Alabama communities, who have higher rates of bullying, kids considering suicide, and mental health provider shortages.

2026 Goals

» Intervene, empower, and support caregivers and patients.

» Reduce stigma through education and advocacy.

» Focus PIRC database listings on updating and adding statewide Applied Behavioral Analysts (ABA) providers.

» Develop marketing strategies for greater statewide outreach, including rural counties.

» Continue partnering with the PATHS program to support statewide pediatricians, family practice physicians, and nurse practitioners.

» Identify new partnerships with community stakeholders.

“You helped me with a 13-year-old who was suicidal. Me, mother, and child did a three-way call and talked through things. PIRC helped her get help. It worked beautifully.”

Melissa McNally, MD, Partners in Pediatrics, Montgomery

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RURAL OUTREACH

Lauderdale

Limestone

Jackson

Madison

Colbert

20 out of 39 PIRC events reached 28 Alabama rural counties

Lawrence

DeKalb

Franklin

Morgan

Marshall

Cherokee

Marion

Winston

Cullman

Etowah

Blount

Other rural counties

Walker

Cleburne

Calhoun

Lamar Fayette

St. Clair

Jefferson

Urban counties

Talladega

Randolph

Clay

Tuscaloosa

Pickens

Shelby

Bibb

Chambers

Coosa

Tallapoosa

Greene

Chilton

Hale

Perry

Lee

Elmore

Autauga

Sumter

Macon

Dallas

Russell

Montgomery

Marengo

Lowndes

Bullock

Wilcox

Choctaw

Barbour

Crenshaw

Pike

Butler

Clarke

Monroe

Henry

Dale

Conecuh

Washington

Coffee

Covington

Houston

Escambia

Geneva

Mobile

Rural counties are identified by more than 50% of their population living in rural areas.

Baldwin

Source: U.S. Census Bureau and the Center for Business and Economic Research, The University of Alabama, 2024.

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The PIRC provides its services thanks to generous support from the Community Foundation of Northeast Alabama, The Daniel Foundation, Children’s of Alabama PATHS program in collaboration with the Alabama Department of Mental Health (ADMH) and UAB, the United Way of Central Alabama, the Walker Area Community Foundation, and individual donors. The PIRC was established in partnership with The Anne B. LaRussa Foundation of Hope’s support.

Psychiatric Intake Response Center • Children’s of Alabama Emergency Department 1601 5th Ave. S. • Birmingham, AL 35233 ChildrensAL.org/PIRC