For nearly a decade, Staci Owens struggled to keep consistent shelter. The 53-year-old had confrontations with landlords, friends and shelter providers that resulted in bans from their properties. Her family relationships were strained, and a felony conviction complicated matters. 

Owens lived in a tent under a bridge near downtown Tulsa that would occasionally get swept away with all her possessions by city officials. She always returned and rebuilt. She was diagnosed with depression and anxiety but said she doesn’t believe those affect her much.

Things changed about two years ago when a member of the Blue Team, a newly formed outreach team at the Tulsa Day Center, developed a friendship with her. She was convinced to get off the streets, take medication regularly and work toward goals for permanent housing. 

Three months ago, Owens progressed enough to be placed in a unit at a secured motel used as temporary housing by the Tulsa Day Center. She has decorated its walls with art she made, keeps her medical appointments and meets with the team at least once a week. 

“I trust these people with housing more than the others because they promise not to let me go homeless,” Owens said. “I believe that. They did fight for me. They did stick up for me.” 

The Blue Team is the first in the nation rooted in a method of outreach, shelter and treatment for people who are homeless, have a mental health disorder and show signs of anosognosia, a condition referring to patients who do not recognize they are ill. 

While only 10% to  20% of the total homeless population are in this group, they place the biggest demand on community resources.

In Oklahoma, about 1,000 residents fall into this category. It’s this group experiencing decades-long chronic homelessness and going through revolving doors of incarcerations, emergency room visits and involuntary admissions for crisis care.

In September 2022, the Tulsa Day Center created the Blue Team from training provided by the LEAP Institute, founded by psychologist Xavier Amador. He launched a field of research about 35 years ago, applying anosognosia to mental health. 

The Blue Team released its first outcomes data, which shows promising results. 

In the team’s first year, they spent time educating their partners about this new approach. Then, from September 2023 to Sep. 30, the team worked with 43 people meeting the criteria.

Of those, all but one remain in a stabilizing shelter. The group included 19 people finding long-term housing and treatment. The others are working toward goals to enter permanent housing but live in a motel room or at Tulsa Day Center.

All have consistent check-ins from a Blue Team member. The one person who returned to homelessness has since come back into the shelter.

Blue Team Director Kellie Wilson, a retired commercial banker, said she didn’t want to put too much attention on the effort until the numbers backed up the work. 

“I wanted solid data behind us,” Wilson said. “When we set out to do this, the one thing I said is that we are not going to be the flavor of the day. We aren’t going to go out there, be splashy and say, ‘Let’s do this or let’s try that’ and hope it worked

“This is the real deal,” she said. “We are continuing to learn. We haven’t figured it all out. But we have enough data now that tells us we are doing something right. And, it also tells me that this can be replicated.”

The method resembles more of a toolbelt than a formula, focusing on relationship building even when people are combative or resistant. 

“This has allowed us to make a difference in places where we have been frustrated for years,” Wilson said. “So for us to be able to make some headway is very important to us.”

The critical piece of the Blue Team is understanding anosognosia. The term was coined in 1914 by neurologist Joseph François Babinski to describe the symptoms of patients unaware of their paralysis, such as slurring words or not seeing that their limbs were immobile.

In 1991,  Amador, a clinical psychologist on the medical school faculty at  Columbia University’s College of Physicians and Surgeons in New York, published a paper about anosognosia in patients with schizophrenia. That moved away from the belief that a person resisting treatment for a mental illness was doing so out of denial or stubbornness.  

Anosognosia has been part of the Diagnostic and Statistical Manual for Mental Health Disorders by the American Psychiatric Association for 25 years. In 2000, Amador founded the LEAP Institute, which has trained thousands of professionals internationally.

The traditional approach focused on convincing people they were sick and needed treatment. A person with anosognosia would often lash out, insisting they were fine and the problem lies with other people. The LEAP method follows a listen, empathize, agree and partner model. The technique validates a person’s beliefs to reduce conflict and move toward a common goal. 

Several studies indicate that anosognosia affects about 60% of people with schizophrenia, 25% of those with schizoaffective disorders and 50% of people with bipolar disorder.

Michael Brose, the former executive director of Mental Health Association Oklahoma, came across Amador’s work in the early 1990s and incorporated the research into staff training and family support groups. Now, the language and approach are expanding into areas such as law enforcement and homeless encampment decommissioning. 

“What’s really new are a number of groups that do outreach to the homeless putting anosognosia front and center,” Brose said.”I absolutely think this will have an effect statewide. Oklahoma City and Tulsa have collaborative, meaningful intercity sharing of information. We can learn from each other.”

In early September, the University of Oklahoma-Tulsa hosted Amador with a training session for community members with a focus on mental health and criminal justice professionals, law enforcement, educators and families. More than 300 people completed the training. 

“The Clinical Mental Health Counseling graduate degree program at OU-Tulsa specifically works with area mental health agencies, addressing issues related to anosognosia and its impact on individuals, families, and communities,” said Linda Barnum, OU-Tulsa assistant professor in the Clinical Mental Health Counseling program. “The LEAP Institute training supports our students who intern in area agencies and, upon graduation, go on to work in the field of mental health as licensed professional counselors who encounter and address the devastating impact of anosognosia.”

Oklahoma City doesn’t yet have a team similar to the Blue Team, said Jamie Caves, homeless strategy implementation manager for the Key to Home Partnership.

“We are seeing a definite need for coordinated higher level of care for some individuals,” Caves said. “We are just beginning to have conversations about what a complex case team could look like and how we could partner with other systems to provide better support. Next year, we will begin the work to design a complex case team and program model in Oklahoma City.”

Caves said estimates indicate about 5% of its unhoused population shows anosognosia. 

“Like most communities, we are still struggling to find effective tools to support everyone,” Caves said. 

The Blue Team keeps its caseload to one worker per eight clients to provide enough attention. The team has six members. On any given day, there are between 70 and 80 people who are homeless in Tulsa who would be eligible for this case management. The team recently started a waiting list.

“It is all about relationship building,” Wilson said. “With families, there is a built-in trust. We don’t have that, so we have to find ways to bridge that gap to do the outreach to help them. We had to get to the point of trust.

“With our team, we don’t get them housed then let another team take over,” she said. “We stick with them. We’ll stay with them for years.”

The Blue Team is continuing to collect data in areas such as ER usage and law enforcement encounters. Graduate students from several Oklahoma universities are working to track the various outcomes. 

“Our goal is not two years’ sustainability but to see a five-year retention rate on these individuals,” said Tulsa Day Center Executive Director Mack Haltom. “I’m pleased with the numbers. We have a frontline piece that is working.”

In five years, Owens said, she sees herself in a tiny home. She plans to work on her health and would like to restore relationships with her family, including her two children and a grandchild.

“I want to hang out with my kids more,” Owens said. “I’m always thinking about having the holidays, and I used to have them. I wish I could have a holiday where the kids would want to come to.”

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