START Systemic, Therapeutic Assessment, Respite and Treatment. Joan B. Beasley, Ph.D.
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1 START Systemic, Therapeutic Assessment, Respite and Treatment Joan B. Beasley, Ph.D.
2 Time after time, I have found that when people are taken seriously, when they are respected, when their behavior is interpreted, understood and responded to accurately, when they are engaged in mutual dialogue rather than subjected to unilateral schemes of behavior management, somehow as if miraculously, they become more ordinary. I know a number of people who have had severe reputations who have shed them when those supporting them listened more carefully. Herb Lovett, Ph.D.
3 Crisis prevention and intervention through a system of care approach AKA: A Crisis is a problem without the tools to address it
4 MH/ID Community service system Service Planning/Coordination Cross Systems/Interdisciplinary Training Outpatient mental health: counseling/psychiatry Health care and dentistry Crisis Prevention and Crisis Intervention Planning Residential/Housing/Day/Vocational: Habilitation Respite Inpatient Hospitalization Hospital Diversion/mobile crisis support Psychology/Behavioral Support Planning Family Support/Education/Outreach
5 Problems with most ID/DD systems: Troublesome behaviors considered unacceptable in many support and service venues. The last and least served (i.e. latest trends in congregate or institutional living)
6 Problems with the MH System Stigma Much more likely to use emergency services Lack of training (diagnostic overshadowing) Lack of expertise Medication issues
7 Effective Service Systems: The 3 A s Access Appropriateness Accountability
8 Access Timeliness Array of services Availability Geographic proximity Resources alone should not define service use
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10 Appropriateness Service matches recipients wishes Service allows for self determination whenever possible Providers have expertise Service matches needs
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12 Accountability There is consensus with regard to roles and responsibilities on the part of providers Services are cost effective Recipient is satisfied with services Services meet objectively established goals Services change with the changing needs of the service user Listening and mutual respect in the system is required
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14 Coordination of services helps to insure effectiveness
15 The Core Elements of an Effective system building process (Building a System of Care Primer Sheila Pires) 1. Leadership and constituency building 2. A strategic mindset 3. The importance of orientation to sustainability
16 Constituency Building: A Core leadership group Constituency (representatives) Credibility (within the community) Capacity ( to engage other stakeholders) Commitment ( to the challenge of system building) Consistency ( in vision and message)
17 Effective collaboration the roles and goals are clear with concrete purpose and objectives systemic consultation meaningful partnerships mediation and team building a positive attitude (all are competent)
18 Strategic planning Common goals Common values Common principles a clear population focus
19 Funding and resources the importance of fidelity monitoring resources importance of measuring what you are doing and what it takes to do it
20 The START model: Systems Linkage Approach (developed in 1989) KEY: Enrich the system (avoid strain) Resources allocated to promote linkages (i.e. the use of a linkage team ) Resources allocated to fill in service gaps Services provided across systems Outreach is key Develop a common language Indentified by the US Surgeon General in 2000 as a national model to overcome disparities in access to mental health care
21 Strategic planning and START Written interagency linkage agreements specifying roles and responsibilities of various agencies and providers. Forum designed to promote interagency collaboration both with regard to stake holder needs and clinical issues. Standardized protocols for comprehensive crisis prevention and intervention assessments and plans that link MH and ID providers and treaters. The ability for provide outreach and hand on assistance to caregivers and families to improve collaboration and service outcomes. Contract requirements to insure interagency collaboration and cooperation?
22 START Structural Planning Identify the key decision makers in the system at large and for the individual Clarify roles and responsibilities Understand how decisions are made and should be made Data driven evidence based practices are essential Assume the competency of partners Engagement of stakeholders
23 Focus on maximizing resources Technology: web-ex, webinars, on line training, conference calls, Skype, etc Review of data and modification of services as needed Both actual and virtual team meetings Natural supports are key
24 Stars indicate states with full implementation of START Services START Locations
25 The START Model (Beasley, Kroll & Sovner, 1989) START Service Elements IDD Services Day/vocational Residential Recreation Habilitative Affiliation agreements Crisis prevention planning Clinical consultation Emergency assessment Crisis intervntion Emergency respite Family respite e (planned) Training Facilitation of interdisciplinary meetings Natural SUPPORTS Mental Health Services Outpatient Inpatient Crisis Individual Family Friends Other informal supports
26 Service Enhancements Intensive case management/service brokers Consultation Training Crisis support 24 hours/7 days a week Respite/hospital diversion Outpatient services Inpatient support
27 Essential components Linkages Expertise (in some places this needs to be developed) Family support and education Planned and emergency respite services Cross systems crisis prevention and intervention planning Evidence based practices and outcome measures (advisory council, clinical team, data analysis)
28 Short term Respite Services diagnosis and treatment formulation symptom monitoring emergency support hospital diversion community transition from hospital family support and education
29 Sustainability Statewide plans evolved in short period of time The Medicaid Waiver program Legislated dollars used to develop projects later included in home and community based waiver and state mental health plan
30 Difficulties Associated with Service Linkage Resource issues Cultural issues Systemic obstacles Training issues and the need for expertise
31 Outcomes associated with START: 1.Reduction in inpatient and emergency service use 2.Improved capacity of the system to provide services. 3.Families remained in tact with high degree of satisfaction 4.Cost effective 5.Application of the model varies with venue
32 New Hampshire START Training service coordinators in three regions to do comprehensive service evals. Development of expertise Clinical Education Teams Development of services and service linkages
33 TN START NC START Other START Programs Butler County START The START Partnership for Children ( Ohio and CT.)
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