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START START
Region I – Charlottesville Region II- Fairfax County
Region III -New River Valley Region IV- Richmond
Region V-Hampton/Newport News
START is a national initiative that strengthens START is a national initiative that strengthens efficiencies and person centered service outcomes for efficiencies and person centered service outcomes for individuals with an intellectual or developmental individuals with an intellectual or developmental disability, and co-occurring behavioral health needs disability, and co-occurring behavioral health needs in the community.in the community.
The START model offers proactive, clinically based The START model offers proactive, clinically based assessment, consultation and training for crisis assessment, consultation and training for crisis prevention and intervention.prevention and intervention.
This presentation has been developed in collaboration This presentation has been developed in collaboration with the Center for START Services, a program of with the Center for START Services, a program of the Institute on Disability/UCED at UNH.the Institute on Disability/UCED at UNH.
Who is eligible for START?Who is eligible for START? At least 18 years of ageAt least 18 years of age A supported diagnosis of intellectual disability A supported diagnosis of intellectual disability
and/or developmental disability is required, andand/or developmental disability is required, and Have a co-occurring mental illness or Have a co-occurring mental illness or
significant challenging behaviorssignificant challenging behaviors START admissions are approved based on the START admissions are approved based on the
teamteam’’s review of individual needs, situation, s review of individual needs, situation, and and assessment information information
Who Should be referred to STARTWho Should be referred to START Someone who:Someone who:
is atis at risk of losing their home or job due to behavioral risk of losing their home or job due to behavioral concerns; concerns;
has a history of complex medical, behavioral, and/or has a history of complex medical, behavioral, and/or trauma related issues; trauma related issues;
has exhibited a significant deterioration in functioning has exhibited a significant deterioration in functioning over the past 24 months: over the past 24 months:
has been hospitalized or admitted to a psychiatric has been hospitalized or admitted to a psychiatric hospital or training center; hospital or training center;
has exhibited behavior that resulted in contact with law has exhibited behavior that resulted in contact with law enforcement or jail. enforcement or jail.
A Few Key Points…A Few Key Points… START is not a separate system, but START is not a separate system, but
focuses on establishing integrated focuses on establishing integrated service linkages.service linkages.
START does not replace any current START does not replace any current emergency services providers, but emergency services providers, but serves as a consulting clinically-based serves as a consulting clinically-based support for individuals, emergency support for individuals, emergency and clinical providers, and other and clinical providers, and other support systems.support systems.
A Few More Key Points…A Few More Key Points…
ItIt’’s all about the Assessmentss all about the AssessmentsSTART emphasizes crisis PREVENTION START emphasizes crisis PREVENTION Through early identification of Through early identification of
individuals at high risk individuals at high risk Involvement in development of crisis Involvement in development of crisis response plans, response plans,
Training and technical assistance.Training and technical assistance.
START ServicesSTART ServicesAll START programs respond to crisis calls by All START programs respond to crisis calls by
phone 24/7 and face to face within 2 hours phone 24/7 and face to face within 2 hours whenever possiblewhenever possible
A START Coordinator is assigned to each A START Coordinator is assigned to each individual accepted into STARTindividual accepted into START
Therapeutic Respite Services/Crisis and PlannedTherapeutic Respite Services/Crisis and Plannedo Community In-HomeCommunity In-Homeo 6 -Bed site in each Region (Maximum 30 day 6 -Bed site in each Region (Maximum 30 day
stay)stay)
On-going START ServicesOn-going START Services Provisional Crisis PlansProvisional Crisis Plans Cross Systems Crisis Prevention Cross Systems Crisis Prevention
and Intervention Plansand Intervention Plans Comprehensive Service Evaluations and Comprehensive Service Evaluations and
AssessmentsAssessments Emergency co-evaluations, both during Emergency co-evaluations, both during
business and after hoursbusiness and after hours Family and Provider Support, Education and Family and Provider Support, Education and
TrainingTraining
11stst Year Accomplishments Year Accomplishments
Over 600 Enrolled in ServicesOver 600 Enrolled in Services 230 Crisis Responses; over half were to 230 Crisis Responses; over half were to
individualsindividuals’’ homes homes Average response time 1:45 hoursAverage response time 1:45 hours
30 Individuals used Emergency Respite30 Individuals used Emergency Respite 37 Individuals used planned Respite37 Individuals used planned Respite 76 Individuals received In-home Respite76 Individuals received In-home Respite Annual Conference 150 participantsAnnual Conference 150 participants
Residential Team
Respite Director
Therapeutic Respite Site
START Director
Home-BasedCrisis Intervention &
Stabilization
Clinical Team
Psychiatrist
Psychologist
Nurse
Clinical Team Leaders/START Coordinators
Example of STAFF for a START Program
Non Emergency START Referral Non Emergency START Referral ProcessProcess
- After a referral, a START Coordinator will contact you to After a referral, a START Coordinator will contact you to schedule an intake meeting.schedule an intake meeting.
- An intake meeting will involve:An intake meeting will involve:- necessary paperwork for admission to START necessary paperwork for admission to START - discussion on the presenting problems discussion on the presenting problems - review of the needs of the system of supportreview of the needs of the system of support- Development of a provisional crisis planDevelopment of a provisional crisis plan
- During this time the START Coordinator may observe the During this time the START Coordinator may observe the individual in various settings, request additional individual in various settings, request additional documentation and complete necessary assessments to assist documentation and complete necessary assessments to assist with providing the most effective services. with providing the most effective services.
START Emergency Respite Admission Flowchart
Client and primary team recognize psychiatric or
behavioral crisis
Contact local emergency services
and START
Emergency services evaluates for psychiatric hospitalization while START co-evaluates for services. If individual meets criteria for hospitalization--->process with START respite
ends for the event. If does not meet criteria for hospitalization and psychiatrically cleared:
START on call staff determines what START crisis
services may be appropriate
If START on-call staff determine that the respite facility may be an
appropriate service, they contact the on-call START supervisor
START Emergency Respite Admission Flowchart (cont)
START on-call supervisor determines whether admission to the Respite Facility is
possible or appropriate, based on space availability, nature of crisis, and other current guests. If admission is denied->START will
attempt to find/offer other resources. If admission is tentatively approved:
Individual must be medically cleared, to include a chest x-ray.
Also need scripts for all medications, and all medications must be in original containers.
All documentation must be faxed to the Respite Facility:
Admission is not fully approved Admission is not fully approved and team should not make move and team should not make move
towards transporting until towards transporting until verification has occurred that all verification has occurred that all documentation has been received documentation has been received
at Respite Facility.at Respite Facility.
If admission is fully approved, START Coordinator and primary team must arrange
transportation to the facility. START cannot be relied on to be the primary transportation
provider, but will assist as able.
Within 48 hours, the START Coordinator will schedule an admission meeting or conference call to discuss goals of respite and set tentative discharge date. START
Coordinator will be the point of contact for communication while individual is at the START Respite Facility.
11stst Year Challenges Year Challenges
WeWe’’re still learningre still learning TurnoverTurnover Challenge of buying/building/rehabbing Challenge of buying/building/rehabbing
Respite HomeRespite Home Regions IV and V are opening their Respite Homes Regions IV and V are opening their Respite Homes
this summerthis summer Getting the correct message Getting the correct message ““Out thereOut there”” Gaps still remainGaps still remain
Quarterly Advisory CouncilsQuarterly Advisory Councils Meetings are open to all!Meetings are open to all!
Region I Gail Paysour Region I Gail Paysour [email protected]
Region II Lyanne Trumbull Region II Lyanne Trumbull [email protected]@fairfaxcounty.gov
Region III Angie Helm Region III Angie Helm [email protected]@nrvcs.org Region IV Lateshia Goode Region IV Lateshia Goode
[email protected]@co.goochland.va.us Region V Denise Waters [email protected] V Denise Waters [email protected]
Outcomes…Outcomes…
Positive engagement in services and resourcesPositive engagement in services and resources Effective services (access, appropriateness, Effective services (access, appropriateness,
accountability)accountability) Decreased behavioral challenges and mental health Decreased behavioral challenges and mental health
symptoms through an increased understanding of the symptoms through an increased understanding of the population.population.
Ability to remain with familiesAbility to remain with families Decreased facility and hospital utilizationDecreased facility and hospital utilization Increased community participationIncreased community participation Successful and healthy livesSuccessful and healthy lives
Regional Crisis and Regional Crisis and Referral Numbers Referral Numbers
START DirectorsSTART Directors
Region IRegion I
Easter Seals UCPEaster Seals UCP
START Director - James Vann START Director - James Vann
[email protected]@eastersealsucp.com
24 Hour Crisis Line 24 Hour Crisis Line
855-91-START855-91-START
Region II
Easter Seals UCP START Director- Philippe Kane
24 Hour Crisis Line 855-89-START
Region IIIRegion III
New River Valley Community ServicesNew River Valley Community Services
Denise Hall, LCSW START DirectorDenise Hall, LCSW START Director
[email protected]@swvastart.org
24 Hour Crisis Line 24 Hour Crisis Line
1-855-88-START 1-855-88-START (855) 887-8278
Region IV
Richmond Behavioral Health AuthorityAutumn Richardson, interim START Director
24 Hour Crisis Line 1- 855-282-1006
Region V
Hampton-Newport News CSBDona M. Sterling-Perdue START Director
24 Hour Crisis Line 1-855-80-START 855-807-8278
Virginia Department of Behavioral Health and Developmental
ServicesDivision of Developmental Services
Bob Villa State Manager804/371-4696
For updates, please see the following webpagehttp://www.dbhds.virginia.gov/ODS-default.htm
