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The Coalition Endorses START Model to Address Service Gaps

Bookmark and Share Raleigh, NC - March 10, 2011 -

The Coalition Endorses START Model to Address Service Gaps

The Coalition, a group of 40 statewide organizations advocating together to meet the needs of North Carolinians living with the disease of addiction, developmental disabilities and mental illness, has reported that studies show that people who have a dual diagnosis of intellectual/ developmental disability and mental illness/behavioral issues are at greater risk for institutionalization than people diagnosed with an intellectual/ developmental disability alone (Kearney & Smull, 1992). In addition, overuse of community emergency departments and long stays in psychiatric facilities has been documented in this population (Friedlander, 2006). There is also empirical evidence that people with co-occurring mental illness and intellectual/ developmental disability (MI/DD) are more likely to use emergency mental health services and psychiatric inpatient services than other forms of community mental health care (Dorn & Prout, 1993).

Experts have attributed these outcomes to a lack of coordination across professional disciplines and a lack of expertise amongst community mental health practitioners (Fletcher, 1993). As with many populations that require the use of multiple services and systems of care, there are gaps in the service system that undermine the ability to provide successful support.

In order to address these gaps the START Model was developed in Massachusetts by Dr. Robert Sovner and Dr. Joan Beasley. START provides prevention and intervention services to individuals with developmental disabilities and complex behavioral needs through crisis response, training, consultation, and respite. The goal is to create a support network that is able to respond to crisis needs at the community level. Providing supports that enable an individual to remain in their home or community placement is the first priority. Short-term emergency respite and planned respite is available when necessary.

In North Carolina, NC START is being implemented across the state through three regionally based START teams.

Four Major Components of START: Addressed by NC-START

1) Development of Collaborative Linkages

• NC-START Team Clinicians are responsible for the coordination of Cross Systems Crisis Plans, visits to family homes and residential settings, consultation to families and staff, and training and technical assistance to partners in the system (LME’s, case managers, emergency responders, mobile crisis teams, providers, hospitals, etc.)

• NC-START Directors are responsible for developing relationships with community partners. This includes development of affiliation agreements.

• NC-START Psychologist is responsible for providing consultation and training to Team Clinicians through weekly clinical team meetings, coordinating monthly Cross Systems Clinical Team Meetings, providing consultation to community psychologists and other providers in the system, identifying community resources, providing training and technical assistance to community partners.

• NC-START Psychiatrist is responsible for consultation to Team Clinicians and consultation and training to psychiatrists in the community

• NC-START Respite Staff are responsible for coordinating with Team Clinicians and community partners.

2) Emergency Coordination

• Team Clinician serves as conduit for in-patient and out-patient services

• Team Clinicians develop relationships with first responders and crisis providers in the community

3) After Hours Contact

• Team Clinicians provide 24/7 crisis response in coordination with local Mobile Crisis Teams

• Team Clinicians provide emergency consultation to families and community providers/partners

4) Respite Services

• Respite staff are responsible for provision of emergency respite through utilization of two of the four beds available. Team Clinicians coordinate closely with Respite Director for admission to respite and begin discharge planning at time of admission

• Team Clinicians are responsible for recommending individuals who would benefit from planned respite. Planned respite is available to individuals who live in their own home or family home. Team Clinicians work closely with Respite staff to coordinate provision of respite, as well as consultation and assistance to the family.

English is an 18-year-old young woman with autism spectrum disorder, intellectual disability and explosive behavior disorder. She lived with her parents and a 7-year-old brother with Down Syndrome when she was referred. She is one of more than 500 people who have accessed NC-START resources. Her mother explains, “When she turned 18, her behaviors were out of control… you and I have brakes on our emotions and behaviors. A lot of children with autism and explosive behavior disorder have no brakes.” She goes on to say that English’s difficulties were “starting to affect my 7-year-old; it was really affecting my emotions and me physically.” English was referred to NC-START and a START Coordinator worked with the family on strategies to use in the home. In addition, English utilized NC-START respite where medications could be reviewed by the NC-START psychiatrist and the NC-START psychologist could work with staff on specific strategies that could be used in the community. English was able to utilize planned respite stays in order to stabilize her so she could function well in her home setting. Eventually, English and her parents made a decision for English to move to another setting in the community. NC-START assisted with this move and worked with the staff in the group home to ensure a successful transition. “One amazing thing that I really like about NC-START is that this doesn’t stop just because English left home. They have written a crisis plan for her group home. If they get to point that they need a break or they get to a point that they are in crisis, they also can utilize NC-START. That has been an added security blanket for me. It’s been amazing.”

For more information on The Coalition and issues affecting individuals and families managing disabilities and mental health challenges, visit www.thecoalitionnc.org.

Press Contact

Contact: Jane Phillips
Email: jane.phillips@nc.eastersealsucp.com
Phone: 919 865 8724