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 efficiencies and person centered service outcomes for individuals with an intellectual or developmental disability, and co-occurring behavioral health needs in the community. START is a national initiative that strengthens efficiencies and person centered service outcomes for individuals with an intellectual or developmental disability, and co-occurring behavioral health needs in the community. The START model offers proactive, clinically based assessment, consultation and training for crisis prevention and intervention. The START model offers proactive, clinically based assessment, consultation and training for crisis prevention and intervention. This presentation has been developed in collaboration with the Center for START Services, a program of the Institute on Disability/UCED at UNH. This presentation has been developed in collaboration with the Center for START Services, a program of the Institute on Disability/UCED at UNH.

Who is eligible for START? At least 18 years of age At least 18 years of age A supported diagnosis of intellectual disability and/or developmental disability is required, and A supported diagnosis of intellectual disability and/or developmental disability is required, and Have a co-occurring mental illness or significant challenging behaviors Have a co-occurring mental illness or significant challenging behaviors START admissions are approved based on the team’s review of individual needs, situation, and information START admissions are approved based on the team’s review of individual needs, situation, and assessment information

Who Should be referred to START Someone who: Someone who: is at risk of losing their home or job due to behavioral concerns; is at risk of losing their home or job due to behavioral concerns; has a history of complex medical, behavioral, and/or trauma related issues; has a history of complex medical, behavioral, and/or trauma related issues; has exhibited a significant deterioration in functioning over the past 24 months: has exhibited a significant deterioration in functioning over the past 24 months: has been hospitalized or admitted to a psychiatric hospital or training center; has been hospitalized or admitted to a psychiatric hospital or training center; has exhibited behavior that resulted in contact with law enforcement or jail. has exhibited behavior that resulted in contact with law enforcement or jail.

A Few Key Points… START is not a separate system, but focuses on establishing integrated service linkages. START is not a separate system, but focuses on establishing integrated service linkages. START does not replace any current emergency services providers, but serves as a consulting clinically- based support for individuals, emergency and clinical providers, and other support systems. START does not replace any current emergency services providers, but serves as a consulting clinically- based support for individuals, emergency and clinical providers, and other support systems.

A Few More Key Points… It’s all about the Assessments START emphasizes crisis PREVENTION Through early identification of individuals at high risk Through early identification of individuals at high risk Involvement in development of crisis response plans, Training and technical assistance. Training and technical assistance.

START Services START Services All START programs respond to crisis calls by phone 24/7 and face to face within 2 hours whenever possible A START Coordinator is assigned to each individual accepted into START Therapeutic Respite Services/Crisis and Planned o Community In-Home o 6 -Bed site in each Region (Maximum 30 day stay)

On-going START Services Provisional Crisis Plans Provisional Crisis Plans Cross Systems Crisis Prevention Cross Systems Crisis Prevention and Intervention Plans Comprehensive Service Evaluations and Assessments Comprehensive Service Evaluations and Assessments Emergency co-evaluations, both during business and after hours Emergency co-evaluations, both during business and after hours Family and Provider Support, Education and Training Family and Provider Support, Education and Training

1 st Year Accomplishments 1 st Year Accomplishments Over 600 Enrolled in Services Over 600 Enrolled in Services 230 Crisis Responses; over half were to individuals’ homes 230 Crisis Responses; over half were to individuals’ homes Average response time 1:45 hours Average response time 1:45 hours 30 Individuals used Emergency Respite 30 Individuals used Emergency Respite 37 Individuals used planned Respite 37 Individuals used planned Respite 76 Individuals received In-home Respite 76 Individuals received In-home Respite Annual Conference 150 participants Annual Conference 150 participants

Residential Team Respite Director Therapeutic Respite Site START Director Home-Based Crisis Intervention & Stabilization Clinical Team Psychiatrist Psychologist Nurse Clinical Team Leaders/ START Coordinators Example of STAFF for a START Program

Non Emergency START Referral Process - After a referral, a START Coordinator will contact you to schedule an intake meeting. - An intake meeting will involve: - necessary paperwork for admission to START - discussion on the presenting problems - review of the needs of the system of support - Development of a provisional crisis plan - During this time the START Coordinator may observe the individual in various settings, request additional documentation and complete necessary assessments to assist 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 and team should not make move towards transporting until verification has occurred that all documentation has been received 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.

1 st Year Challenges We’re still learning We’re still learning Turnover Turnover Challenge of buying/building/rehabbing Respite Home Challenge of buying/building/rehabbing Respite Home Regions IV and V are opening their Respite Homes this summer Regions IV and V are opening their Respite Homes this summer Getting the correct message “Out there” Getting the correct message “Out there” Gaps still remain Gaps still remain

Quarterly Advisory Councils Meetings are open to all! Meetings are open to all! Region I Gail Paysour Region I Gail Paysour Region II Lyanne Trumbull Region II Lyanne Trumbull Region III Angie Helm Region III Angie Helm Region IV Lateshia Goode Region IV Lateshia Goode Region V Denise Waters Region V Denise Waters

Outcomes… Outcomes… Positive engagement in services and resources Positive engagement in services and resources Effective services (access, appropriateness, accountability) Effective services (access, appropriateness, accountability) Decreased behavioral challenges and mental health symptoms through an increased understanding of the population. Decreased behavioral challenges and mental health symptoms through an increased understanding of the population. Ability to remain with families Ability to remain with families Decreased facility and hospital utilization Decreased facility and hospital utilization Increased community participation Increased community participation Successful and healthy lives Successful and healthy lives

Regional Crisis and Referral Numbers START Directors START Directors

Region I Easter Seals UCP START Director - James Vann 24 Hour Crisis Line START

Region II Easter Seals UCP START Director- Philippe Kane 24 Hour Crisis Line START

Region III New River Valley Community Services Denise Hall, LCSW START Director 24 Hour Crisis Line START START (855)

Region IV Richmond Behavioral Health Authority Autumn Richardson, interim START Director 24 Hour Crisis Line

Region V Hampton-Newport News CSB Dona M. Sterling-Perdue START Director 24 Hour Crisis Line START

Virginia Department of Behavioral Health and Developmental Services Division of Developmental Services Bob Villa State Manager 804/ For updates, please see the following webpage