START

1. START Region I – Charlottesville Region II- Fairfax County Region III -New River Valley Region IV- Richmond Region V-Hampton/Newport News

2. 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. • This presentation has been developed in collaboration with the Center for START Services, a program of the Institute on Disability/UCED at UNH.

3. Who is eligible for START? • At least 18 years of age • A supported diagnosis of intellectual disability and/or developmental disability is required, and • 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 assessment information

4. Who Should be referred to START • Someone who: • is atrisk of losing their home or job due to behavioral concerns; • 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 been hospitalized or admitted to a psychiatric hospital or training center; • has exhibited behavior that resulted in contact with law enforcement or jail.

5. A Few Key Points… • 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.

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

7. 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 • Community In-Home • 6 -Bed site in each Region (Maximum 30 day stay)

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

9. 1st Year Accomplishments • Over 600 Enrolled in Services • 230 Crisis Responses; over half were to individuals’ homes • Average response time 1:45 hours • 30 Individuals used Emergency Respite • 37 Individuals used planned Respite • 76 Individuals received In-home Respite • Annual Conference 150 participants

10. Example of STAFF for a START Program START Director Clinical TeamPsychiatrist Psychologist Nurse Clinical Team Leaders/START Coordinators Residential Team Respite Director Therapeutic Respite Site Home-BasedCrisis Intervention & Stabilization

11. 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.

12. 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: If START on-call staff determine that the respite facility may be an appropriate service, they contact the on-call START supervisor START on call staff determines what START crisis services may be appropriate

13. 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.

14. 1st Year Challenges • We’re still learning • Turnover • Challenge of buying/building/rehabbing Respite Home • Regions IV and V are opening their Respite Homes this summer • Getting the correct message “Out there” • Gaps still remain

15. Quarterly Advisory Councils Meetings are open to all! • Region I Gail Paysour gail.paysour@regionten.org • Region II Lyanne Trumbull lyanne.trumbull@fairfaxcounty.gov • Region III Angie Helm Ahelm@nrvcs.org • Region IV Lateshia Goode lgoode@co.goochland.va.us • Region V Denise Waters dwaters@hnncsb.org

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

17. Regional Crisis and Referral Numbers START Directors

18. Region I Easter Seals UCP START Director - James Vann James.vann@eastersealsucp.com 24 Hour Crisis Line 855-91-START

19. Region II Easter Seals UCP START Director- Philippe Kane Philippe.kane@eastersealsucp.com 24 Hour Crisis Line 855-89-START

20. Region III New River Valley Community Services Denise Hall, LCSW START Director info@swvastart.org 24 Hour Crisis Line 1-855-88-START (855) 887-8278

21. Region IV Richmond Behavioral Health Authority Autumn Richardson, interim START Director richardsona@rbha.org 24 Hour Crisis Line 1- 855-282-1006

22. Region V Hampton-Newport News CSB Dona M. Sterling-Perdue START Director donas@hnncsb.org 24 Hour Crisis Line 1-855-80-START 855-807-8278

23. Virginia Department of Behavioral Health and Developmental Services Division of Developmental Services Bob Villa State Manager 804/371-4696 Bob.Villa@dbhds.virginia.gov For updates, please see the following webpage http://www.dbhds.virginia.gov/ODS-default.htm