Return to Table of Contents / Previous Article / Next Article

Collaborative Services in Massachusetts: The START/Sovner Center Program

by Joan B. Beasley

START – an acronym for Systemic, Therapeutic, Assessment, Respite and Treatment – has been providing clinical, emergency, and respite services since 1989. The Massachusetts Department of Mental Retardation (DMR) funds the START program in order to provide community-based crisis intervention and prevention services to individuals with developmental disabilities and behavioral (mental) health care needs in the northeast part of the state. START and the Robert D. Sovner Behavioral Health Resource Center of which it is a part serve a region of approximately 750 square miles and 1.1 million total residents. Over 1200 individuals have used Sovner Center and START services.

The program’s underlying philosophy is that services will be most effective when everyone involved in care and treatment is allowed to participate actively in treatment planning and service decisions. In order for this to occur, collaboration between service providers and with service users is necessary, and an integral part of the program.

START Services

In order to access appropriate mental health services and to facilitate a coordinated service approach and foster service linkages, START provides a number of opportunities for consultation, education, and individualized treatment planning. START also provides a number of services to coordinate care and fill in service gaps. The services include collaborative contacts, after-hour contacts, emergency team meetings, planned respite, and emergency respite services:

• Collaborative Contacts: Collaborative contacts are made up of crisis prevention planning meetings, consultation visits, treatment planning meetings, and follow-up meetings. START clinicians are required to facilitate individual crisis prevention planning meeting at least once a year. Whenever possible, the START clinician, the service user, members of the mental health service team (i.e., the outpatient therapist, a representative from the mental health crisis team, the psychiatrist), members of the developmental disabilities service team (i.e., the service coordinator, residential and day program providers), and the individual’s informal or social supports (family members, friends, and other interested parties) meet to develop a plan to assist the individual and his or her caregivers during times of difficulty. START clinicians are also required to maintain ongoing contact with family members and other caregivers. Follow-up meetings are scheduled to evaluate the effects of treatment strategies, update crisis prevention plans and to foster active communication among providers and with direct caregivers.
• After Hours Contacts: START provides 24-hour mobile crisis services. After hours (5 p.m. – 9 a.m. Monday through Friday and all weekend), START clinicians rotate on-call responsibilities and are available to provide assistance to families, DMR, psychiatric pre-screening teams, and residential providers 24 hours a day, 7 days a week. After-hours contacts may include phone calls to assist during a time of crisis, clinicians providing mobile evaluation services and assisting a mental health crisis team to determine whether or not a psychiatric inpatient admission is needed, assistance locating an available inpatient bed, or pre-screening the individual for an emergency respite admission.
• Emergency Meetings: Emergency meetings are team meetings facilitated by START clinicians on a psychiatric inpatient unit or at the emergency respite facility following an admission. The meetings are scheduled within 24 hours of the admission or the next business day whenever possible. The purpose of the meeting is to allow the START clinician and other members of the team to provide information to the inpatient unit in order to assist with treatment and disposition planning. Family members and residential providers are strongly encouraged to participate in the meeting. In addition, the START clinician attempts to facilitate phone contact between the individual’s outpatient and inpatient psychiatrists, and encourages ongoing contact between the family and residential provider throughout the admission. Whenever possible, a discharge planning meeting is also scheduled to ensure a smooth transition back home.
• START Respite: START respite is a place where people can live for short periods of time when they are in distress or in need of support and assistance. The START respite facility is staffed with a full-time director, a weekend coordinator, direct care specialists, and awake overnight staff. The staffing pattern is 3:4 during “awake hours” (8 a.m.– 10 p.m.) and 2:4 during “sleep hours”(10 p.m.– 8 a.m.). However, one-to-one staffing is provided as needed. The respite center has private bedrooms, and one bedroom has a private bath. It is divided into two wings so those individuals who have more severe difficulties do not disturb or become disturbed by other guests. Additional facility-based emergency respite is provided by independent affiliates of START. They maintain the same staff to guest ratio, and work closely with START personnel.
• Planned Respite Services: Two of the beds in the four-bed respite home are designated as “planned respite beds.” Planned respite beds at START are intended to serve individuals who have not been able to use respite in more traditional settings due to their ongoing mental health and/or behavioral issues. Families participating in the program must be approved by DMR as eligible for these services, but once approved, they schedule visits as needed and as space is available. Planned respite visits are provided to any START service recipient and are not restricted to people living with their family. An individual can visit respite for dinner, a recreational activity, or to just “check in” for a few hours. Some families visit respite with the guest to become familiar with the facility and staff prior to scheduling overnights.
• Emergency Respite Services: Emergency respite services are provided at the START respite facility. Two beds in the four-bed respite facility operated by START are designated for emergency respite purposes. Emergency respite is designed to provide out-of-home housing and services to individuals who for a short period of time (suggested 30 days or less) cannot be managed at home or their residential program. Additional emergency respite services are purchased on an as-needed basis from START affiliates.
• Psychiatric Inpatient Services: Community mental health hospitals and general community hospitals provide psychiatric inpatient mental health services. Inpatient psychiatric services are expected to be very short term (seven days or less). Inpatient psychiatric services are primarily provided by three hospitals in the region. The hospitals have affiliation agreements to coordinate services with START and DMR representatives. The affiliation agreements are with the hospitals that provide the bulk of the inpatient services to people with developmental disabilities in the region. However, other hospitals also provide some psychiatric inpatient services. START clinicians offer the same services at these times. In order to access needed services, START relies upon the use of affiliation agreements and linkages with the developmental disabilities and mental health service systems, and the individual’s natural support system.

Nearly, 20 years ago, the late Frank Menolascino recommended a “systematic” approach to the management of behavioral health needs of persons with developmental disabilities, including the provision of comprehensive diagnostic evaluations, active family involvement and education, early diagnosis and treatment, vocational services, residential services, and family support with short-term crisis care facilities to provide back-up support when needed. He stressed that “Coordination of the many services needed for individuals with dual diagnoses requires awareness of the various services available in a given community and a professional attitude that permits active collaboration. It necessitates sharing of the overall treatment plan with the individual, the family, and with community resources. Close attention to the clarity and continuity of communication is essential” (Menolascino et al. 1983). START is one model of a “systematic approach” to care as described by Menolascino and others to assist people with developmental disabilities and behavioral health care needs in the community. The guiding premise of START is that the individual’s needs and wishes drive all services and supports, while the coordinated linkages fill service gaps and allow for the use of multiple services and service systems through proactive communication and collaboration. Jimmy’s story, below, helps to demonstrate how START works with individuals who have developmental disabilities and behavioral support needs.

Jimmy’s Experience

Jimmy* is in his early 20’s and has moderate cognitive impairments and autism. He has lived with his family all of his life, and they would like to continue to have him with them. They have tried to access family support for many years, but Jimmy has not been able to use traditional out-of-home respite services available to other DMR service recipients because of ongoing severe self-injury and major property destruction.

Prior to Jimmy’s referral to START, his family was in constant crisis. His behavior problems were severe and out of control. He was hospitalized in psychiatric facilities on numerous occasions, and after each admission seemed worse. He was referred to the START team and Sovner Center clinic, and upon arrival the family expressed doubts that they could continue to manage the situation.

Jimmy and his family received services from START, and since working with the START team, he has been diagnosed and successfully treated for obsessive-compulsive and bipolar disorders, and his behavior has improved dramatically. He continues to receive support staffing through a DMR provider agency in the family home, and members of the START team provide ongoing training and support to his direct service staff. A START clinician attends Jimmy’s psychiatric appointments to assist in communicating with his psychiatrist, and also talks with his day program provider to ensure that everyone on his team is in communication with regard to Jimmy and his mental health care needs.

Jimmy continues to have ongoing challenges, however, he and his family are no longer in constant distress. The system is linked, communication is active, and everyone continues to benefit from this approach – especially Jimmy.

* Pseudonym

References

Menolascino, Frank J. & McCann, Brian M. Eds. (1983) Mental health and mental retardation: Bridging the gap. Baltimore: University Park Press

Joan B. Beasley is founder and former Director of the Sovner Center, Danvers, Massachusetts. She may be reached at 617/469-7391 or jbbeasley@rcn.com.

Top

Return to Table of Contents / Previous Article / Next Article

Resources: Resources and Related ICI Publications

__________

Citation: Hanson, R., Wieseler, N., & Lakin, K. (2000). Impact: Feature Issue on Behavior Support for Crisis Prevention and Response, 14(1) [online]. Minneapolis: University of Minnesota, Institute on Community Integration. Available from http://ici.umn.edu/products/impact/141/.

__________

Hard copies of Impact are available from the Publications Office of the Institute on Community Integration. The first copy of this issue is free; additional copies are $4 each. You can request copies by phone at 612-624-4512 or E-mail at icipub@umn.edu, or you can fax or mail us an order form. See our listing of other issues of Impact for more information.

The print design version (PDF, 448K, 28 pp.) of this issue of Impact is also available for free, complete with the color layout and photographs. This version looks the most like the newsletter as it was printed.

The University of Minnesota is an equal opportunity employer and educator.