2022 START National Training Institute

Monday May 2

11:45 am – 12:30 pm ET| Opening Remarks

Opening Remarks with Kelly Nye-Lengerman, PhD, MSW, Director, University of New Hampshire Institute on Disability/UCED 
Opening Remarks & Gardner Awards with Joan B. Beasley, PhD, Research Professor, University of New Hampshire , Director, National Center for START Services

12:30 – 1:10 pm ET| Keynote 

Search Within for Happiness 
Nirbhay Singh, PhD, BCBA-D, Clinical Professor of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University 

This Keynote is sponsored by Community Bridges of Concord, NH

Everything we need to be happy and joyous lies dormant within us. What we need to do is to awaken what we already have. How do we do this? We could go to South America and engage in mind altering Ayahuasca tea ceremony, or eat magic mushrooms (psilocybin), or ingest other psychedelic drugs. Or, we could simply sit for a few minutes each day, observe our breath, and achieve stillness, spaciousness, and happiness right here, right now. Of course, this is effortful to begin with, overcoming inertia is always harder than we think, but it pays off handsomely with practice. Just as we engage in a physical workout to attend to our bodies, we need to meditate to attend to our mind. When we are able to control our mind, we give up clinging to our body and mind, we stop believing everything we think, and happiness and joy pervade our lives. Stress, anxiety, and worries depart leaving us with a lightness of being, ease in life, and a joy to be with ourselves and others. So, what are we waiting for? 

At the conclusion of this session, participants will be able to: 

• Explain the nature of happiness
• Describe how to practice mindfulness meditation
• List at least three (3) positive outcomes of mindfulness meditation

1:10 – 2:00 pm ET| Plenary Presentation

The Science of Hope—The Practice of Happiness  
Dan Tomasulo, Ph.D., TEP, MFA, MAPP, Academic Director, Spirituality Mind Body Institute, Teachers College, Columbia University 

This presentation will look at how interventions designed to cultivate hope can be applied to generate more sustainable happiness through emotional regulation. Scientists, writers, healers, politicians, religious leaders, and activists have long spoken about hope, but it is only within the last 20 years that researchers have joined the search for practical uses and a deeper understanding of hope and hopefulness. Uniquely different from optimism, intention, and faith, hope offers a transformational opportunity.  As the only positive emotion that requires activation through negativity or uncertainty, hope provides the capacity to turn our struggles into opportunities and our tragedies into triumphs.  

At the conclusion of this presentation, participants will be able to: 

• Demonstrate evidence-based interventions that cultivate hope
• Identify and describe the 7 decisions high-hope people make
• Demonstrate and practice interventions to increase happiness

2:15 – 3:30 pm ET | Breakout Sessions 

Strand A |Building Our Personal Strength from the Inside Out 
Nirbhay Singh, PhD, BCBA-D, Clinical Professor of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University 

Chronic stress saps our inner strength, depletes our resilience, and results in burnout regardless of the origins of the stress in our lives – family circumstances, where we work, nature of our work, or life itself. Stress affects all six body systems: central nervous and endocrine systems; respiratory and cardiovascular systems; digestive systems; muscular systems; sexuality and reproductive systems; and immune systems. But what is more insidious is that it may be epigenetic as well, with stress being transmitted across generations. We can seek help from medical, psychiatric, psychological, and other professionals. The core issue is that we cannot control what happens in life - what events take place at home and with family members, at work and our community, or when pandemic spreads throughout the whole world. But we can certainly control how we respond to the events regardless of their origin and setting. This means that we need to dig deep within ourselves to find what strength we have and build on it until our personal strength enables us to overcome adversities in life. This requires a transformative process. Let’s chat about this transformative process and what practices we can engage in that may build strength and resilience in our lives.  

At the conclusion of this session, participants will be able to: 

• Identify the six body systems affected by chronic stress and how each body system is uniquely affected
• List at least three (3) ways of reducing stress and burnout
• Describe how to mindfully respond to life events without being stressed

Strand B | Culturally Competent Prescribing & Treatment 
Emaya Anbalagan, MD, Medical Director, CA START San Andreas, CA START East Bay; I Leslie Rubin MD, Associate Professor, Department of Pediatrics, Morehouse School of Medicine; Adjunct Associate Professor, Department of Pediatrics, Emory University School of Medicine; Director, Break the Cycle Program, Southeast Pediatric Environmental Health Specialty Unit, Emory University, President and Founder, Break the Cycle of Health Disparities, Inc.; Medical Director, The Rubin Center for Autism and Developmental Pediatrics; Roberto Blanco, MD, Medical Director, NC START Central, Associate Professor, UNC School of Medicine, Division of Child and Adolescent Psychiatry 

This presentation discusses the impact of the development of cultural differences in prescribing habits and treatment in the IDD population.  Human life has evolved from the ancients’ race for survival to the modern man’s pursuit of happiness, branching out in varied ways. However, we still retain xenophobic tendencies that cause us to react to people who are different from us, physically, intellectually, socially, economically, politically, philosophically, as well as to ethnic, racial, and cultural differences. These operate at a macro level politically, economically, and socially as well as at a micro level in personal interactions.  We look into some of the prominent cultures in America and how cultural practices impact the people we assess and treat on a day-to-day basis – affecting all aspects of development and treatment. The presenters discuss their unique perspectives and the importance of bringing cultural sensitivity to the table.  

At the conclusion of this session, participants will be able to: 

• Identify 3 significant beliefs or practices unique to cultures different from their own
• Discuss the impact an identified belief or practice might have on treatment
• Apply knowledge of culturally sensitive prescribing in practice
• Generate 3 strategies to overcome cultural biases in health care practice

Strand C | Role of Research & Evaluation in the Examination of START Crisis Prevention & Intervention Methods 
Luther Kalb, PhD, Assistant Professor, Kennedy Krieger Institute, Johns Hopkins University; Ann Klein, Director of Evaluation and Outcomes, National Center for START Services; Jessica Kramer, PhD, Associate Professor, University of Florida; Joan B. Beasley, PhD, Research Professor, University of New Hampshire , Director, National Center for START Services

This presentation will describe how the START Information and Reporting System (SIRS) database has facilitated the use of clinical data to answer research questions. Two researchers will then describe how: 1) START data can be used to better understanding crisis outcomes for people with IDD; and 2) key research findings have led to refinement of the START conceptual model, ultimately improving START practices. START providers generate valuable information every day, often by entering data into SIRS. Those data can be leveraged to understand and improve clinical practices and START client outcomes. This effort requires integration of research and evaluation with clinical practice. Findings will even hold implications for generating new knowledge for the field about ways to optimize well being for individuals with IDD and their caregivers. This presentation will introduce attendees to a research life cycle involving clinical data input, analysis, interpretation, and implementation to support and improve practices.  

At the conclusion of this session, participants will be able to:

• Describe the relationship between clinical data input, analysis, interpretation, and dissemination.
• Explain how the START Information and Reporting System (SIRS) database is used to answer clinical research questions
• Demonstrate how START data can be used in the research life cycle by employing a real-world example involving crisis contacts
• Summarize how clinical evidence has been used to refine the START conceptual model and improve START practices

Strand D | What’s Getting in Your Way? Leadership to Advance and Sustain Cultural and Linguistic Competence – Part 1

This session is by invitation only

Tawara D. Goode, MA, Associate Professor & Director Georgetown University National Center for Cultural Competence 

There is a clear and compelling need to approach equity, diversity, and inclusion not as problems to be solved, but rather as opportunities to be realized. The 2000 federal statute, Developmental Disabilities Bill of Rights and Assistance Act,1 cites cultural competence as needed to ensure that services and supports are provided in a manner that assure maximum participation and benefit for persons with IDD.  Cultural and linguistic competence are evidence-based practices that reduce disparities, address diversity, and promote equity.

Achieving CLC requires strong and informed leadership to spur the necessary changes within systems, organizations, and practice. It requires responding effectively to race, ethnicity, culture, and other intersecting identities in leadership development and opportunities.  There is a need for leaders with the commitment, energy,  knowledge, and skills to do the difficult work of advancing and sustaining CLC in systems, organizations, and programs that develop policy, provide supports and services, conduct research, and advocate with persons with IDD and their families. It is important that leaders have the insight, courage, and skill to step out in the forefront of this complex set of dynamics and be the catalyst to garner the collective will to make change.  Leaders are needed that are able to address the entrenched challenges that are inherent in efforts to advance and sustain CLC in IDD systems of supports and services in general and those providing mental health services in particular. This may include and it not limited to: a) orchestrating organizational change processes; b) addressing organizational and personal resistance to change; c) understanding and responding affirmatively to the dynamics of diversity; d) confronting biases, stereotyping, discrimination, and other “isms”; and (e) advocating for equity with persons with IDD, their families, and the communities in which they live. Advancing and sustaining CLC is the responsibility of all within the IDD network and should not be relegated as the primary obligation of persons from racial and ethnic groups other than non-Hispanic White. 

This two-part session will examine the role of leadership in advancing cultural and linguistic competence within the context of START and provide practical opportunities for application of leadership concepts. 

At the conclusion of this session, participants will be able to:

• Define leadership and differentiate it from management, advocacy, and authority.
• Apply the concept of technical challenge and adaptive challenge to the challenges of leading cultural and linguistic competence in their roles and responsibilities.
• Identify one leadership practice to advance cultural and linguistic competence in their respective settings.

3:45 – 5:00 pm ET | Research Poster Session 1 

Tuesday May 3

 

12:00 – 12:10 pm ET | Welcome 

12:10 – 1:10 pm ET | Keynote 

The Importance of Including People with Lived Experience of IDD-MH in Research
Melanie Hecker, MPA, Research and Training Associate, National Center for START Services

In this presentation, we will explore the history of the exclusion of people with lived experiences, why including people with lived experiences is important, and tools which can be used to meaningfully include people with IDD-MH in research.  For a very long time, developmental and intellectual disability researchers have wrongly assumed that people with developmental or intellectual disabilities should not be included in research leadership, design, and analysis. This wrong assumption has led to the crucial voices of people with lived experiences being largely absent from IDD-MH research. To correct this gap, it is important for IDD-MH researchers to know how to include people with lived experiences in their work. 

At the conclusion of this session, participants will be able to: 

• Describe the importance of including people with IDD-MH in research
• Discuss the history of IIDD-MH research, including past mistakes & harms
• Identify tools for meaningfully including people with IDD-MH in research

1:10 – 2:30 pm ET | Research Panel

The START Research Panel Presentation
Andrea Caoili, LCSW, Director of Research and Quality Assurance, National Center for START Services; Ann Klein, MA, Director of Evaluation and Outcomes, National Center for START Services; Luther Kalb, PhD, Assistant Professor, Kennedy Krieger Institute, Johns Hopkins University; Jennifer McLaren, MD, Chief Medical Advisor, National Center for START Services; Joan B. Beasley, PhD, Research Associate Professor, University of New Hampshire , Director, National Center for START Services; Melanie Hecker, MPA, Research and Training Associate, National Center for START Services 

Recent research will be shared by the National Center for START Services Research Committee and partners about the work being done to improve the wellbeing of persons with IDD, their families, and communities. The National Center for START Services Research Committee is made up of START experts, researchers, policy experts, and persons with IDD and mental health service experiences. Topics that will be covered in this presentation include national trends associated with START Services outcomes in 2021, and results from a nationwide survey about access to emergency services for persons with IDD-MH during the COVID-19 pandemic, recently published best practice guidelines in mental health prescribing for patients with IDD-MH, and psychometric analysis of a family experiences interview tool. 

At the conclusion of this presentation, participants will be able to: 

• Describe the research being conducted by the National Center for START Services Research Committee
• Utilize strategies for inclusive research practices involving persons with IDD-MH
• Identify implications for training, practice, and policy related to the community-based services and supports for persons with IDD-MH and their families

2:45 – 4:00 pm ET | Breakout Sessions 

Strand A | Positive-Interactive-Behavioral Therapy (P-IBT): Positive Group Psychotherapy for Individuals with Intellectual and Psychiatric Disabilities 
Dan Tomasulo, Ph.D., TEP, MFA, MAPP, Academic Director, Spirituality Mind Body Institute, Teachers College, Columbia University 

The focus of this presentation is Positive Interactive Behavioral Therapy (P-IBT). Interactive-Behavioral Therapy (IBT) was developed in the ’80s and has become one of the most widely used forms of group psychotherapy for people with intellectual and developmental disabilities (IDD) and mental health concerns. It uses a modification of theory and technique borrowed from other models in group psychotherapy and has evolved over the past thirty-five years. The model’s theoretical underpinnings, as well as many of its techniques, are drawn directly from psychodrama as originated by J. L. Moreno (Marineau, 1989) as well as the work on therapeutic factors of Irvin Yalom (1995). A four-stage format is used for IBT: (1) orientation, (2) warm-up and sharing, (3) enactment, and (4) affirmation. The advent of positive psychology has allowed for the pioneering work of Martin Seligman, Chris Peterson, Tayyab Rashid, and Angela Duckworth to be added to the elements and dynamics of facilitation of IBT.  This has resulted in a more robust approach to identifying and prompting therapeutic change through priming leading to character strength-spotting, activation of positive emotions, and relationship-building interventions.  

At the conclusion of this session, participants will be able to: 

• Describe the use of therapeutic factors within the IBT model
• Explain the evolution of the Positive-Interactive Behavioral Therapy (P-IBT) model
• Describe and utilize how positive interventions (such as priming and activating character strengths) are employed within the Positive-Interactive Behavioral Therapy (P-IBT) model
• Demonstrate action methods (such as the double) designed to facilitate positive psychotherapy as modified for individuals with intellectual/developmental disabilities and mental health needs

Strand B | Psychiatric Treatment Considerations from an Integrated Health Perspective 
Jill Hinton, PhD, Clinical Director, National Center for START Services; Michael Cummings, MD, Vice Chair, Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo; Janell Van Cleve, MS, Clinical Director, APIC Program; Jennifer McLaren, MD, Medical Director, New Hampshire Bureau of Developmental Services, Associate Professor of Psychiatry, Pediatrics and The Dartmouth Institute Department of Psychiatry; Jenee Lewis-Walker, PsyD, START Director of Child Mental Health Services, National Center for START Services

Psychiatric assessment and treatment are critical to an Integrated Heath Perspective.  An integrated perspective is a holistic approach that considers the biopsychosocial factors that contribute to a person’s current presentation. It requires active participation from the individual receiving treatment as well as from caregivers. Interprofessional collaboration and communication is necessary for creating a common understanding and achieving positive outcomes. This panel of professionals will share their expertise and experience in providing care from an integrated health perspective 
At the conclusion of this session, participants will be able to: 

• Explain the core principles of an integrated health approach
• Describe how psychiatric care is impacted by and contributes to an integrated health approach
• Identify strategies for achieving effective interprofessional collaboration and communication
• Demonstrate the importance of a shared philosophy/foundation to providing integrated health care

Strand C | A Cross Systems Approach to Mental Health Coaching 
Dan Baker, Ph.D., NADD-CC, CCEP, Associate Project Facilitator and Trainer, National Center for START Services; Andrea Caoili, LCSW, Director of Quality Assurance & Research, National Center for START Services; Anne LaForce, MA ,LPA, Director of Therapeutic Coaching, National Center for START Services

This focus of this presentation will describe mental health coaching and how this evidence-based approach is used within START. The session will include a description of the theoretical frameworks and evidence-based approaches used in START Therapeutic Coaching, and a discussion about how coaching is provided as part of a cross-systems, integrated continuum of START supports. Practice elements of START Therapeutic Coaching will be detailed, and evaluation of efficacy will conclude the session. Video clips from coaches, START enrollees, and family members will support the discussion. 
At the conclusion of this session, participants will be able to: 

• Identify the theoretical frameworks and underpinnings of mental health coaching and how it is applied within START.
• Describe the evidence-based approaches used in the delivery of mental health coaching and how these approaches are utilized in START cross-systems crisis intervention.
• Interpret evaluation data related to the effectiveness of START Therapeutic Coaching

Strand D | What’s Getting in Your Way? Leadership to Advance and Sustain Cultural and Linguistic Competence – Part 2

This session is by invitation only

Tawara D. Goode, MA, Associate Professor & Director Georgetown University National Center for Cultural Competence 

There is a clear and compelling need to approach equity, diversity, and inclusion not as problems to be solved, but rather as opportunities to be realized. The 2000 federal statute, Developmental Disabilities Bill of Rights and Assistance Act,1 cites cultural competence as needed to ensure that services and supports are provided in a manner that assure maximum participation and benefit for persons with IDD.  Cultural and linguistic competence are evidence-based practices that reduce disparities, address diversity, and promote equity. 

Achieving CLC requires strong and informed leadership to spur the necessary changes within systems, organizations, and practice. It requires responding effectively to race, ethnicity, culture, and other intersecting identities in leadership development and opportunities.  There is a need for leaders with the commitment, energy, knowledge, and skills to do the difficult work of advancing and sustaining CLC in systems, organizations, and programs that develop policy, provide supports and services, conduct research, and advocate with persons with IDD and their families. It is important that leaders have the insight, courage, and skill to step out in the forefront of this complex set of dynamics and be the catalyst to garner the collective will to make change.  Leaders are needed that are able to address the entrenched challenges that are inherent in efforts to advance and sustain CLC in IDD systems of supports and services in general and those providing mental health services in particular. This may include and it not limited to: a) orchestrating organizational change processes; b) addressing organizational and personal resistance to change; c) understanding and responding affirmatively to the dynamics of diversity; d) confronting biases, stereotyping, discrimination, and other “isms”; and (e) advocating for equity with persons with IDD, their families, and the communities in which they live. Advancing and sustaining CLC is the responsibility of all within the IDD network and should not be relegated as the primary obligation of persons from racial and ethnic groups other than non-Hispanic White.

This two-part session will examine the role of leadership in advancing cultural and linguistic competence within the context of START and provide practical opportunities for application of leadership concepts. 

At the conclusion of this session, participants will be able to:

• Define leadership and differentiate it from management, advocacy, and authority.
• Apply the concept of technical challenge and adaptive challenge to the challenges of leading cultural and linguistic competence in their roles and responsibilities.
• Identify one leadership practice to advance cultural and linguistic competence in their respective settings.

4:15 – 5:30 pm ET | Research Poster Session 2

Wednesday May 4

12:00 – 12:10 pm ET | Welcome 

12:10 – 1:10 pm ET | Keynote

Practices to Promote Joy: The Power of Positive Emotions and Role-Play 
Andrea Szucs,  LMSW, RDT-BCT, SIFI, Field Advisor / Faculty – Fordham GSS, Clinician / Drama Therapist / Field Supervisor - AHRC NYC 

The art & science to cultivate joy and generate hope with positive interventions in action. 

At the conclusion of this presentation, participants will be able to: 

Identify the benefits of positive emotions and joy
Describe the fundamental use of role play and role theory
Demonstrate effective applications of action methods to cultivate positive emotions

1:15 – 2:15 pm ET | Panel Presentation 

START Research Update: Positive Advancements in IDD-MH Research  (PCORI Telehealth Grant)
Joan B. Beasley, PhD, Research Professor, University of New Hampshire , Director, National Center for START Services;  Andrea Caoili, LCSW, Director of Research and Quality Assurance, National Center for START Services; Elizabeth Grosso, MSW, Director of Training & Professional Development, National Center for START Services; Jessica Kramer, PhD, Associate Professor, Dept of Occupational Therapy, University of Florida; Luther Kalb, PhD, Assistant Professor, Kennedy Krieger Institute, Johns Hopkins University; Melanie Hecker, MPA, Research and Training Associate, National Center for START Services; Tawara D. Goode, MA, Associate Professor & Director, Georgetown University, National Center for Cultural Competence & UCEDD

This presentation will offer a study overview with particular focus on study Aim 1. Staff from certified START programs should attend this session.  

Disparity in access to mental health care increases risk of crisis service use for people with intellectual/developmental disabilities (IDD), and young adults with IDD are amongst the highest mental health crisis service users. While telemental health studies demonstrate potential to enhance access to care, little of this research includes those with IDD, or crisis prevention and intervention services. This gap in knowledge undermines the ability of people with IDD, their family caregivers, clinicians, policy makers, and funders to make informed decisions about use, delivery, and funding of telemental health for youth and young adults with IDD.  This study is grounded in stakeholder engagement, from the design of the procedures to the dissemination of outcomes. Our core leadership team includes persons with IDD and family caregivers.  

This study will be delivered within START (Systemic, Therapeutic, Assessment, Resources, and Treatment), an evidence-based mental health model of crisis prevention and intervention for people with IDD. The aims of the study are:  

Aim 1 (n=160): Refine START telemental health practices to meet the needs of persons with IDD and mental health needs, their family caregivers, and providers.  
Aim 2 (n=500): Compare the effectiveness of in-person START practices versus START telemental health using a randomized control design. 

Aim 3 (n=500): Evaluate heterogeneity of treatment response by assessing differences in outcomes (emergency service diversion, mental health stability, and perceived quality of care) across diverse groups (e.g., race, ethnicity, language spoken, rural settings, level of intellectual disability). 

At the conclusion of this presentation, participants will be able to:

• Describe the primary purpose of the study
• List the three aims of the study and hypotheses being tested
• Identify at least three (3) ways the study will/may impact START practices

2:20 – 4:00 pm ET| START Awards Ceremony

4:00 – 4:30 pm ET| Closing Remarks