Each of START’s guiding principles are identified in literature as best practices. The following descriptions provide a brief overview of each of these principles. Each service, tool, and intervention endorsed by START is designed with these principles in mind. Endorsed approaches should be seen as touchstones for START team members and a clear reminder of the rationale and reason behind the work of the START community. Additional information regarding the tenants of these approaches are included below:
Positive Psychology & Strengths-Based Practice
Positive psychology is the scientific study of strengths that enables individuals and communities to thrive. It is founded on the belief that people want to lead meaningful and fulfilling lives.[i] The three pillars of positive psychology are 1) positive experiences; 2) positive individual traits; and 3) positive institutions. Positive psychology is built on the concept of character strengths, the psychological ingredients for displaying human goodness. There are 24 universal character strengths that are present in everyone, and each person has primary or “signature strengths.” Signature strengths are ones that are practiced more regularly and help put a person in “flow,” which means that by fostering these primary strengths, a person is more likely to experience happiness, contentment, and wellness[ii].
A core concept of positive psychology is PERMA, which is a theory of well-being that attempts to discover what enables human flourishing and puts a person in flow. The five building blocks of PERMA are: Positive Emotions, Engagement, Positive Relationships, Meaning, and Accomplishment. PERMA Plus (+) incorporates core elements of happiness and health, leading to personal fulfillment, meaning, and well-being.11
Strengths-based practice is built on the premise that all people have inherent strengths and skills that promote resiliency and resourcefulness in the face of challenges. By focusing on strengths, the START team creates a shift in attention from “what is wrong” to “what is strong” and enables people to draw on inherent strengths and resources when experiencing adversity. Strengths-based interventions include empowering individuals and systems to take a lead in identifying and applying solutions; developing respectful and reciprocal collaborations between the individual, family, and providers; and drawing upon already existing personal resources to solve problems. These interventions create sustainable, positive change through the process of capacity building.
[i] Seligman, M. E. (2011). Flourish: A visionary new understanding of happiness and well-being. Simon and Schuster.
[ii] The 24 Character Strengths. VIA Institute on Character. https://www.viacharacter.org/character-strengths.
Person and Family-Centered
A person and family-centered approach to service planning and delivery includes fostering mutual respect, expertise, shared experiences, and partnerships between service providers, families, and individuals receiving services. A person and family-centered process involves listening, thinking together, coaching, sharing ideas, and empowering individuals and families to take an active role in treatment and decision-making. This approach is collaborative and participatory. It also improves clinical decisions, promotes greater understanding of strengths, and improves follow through. Person and family-centered interventions promote open dialogue between providers and families and leads to fewer misunderstandings, better outcomes, and improved satisfaction. The application of person and family-centered practices require a culturally competent lens.
Cultural and Linguistic Competence
Culture is at the core of our humanity. Everyone has a cultural perspective that helps us to know who we are. The National Center for Cultural Competence at Georgetown University defines cultural and linguistic competency as “the capacity of an organization and its personnel to communicate effectively and convey information in a manner that is easily understood by diverse groups including persons of limited English proficiency, those who have low literacy skills or are not literate, individuals with disabilities, and those who are deaf or hard of hearing. Linguistic competence requires organizational and provider capacity to respond effectively to the health and mental health literacy needs of populations served.”[i] Leading the way through acceptance and awareness allows for important connections that expand individual and system capacity. The approaches, practices, and tools endorsed by START should be applied through a culturally and linguistically competent lens. Cultural competency is a journey and goal of the START model, and additional opportunities for reflection, collaboration, and learning are available through NCSS.
[i] Goode, T., & Jones, W. (2009). Definition of linguistic competence. National Center for Cultural Competence. Georgetown University Center for Child and Human Development. Box, 571485, 20057-1485.
Trauma-Informed Care
A trauma-informed approach is broader than trauma-specific services or trauma systems and is considered an essential part of mental healthcare.
Trauma-Informed Care is a strengths-based framework that incorporates key trauma principles in organizational culture, and is responsive to the impact of trauma, emphasizing physical, psychological, and emotional safety for service users and providers. It is an organizational structure that involves realizing the prevalence of trauma, recognizing how trauma affects all individuals, responding by integrating knowledge into practice, and resisting re-traumatization. According to the Substance Abuse and Mental Health Services Administration (SAMHSA),[i] the six primary principles for trauma-informed care are:
- Safety - The physical setting is safe and interpersonal interactions promote a sense of safety. Understanding safety as defined by those served is high priority.
- Trustworthiness and transparency - Operations and decisions are conducted with goal of building and maintaining trust among staff, service users, and family members.
- Peer support and mutual self-help - These are integral to the organizational and service delivery approach and are understood as a key vehicle for building trust, establishing safety, and empowerment.
- Collaboration and mutuality - Recognition that healing happens in relationships and in the meaningful sharing of power and decision-making. Everyone has a role to play in a trauma-informed approach.
- Empowerment, voice, and choice - Individuals' strengths are recognized, validated, and built on, rather than responding to perceived deficits. There is a recognition that every person's experience is unique and requires an individualized approach to promote resiliency.
- Cultural, historical, and gender issues - Actively move past cultural stereotypes and biases (e.g., based on race, ethnicity, sexual orientation, age, geography), offer responsive services, leverage the healing value of traditional cultural connections, and recognize and address historical trauma.
[i] Substance Abuse and Mental Health Services Administration. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014. https://store.samhsa.gov/product/SAMHSA-s-Concept-of-Trauma-and-Guidance-for-a-Trauma-Informed-Approach/SMA14-4884
Biopsychosocial Approach
The biopsychosocial approach considers the biological, psychological, and s ocial strengths and vulnerabilities related to mental wellness and how these different factors might contribute and influence one another[i]. This is an important way of thinking and operating within a START program and promotes the value of multi-disciplinary perspectives. The biopsychosocial approach is based on the idea that each of these factors exist across a continuum and are the key to comprehensive, holistic assessment, evaluation, and service delivery.
[i] Engel, G. (1979). The biopsychosocial model and the education of health professionals. General Hospital Psychiatry, 1(2), pp.156-165.
Wellness-Based
The World Health Organization defines wellness as a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmary.[i] It is the promotion of health and happiness, not simply the absence of illness. Wellness-based approaches can be applied to mental health as well as the provision of START Services as the many domains of wellness directly impact and play a vital role in overall happiness and quality of life. The wellness-based perspective to mental health treatment includes an understanding and integration of all parts of the human experience and a need to address each domain to maximize outcomes.
[i] World Health Organization (1998.). The World Health Organization Constitution. Retrieved from https://www.who.int/healthpromotion/about/HPR%20Glossary%201998.pdf