START Clinical Team Personnel
Although START program development is tailored to meet regional needs, all programs must have a START clinical team. The required composition of the clinical team is described below. Apart from the Medical Director, all positions are full-time.
- Program Director - Provides full-time supervision & 24/7 support to the clinical team. Serves as liaison to community providers, works with Clinical Director to coordinate training activities, develops community linkages, chairs Advisory Council, responsible for reporting to stakeholders, developing policies and procedures, provides back-up on-call support.
- Clinical Director - Provides full-time clinical oversight and supervision to clinical team and therapeutic support services, responsible for Clinical Education Team Meetings, provides consultation to community providers/psychologists, provides training to build capacity in the system, provides back-up on-call support.
- Medical Director - Provides part-time consultation and training to clinical team and to START therapeutic supports staff as needed, provides consult/outreach to physicians and prescribers treating individuals supported by START.
- Clinical Team Leaders - Provides day-to-day support and supervision to START Coordinators, including data monitoring, may maintain small caseload and fills in as needed, provides back-up on-call support and coaching to Coordinators.
- START Coordinators - Provides direct, community based START clinical team services to individuals enrolled in the program, completes required assessments, evaluations, and plans, provides 24 hour on-call crisis support for enrolled individuals. Learn more about START Coordination
The Cross-Systems Crisis Prevention & Intervention Plan (CSCPIP) is a person-specific, written plan of response for acute crises. The CSCPIP provides a clear, concrete, and realistic set of supportive interventions that de-escalate, and protect the person from experiencing a mental health crisis. Interventions in the CSCPIP are positive and solutions focused, promote reassurance for all involved and build on strengths and skills of the person and team. Development of the CSCPIP is facilitated by the START Coordinator with the person’s circle of support and in collaboration with others (such as emergency supports personnel) as needed. The CSCPIP process assists the team in implementing positive strategies, preventing difficulty from occurring, de-escalating a situation, and assuring the safety of all involved. The CSCPIP planning process also helps the team to reframe their understanding of the person’s challenges by promoting a strengths-based support approach. It is designed for use in a variety of settings including the person’s home, school, day supports and community. Stakeholders involved in the planning and implementation of a CSCPIP might include:
- Family and friends
- Case managers
- Psychologists
- Residential/vocational provider or community respite providers, including day support staff
- Mental health crisis responders or diversion teams
- Emergency medical and law enforcement personnel
- Psychiatric and medical personnel
A CSCPIP’s supportive, and protective intervention procedures are based on an understanding of environmental issues as well as biopsychosocial indicators of increased stress. Escalation and difficulty occur over time, or in “stages,” based on a combination of biopsychosocial vulnerabilities that may be influenced by conditions known as triggers or circumstances that result in increased stress when they occur. Vulnerabilities and triggers generally increase in intensity and/or frequency when the person’s difficulties progress from one stage to another. The stages are outlined in accordance with the public health model of tertiary care, from less to most intensive.
Emergency Assessment & Intervention Overview
One of the essential roles of the START clinical team is to assist in the evaluation of persons with emergent needs. Fully operational START programs provide emergency on-call supports that are available 24 hours a day, 7 days a week. Telephone access is immediate, and in-person response occurs within two hours of contact. In larger regions, two or more coordinators are on-call to cover the region. Each START team member has on-call responsibilities, including the director, team leaders, and clinical director. While coordinators provide mobile on-call supports for 24-hour periods at a time, the director, clinical team leader, and clinical director provide back-up clinical and administrative support as well.
The primary role of the on-call coordinator is to enhance the abilities of the current mental health emergency service system. START collaborates closely with local mental health entities responsible for the provision of emergency services and assists with crisis stabilization and prescreening for inpatient admissions. The coordinator may also initiate follow-up, additional clinical consultation and support, START emergency therapeutic supports, or other services.
START is a support to the person and the system (the team), so in some instances an enrollee may call the START crisis line directly, but this is rare. The START crisis line is different from traditional mental health hotline supports in that the primary support is offered to the system. It is the goal of START to support the system in helping the person through challenging and stressful times. Only then will capacity be built and sustained. The START Emergency Assessment is an in-person assessment conducted following a crisis call using START sanctioned tools. The purpose is to quickly determine the factors that contribute to the presenting problem and identify interventions that may be employed to intervene quickly and effectively.
Comprehensive Service Evaluations Overview
Comprehensive Service Evaluations (CSEs) provide an in-depth review of a person’s treatment and service history to identify opportunities to strengthen outcomes. Initial information is gathered in the context of outreach meetings, observations of the person in their typical setting and comprehensive record reviews. A CSE is not simply a summary of records reviewed, it offers a strengths-based reframing of the person’s service history, attempting to identify opportunities to strengthen outcomes for the person. A CSE describes biopsychosocial influences on the person’s current functioning and helps to interpret what this means for system planning.
The START Clinical Education Team
Clinical Education Teams (CETs) are learning forums for START teams and community partners to learn together in the context of an active individual. The interdisciplinary CET team is developed by the START Clinical Director and may be comprised of START team members, local mental health clinicians, IDD, emergency, and/or inpatient service providers. Representation from clinical, medical, and systems experts is expected. CETs are learning forums, not individual consultations, and individuals, family members, and/or guardians do not attend. However, a review of recommendations with individuals and families occurs as follow up.
CETs are learning forums, not community trainings, and active engagement and interaction among CET attendees is an integral aspect. For this reason, the number of active community partners generally should not exceed 20-25. While all START team members are welcome to attend, the number of START attendees should not exceed the number of community partners. Coordinators and coaches are not required to attend all CETs.
In consultation with their Team Lead and Clinical Director, the START Coordinator selects an individual for the basis of the CET. Prior to the CET, the START Coordinator collects and reviews records, observes and interviews the person, and communicates with family and team members. This information is used to complete the CET Presentation Summary. Following the CET, the coordinator records impressions, conclusions, and recommendations from the CET meeting and, with the help of the clinical team, translates the recommendations into an action plan to be reviewed with the support team. The interdisciplinary forum of the CET offers an open dialogue and brainstorming around complex issues faced by those receiving START services and their teams. The in-depth discussion identifies innovative interventions and potential solutions from a variety of disciplines.
Programs are required to host monthly CETs with a minimum of 10 per year to allow for holidays and other conflicts. Clinical directors are responsible for maintaining a CET schedule, facilitating the CET event, and coordinating with the START team to identify individuals for presentation. The CET meeting typically last about 1 ½ - 2 hours and follows a structured agenda and plan which includes a training component and discussion of an individual and their system.