START Therapeutic Supports Overview

    START therapeutic supports employ a positive psychology approach to "build what's strong" and supplement the traditional "fix what's wrong" approach. This promotes serious consideration of people's intact faculties, ambitions, positive experiences, and character strengths. There are three essential elements that START incorporates into therapeutic supports based on the positive psychology approach:

    1. Fostering positive experiences
    2. Identifying signature strengths
    3. Identifying talents, interests, and abilities

      START therapeutic supports include planned and emergency center-based supports and community-based therapeutic coaching. START therapeutic supports can:

      • Provide an alternative to a mental health in-patient admission
      • Provide assessment and support to someone in distress
      • Assist someone after discharge from a mental health in-patient facility
      • Provide ongoing support to a person who lives with family and cannot access or benefit from traditional respite programs.

      These unique START services promote person-centered approaches and training for persons, families, and caregivers using positive approaches and other therapeutic tools. Positive outcomes are achieved through:

      • Strong, positive, and diverse linkages with partners
      • Active guest, family, and support team involvement
      • A commitment to recognizing and embracing cultural and linguistic diversity
      • Recognizing and embracing each person’s unique character strengths
      • Promotion of improved expertise across systems of care
      • Services designed to fill service gaps


      Center-Based Services

      The Resource Center provides community-based, short-term therapeutic support for people enrolled in START. This service is utilized when people experience acute needs that may be identified as "crisis" or when people live with their families and cannot access traditional community respite options and need additional support. Different from an in-patient mental health facility, the intent of the Resource Center is crisis stabilization, assessment, treatment, and identification of interventions to reduce stress for the person and system. The START team accomplishes this by providing a change in environment and a structured, community-based, home-like, therapeutic setting. All guests of the Resource Center are admitted because they have a recent history of, are at risk for, or are currently experiencing intense crisis events.

      The START Center offers planned admissions and emergency admissions. While the day-to-day activities will be the same for all guests, the purpose and goals for the visits will likely vary depending on the type of admission. The table below provides an overview of the design of START Resource Center admissions.

      The START Resource center requires clear emergency back-up policies and procedures and a highly trained staff to provide the needed services to guests. The START clinical and resource center team work collaboratively, and all admissions/discharges are facilitated by the assigned START coordinator and center director or designee. START Resource center services also include evaluations by the medical and clinical directors in addition to ongoing discharge planning facilitated by coordinators.

      Therapeutic Coaching

      In addition to center-based supports, programs may also offer START therapeutic coaching (STC) services. The goals are similar to that of the START Resource center, but STC is designed to assess and stabilize a person in their community environment(s). START Therapeutic Coaching (STC) provides planned and emergency strengths-based, clinical coaching to primary caregivers and persons in their home setting to rethink presenting challenges. This service is part of the START crisis continuum and is only provided with participation of the START clinical team. The START coordinator determines the need for coaching services in collaboration with the STC team leader, clinical director, the person, and their circle of support. In most situations, STC is planned in coordination with coaches that are familiar with the person and the setting. However, at times, the service may be provided in a more urgent capacity. The provision of supports may occur any day of the week and will depend on the CSCPIP and need for services that are outlined in the plan.

      STC promotes person- and family-centered approaches and training using positive therapeutic tools that include the use of multi-modal clinical assessments, enjoyable therapeutic experiences, and optimal utilization of existing resources. The goal of STC is to assist the person's caregiver by offering observational assessment of the person and their circumstances and implementing planned and/or crisis intervention strategies. Specifically, STC can be helpful as:

      • An alternative to a mental health in-patient admission (emergency coaching)
      • A tool to identify support strategies that are positive, enjoyable, and promote mental wellness (Positive Psychology, PERMA+)
      • A resource for assessment and support to someone in distress (mental health coaching)
      • Ongoing support to a person and family/caregiver in their community (caregiver coaching)
      • Coaching and education for family and support staff on positive, effective support strategies
      • Continued assessment of biopsychosocial factors that may contribute to crisis
      • Increase the likelihood that the person can maintain their preferred community living situation
      • Transition successful intervention strategies to the person's home setting
      • Provide support if a person is unable to leave their home for therapeutic intervention (e.g., symptoms of ASD keep a person from feeling comfortable in new environments)
      • Additional support prior to or following emergency Resource Center admission (in these circumstances, Resource Center staff participate in admissions and transition planning)

      24-Hour Crisis Response for START Therapeutic Support Services

      START therapeutic supports are provided 24 hours per day, 365 days per year, and emergency admissions can occur at any time. A START coordinator, a Resource Center director or STC team leader, and an administrator are also on-call at all times with the coordinators being mobile and responding immediately. If there is an emergent need, the on-call coordinator works with other team members to provide timely, on-site response to help diffuse the crisis event and assist in identifying solutions to assure safety and stability. Once the crisis is stabilized, the assigned START coordinator debriefs with team members involved in the crisis and community team members on what was learned and next steps. Next steps may include additional assessments, consultation with the START medical or clinical director, or Cross Systems Crisis Prevention and Intervention Plan (CSCPIP) revisions.