Joan B. Beasley, Ph.D. Institute on Disability/UCED, University of - - PowerPoint PPT Presentation

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

www.centerforstartservices.org

Mental Health Outcomes and Caregiver Service Experiences Associated with START Clinical Team Services

Joan B. Beasley, Ph.D.

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Lets review what we have learned

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

IDD and Mental Conditions

• Across the United States approximately 1.5% to 2.5% of the population

has an intellectual developmental disorder (IDD).

• The (DSM5) defines IDD as a disability that involves impairments of

general mental abilities that impact adaptive functioning in three domains, or areas.

• These domains determine how well an individual copes with everyday

tasks.

• Epidemiological studies have established that the incidence and

prevalence of mental health conditions for people with IDD is typically 2 to 3 times that of the general population

• and that these mental health conditions often contribute to challenging
• behavior. For people with IDD, aggression and self-injurious behavior

are two of the most common reasons for referrals for mental health services.

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Biopsychosocial Model Engel, 1977

• The biopsychosocial model (abbreviated "BPS") is a general model or

approach stating that biological ( physical make up or condition) , psychological( thoughts, emotions, level of development, communication) and social ( socio-economic, environmental, cultural experiential influences) significant role in human functioning in the context of disease or illness.

• Health is best understood in terms of the context of these combined factors

rather than purely biological terms.

• Used in mental health and humanistic psychology, family systems and other

practices

• Applied assessment of people with IDD and challenging behavior (Gardner)

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

The "START" model:

• First developed in 1988, and still learning
• KEY: Partnerships that Enrich the system
• Nationally recognized
• Let’s discuss our values

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Capacity building begins with posi4ve engagement – Whether it is an individual or a large system, we emphasize building upon abili8es in each individual and in their system of support. Service recipients and their families are our most valued partners.

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Help begins with providing oxygen - helping to resolve an immediate destabilizing situation allows for hope and change going forward.

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Networking - increases depth of knowledge and capacity to provide services for all. The three A’s of service effectiveness - Access, Appropriateness and Accountability.

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Access

(timely, available)

Appropriateness

(matches real needs, provides tools)

Accountability

(responsiveness, engaging, flexible, creative)

10/30/17

The 3 A’s

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Networking: Synergy and linkages (Buckminster Fuller)

• A dynamic state in which combined action is favored
• ver the difference of individual component actions.
• Behavior of whole systems unpredicted by the behavior
• f their parts taken separately, known as emergent

behavior

• The cooperative action of two or more stimuli, resulting in

a different or greater response than that of the individual stimuli.

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

The Benefits of Linkages

Synergy:

• 1. Mutually comparable combined action or operation.
• 2. The interaction of elements that when combined produce

a total effect where the sum is greater than its parts.

Video Link

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

We must all be open to learning and teaching - through continuous assessment of outcomes along with educational opportunities with easily accessible local, regional, statewide, national forums, study groups and training materials.

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Team effort - we work as a team to create opportunities. This includes mutual respect that allows for team input to help the program continue to improve and change over time

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Humanity - conduct all activities with compassion, understanding, and kindness. Community - develop and maintain fellowship with others that share common attitudes, values, interests, and goals.

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Fidelity – provide training and consultation to support the integrity of activities that make the START Model effective and directly impact the success of desired outcomes.

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Options to join the START Network

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Elements of the START Model National Certified START Clinical Team Program Based

• n the START

Model START Network (PLC) Provider Applies START evidence based practices with fidelity to the START model

X

Applies practices based on the START model

X (op8onal)

Access to START trainings/curriculums

X X Some*

Use of the SIRS database (required)

X

START coordinator certification

X X (op8onal)

Proficiency in the use or START sanctioned tools (required)

X (op8onal)

Research toward evidence based practices

X

Quality assurance and training ongoing

X (op8onal)

*As determined for the project

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Elements of the START Therapeutic Supports/RC Model National Certified START Clinical Team Program Based

• n the START

Model START Network (PLC) Provider

The program meets the fidelity for START certified Resource Center/therapeutic supports

X (optional)

Services based on the START model

X

Training on and use of standardized, START endorsed assessment tools

X (optional)

Use of START endorsed admissions and discharge protocols

X (optional)

Therapeutic milieu provides therapeutic group activities, uses positive psychology and strengths-based approaches

X X X

Designated planned and emergency beds

X (optional)

Length of stay is short term (planned=avg. 3 days/month; emergency=

• avg. of 2-3 weeks (less than 30 days)

X

Connection to START clinical team services

X (optional)

Director of center is a certified START coordinator and is trained in providing

• utreach to families and systems of support

X (optional)

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Whatever option, there is a commitment to learning

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

We perform best through our collective intelligence

“As long as everyone got a chance to talk, the team did well. But if only one person or a small group spoke all the time, the collective intelligence declined”

• NYT Magazine “The Work Issue” 2/28/16

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

UNH/IOD Center for START Services: Building capacity

• PLCs
• Coaching
• Technical Support
• Certification ( coordinators and program)
• National Online Training Series
• Certification Course
• Fidelity Guides
• START Curricula
• MH/IDD training lifespan
• CETs
• START National Training Institute

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Therapeutic Resources & Services

• Emergency Beds
• Planned Beds
• Therapeutic Activities
• Autism Services
• Positive Psychology
• Sensory Activities
• Mobile In-Home Community Support

Services

• 24-Hour Crisis Response

Linkages

• State/local stakeholders
• Residential
• Schools
• Inpatient
• Outpatient
• Respite
• Day
• Natural Supports

24-Hour Crisis Response

• Mobile Mental Health Crisis

Teams

• Hospital Emergency Rooms
• Police
• Other First Responders

Advisory Committee

• Director (master's or above)
• Clinical Director (Psychologist or

equivalent)

• Medical Director (Psychiatrist or APRN)
• Certified START Coordinators
• Team Leader

The Center for START Services

• Customized Coaching
• Technical Support
• Certification of START Coordinators
• National Online Training Series
• Online Certification Course for

START Teams

• National Database
• Fidelity Guides
• START Curricula

START Regional Team Services

Clinical Services

• Neurology
• OT
• Forensic Psychology
• Nursing
• Dentistry
• Family Supports

Training and Consultation

• Didactic Training
• Eco-mapping and systems support
• Crisis prevention and intervention planning
• Emotional Intelligence training

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

www.centerforstartservices.org

The START Clinical Team

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

START Clinical Team

• Director ( MSW or equivalent for all listed below as well)
• Assistant Director ( in larger teams)
• Team leaders ( in geographic hubs)
• Clinical Director Ph.D. preferred if equivalent)
• Psychologist
• Medical Director MD or Nurse Practitioner
• Linkage partners and or Multimodal assessment team

(in some locations)

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

START 24 hour Community-Based Crisis Response

• Integrated into the overall system, use a multidisciplinary

team approach, and be able to communicate effectively; Working with inpatient units, mobile crisis teams, emergency rooms

• Crisis Evaluation, Prevention, Intervention, and Stabilization:

START Center

• 24 hour access to care providers for assistance
• Discharge planning meetings within 24 hours with START

Coordinators linked with in-home services, inpatient and START Resource Centers

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

START Assessments and training

• Certified Coordinators
• Access to experts
• Multimodal consult teams
• CETs, START Plans, CSCPs, CSEs, SIRS, Systemic

analysis

• Study Groups across the country
• PLCs
• In home supports
• Therapeutic Centers

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

START Practices

• All team members with the exception of MD are START certified.

MDs participate in MD practice group that meets every other month. Clinical Directors, Team leaders and Directors also have national group meetings.

• The START Network is a group of individuals with a common

repertoire of knowledge about the ways of addressing similar (and

• ften shared) problems and purposes.
• This collective practice is made accessible to newcomers through

the START training forums: activities through which individuals develop ways of thinking and reframing their views.

• The apprenticeship of START coordinators is aimed to reproduce

practices through which the next generation START coordinators is

• developed. We need to teach coordinators to act like START

coordinators.

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

START Coordination

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

What is Our Goal?

The challenge of START coordinators is to become professionals that help to solve problems with no easy answers and that requires judgment and discretion. START fidelity requirements are aimed to frame a language to define START for new members to become acculturated and internalize the conventions of participation.

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Training for Creative Thinking, Collaboration, and Complex Problem Solving

• Coordinators must be prepared to work in complex and

uncertain contexts that demand autonomy, judgment, and the ability to solve problems in action on the spot.

• Innovation and creative thinking are critical skills.

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Innovation

• Innovation is defined as something that cannot be
• standardized. However, the people who innovate are not

simply doing whatever they want and innovation does not happen in a vacuum.

• Innovation and creativity occur in the context of a

community of practice. The START Network is a community of practice.

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

START Coordinator Community of Practice

• Community of practice establishes our cultural

expectations (values). These include skills, affiliations, habits, and understandings made possible by looking at the world through the particular lens of a START coordinator.

• The START coordinator practices establish a community
• f a shared culture or ideology, a way of seeing, valuing,

and practicing our craft.

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Teaching START Practices

• START coordinators are encouraged to make the link

between knowing and doing through practice and reflective processing. This is the intent of our methods professional practicum (through study groups, live supervision, apprenticeship, and coaching).

• While providing the needed didactic information, we are

implementing an alternative model of teaching to incorporate START practices and acculturation into training forums in order to create more independent and creative coordinators.

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

START leadership training

• Leadership is not the same as formal authority
• Most of the time, START has no formal role to perform

specific tasks in an organizational hierarchy

• Rather, START staff are trained as leaders with the values,

skills and observable behaviors that result in mobilizing

• thers toward capacity building, through shared

understanding and values.

• Gaining informal authority requires: knowledge and skills

( including cross cultural), strategic use of self, influence and credibility, trusting relationships.

• In crisis situations advocacy is sometimes needed, however

the goal is to lead the system to change to reduce the dependence on advocates

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

We perform best through our collective intelligence

“As long as everyone got a chance to talk, the team did

• well. But if only one person or a small group spoke all the

time, the collective intelligence declined” NYT Magazine “The Work Issue” 2/28/16

Joan B. Beasley, Ph.D. Director

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Interest based communication and collaboration

START staff members are trained to facilitate communication and collaboration together with the systems they work with by reframing competing positions to positive, future oriented, and common interests. We focus on interests to:

• Redefine the problem
• Promote solutions focused thinking
• Mutual engagement within the system
• Collective intelligence

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Joan B. Beasley, Ph.D. Director

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Cultural and linguistic competency

• We all have multiple cultural identities ( including the

system in which we reside)

• Language and words matter
• They are all layered in differing ways due to our

experiences

• Different conditions draw on these layers
• These are key to understand for START programs to

help lead the way to positive change

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

START with Positive Thinking

• We have a choice about how we view something
• We can change how we as a group think and feel about

what we see

• We can cultivate sustainable positive feelings about
• urselves and our network
• We can create and inspire that in others through this

approach

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Why a Positive Psychology approach?

“We believe that persons who carry even the weightiest psychological burdens care about much more in their lives than just the relief of their

• suffering. Troubled persons want more satisfaction,

contentment, and joy, not just less sadness and worry.”

• Duckworth, Steen, & Seligman, 2005

45

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Positive psychology

• Shift in perception, reframe and refocus
• There is more than one way to view a situation
• Optimism can be taught
• If you practice these skills you will be more effective in

all elements in your life

• If you use these practices with teams, it will have an

impact on everyone connected to you

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Evidence Informed

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

SIRS Database START Information Reporting System

Purpose

Collect and report on various data to provide evidence-informed information to stakeholders, community members

SIRS is a web-based data collection system for managing START services

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

www.centerforstartservices.org

Psychiatric Hospitalization Among Individuals in the START Program

(JIDR)

Luther Kalb, MHS PhD Student, Department of Mental Health Johns Hopkins Bloomberg School of Public Health Co-Authors Joan Beasley, PhD; Ann Klein, MA; Jill Hinton, PhD; Lauren Charlot, PhD

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

START Population sample

• N =3299
• Data were gathered across 6 states (28 sites) between 2011-2015
• Wide age range of individuals (Mage= 31y, SD = 14y, Min = 17y, Max

= 78y)

• 61% male, 63% Caucasian (26% Black/AA, 3% Other, and 8%

Hispanic)

• 23% ASD, 7% Borderline/No ID, 53% Mild, 29% Moderate, 10%

Severe/Profound

• 80% of referrals listed aggression as the primary reason for seeking

START services

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Results

• 28% of referrals reported past year hospitalization. Similar

prevalence across states (24%-37%)

• Multivariate Analyses ( Andersen model)
• Increased Odds of Hospitalization
• Predisposing Variables
• Mild ID, Younger Age, and Black/AA race (p<.05)
• Need Variables
• Psychotic/Schizophrenia Diagnosis and Increased

ABC scores (p<.05) ( irritability and lethargy)

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Conclusion

• High levels of psychiatric hospitalization among START

referrals

• Predisposing, Need, and Enabling Factors all related to

hospitalization

• Targets for interventions (Irritability) and supports

(younger, schizophrenia)

• Socio-demographics indicate disparities continue to exist

in the MH system (race, receipt of SSDI, perhaps level of ID)

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

www.centerforstartservices.org

Improvement in Mental Health Outcomes and Caregiver Service Experiences Associated with START Clinical Team Services

Luke Kalb, PhD; Joan B. Beasley, PhD; Andrea Caoili, MSW; Ann Klein, MA

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Study Overview

• Introduction
• Study Goals/Hypotheses
• Sample
• Results
• Conclusions

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Introduction

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

1/3

Prevalence of Psychiatric Disorders among those with ID

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Family Stress Problems with Access to Healthcare Psychiatric ED use Psychiatric Hospitalization

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Improved Patient Outcome s

Individual Clinical Expertise Patient’s Values & Expectations Best Available Clinical Evidence

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Study Goals /Hypotheses

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Study Goals

Caregiver’s Service Experiences

1 Year Pre- Post

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Study Hypotheses

• A trend towards improvement across each aim.
• Based on prior research*, changes in caregiver

service experiences and hospitalization/ED use may require longer periods of observation given the known difficulties in making systemic changes

*Beasley J. B., ed. Trends in coordinated and planned mental health service use by people with dual

• diagnosis. Kingston, N.Y.: NADD; 2002. Contemporary Dual Diagnosis: MH/MR Service Models,

Volume II: Partial and Supportive Services.

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Sample

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Demographics – Individual (N = 116)

Variable Children (N=57) Adults (N=59) Age; Mean (min, max) 14 (6, 17) 28 (18, 61) ID None Borderline/Mild Moderate Severe/Prof 16% 35% 28% 12% 10% 49% 22% 15% Gender (% male) 68% 75% Race (% White) 78% 83% Ethnicity (% Non-Hispanic) 90% 58% MH Diagnosis Psychosis ASD Mean Diagnoses (all other) 2% 74% 1.2 17% 42% 1.3

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Demographics - Informant

Variable Children Adults Relationship (% parent) 88% 76% Education High School Some College College Graduate+ 32% 21% 37% 36% 29% 24% Income <= 29k 30-69k >=70k missing 26% 25% 32% 18% 37% 19% 17% 27% Gender (% female) 88% 90% Employment Full Time Part Time Not working Retired/Volunteer 26% 15% 51% 9% 31% 20% 46% 3%

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Demographics – Informant II

Variable Children Adults Age 45.4 years 52.9 years Health (1 = poor, 4= excellent) 2.5 2.4 Marital Status (% Married) 78% 56% ** n = 11 surveys were done in Spanish, all of which were in El Paso

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Services

Variable Children Adults Crisis Planning (hours) % receiving service Mean (median) Min, Max 98% 10 (8) 0, 36 83% 9 (8) 0, 26 Outreach (hours) % receiving service Mean (median) Min, Max 96% 10.9 (8) 0, 36 96% 10.6 (7) 0, 50 Clinical Med Consultations (hours) % receiving service Mean (median) Min, Max 65% 2.6 (1) 0, 17 62% 2.8 (1) 0, 12 # of Start Crisis Interventions % receiving service Mean (median) Min, Max 42% 2.7 (0) 0, 31 39% 3.1 (0) 0, 31

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Results

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Aim 1

The Family Experiences Interview Schedule*

• Measures caregivers perspectives about the

effectiveness of the mental health service system and providers.

• Questions are not about START, rather the system as a

whole.

• Measures each of START’s 3 A’s:
• Access, Appropriateness, Accountability

*Tessler and Gamache

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Subscale 1: Family members evaluations of their involvement with mental health professionals % Reporting they received All/Some that was wanted or needed Pre Post

• 1. Receive enough information
• 2. Assistance if there was a crisis
• 3. Information about who to call during a

crisis

• 4. Encourage to take an active role
• 5. Respond to concerns
• 6. Take into account ideas
• 7. Involve caregiver in treatment
• 8. Recognize Burdens
• 9. Regular contact with providers

59 46 43 63 59 60 77 53 82 78 72 74 84 76 83 89 80 89

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Subscale 2: Family member evaluations of client services % Reporting they Received All/Some that was wanted or needed Pre Post

• 10. Services available were the ones that are

needed

• 11. Express opinion

12.Choose between service options 13.Choose between different providers

• 14. Convenient to use services
• 15. Services flexible enough to meet needs
• 16. Satisfied with services

53 71 37 47 49 67 57 82 84 63 58 79 80 75

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Subscale 3: Mental Health System Response to Caregivers % Reporting they Received All/Some that were needed Pre Post

• 17. Respond to the wishes of the family
• 18. Say about services needed
• 19. Satisfied with role in treatment
• 20. Available help on nights/weekends

52 61 63 27 71 82 86 61

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

25 30 35 40 45 50 55 60 65 Pre Post

*

.0-.19 = no effect .2-.49 = small effect .50-.79 = moderate effect >.80 = large effect

Effect Size

• r Magnitude
• f Difference

= .70

FEIS – Total Score

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Aim 2: Measure clinical stability

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

The Aberrant Behavior Checklist (ABC)

• The ABC is a heavily cited and psychometrically sound

measure of psychiatric symptoms for both adults and youth with ID.

• The ABC consists of 40-items across five subscales.

Three of the five subscales – the Irritability, Lethargy, and Hyperactivity subscales – were employed in this study.

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

ABC - Subscales

5 10 15 20 25 30 Hyperac8vity Irritability Lethargy Pre Post

* * *

ES = . 58 ES = . 62 ES = . 56

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Aim 3 Measure Emergency Service use

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Hospital and ED Average Visits

0.1 0.2 0.3 0.4 0.5 0.6 0.7 Hospital ED Pre Post

* *

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Change in Average ABC Hyperactivity Associated with Change in Service Use

25.5 27 26.4 26 28.5 27.1 17.7 31.5 21.3 19 29.8 19

No Change > Hosp < Hosp No Change > ED < ED

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Other findings of interest

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

1 2 3 4 5 6

Mean Hours of Clincial Consulting

No Change > Hosp < Hosp

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Conclusions

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Improvements in All Study Goals

Caregiver’s Service Experiences

1 Year Pre-Post

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Overall Implications

• Improvements in all 3 outcomes at the level of the service

user, caregiver, and system

• Fills a large gap in the literature since health services for

individuals with IDD have been historically underdeveloped and understudied

• Very little evidence, for any population, on the effectiveness
• f crisis intervention programs

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

FEIS Implications

• Improvements in caregivers’ perceived inclusion in their

dependents care and how responsive the mental health system was when they expressed their concerns.

• All elements of START, especially START coordination and
• utreach, are designed to include caregivers in their

dependents care whenever possible.

• Significant improvement in the two aforementioned

constructs substantiate a primary goal of START: to listen, support, and respond to the person who knows the individual best

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

FEIS Implications II

• Improvements in the perceived quality of services provided

directly to the caregivers’ dependent

• Findings suggest START can improve both the access and

appropriateness of services.

• Enhancing the quality of care that is afforded to the

individual with IDD - through services such as medical/ clinical consultation, crisis planning and intervention, provider education and linkage agreements – is another principle goal of START

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

ABC Implications

• Improvements in the hyperactivity, lethargy, and irritability

were observed

• These symptoms are the principle reason for referral to

START and are a primary reason for caregiver stress and decreased family wellbeing

• Effect sizes observed are tantamount to meta-analyses of

wraparound interventions and psychiatric medications

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Emergency Service Implications

• ~40% reduction in ED visits and Hospitalizations
• Psychiatric ED visits and Hospitalizations are expensive

and restrictive

• Hospitalizations are needed at times.
• ED visits offer little in terms of treatment and may be

iatrogenic

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Crisis Support

• Directly targeted by cross systems crisis plans, START

crisis response, and consultation services.

• The influence of these interventions can be seen in the

significant improvements in knowing who to call during times of crisis, support during crisis, and assistance on nights and weekends (from the FEIS).

• These findings, alongside a reduction of inpatient

admissions and ED visits, are promising in terms of supporting those with the greatest needs.

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Limitations

• No control condition
• We do not know what the effects would have been among

similar individuals who did not receive START

• Only 2 time points
• Unknown selection issues
• Social Desirability bias

Institute on Disability/UCED, University of New Hampshire Joan B. Beasley, Ph.D.

Next Steps

• Manuscript under review with the American Journal on

Intellectual Disabilities

• Complete comparative analysis using NY Medicaid

claims

• Development of a Research Department with peer

review council