University of New Hampshire Institute on Disability/UCED The START Network PLC Joan Beasley, PhD...

University of New Hampshire Institute on Disability/UCED

www.centerforstartservices.com

The START Network PLC

Joan Beasley, PhDDirector, Center for START Services

Jarrett Barnhill, MD DLFAPA, FAACAP, NADD-CCUniversity of North Carolina

Karen L. Weigle, PhDAssociate Director, Center for START Services


Joan B. Beasley, Ph.D. Director



Problems with Most ID/DD Systems :

• "Troublesome" behaviors considered unacceptable in many support and service venues

• The last and least served• Continued concept of “primary” vs. “secondary” disorders:

were not trained in MH or health practices that could contribute to challenging behavior were sent to be “fixed”



Problems with the MH System

• Stigma

• Much more likely to use emergency services

• Lack of training (diagnostic overshadowing)

• Lack of expertise

• Medication issues

• Believed that challenging behavior was a result of developmental issues

alone

• “ Did not have the IQ for depression”

• Primary vs. secondary diagnosis instead of presenting issue



Challenge: The absence of curricula in most higher learning institutions and credentialing in the U.S.

• MH “language” vs. IDD language

• Unable to keep up with evidence based practices

• Capacity building is segregated at best

• Developing mutual understanding is key to effective collaboration and communication



Solution focused

• Need for more training across disciplines to share and develop knowledge within communities, between communities and nationally

• Must be cost effective learning process

• Apprenticeship is key


The "START" model:Tertiary care Systems Linkage

Approach

• KEY: Enrich the system (avoid strain)

• Resources allocated to promote linkages (i.e. the use of a linkage "team")

• Resources allocated to fill in service gaps

• Services provided across systems and needs bio-psycho-social

• Expertise, training, mentoring improves capacity

• Outreach is key

• Positive psychology/strength based approach

• Develop a common language



World Health Organization research to improve performance (2000, 2002)

• Integration of health and social services • Stop blaming the patient, attend to failures in the system• Integrated approaches are key• Capacity building is essential• Policy makers must focus on the interplay between health

systems• Defining a health system as to include all activities whose

primary purpose is to promote, restore or maintain health, the main message health and well being of people depends critically on the performance of the health system.



Tertiary WHO Approach • Primary: Capacity building; communication and

collaboration, improved quality services and quality of life; accountability

• Secondary: Expertise, access to appropriate care, cross systems communication; crisis prevention; accountability

• Tertiary: Expertise, appropriate response, stabilization, intervention; accountability


In order to have effective secondary and tertiary interventions you must develop primary capacity

• Primary drives shared knowledge and responsibility• Secondary supports primary when needed requires

expertise• Tertiary you must have a safety net but caution against

over reliance as remedy


Primary Interventions: Building capacity

• Training the trainers• Giving and receiving feedback• Developing new skills as a community• Measuring outcomes• Continuous learning process



The START Professional learning community

FOCUS: • on reflective inquiry, • Improved opportunities for learning, • shared values and norms, • development of common practices, • Peer teaching and • evidence based analysis



The START Network: PLC Elements

Identify, Dedicate & DevelopBegan in 2011 by naming (START Network) and developing an identity, which includes: • Commitment

o Members are engaged and available to one another• Collaboration

o Shared expertise, resources, and accessibility • Cooperation

o Dedication to coaching model to develop others, peer review, and enhanced practices


16Joan B. Beasley, Ph.D.



The START Network PLC online

Varied methods for Implementation

• Monthly START Network communications and updates

• Online Resource Area with alerts about changes and resources

• Quarterly live web-based National training series

• Responsive, targeted web-based workshops

• Ongoing online study groups


Joan B. Beasley, Ph.D.

START National Online Training Series

Aggregate Survey Data: 2011-2015


Joan B. Beasley, Ph.D. 19


Engaging the system through linkages

"The world as we created it is a process of our thinking. It cannot be changed without changing our thinking."

~ Einstein

• Note: we are not for everyone..



START Program development,Coordinator Certification

and Study Groups

Karen L. Weigle, PhDAssociate Director, Center for START Services


PLCs: What they accomplish

• Provide ongoing education and support to teams in the field

• Access to most recent research- what lies beyond best practices and evidenced-based approaches

• Impact all 3 levels of intervention through sharing and outreach

• Build a culture of life long education • Continue to build and improve the START model



The National START Network: Program Development

Outreach/coaching support• On site visits/ facilitated peer review of all assessment and

treatment protocols: apprenticeship

• Happens every day both formally and informally through trainings, in-person and web-based meetings, phone calls, etc.

• Knowledge and evidence-informed practices are shared beyond the work of a particular setting; a desire to advance the field as a whole, not just within a specific discipline

• Training for trainers, START team then trains/coaches others



START capacity development within teamsPeer review and supervision

• Positive/strength based• START plan considers the person and system • Cross systems crisis plans• Eco-mapping• Emotional intelligence training/live supervision• Case reviews (CETs)• Team approach to service provision• Statewide forums within states



Secondary approaches: developing expertise

• Certification of coordinators and programs; rigorous standards ( 125 certified since 2012, about 100 trainees in 2015-16)

• Linkages with experts• Consultation teams ( multi modal)• Comprehensive evaluation tools and protocols• Bio-psycho social integrated assessment• Positive-strength based approaches, modeling and

coaching



START Coordinator Certification

• Typically takes 12 months for FTE to accomplish (18 months for PTE)

• Online courses and national lecture series: view and complete questionnaire for each (58 hours)

• Individual supervision (minimum 50 hours)• Internship/apprenticeship/practice is 20-40 hours/week



START Coordinator: Requirements for Certification

• 85% attendance at all training events and supervision• Complete at least 5 hours of START-approved training in

the community• Present cases and follow-ups at the Clinical Education

Team forums• Complete at least one approved Cross Systems Crisis

Prevention and Intervention Plan



START Coordinator: Requirements for Certification

• Complete at least one approved Comprehensive Service Evaluation (or START Center-Based Admission & Discharge Summary)

• Demonstrate competency in systemic analysis and planning

• Demonstrate understanding and integration of biopsychosocial information in your work

• Complete Certification Review



Study Groups

• Meet monthly (except Program Directors & Medical Directors)

• Have identified topics, based on group member input• Invited presenters as well as participants from projects

share expertise and tips, provide case studies, problem-solve as a group

• Information informs best practices within START teams• Information then shared with local communities



Study Groups

• Resource Center Directors• Clinical Directors• Team Leaders• Children’s Services• Program Directors (meet quarterly)• Medical Directors



CETs and START Medical Directors Study Group

Jarrett Barnhill MD DLFAPA, FAACAP, NADD-CCUniversity of North Carolina


Goals

• Review the basic format of educational programs for medical directors

• The psychiatrist’s role in CET and working with children



Clinical Education Teams (CET)

• HIPPA protected cases, trainings on specific diagnostic issue• Multidisciplinary review approach; includes Eco mapping• More than 200 events across the country since 2010• Enhanced systems capacity through case presentation method• Topic-specific trainings and resources become part of the

START Online Resource Area• Case follow-up showcases real-world results for individuals,

families, and community partners as a result of practice change


CET- Role of the Psychiatrist

• Case based presentations• Discussion of developmental history, temperament,

attachment, behavioral phenotypes• Discussion of challenging behaviors as social phenomena-

ecology, gene-environment interactions, bio-behavioral factors

• Differential diagnosis- matching diagnosis and treatment to clinical presentation

• Impact of trauma, medical and neurological complications


Children with IDD

• Child psychiatrists role in CET• Exploration of developmental trajectories, vulnerability,

predisposing or risk factors/resilience, precipitating/trigger events, perpetuating forces as well as the impact of age of onset on both challenging behaviors and psychiatric disorders

• Trauma related disorders


Medical Director Study Groups

• Topics drawn from preference list of medical directors• Quarterly discussions of diagnostic and treatment issues • Topics are practical reviews with a focus on clinical

applicability• Review of crisis management issues, methods of

minimizing ER visits• Overview of changes in diagnostic criteria• Discussion of intervention strategies, rational use of

psychotropic medications


Joan B. Beasley, Ph.D.

University of New Hampshire Institute on Disability/UCED The START Network PLC Joan Beasley, PhD...

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