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History of START
The Integrated health approach to cross systems crisis prevention and intervention
by Joan B. Beasley, PhD
In 1982, Dr. Steven Reiss published a landmark article about the concept of “diagnostic overshadowing”, which is the tendency to attribute presentation of a person with IDD to their IDD without consideration of other possibilities. At around the same time, Robert Sovner, MD and Anne Hurley, PhD were publishing work on depression and other mental health conditions that should be considered for people with IDD, that were often missed, in part due to diagnostic overshadowing. These had a great impact on the foundation of START and on our practices today.
In the early 1980’s before we developed the first START program, it was common practice to consider all the challenges presented by people with IDD to be as the result of their functional capacity to communicate and engage with others, to a large part as learned behavior. The issues were most often described as “attention seeking behavior”, “manipulation” and “poor social skills”. This was not difficult to “prove” with a functional analysis when you consider the broad descriptions. Many of us seek “attention” for example. However, many of the people did not get better, were in institutions or at risk. This again was attributed to the severity of their impairment.
The interventions focused on behavior management and medication to calm the person down, to teach new skills though reward and punishment and “manage behaviors”. There were prominent leaders in the field who the founders of START and I had the good fortune to work with that challenged these assumptions. Dr. Herb Lovett practiced methods to address the quality of the person’s life. His approaches were humanistic, and strength based. Dr. Robert Sovner explored the mental health aspects of people with IDD and considered vulnerability to mental health conditions a key to understanding, treatment and supports, and Dr. Bill Gardner was perhaps the most impactful for the development of START as he described the need to integrate multiple perspectives and contexts to what people were telling us through a multimodal approach. While all are no longer with us, their legacy lives on.
So why do we do what we do? Because people are complex and there has been a long history of reducing people with IDD to being less than capable of having this complexity. It is also because what you think you know about someone may not be enough to truly help them.
For more information about positive, strength-based approaches, mental health diagnosis and treatment and an integrated approach to diagnosis, treatment and support please go to these resources on our website:
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Training Spotlight - Staff Pick
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Bereavement and Grief in Individuals with IDD
"This session opened my eyes to the experience of grief and bereavement for people with IDD, and created a change in the way I provide support. While I had always been aware of how significant the issue was, Dr. Stratigos's presentation, with the effective mix of data and example, helped create a new understanding and sense of urgency in address grief and bereavement. This presentation ends with a grabs bag of practical tips and supports. After my many years in the field, it is refreshing to see a session which compels me to do things differently. "
- Dan Baker, PhD
CSS Associate Project Facilitator & Trainer
Minnesota DHS Positive Supports Compliance Specialist
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Presenter: Katy Stratigos, MD, Medical Director, NY START Region 4 Tri-Borough
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Kudos From Iowa START
"Jhanna DeHeck, Iowa-START (I-START) Coordinator, works tirelessly to support and advocate for individuals served by the I-START Program. Jhanna has shown such patience and resiliency, especially when working through complex clinical and systemic cases. I think we’ve all had moments where we question our abilities. They can leave you thinking, what do I do now? Every day she shows up, no matter the barriers faced the day before. She has been an ally for families. She is there when they need her and helps them navigate through complex systemic challenges. She lifts their voices when advocating for their loved one, helping them feel a bit more in control of very difficult situations.
She uses every START tool and support to try to promote change and stability for I-START service recipients and their systems. Jhanna continues to reach out for support. She takes suggestions and feedback from others humbly. Even if she has tried something and it failed, she will try again if she feels it could make even the smallest differences for these individuals. She continues to knock on doors that have been closed. She has demonstrated a mastery of the START guiding principles through her work on these cases. We applaud Jhanna! We know she is making a change even if we can’t see it just yet. Thank you for your service Jhanna!" - Felicia Bates, I-START Program Director
Share Good News. We welcome START programs to share their good news - this could be a START team member accomplishment, kudos to an entire START team, an update about a well-received training delivered in your community, or any other news worth celebrating! Your good news updates will be shared as part of future editions of CSS News & Views.
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MHIDD Course for Direct Support Professionals
November 2021 session postponed until February 2022 - stay tuned for more details!
This live, 6-session course gives Direct Support Professionals (DSPs) the knowledge, skills, and resources needed to provide individuals with IDD and mental health service needs (IDD-MH) positive, person-centered, strengths and wellness-based supports and services. The course facilitators will demonstrate how the information reviewed during session can be applied in the day-to-day support of people with IDD-MH. Registration fee is $149 per person.
"This course offers the content I need to do my job and the many facets of one’s life we must always consider." - Course Participant
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Have a healthy and happy week,
The Center for START Services
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