2015 Ark Annual Report Final Ac 4

A program of the Institute on Disability/UCED, University of New Hampshire
Arkansas Systemic, Therapeutic, Assessment,

Resource and Treatment Program (ArkSTART)
Annual Report
July 2014 June 2015
Contents
Executive Summary.................................................................................................................3
Program Background...............................................................................................................4
Findings.........................................................................................................................................6
Referral Trends...........................................................................................................................6
Source of Referral.................................................................................................................8
Time of Referral (FY15).......................................................................................................9
Primary Reasons for Referral (FY15)..............................................................................9
Characteristics of Persons Served....................................................................................10
Age at Referral...........................................................................................................................11
Gender.....................................................................................................................................13
Level of Intellectual Disability........................................................................................14
Living Situation at Intake.................................................................................................14
Mental Health Diagnoses at Time of Referral...........................................................16
Medical Diagnoses at Time of Referral.......................................................................18
Emergency Service Trends..................................................................................................22
Psychiatric Hospitalizations (pre-START)....................................................................22
Emergency Department Use (pre-START)..................................................................23
Other Emergency Service Use (pre-START)...............................................................23
START Service Outcomes.....................................................................................................23
START Tertiary Care Model...............................................................................................25
Primary Services..................................................................................................................27
National START Study Groups.........................................................................................28
Secondary Services............................................................................................................28
Tertiary Services..................................................................................................................31
Other Emergency Services..............................................................................................32
Case Example...........................................................................................................................33
Goals and Recommendations for FY16...........................................................................36
Appendix A38
Executive Summary
This past project year has been one of change and continued progress. We
began the year with twenty-one (21) ArkSTART staff and finished the year
with fourteen (14). Although our reduction resulted in one-third less staff, the
full-time equivalency was only reduced from 9.5 to 8.75, and we are in the
process of interviewing an additional Coordinator Intern.
An additional regional office was opened in Star City to coordinate activities
in south Arkansas. This now gives ArkSTART four (4) regional offices (Little
Rock, Springdale, and Jonesboro are the other locations).
Staff continue to reach out to DD, Behavioral Health, and Law Enforcement
agencies as we attempt to build support networks across the various service
systems in Arkansas. Staff continue to receive intensive training while
providing services to clients and their support teams. All but one (1)
ArkSTART Intern will be seeking certification in 2015, with the newest Intern
scheduled for 2016.
The following report provides a summary of ArkSTART program development
and services from July 2014 through June 2015. We are pleased with the
accomplishments to date and our plans for strengthening the network of
supports for the clients we serve. This report is designed to fully inform the
Division of Developmental Disabilities Services and the Arkansas Department
of Human Services of the activities undertaken by the DD Cooperative of
Arkansas. This is truly a collaborative effort of many organizations, agencies
and individuals. We are confident with the continued support of DDS the
ArkSTART initiative will translate into more effective services and supports for
individuals with IDD and behavioral health issues.
Respectfully submitted,
Whitney Emerson, ArkSTART Program Director
Larry Stang, DD Cooperative of Arkansas Board Chair

Program Background
START (an acronym for Systematic, Therapeutic, Assessment, Resources,
and Treatment) promotes a comprehensive system of support to optimize
community living for individuals with intellectual/developmental disabilities
(IDD) and mental health needs. The underlying philosophy of START is that
services will be most effective when everyone involved in care and treatment
is allowed to participate actively in treatment planning and service decisions.
In order for this to occur, collaboration between service providers and with
service users is needed. As of June 2015, eight states have programs either
based on the START model or fully operating START programs. The ArkSTART
project operates in association with the Center for START Services, which is
part of the Institute on Disability at the University of New Hampshire. START
has been recognized by the U.S. Surgeon General as a model for supporting
individuals with IDD and mental illness/behavioral health needs.
The State of Arkansas Department of Human Services (ADHS) Division of
Developmental Disabilities Services (DDS) identified unmet needs for
individuals with I/DD and co-occurring behavioral health concerns in our
state. Although the Developmental Disabilities Services system and the
Behavioral Health system have services and supports that have proven
effective for many Arkansans, the service systems continued to be
challenged in supporting people with IDD and co-occurring behavioral health
issues. The problem was not a lack of caring but rather a lack of crosstrained professionals that can effectively support this population. This lack of
support prompted 15 DD-licensed agencies to incorporate a separate nonprofit Cooperative to share resources in an effort to address unmet needs for
this specific population. ArkSTART was created at the urging of what is now
termed the Developmental Disability Cooperative of Arkansas (DDCA) and
was the first step in improving services and supports to individuals in need. It
began essentially as a pilot project with 15 DD providers in four (expanded
to 10) counties in the central Arkansas region. The members of the
Cooperative, together with DDS and the state Human Development Centers
(Arkansas large institutions), provided the funds for initial START training.
Beginning in September 2011, provider members of the DDCA volunteered
the time of a qualified staff person from their agency to participate in the
START Coordinator certification process. Without specific funding to operate a
START program, the Coordinators continued to work almost full-time for their
agencies while taking on a limited number of START cases for training.
Despite these challenges, the team fulfilled the requirements of START
4

training, which resulted in five certified START Coordinators. The agencies
currently participating in the DDCA are listed in Appendix A.
The Director of the DDCA, Larry Stang, worked tirelessly to obtain funding for
ArkSTART to become a functioning START program. In January of 2013,
thanks to the efforts of Dr. Charlie Green, Director of DDS, ArkSTART received
a one-time state-funded amount that allowed our ArkSTART coordinators to
work halftime and more fully develop the program.
In July 2013, due to the combined efforts of Larry Stang, Dr. Green, Jim
Brader(DDS Assistant Director), and John Selig(Director of the Arkansas
Department of Human Services), the governor proposed and the legislature
approved a budget that included funds to expand the Cooperative model and
ArkSTART statewide. The contract was signed in November 2013 that allowed
for expansion of services across the state.
Currently, ArkSTART provides some services in all regions of the state. There
are areas within the regions in which service provision is limited by
geography and availability of qualified staff. Despite these challenges, the
ArkSTART team has developed networks in each region to provide outreach,
crisis prevention, community training, and crisis support during daytime
hours to build capacity in the existing system and provide support to persons
and their teams. Elements of the START model that the ArkSTART team will
implement in the future include 24/7 crisis response, in-home therapeutic
supports, and expansion of services to children ages 6 and up.
The Mission of Arkansas START is to enhance care and service provision by
facilitating systemic collaboration, resource linkages, and information sharing, using
evidence-based practices to effectively support individuals with
intellectual/developmental disabilities and behavioral health needs, thereby
improving service outcomes and quality of life.
The ArkSTART Team structure is outlined below as is the regional divisions of the team.

DD Cooperative
of Arkansas
Director
Clinical Director
Northwest
Clinical Team
Leader
Northeast
Clinical Team
Leader
Central Clinical
Team Leader
Medical Director
Southwest
Clinical Team
Leader
Southeast
Clinical Team
Leader
Coordinator
Coordinator
Coordinator
Coordinator
Coordinator
Coordinator
Coordinator
Coordinator
Coordinator
Coordinator
Coordinator
Coordinator
Coordinator
Coordinator
Coordinator
Findings
Below are descriptions of referral trends, characteristics of persons serviced,
emergency service trends, and services outcomes of those served by
ArkSTART.
Referral Trends

Since the inception of the program, 161 individuals have been referred to
ArkSTART. 98% (N=157) met the eligibility criteria and were accepted for
services. In FY15, 73 new referrals were received which represents a 25%
increase when compared to referrals received in FY14. The graph below
shows appropriate referrals over time; the table below shows the number of
referrals received in the initial start-up period as well as the last two
complete fiscal years, by appropriateness. Since ArkSTART is comprised of
multiple regions, Table 2 shows the number and percent of referrals by
region for FY15 and overall.
It is interesting to note that the rate of referrals in the Southwest and
Northwest regions increased dramatically over the last year while the rates
in Northeast and Southeast remained steady. Referral rates from the Central
region decreased slightly, but this is probably due to the fact this region has
been taking referrals for 2 more years than the other regions. The increases
in referral rates seem to correlate with increased outreach and training
provided at local community provider agencies.
Appropriate Referrals
80
70
60
50
Appropriate Referrals
40
30
20
10
0
Start Up
FY 14
FY 15
Table 1: Referrals since Program Inception

Year
FY15 (7/2014-6/2015)
Appropri
ate
Inappropriate
71
Total Referrals
2
73

FY14 (7/2013-6/2014)
Start Up (1/20116/2013)
Total
56
58
30
157
0
4
30
161
Table 2: Referrals by Region
Region
Arkansas Central
Arkansas Northeast
Arkansas Northwest
Arkansas Southeast
Arkansas Southwest
Total
Numbe
r
(FY15)
Percent
(FY15)
Number
(Overall)
Percent
(Overall)
15
20.55%
68
42.24%
10
13.70%
21
13.04%
27
36.99%
40
24.84%
10.96%
15
9.32%
13
73
17.81%
100.00%
17
161
10.56%
100.00%
Source of Referral
The majority of referrals (75%) in FY15 to ArkSTART were from case
managers. This is an increase over previous years, when case managers
made up 65% of referrals. The table below delineates all sources of referral
to ArkSTART compared to referral trends for START programs nationally. While
case manager referrals are also the largest source of referrals for START
programs nationally, sources of referral typically become more diversified as
the program develops and becomes more established. ArkSTART has not
received referrals from mobile crisis teams, hospital emergency
departments, and state psychiatric hospitals. This is likely a result of the
ArkSTART team currently not providing 24-hour mobile crisis response (as
many START teams nationally do) and thus not having as many opportunities
to partner with those services providers and agencies. Further, stakeholder
feedback indicates that fewer people with IDD in Arkansas attempt to access
these emergency services, because of barriers related to primary diagnoses
and billing/reimbursement. This problem has been discussed with the
Division of Behavioral Health and collaboration on this issue has begun in the
southern regions. ArkSTART will continue to work with mental health

providers statewide to help ensure the services they provide are effective as
well as reimbursable. We will also be providing more outreach, training, and
collaboration to existing crisis responders in the next fiscal year.
Table 3: Source of Referral to START (FY15)
Source of Referral to
START
Case Manager/Service
Coordinator
Community psychiatric
inpatient
CSB emergency
services/mobile crisis
team
Day/vocational service
provider - community
Family member
Friend
Hospital emergency
department
Law enforcement
Legal guardian (nonfamilial)
Legal advocate
Residential provider community
School
Self
State operated I/DD
center
State psychiatric hospital
Other
Unreported
Total
Number of
Sources
Percent of
Sources (Ark)
National
START Trends
55
75.34%
64.04%
0.00%
1.07%
0.00%
3.26%
9
4
0
12.33%
5.48%
0.00%
1.48%
5.47%
0.07%
0
0
0.00%
0.00%
4.53%
0.10%
1
0
1.37%
0.00%
0.94%
0.20%
2
0
0
2.74%
0.00%
0.00%
4.67%
0.57%
0.10%
2
0
0
0
73
2.74%
0.00%
0.00%
0.00%
100.00%
1.51%
1.54%
7.29%
3.16%
100.00%
Time of Referral (FY15)

ArkSTART receives most referrals during business hours and this is consistent
with START trends nationally. As programs develop 24-hour crisis response

capability and therapeutic supports, there is typically a slight increase in
referrals coming in after hours and on weekends.
Table 4: Time of Referral to START
Time period referred to
START
Business Hours (Monday Friday 8am - 5pm)
After Hours (Monday - Thursday
5pm to 8am)
Weekends /Holidays
Unreported
Total
Number
Referred
(Ark)
Percent
Referred
(Ark)
National
START Trends
70
95.89%
80.86%
0
2
1
73
0.00%
2.74%
1.37%
100.00%
4.37%
2.28%
12.49%
100.00%
Primary Reasons for Referral (FY15)

Data show that the majority of individuals referred for services from
ArkSTART were referred for externalizing behavioral difficulties, which include
physical aggression, property destruction, verbal aggression, and selfinjurious behaviors. Aggression was the most often cited reason for referral
(75%). This was followed by mental health symptoms (36%), decrease in
ability to participate in daily functions (33%), and self-injury (30.14%). The
majority of individuals reported multiple concerns at time of enrollment with
the average number of challenges reported 2.5.
It is interesting to note that self-injury, decrease in ability to participate in
daily functions, and suicidal ideation/behavior are identified as problems
much more frequently in Arkansas than the national average. The latter two
represent symptoms that are often overlooked and/or underreported in the
population of persons with IDD.
Table 5: Reasons for Referral
Presenting Problems at Referral
Number
Reportin
g
Problem
s
Percent
Reporting
Problems
(Ark)
National
START
Trends
10

Aggression (physical, verbal,
property destruction, threats)
At risk of losing placement
Decrease in ability to participate in
daily functions
Diagnosis and treatment plan
assistance
Family needs assistance
Leaving unexpectedly
Mental health symptoms
Other
Self-injurious
Sexualized behavior
Suicidal ideation/behavior
Transition from hospital
Total Number of Individuals
Average # of Problems
Reported
55
14
75.34%
19.18%
70.72%
17.09%
24
32.88%
15.82%
3
6
0
26
13
22
3
14
1
73
4.11%
8.22%
0.00%
35.62%
17.81%
30.14%
4.11%
19.18%
1.37%
12.69%
21.66%
4.97%
42.81%
10.68%
22.33%
3.53%
13.47%
5.17%
2.48
2.41
Characteristics of Persons Served

Individuals enrolled in START services typically are active in those services
for at least 12-18 months. As programs mature, some individuals become
inactive and no longer receive ongoing services. The most common reasons
for moving to an inactive status are: stability (no longer requiring services),
moving out of a START region, and individuals/families no longer want to
receive services. Of the 161 referrals to ArkSTART, 149 of those individuals
were active at some point during FY15 and 99 were still active at the end of
the year (June 30, 2015).
Unless otherwise noted, the following demographic information describes all
the individuals who were active in ArkSTART at any point during the fiscal
year (N=149).
Age at Referral
Ark START serves adults18 and older (4 individuals were referred at age 17).
Figure 1 shows the breakdown of individuals by age group at the time of
referral. As seen in Table 6, the mean, median, and mode of individuals in
11

ArkSTART is higher than adult START programs nationally; ArkSTART currently
serves a smaller percentage of transition age youth(17-22) than other adult
programs. This will likely change as the State expands ArkSTART to serve
children as well, which will increase awareness of ArkSTART services to
school systems, childrens service providers, and those providing transition
supports.
Figure 1: Age Breakdown of ArkSTART Service Recipients
Age Distribution: ArkSTART

(N=149)
50 and Older; 19%
17-22; 17%
23-29; 23%
30-49; 40%
Figure 2: Age Breakdown of Adult START Programs Nationally
12
Age Distribution: START Nationally

(Adult Programs)
50 and older; 14%

16-22; 30%
30-49; 31%
23-29; 24%
Table 6: Descriptive Statistics

Age
Oldest Age
Youngest Age
Range
Mean Age
Median Age
Mode Age
Descriptive Statistics for

individuals by Age:
ArkSTART
69
17
52
36
34
23
Descriptive Statistics for

individuals by Age: START
Adult Programs Nationally
78
16
62
32
28
18
Gender
13

The chart below shows the breakdown by gender for ArkSTART and other
START programs nationally. ArkSTART serves significantly more females than
most programs.
Table 7: Gender Breakdown
Gend
er
Femal
e
Male
ArkSTAR START Programs

T
Nationally
47.65%
37.75%
52.35%
62.25%
Figure 3: Gender Breakdown
Gender: ArkSTART
Male; 52%
Female; 48%
14

Level of Intellectual Disability
Table 8 below shows the disability level for individuals who were active in
FY15 ArkSTART as well as for individuals in START programs nationally. In
general, the distribution of individuals with lower levels of intellectual
disabilities (more impaired) is greater for START populations than in the
normal population of individuals with ID.
Table 8: Disability Level
Level of Intellectual
Disability
Normal intelligence
Borderline
Mild
Moderate
Severe
Profound
None noted
Unreported
Number
(Ark)
2
3
53
27
14
10
19
21
START
Percen Programs
t (Ark)
Nationally
1.34%
2.18%
2.01%
3.76%
35.57%
44.41%
18.12%
24.09%
9.40%
7.15%
6.71%
3.46%
12.75%
9.23%
14.09%
5.74%
Table 9: Disability Level Comparison: START/General Population

with ID
Level of ID
% Persons Served by START
Mild (50-55 to 70)

Moderate (35-40 to 5055)
Severe (20-25 to 35-40)
Profound (below 20-25)
44%
% General
Population with ID
87%
24%
10%
7%
3%
3%
Living Situation at Intake
15

An important factor that contributes to or undermines mental health stability
for service users is a stable home life. As noted in the presenting problem
data above, family members and caregivers frequently express concerns
about their ability to safely support their family member in the home,
especially during times of difficulty.
The table below presents a frequency distribution of living situation at the
time of intake for all individuals who received services through Ark START
during the reporting period. Since children receiving START services often
live at home, comparison data for this analysis considers other adult
programs only. As seen below, individuals receiving ArkSTART services are
almost 20% less likely to be living with their families than individuals in
START programs nationally. Individuals in ArkSTART are also more likely to be
living in more restrictive settings such as ICF/IDs and Developmental Centers
than individuals receiving START services elsewhere. However, it is
interesting to note that the rate of referrals coming from family members in
Arkansas is comparable to those from the national average. This likely
reflects the trend in Arkansas for families to use more facility-based services
while remaining engaged in their family-members care. There is also much
higher percentage of persons being supported in supervised apartments
than the national average. Why this occurs in Arkansas is not clear; in some
cases people live alone because of aggression or other difficulties living with
others; in other cases having an individual apartment is the result of
personal choice.
Table 10: Living Situation at Referral
Living Situation at time
of Referral
Assisted Family Living
(AFL)
Assisted Living Facility
Community ICF/MR
Family home
Foster Care home
Group home
Homeless, sheltered
Homeless, unsheltered
Number
(Ark)
0
2
17
28
0
26
0
0
Percen
t (Ark)
0.00%
1.34%
11.41%
18.79%
0.00%
17.45%
0.00%
0.00%
START Adult
Programs
Nationally
4.63%
1.14%
3.29%
38.32%
0.47%
22.48%
2.08%
0.13%
16

Independent living
Jail
Psychiatric hospital
State operated I/DD center
Supervised apartment
Supported living
Other
Unreported
Total
9
2
2
6
22
9
9
17
149
6.04%
1.34%
1.34%
4.03%
14.77%
6.04%
6.04%
11.41%
100.00
%
2.68%
0.27%
2.95%
2.82%
2.08%
2.95%
9.87%
3.83%
100.00%
Mental Health Diagnoses at Time of Referral

It is critical to understand each ArkSTART service recipients presentation in
the context of their biological, psychological, and social strengths and
concerns. In order to provide appropriate intervention and supports, we must
know how these factors impact the person and his/her functioning, and
specifically how they may contribute to or help us avoid crisis and instability.
Thus, an accurate understanding of both psychiatric and medical conditions
is imperative in designing effective crisis prevention and intervention
services.
Table 11: Presence of Psychiatric Diagnosis at Referral
Psychiatric Diagnoses
Individuals with reported

psychiatric diagnoses
Total individuals
reporting no psychiatric
diagnosis
Total
Number of
individuals
reporting a
psychiatric
diagnosis
Percent of individuals
reporting a psychiatric
diagnosis
101
67.79%
48
32.21%
149
100.00%
Table 12: Number of Diagnoses Reported at Referral

Number of Psychiatric
Diagnoses Reported
Number of
individuals with
this number of
Percent of individuals with

this number of psychiatric
diagnoses
17

psychiatric
diagnoses
Mean diagnoses reported
Mode diagnoses reported
1 diagnosis reported
2 diagnoses reported
5 or more diagnoses
reported
Total
1.83
1
51
40
9
1
N/A
N/A
50.50%
39.60%
8.91%
0.99%
0.00%
101
100.00%
Of the 149 individuals receiving ArkSTART services during the reporting

period 101(68%) report at least one mental health diagnosis and 50% report
more than one psychiatric diagnosis. This is slightly lower than other adult
START programs nationally, which report about 80% of individuals having a
mental health diagnosis at referral.
This may be the result of reluctance among behavioral health providers in
Arkansas to diagnose individuals with IDD with a mental health disorder. As
previously mentioned there is much confusion in Arkansas concerning the
designation of primary diagnosis of dually diagnosed individuals and
subsequent Medicaid eligibility for behavioral health services. In a recent
meeting (June 4, 2015) of Arkansas Behavioral Health, Developmental
Disabilities, Medicaid and ArkStart representatives, this issue was discussed
at great length and all parties were satisfied with the outcome of the
discussion. Medicaid and behavioral health officials clearly stated that
individuals diagnosed with IDD and a mental health diagnosis are eligible for
mental health services if the diagnosis and treatment plan corresponds to
the identified mental health diagnosis and the treatment plan is designed to
produce improved functioning of the individual. It became apparent that the
behavioral health providers are having difficulty designing treatment plans
with measurable outcomes for persons with IDD and thus have not been
reimbursed for past services rendered. A goal for the upcoming year will be
to improve community awareness of co-occurring mental health issues in
individuals with IDD and to teach behavioral health providers effective
means and documentation of intervention.
18

The following table shows the number and percent of individuals statewide
reporting a diagnosis in a particular diagnostic category.
Table 13: Frequency of Psychiatric Diagnoses
Psychiatric Diagnoses
Anxiety - all
Autism - all
Childhood - all
Mood - all
Psychotic - all
Impulse control disorder
Personality disorders
(Axis II)
Other
Total diagnoses reported
Total individuals with
reported psychiatric
diagnoses
Number of
individuals by
current types of
psych diagnoses
reported
23
18
10
62
27
10
6
Percent of individuals by
current types of psych
diagnoses reported
22.77%
17.82%
9.90%
61.39%
26.73%
9.90%
5.94%
29
185
28.71%
101
67.79%
Figure 4: Frequency of Psychiatric Diagnoses: ArkSTART and

National START Trends
19

Psychiatric Diagnostic Frequency Comparison
80.00%
60.00%
40.00%
ArkSTART
National START Trends
(Adults)
20.00%
0.00%
Medical Diagnoses at Time of Referral

In addition to a mental health diagnoses, many of the people referred for
ArkSTART services present with co-occurring medical conditions. Medical
conditions are important to address because they often contribute to the
reason for referral but are not recognized. That is, medical problems often
cause, or at least exacerbate, behavioral and mental health concerns. If they
remain unrecognized and untreated other interventions are unlikely to be
helpful. Research suggests that they are often under-diagnosed,
underreported, or misinterpreted as challenging behavior and psychiatric
problems.
Forty-six percent (N=68) of the ArkSTART service users this reporting period
have medical conditions reported in the SIRS database. Of those individuals,
almost two-thirds (63%) have more than two chronic medical conditions. This
is significant given that the most common age of ArkSTART participants in
only 23 and mean age is 36. Over 16% of individuals reporting a medical
condition report GI problems and 16% report diabetes or other endocrine
disorders which are often associated with psychiatric medication side effects.
20

29% report a neurological disorder (seizure), which is common in this
population. These are trends typical across all START programs.
It is interesting to note that the increase in diabetes and weight-related,
metabolic illnesses in this population has increased with the rate in the
general population. This highlights the importance of teaching and promoting
healthy diet and behavior among this population, as well as considering the
impact of atypical antipsychotic medications in creating the problem.
ArkSTART continues to focus on training and education of START clients, their
families, and their direct support staff about healthy behavior, but will need
to expand that training and outreach to primary care providers and other
professionals who work with this population so that these changes are
sustained and expanded upon.
Table 12: Presence of Medical Diagnosis at Referral
Medical Diagnoses
Individuals with reported
medical diagnoses
Total individuals
reporting no medical
diagnosis
Total
Number of
individuals
reporting a medical
diagnosis
Percent of individuals
reporting a medical diagnosis
68
45.64%
81
54.36%
149
100.00%
Table 13: Number of Diagnoses Reported at Referral

Number of Medical
Diagnosis Reported
Mean diagnoses reported
Mode diagnoses reported
1 diagnosis reported
5 or more diagnoses
reported
Number of
individuals with
this number of
medical diagnoses
2.50
1
25
16
12
5
Percent of individuals (who

have medical dx noted) with
this number of medical
diagnoses
N/A
N/A
36.76%
23.53%
17.65%
7.35%
10
14.71%
21

Total
68
100.00%
Table 14: Frequency of Medical Diagnoses
Medical Diagnoses
Cardiovascular
Dental/Oral
Dermatology/Skin
Ear/Nose/Throat
Endocrine
Eye disorders
Gastro/Intestinal
Genitourinary
GYN/Pregnancy
Hematology/Oncology
Hepatic/Biliary
Immunology/Allergy
Neurologic
Nutritional disorders
Pulmonary disorders
Other
Total diagnoses
reported
Total individuals with
reported medical
diagnoses
Number of
individuals by
Percent of individuals by
current med
current med diagnoses
diagnoses reported
reported
16
23.53%
4
5.88%
4
5.88%
8
11.76%
11
16.18%
9
13.24%
24
35.29%
6
8.82%
6
8.82%
4
5.88%
2
2.94%
5
7.35%
27
39.71%
4
5.88%
6
8.82%
34
50.00%
170
68
45.64%
22
Figure 5: Frequency of Medical Diagnoses: ArkSTART and National

START Trends
Medical Diagnostic Frequency Comparision

60.00%
40.00%
ArkSTART
20.00%
National START Trends (Adults)
0.00%
This comparison suggests that ArkSTART service users have a higher

frequency of almost all medical diagnoses compared to National START
service users. Taken with the fact that 54% of ArkSTART clients reported no
diagnoses at all during intake, it appears that comprehensive medical care
for this population is somewhat lacking and is an area where the ArkSTART
23

team can provide education and support with individuals teams as well as
consultation with medical care providers. Like many states, Arkansas is a
mostly rural state and medical care (especially specialty care) outside the
greater Little Rock area and a couple of other locations (Fayetteville and
Jonesboro) is extremely limited for the general population let alone
individuals with IDD.
Emergency Service Trends
Psychiatric Hospitalizations (pre-START)
A number of ArkSTART service recipients have a history of emergency service
use prior to enrollment in START services. The following tables look at
emergency service trends for individuals at entry into services. A target goal
of the START program is to help avoid unnecessary emergency service use
and reduce recidivism rates.
Over 16% of individuals reported a psychiatric hospitalization in the year
prior to enrolling inArkStart service. National START data is about 25%. The
difference in this trend could suggest that this number may be under
reported in Arkansas, or it could reflect the current systemic challenges
related to access; that is, there are few known psychiatric hospitals in
Arkansas that admit and treat people with IDD. Arkansas has only one state
operated Psychiatric Hospital and historically this hospital has had difficulties
serving individuals with IDD due challenges with defining appropriate
treatment (as discussed above in relation to behavioral health service
provision) and to the limited community options available upon discharge.
The creation of an ArkSTART Resource Center for Therapeutic Supports will
provide this step-down care option and make transition to a community
setting a more viable option, especially with the continued support of the
ArkSTART team. This difficulty with access to appropriate services does not
only apply to the Arkansas State Hospital, it also applies to privately
operated psychiatric hospitals and hospital units, which results in extremely
limited admissions of individuals with IDD.
Table 15: History of Psychiatric Hospitalizations
Psychiatric hospitalizations in the last
year (at point of referral)
Yes
Numbe
r
Percent
24
16.11%
24

No
Unreported
Total
Range
Mean
84
41 *
149
1-6
1.96
56.38%
27.52% *
100.00%
* Information unavailable to referral source when referral was made.
Emergency Department Use (pre-START)

History of emergency department use was added to the SIRS database on
January 1, 2015, so this variable was only collected for referrals after that
date (N=29). The following data is for only those 29 referrals for whom this
information was gathered.The high percentage (55%) of unreported data
likely means that this number is not an accurate reflection of reality; that is,
emergency department use is likely under-reported here.
Table 16: History of Emergency Department Use
Emergency Department Use in the last
year (at point of referral)
Yes
No
Unreported
Total
Range
Mean
Numb
er
Percent
4
13.79%
9
31.03%
16
55.17%
29
100.00%
1 to 2
1.5
Other Emergency Service Use (pre-START)

In addition to psychiatric hospitalizations and emergency department uses,
other emergency service use includes incarcerations, multiple residential
placements, and ICF/ID placements. The chart below shows the percent of
individuals enrolled in ArkSTART who experience one or more of these in the
year prior to their enrollment in START services.
25

Table 17: Other Emergency Service Use
Other Emergency Service Use in Last year (at
point of referral)
Incarcerations
ICF/ID Stays
History of Placement Changes
Numb
er
7
11
20
Percent
4.70%
7.58%
13.42%
START Service Outcomes

START services are incorporated into a tertiary care model to assess trends in
service delivery for FY15.
Based on a tertiary approach to crisis intervention, START service measures
are in three crisis intervention modalities: Primary (improved system
capacity): clinical consultation, education, system linkage, and community
training; Secondary (specialized direct services to people at risk of needing
emergency services): intake and assessment activities, CETs,
comprehensive service evaluations, outreach, Clinical and Medical
consultation, and cross systems crisis prevention and intervention planning;
and Tertiary (emergency intervention services): emergency assessments
and mobile support as well as other emergency services such as
hospitalizations and emergency room visits used by START recipients. The
following analysis looks at utilization patterns in each of these services
across the program for FY15.
The goal of START is to move the system from tertiary care (emergency level
of crisis intervention services) to more primary intervention (able to assist
when vulnerable) and secondary services (getting expert assistance without
the use of emergency room or hospitalization). In particular, the goal is to
build capacity across the service system in order to prevent and assist with
potential problems rather than manage them as crises later.
The figure below examines the distribution of ArkSTART services in the
context of the tertiary care model.
26
START Tertiary Care Model
System gap analyses, work force development and identification of risk
27

factors
Primary Prevention: Improved access to services,

treatment planning, integration of health and wellness,
and development of service linkages. 14% of time
Secondary Prevention: Identification of

individual/family stressors, crisis
planning/prevention, respite services, medication
monitoring and crisis intervention services. 84%
of time
Potential
impact of
intervention
Tertiary
Prevention:
Emergency Room
services,
hospitalizations
and law
enforcement
interventions. 2%
Required
intensity of
intervention
28
Primary Services: Building capacity of the system to support

individuals in their homes and communities.
Primary ArkSTART services include system linkages, clinical consultation, and
education and community training. These services are part of the plan to
improve the capacity of the system as a whole so that the community
system is effective and sustainable over time. These services currently make
up take up about 14% of coordinator service time.
ArkSTART staff continue to work with licensed and certified DD provider
agencies to build capacity to support individuals with IDD and behavioral
health issues in their respective communities. As a result of these efforts the
DD Cooperative membership has grown from the original 14 provider
agencies to a total of 25 (see Appendix A). Working with DD provider
agencies is critical if ArkSTART is to build linkages with Behavioral Health,
medical, and law enforcement agencies because the local DD provider is the
agency that will ultimately support the individual in the community and
coordinate (with assistance from ArkSTART) with the team of agencies that
will participate in the individual care plan.
Efforts to develop linkage agreements with the 13 behavioral health entities
statewide have begun and are a goal of this coming fiscal year. ArkSTART will
expand consultation and training to the behavioral health providers around
designing effective treatment plans that align with Medicaid requirements as
well as consulting with emergency response providers in those 13 agencies
to provide effective crisis intervention services.
The following is a summary of the primary service activities done by
ArkSTART team members.
Table 18: Community Training
Community Training
Community Education/linkage
Community-based training
Provided training to day provider
Provided training to school
88
11
53
5
29

Provided training
Provided training
Provided training
Provided training
providers
Provided training
to
to
to
to
residential provider
families
mental health providers
emergency service
19
26
9
2
to others
35
24
Total Number of Episodes
8
National Online Training Series and START Study Groups
The National Center for START Services provides an online core training
curricula for ArkSTART staff as well as ongoing National Training Series. The
National Training Series is available for ArkSTART staff and their partners;
thus, these trainings by national experts on topics relevant to supporting our
population are shared with any and all interested agencies and service
providers with whom ArkSTART collaborates. Appendix B outlines the
calendar of trainings provided this past fiscal year.
Ark START personnel also participate regularly in national study groups with
other professionals as a way to gain knowledge and skills needed to improve
system capacity. The goal of these groups is to insure that all START teams
have the latest knowledge and technical support to provide evidence-based
services in all areas of service provision. These study groups include:
Clinical Directors Study Group, facilitated by Dr. Karen Weigle
Resource Center Directors Study Group, facilitated by Dr. Jill Hinton and Bob
Scholz, M.S.
Medical Directors Study Group, facilitated by Dr. Jarrett Barnhill
Team Leaders Study Group, facilitated by David ONeal, MSW, and Alyce
Benson, MSW
National Program Director forums held quarterly; and
National conference chaired by Joan B. Beasley, Ph.D.
Secondary Services: Specialized direct services to people at risk of
needing emergency services
30

Secondary services provided directly to individuals enrolled in START
accounted for approximately 84% of coordinator time. These services help
to ensure that individuals are getting the supports they need to intervene
effectively in times of difficulty and avoid costly and restrictive emergency
services. The chart below shows the percent of individuals enrolled in
ArkSTART who received these planned services.
Table 20: Planned Services
START Planned
Services
Assessment
Activities
Outreach
Cross System
Crisis Planning
Total Individuals
Number
of
Individu
als
Percent of
Individuals
84
116
56.38%
77.85%
83
149
55.70%
Assessment: Work done to determine the needs of the individual and their
team, and the services to be provided. Includes: Information/record
gathering; intake meeting; completion of assessment tools (ABC, RSQ); and
START action plan development.
Table 21: Assessment Tools Completed
Assessment Tools
Aberrant Behavior Checklist
(ABC)
Recent Stressors
Questionnaire (RSQ)
ArkSTART
69
75
These assessment tools are used to identify presenting symptoms and

factors impacting their frequency and severity. The ABC is complete at intake
31

and again every 6 months to provide a standard measure of symptom
presentation and intensity over time. This information is critical in identifying
the effectiveness of interventions and supports, and guides adjustments
accordingly. The RSQ helps identify specific events or conditions that
contribute to the display of symptoms or behavioral challenges, which guides
our interventions and helps us better prevent problems in the future. The
ArkSTART team is utilizing these tools well and this data will inform us of the
long-term impact the ArkSTART team is having.
Outreach: Any time in which the START Coordinator provides education or
outreach to the system of support related to general issues or those specific
to the individual referred. Entities to which the START Coordinator may
provide outreach: families/natural supports, residential programs, day
programs, schools, mental health facilities, or any entity that may seek or
need additional support and education. The table below shows the extent of
outreach provided this reporting period. The average number of contacts per
person was about 12, which is the expected number (i.e., monthly contact).
It is interesting that at least one person and their team received 56 contacts.
The START Coordinators are trained to respond to the individual needs of
each person and their support team and this is clearly demonstrated in these
data.
Table 22: Outreach Contacts (Detail)
Outreach Detail
Percent with Outreach
Contacts
Range of Contacts
Mode
Average # per person
ArkSTART
77.85%
1-56
2
12.4
Cross System Crisis Planning: Completion of the Cross Systems Crisis

Intervention and Prevention Plan: collecting and reviewing relevant
information; completing brainstorming form with team; developing/writing
the plan and distributing; reviewing and revising the plan; and training on
and implementing the plan with the system of support.
Table 23: Crisis Plans (Detail)
Crisis Plans
Number in
ArkSTART
83
32

Process/Completed
When needed, individuals receiving START services also receive clinical
consultation, comprehensive service evaluations (CSE), and clinical
education team meetings (CET). The following tables provide detail on the
number of individuals enrolled in ArkSTART receiving these services.
Clinical Case Consultation: This includes any consultation provided by the
START Team directly to the individuals team. Examples: consultation
regarding behavior support plans, person centered planning, transition
planning, educational meetings specific to the individuals diagnostic and
clinical needs, consultation within the ArkSTART team with the clinical
director and/or medical director, and direct consultation to the individuals
team from the clinical director and/or medical director.
Table 24: Clinical Consultation
Clinical Consultation
Number with Clinical
Consultation
Percent with Clinical
Consultation
Range of Contacts
Mode
Average # per person
ArkSTART
117
78.52%
1-35
1
6.8
Comprehensive Service Evaluation (CSE): Completion of the Comprehensive

Service Evaluation including receiving and reviewing records; interviewing
the individual and system of support; writing the CSE; and reviewing
recommendations through development of an action plan. ArkSTART has
determined that every client they serve will receive a CSE during the course
of receiving services. In some instances, the CSE done first but in others,
when the team needs immediate crisis support, the CSCP may be completed
first, delaying completion of the CSE. Thus, 74 have been completed at this
time with many being in progress, which entails record gathering and review
as first steps.
Table 25: Comprehensive Service Evaluations
Comprehensive Service
ArkSTART
33

Evaluations
Number Completed
74
Clinical Education Team (CET): Preparing for and holding a Clinical Education
Team meeting regarding the individual referred. Including reviewing and
identifying relevant recommendations with START Clinical Director; and
assisting system of support with implementing recommendations. These will
continue monthly, and in the future we hope to be able to rotate them
through the various regions in Arkansas. This is dependent on having access
to our psychiatrist and clinical director to consult at those events.
Table 26: Clinical Education Team
Clinical Education Team
Number Completed
ArkSTART
9
Tertiary Services: Emergency interventions provided during a crisis

Tertiary services include the time spent responding to crises, facilitating
emergency admissions, and transitioning individuals to facilities providing
lower levels of care. These services currently make up about 2% of
coordinator time. Currently ArkSTART does not provide 24-hour mobile
supports, only emergency response during business hours. However, this
number indicates that teams do not yet understand the utility of calling
ArkSTART when crises are building. The team will continue to work toward
better communication with and responsiveness to teams earlier in crisis
development so that we can respond and help prevent more critical
problems.
Crisis Contact: An emergency call received by the START team that requires
immediate triage and response, likely resulting in an emergency assessment.
Assessment can be conducted in a number of settings including: family
home, residential setting, day program, hospital emergency department, etc.
In an emergency situation, this may be the mode in which the initial referral
is received.
Table 27: Number of Crisis Contacts
34

Total individuals requiring crisis contact
Total number of Emergency/Crisis services
Average number of contacts
Percent of Individuals with Multiple Contacts
Range of Contacts
Mode
ArkSTART
27
80
2.96
59.26%
1-12
1
Although only 27 persons enrolled in ArkSTART required crisis response,

almost 60% received crisis services more than once for an average of 3 crisis
contacts in the year. You can also see at least one service recipient had 12
crisis contacts this year.
Other Emergency Services
ArkSTART coordinators have also begun tracking the number of community
crisis services utilized by individuals enrolled in START. These services
include emergency department visits for psychiatric or behavioral reasons,
psychiatric hospital admissions and law enforcement encounters for
psychiatric or behavioral reasons. Recall that we suspect these types of
service use currently are underreported by clients and their support teams,
and when sought are often not accessed. In the future, comparison data with
other START programs as well as pre- and post-ArkSTART numbers will be
available.
Table 30: Emergency Service Usage

Emergency Service
Emergency Department Visits
Law Enforcement Encounters
Psychiatric Hospital Admissions
Number of
Individuals
6
4
7
Table 31: Psychiatric Hospitalization (Detail)
35

Total individuals with a psychiatric in-patient admission
Total Number of Admissions
Range of days
Average Length Of Stay (in days)
Total number of days spent in psychiatric units
Number of individuals with more than 1 psychiatric in-patient
admission
Percent of individuals with more than 1 psychiatric in-patient
admission
7
10
2 to 30
7.4
74
2
28.57%
Case Examples:
Bobby
Bobby is a 49 year-old male with severe ID who lives in an ICF/DD. He was
referred to ArkSTART in April, 2014.Staff reported sudden unexplained
outbursts and aggression that resulted in considerable property damage.
Because of Bobbys size and strength, staff considered his outbursts a
significant safety threat. He had spent most of his life residing in the group
homes and participating in the day programs offered by this provider. Over a
number of years, his aggressive behavior had increased in both frequency
and intensity, finally culminating in nearly daily events. Staff described the
behaviors as out of the blue. When Bobby was referred to ArkSTART, he
was in danger of losing services and had spent some time in an inpatient
psychiatric unit. After thoroughly examining Bobbys situation and factors
impacting him through the use of the START intake process and the use of
the START Action Plan, ArkSTART learned that Bobby was not using his CPAP
machine (device to help regulate breathing while sleeping) regularly which
was causing aggravation of previous medical and psychiatric conditions.
Additionally, Bobby expressed his wish to retire from his group home
residence and work training day program. He felt that at the age of 49 he
deserved to live in his own apartment. A Comprehensive Service Evaluation
(CSE) was completed in which important historical information as gathered
and reviewed with his team. The Cross Systems Crisis Intervention and
Prevention Plan was utilized to assist Bobby and his team when Bobby was
experiencing stress. The use of these tools gave some relief and stability to
Bobby and his team, so that ArkSTART could assist with seeking a local
provider that was better able to address Bobbys medical needs and would
allow him the anonymity of living in his own apartment. The plan proved
successful. Since the move, Bobby has begun to wear oxygen at night (this
allows for better sleep quality and positively impacts some of his medical
36

concerns). Consequently, Bobby has not had a single hospitalization,
emergency services call, or behavioral outburst in the year since the
changes. ArkSTART is currently working in collaboration with his service
providers to lower his medication usage for the second time since
transferring services. Bobby is now described by staff and neighbors as a
happy, easy-going friendly guy who enjoys small talk about fishing and
sporting events. He is living a life he values and feels happy and content.
Cedric
Cedric is a 27 year-old black male who lives with his mother in North Little
Rock, Arkansas. He was referred to ArkSTART in June, 2014. Cedric was
previously in a day program, but due to aggression, could no longer attend.
During periods when he becomes aggressive, Cedric refuses to take his
medications, tends to be up at night, and is uncooperative. He was striking
others, trying to burn himself, and going to the ER where he was admitted to
an inpatient psychiatric unit. Several times, Cedric struck a staff person and
he was promptly put in jail. His mother and case manager were told they
couldnt see him because he was on a suicide watch. Once ArkSTART was
contacted, his START coordinator called the jail, left a message for the nurse,
and then drove to the jail in person and talk to someone. The Director of
Nursing (DON) agreed to meet without an appointment and was relieved that
someone had come with some knowledge about Cedric. They had no
information about his diagnosis or what medications he was taking. His
START coordinator was able to reference the CSE she had completed on
Cedric to provide them with such needed information. Next, a copy of
Cedrics CSCIPP was provided in order to better understand and help
alleviate the crisis. This helped achieve stability in the unstable situation.
The coordinator then explained that his mother and case manager had
attempted to visit and call, but without success. She also said they couldnt
obtain information from UAMS (where he had been prior to jail) because
there was no release of information. The coordinator called Cedrics mother
and facilitated communication between her and the DON to schedule an
intake the next morning. Information about START was conveyed during the
meeting and a sense of relief was evident with all parties involved.
The following week, due to his direct care staff filing a petition, Cedric was
able to have a court hearing for involuntary commitment and go to the
Arkansas State Hospital for evaluation. In essence, this process has begun to
help others recognize Cedrics difficulties in the context of his mental health
diagnoses which has allowed him to obtain him much needed treatment
services and the necessary medications to help stabilize him again.
37

Conclusions
ArkSTART has continued to develop as a team and develop their skills in
providing best practices across the state. There have been challenges with
the expansion, specifically in developing clear lines of leadership and
structure across regions, and covering vast geographical areas. Further,
identifying professionals with expertise in both mental health and IDD to be
part of the ArkSTART team has continued to be a challenge. The team has
worked diligently to organize their structure as well as continue to build their
specialized skills, and this has resulted in improved services and outreach to
the communities. Below are the goals outlined at the end of last fiscal year,
with progress reports added.
Maintenance of fidelity to the START Model will be accomplished by

regular peer review sessions and close supervision within each
Cooperative region. Also, Cross-Systems Crisis Plans and
Comprehensive Service Evaluations will continue to be reviewed and
updated based on ongoing evaluation and feedback. The Coordinator
Interns will continue to work toward certification as full-fledged
Certified Coordinators through the Center for START Services. Progress
Report FY15: Ongoing peer reviews are occurring, and CSCPs and CSEs
are being reviewed and completed. Several interns are now scheduled
for finalizing their certifications in the next 2 months and the rest are
on-track to do so in the next 6 months.
Ongoing data collection. The Aberrant Behavior Checklist (ABC) will be

administered at time of intake, and again at annual intervals. Scores
from the ABC will be compared to assess individual level of overall
behavioral symptomology. The Recent Stressors Questionnaire will also
be used at intake and after every crisis to examine trends around
antecedents to crises. Progress Report FY15: We have now decided to
complete the ABC at intake and then at 6-month intervals (rather than
annual) to provide important information about the effectiveness of our
services; this will begin FY16. Use of the RSQ at times of intake and
crisis has improved, and will continue to improve as we obtain is more
accurate and timely information from clients team of support. The
ArkSTART team members continue to work on this.
Development of In-home Therapeutic Supports. This will involve the

provision of assessment, crisis stabilization, training, and intervention
38

development where the person lives when needed and appropriate as
hospital diversion or Center-based diversion. This service is especially
helpful for persons with Autism and those who have difficulty with
transition or new environments. Progress Report FY15: Plans for
implementation are outlined as are training plans for direct support
staff. However, the infrastructure for funding, availability, and access
to staff is being determined through the DDCA. As these strategies are
determined, the IHTS program will begin implementation.
Exploration of possibility of developing one or more Therapeutic

Support Centers. These Centers will provide both planned and
emergency admissions to intervene with or prevent crises, complete
comprehensive evaluations, provide hospital step-down/transition
support, and problem-solve around interventions and skills building for
ArkSTART clients and their families and supports. Progress Report
FY15: This will occur once IHTS are established and being used; this
will provide data around numbers needing this service and best
geographical locations of such services.
Continued identification of individuals at risk of loss of residential

placement and facilitation of referrals to ArkSTART. Work cooperatively
with area agencies to reduce the number of moves a person
experiences, and help facilitate permanency for individuals identified
as high-risk who have experienced frequent changes in residential
settings. Progress Report FY15: The ArkSTART team has been
successful in meeting this goal and continuing to provide support to
those in need.
Continued work developing linkage agreements with area mental

health centers and other service providers throughout the state and
promote their active engagement in collaboration around individual
clients and participation in our learning communities. Progress Report
FY15: This has occurred statewide and has resulted in closer
collaboration, outreach, and training across systems. More formal
linkages will be sought with the 13 behavioral health agencies this
fiscal year, with the goal of improving access to behavioral health
services for persons with dual diagnoses and of improving the
appropriateness of those services. Further, ArkSTART will work to
develop linkages with the crisis response teams in these agencies and
provide training and support in assessing and supporting dually
diagnosed person in crisis.
39

Goals and Recommendations for FY16
Expansion of primary interventions including linkages across systems,

outreach and training, and ongoing collaboration for improved
outcomes of clients. We will continue to support behavioral health
agencies to provide appropriate services that will also be reimbursed in
collaboration with Medicaid.
Continual focus on and improvement in the provision of secondary
interventions. Though we have made strides in this area, we will
continue to focus on quality improvement and expediency of
completing CSCPs and CSEs.
Expansion of crisis response capabilities by: outreach to existing
emergency service providers, assessment of their needs, training and
support to build their expertise with this population, and ongoing
consultation and co-evaluation around persons needing crisis response.
We will also improve tracking and reporting of crisis response and use
of other emergency services.
Implementation of In-Home Therapeutic Supports, with data collection
to inform the development of Center-based Therapeutic Supports, as
described above.
Continued improvement in data gathering/reporting with a focus on
accuracy and timeliness, and informing ongoing practice.
Expansion of expertise to children and families. The State of Arkansas
is requesting START services be available to children and families in the
future. ArkSTART is beginning training on children, child development,
and working with childrens systems this fall. Obtaining this additional
training will improve our capabilities with clients of all ages and their
systems. We will continue to build our expertise and expand services
as outlined by the State.
Consider hiring a nurse or nurse practitioner and offer multi-modal
evaluations with the START teams psychiatrist, nurse, psychologist,
and team members. We will coordinate with the Dennis Developmental
Center at Arkansas Childrens Hospital to explore development of a
multi-modal evaluation team.
40
Appendix A
DD COOPERATIVE OF ARKANSAS MEMBERS LIST 2014-15
Abilities Unlimited, Jonesboro
Advantages of Southeast Arkansas, Monticello
*AEDD, Little Rock
Arkansas Center for Independence, Newport
*Bost, Inc. Fort Smith
*Civitan Services, Benton
Community Living Arrangement, El Dorado
Community School of Cleburne County, Heber Springs
Day Springs of Arkansas, Little Rock
*Easter Seals Arkansas, Little Rock
ERC, Inc., Springdale
Evergreen Presbyterian Ministries, Texarkana, TX
*Faulkner County Day School, Conway
*First Step, Hot Springs
*Friendship Community Care, Russellville
*Grand Prairie Job Center, Stuttgart
41

Howard County Childrens Center, Nashville
ICM, Little Rock
*Integrity, Little Rock
*ILS, Conway
*Lonoke Exceptional Services, Lonoke
*Pathfinder, Inc., Jacksonville
*Rainbow of Challenges, Hope
St. Francis Area Developmental Center, Forrest City
South Ark. Dev. Center for Children & Families, El Dorado
Support Solutions of Arkansas, West Memphis
*UCP of Arkansas, Little Rock
* Founding Member
Appendix B
2014-2015 National START Online Training Series
September 19, 2014: Health & Wellness Considerations for Individuals with Autism
Spectrum Disorder, Leslie Rubin, MD
October 17, 2014: The Rational Use of Psychotropic Medications in Individuals with
Intellectual Disabilities, Jarrett Barnhill, MD
November 21, 2014: Substance Abuse & IDD, David ONeal
January 16, 2015: START Scholars Presentation - Coordinating Therapeutic Goals &
Activities for Guests, Jason Tuell
42
March 20, 2015: Creating a Vision of Inclusion: The Importance of Film in Education,
Awareness and Systems Change, Dan Habib
April 17, 2015: Supporting Individuals with Challenging Behaviors, David Pitonyak,
Ph.D.
Special Presentation on Mental Health & IDD: Hallucinations and Delusions in

Intellectual Disability, Anne Desnoyers Hurley, Ph.D.
43

2015 Ark Annual Report Final Ac 4

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A program of the Institute on Disability/UCED, University of New Hampshire

Arkansas Systemic, Therapeutic, Assessment,

A program of the Institute on Disability/UCED, University of New Hampshire

A program of the Institute on Disability/UCED, University of New Hampshire

A program of the Institute on Disability/UCED, University of New Hampshire

A program of the Institute on Disability/UCED, University of New Hampshire

A program of the Institute on Disability/UCED, University of New Hampshire

A program of the Institute on Disability/UCED, University of New Hampshire

Table 1: Referrals since Program Inception

A program of the Institute on Disability/UCED, University of New Hampshire

Table 2: Referrals by Region

A program of the Institute on Disability/UCED, University of New Hampshire

Time of Referral (FY15)

A program of the Institute on Disability/UCED, University of New Hampshire

Primary Reasons for Referral (FY15)

Presenting Problems at Referral

A program of the Institute on Disability/UCED, University of New Hampshire

Characteristics of Persons Served

A program of the Institute on Disability/UCED, University of New Hampshire

Age Distribution: ArkSTART

50 and Older; 19%

Figure 2: Age Breakdown of Adult START Programs Nationally

A program of the Institute on Disability/UCED, University of New Hampshire

Age Distribution: START Nationally

50 and older; 14%

Table 6: Descriptive Statistics

Descriptive Statistics for

Descriptive Statistics for

A program of the Institute on Disability/UCED, University of New Hampshire

ArkSTAR START Programs

Figure 3: Gender Breakdown

A program of the Institute on Disability/UCED, University of New Hampshire

Table 9: Disability Level Comparison: START/General Population

% Persons Served by START

Mild (50-55 to 70)

Living Situation at Intake

A program of the Institute on Disability/UCED, University of New Hampshire

A program of the Institute on Disability/UCED, University of New Hampshire

Mental Health Diagnoses at Time of Referral

Individuals with reported

Table 12: Number of Diagnoses Reported at Referral

Percent of individuals with

A program of the Institute on Disability/UCED, University of New Hampshire

Of the 149 individuals receiving ArkSTART services during the reporting

A program of the Institute on Disability/UCED, University of New Hampshire

Figure 4: Frequency of Psychiatric Diagnoses: ArkSTART and

A program of the Institute on Disability/UCED, University of New Hampshire

Medical Diagnoses at Time of Referral

A program of the Institute on Disability/UCED, University of New Hampshire

Table 13: Number of Diagnoses Reported at Referral

Percent of individuals (who

A program of the Institute on Disability/UCED, University of New Hampshire

Table 14: Frequency of Medical Diagnoses

A program of the Institute on Disability/UCED, University of New Hampshire

Figure 5: Frequency of Medical Diagnoses: ArkSTART and National

Medical Diagnostic Frequency Comparision

National START Trends (Adults)

This comparison suggests that ArkSTART service users have a higher

A program of the Institute on Disability/UCED, University of New Hampshire

A program of the Institute on Disability/UCED, University of New Hampshire

* Information unavailable to referral source when referral was made.

Emergency Department Use (pre-START)