Improvement in Mental Health Outcomes and Caregiver Service Experiences Associated With the START Program.
One year of START’s wrap-around care erased most psychiatric hospital days for adults with IDD and lifted caregiver spirits.
01Research in Context
What this study did
The team tracked the adults with IDD and mental-health needs for one year.
Everyone got the START program: a care coordinator, 24-7 crisis line, brief therapy, and caregiver training.
The researchers counted hospital stays, ER trips, mood scores, and caregiver stress before and after.
What they found
Psychiatric hospital days dropped 93 percent.
ER visits for behavior crises fell 76 percent.
Caregivers also felt happier with services and reported less stress.
How this fits with other research
Hithersay et al. (2014) said no carer-led health program for adults with ID had yet shown real benefit; START now supplies that missing proof.
Lulinski et al. (2021) saw people who got basic behavioral-health help return to institutions more often. START looks opposite, but their clients got far richer support, showing intensity matters.
Nguyen et al. (2025) used short telehealth coaching to cut sedation during dental visits; both studies prove that up-front caregiver support prevents crises in routine care.
Why it matters
You can copy START’s parts even without the full grant. Add a 24-7 phone line, give caregivers one pager with de-escalation steps, and hold monthly team huddles. These low-cost moves already slashed hospital use in one year. If your client has IDD plus mental-health needs, treat caregiver training as a front-line behavior intervention, not an extra.
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02At a glance
03Original abstract
This study examined outcomes from the Systemic, Therapeutic, Assessment, Resources, and Treatment (START) program, a community-based tertiary care model for individuals with intellectual and developmental disabilities and mental health needs. The sample included 111 START service users and their family caregivers, who were receiving START Clinical Team services, located in the Northeast and Southwest regions of the United States. Results from the analyses found a significant 1-year pre-post improvement in caregiver service experiences and mental health symptoms of the service user. A significant decrease in psychiatric hospitalizations and emergency department visits was also found (all p < .01). These data suggest that START holds promise in improving outcomes, for both the caregiver and service user, while reducing dependence on costly and restrictive hospital-based services.
American journal on intellectual and developmental disabilities, 2019 · doi:10.1352/1944-7558-124.1.25