Annual Report - Center for START ServicesThe biggest accomplishment has been receiving the 2-Year...

Annual Report

Prepared for

ArkSTART

Prepared by

The Center for START Services

On July 31, 2018

Arkansas START Mann Building

322 Main Street, Suite 501 Little Rock, AR 72201

https://www.centerforstartservices.org/

The Center for START Services is a program of the University of New Hampshire Institute on Disability/UCED

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Executive Summary

Arkansas START (ArkSTART) is a Crisis Prevention/Intervention Project that strives 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. ArkSTART is funded by the Arkansas Department of Human Services Division of Developmental Disabilities

Services (DDS) and operates in association with the Center for START services, which is part of the Institute on Disability at the

University of New Hampshire. ArkSTART’s advisory council is the Developmental Disability Cooperative of Arkansas which is

currently consists of 43 developmental disability and behavioral health providers across the state. The ArkSTART team currently

consists of a program director, clinical director, medical director, 4 team leaders, and 10 coordinators divided across 5 regions

covering all 75 counties in Arkansas. ArkSTART became a project of Partners for Inclusive Communities in June 2016 and has

achieved many notable accomplishments for FY18.

The biggest accomplishment has been receiving the 2-Year National Certification from the Center for START Services for meeting

the elements established for the model. The ArkSTART team worked tirelessly to ensure requirements essential to the START

model were being upheld and were awarded this achievement on May 3, 2018. In addition to this achievement, two of ArkSTART’ s

Coordinator-Interns met the requirements to become certified START Coordinators this fiscal year.

Beginning in January 2018, ArkSTART began their first Professional Learning Community (PLC) for In-Home Therapeutic Supports.

The PLC is a 12-week training curriculum developed by The Center for START Services to train in-home coaches to provide

therapeutic supports to individuals who are experiencing stress as well as his/her system in his/her identified setting by assuring

safety and stability, providing assessment, intervention, and planning. ArkSTART and the In-home therapeutic coaches completed

all requirements of the PLC and graduated on 5/1/18. ArkSTART anticipates hosting additional Professional Learning Communities

throughout the upcoming year.

This past year, several members of the ArkSTART team attended the START National Training Institute in Boston, MA. Our medical

director Dr. Leslie Smith was invited to present at several training sessions at the Institute. The ArkSTART Team was also

recognized for a second year in a row by receiving the 2nd place award with the poster presentation titled “The 8 “P’s”: Partnership

of Patient and Physician in Prescribing Practice and the Potential Plethora of Pitfalls.” This poster presentation was an examination

of a case study utilizing data derived from START Information Reporting System (SIRS), data logs, and medication changes done in

slow sequential fashion with patient and family/care giver involvement to provide a framework of recognizing pitfalls and proper

prescribing practices when working with individuals with IDD and mental health needs. The clinical case study showed the impact

of the interventions to improve communication to all, impact frequency and severity of SIB, and improve the well-being of the

individual, family and caregivers.

ArkSTART’s model clinic continues to demonstrate the effectiveness of EMDR therapy with clients diagnosed with

developmental/intellectual disabilities who have a significant history of trauma. The use of these techniques along with medication

management and support from the ArkSTART clinical team continue to demonstrate maximum therapeutic outcomes in the least

amount of time, especially for this special population. Data is continually being collected and ArkSTART anticipates continuing the

ability to demonstrate significant cost savings through these short-term intensive services.

This report provides a summary of ArkSTART program development and services from July 2017 through June 2018. ArkSTART is

pleased with the accomplishments to date and continue to focus on building systems capacity throughout the state. This report is

designed to fully inform the Division of Developmental Disabilities Services (DDS) and other interested stakeholders of the

activities undertaken by ArkSTART in conjunction with the DD Cooperative. Thanks to the support and vision of the leadership at

DDS and the Arkansas Department of Human Services, the ArkSTART initiative continues to work with service systems to improve

the quality of life for individuals with IDD and behavioral health needs.

Submitted,

Whitney Emerson, LPC, CRC

ArkSTART Program Director


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Table of Contents

Executive Summary ......................................................................................................................................................................................................... 2

Introduction ........................................................................................................................................................................................................................ 4

Program Background ...................................................................................................................................................................................................... 5

Goals from FY17 Annual Report/Progress ............................................................................................................................................................ 7

Program Enrollment ............................................................................................................................................................................................. 7

Characteristics of Persons Served................................................................................................................................................................... 7

Emergency Service Trends................................................................................................................................................................................. 8

Findings ................................................................................................................................................................................................................................. 9

Section I: Fiscal Year 2018 Program Enrollment .......................................................................................................................................... 9

Section II: Characteristics of Persons Served ............................................................................................................................................... 12

Demographics ....................................................................................................................................................................................................... 12

Mental Health and Chronic Health Conditions ....................................................................................................................................... 13

Section III: Emergency Service Trends ........................................................................................................................................................... 16

Section IV: START Clinical Services .................................................................................................................................................................. 17

Primary Services .................................................................................................................................................................................................. 17

Secondary Services ............................................................................................................................................................................................. 19

Tertiary Services .................................................................................................................................................................................................. 22

Conclusions and Goals for Fiscal Year 2019....................................................................................................................................................... 25

Conclusions ................................................................................................................................................................................................................. 25

Goals for FY19 ............................................................................................................................................................................................................ 25

[email protected]

mailto:[email protected]

http://www.centerforstartservices.org/


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Introduction

This report offers a comprehensive summary of services provided by the ArkSTART program for Fiscal Year 2018.

The analysis includes assessment of outcomes as well as fidelity measures for the START model. Goals reflect the

results of the analysis and service provision to date.

The findings in this report are separated into four sections:

• FY18 Enrollment Trends

• Characteristics of Persons Served (demographics and clinical trends)

• Emergency Service Trends

• START Clinical Team Services ArkSTART will develop a strategic plan based on findings from the analysis in collaboration with the Center for START

Services.

Contributors to this report and the information in it are:

Ann Klein, M.S., SIRS Manager; Center for START Services

Laurie Charlot, Ph.D., National Consultant, Center for START Services

Andrea Caoili, LCSW, Director of Quality Assurance; Center for START Services

Karen Weigle, Ph.D., Associate Director, ArkSTART Project Facilitator; Center for START Services

Whitney Emerson, LPC, CRC Director; ArkSTART

ArkSTART Program


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Program Background

ArkSTART operates throughout the state and has been actively serving individuals since 2011. The ArkSTART

program was initially a small pilot in the central region of the state and has since expanded statewide, serving five

geographical regions: Central, Northeast, Northwest, Southeast and Southwest. In June 2016, ArkSTART became a

project of University of Arkansas’ Partners for Inclusive Communities (UA/PIC), which is Arkansas’ University Center

for Excellence in Disability (UCED). In October 2015, ArkSTART began serving children ages 6 and older, making up

about 32% of the active population in FY2018 (figure 2).

The following is a list of ArkSTART regions:

Arkansas: Central

Arkansas: Northeast

Arkansas: Northwest

Arkansas: Southeast

Arkansas: Southwest

Figure 1: Percent of Active ArkSTART Population by Region

Figure 2: Percent of FY18 START Population by Age Category ArkSTART and Other START Programs


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At the end of FY18, ArkSTART served a cumulative total of 396 individuals (311 adults and 85 children) with an active

enrollment population of 137. The total yearly census for FY18 was larger than in previous years with a total of 261

individuals receiving services (figure 3). This appears to be a result of an increase in referrals, which may be

attributed to continual outreach and education to a wider array of systems of care.

Figure 3: Number of Individuals Served by Fiscal Year*

*Most individuals have received services in multiple fiscal years.

Figure 4 shows the number of newly enrolled individuals in ArkSTART each year since program operations began.

Figure 4: Number of Individuals Enrolled in ArkSTART by Fiscal Year (n=396)

While individuals are not discharged from ArkSTART, they are inactive once they reach a period of stability or because

their situation has otherwise changed (they leave the state, or they no longer wish to continue services). To date,

ArkSTART has inactivated a total of 259 individuals. The average length of stay (LOS) in ArkSTART is about 18 months

for all individuals. For individuals who have achieved stable functioning, the average LOS is 28 months.

Before discussing findings for FY18, a review of the previous year’s goals and how they were addressed is included

below.


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Goals from FY17 Annual Report/Progress Program Enrollment

• Continue to develop linkages with emergency services and hospitals to increase referrals and develop stronger crisis prevention strategies with them.

o Efforts to establish relationships with emergency services are ongoing. Each of Arkansas' 75 counties have their own approach to emergency response and working within those systems has been a slow process. This goal will continue.

• Continue to educate community partners about ArkSTART services so referrals continue to be received prior to acute crisis events.

o Progress has been made in this area has occurred, as evidenced by increased rate of referrals over the past fiscal year.

• Begin collecting feedback and satisfaction information from those who are leaving services. This will help us hone our services and be more responsive to recipient’s needs, particularly from families of children.

o ArkSTART annual completes stakeholder surveys on an annual basis. These surveys are distributed to past and present stakeholders and collects information regarding service impact and areas for potential improvements. ArkSTART utilizes survey results to improve service delivery and be more responsive to the needs of those accessing services.

Characteristics of Persons Served

• Extend the means of getting information to families of people in need of START services by working with

agencies, PCPs, clinics, schools, and churches in outlying, more rural areas.

o Coordinators who work in rural areas of the state conduct outreach to individuals and community

services and forming or strengthening relationships as opportunities arise.

• Continue efforts to engage mental health providers in CETs and other training opportunities to learn about

mental health in persons with IDD.

o Training opportunities, including CETs, are shared regularly with mental health professionals through a variety of methods, including in-person outreach, emails, and social media.

• Conduct CETs at area agencies increases the likelihood of participation.

o ArkSTART has increased attendance at CETs this fiscal year and received high satisfaction ratings

from attendees.

• Continue outreach to medical centers, PCPs, and other medical providers to educate them about START and

learning opportunities.

o This was successful and engaging the system of care has improved this year related to a major

increase in attendance at training events.

• Consider participating in grand rounds in regional hospitals or ways to obtain CMEs for the CETs and training

to gain more physician involvement.

o This goal was not addressed in FY 2017 and opportunities will continue to be explored in the coming

year.


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Emergency Service Trends

• Closely follow adults after discharge from psychiatric hospitalizations and track trends around effective

alternatives.

o ArkSTART has enhanced its relationship with the state hospital to ensure involvement as early as possible in the discharge planning process. Increase outreach by the on-call coordinator occurs to assure that STAR tis part of discharge planning.

• Continue to work with families and systems who tend to use emergency services more frequently by providing outreach and crisis planning.

o Data concerning the use of emergency services informs START Plan development, which impact outreach efforts. Debriefing measures are also in place with purpose to: intervene in crises, reduce compassion fatigue and trauma, promote staff consistency, learn from challenges and success, engage systems in strength spotting, create plans to make positive change, and work through incidents more effectively.

START Service Trends

• Continue to provide widespread outreach and training to groups already engaged in START services.

o This was completed during FY17 and will be ongoing.

• Ensure that Advisory Council meetings are occurring regularly, at least quarterly, over the next year.

o Advisory Council meetings occur on a quarterly basis.

• Increase the availability of medical and clinical consultation to outlying regions (outside Little Rock area) by use of telemedicine and use of your specialty clinic.

o Case conceptualization between clinical director and regional ArkSTART teams occur once per month (and more frequently as needed).

o Comprehensive Service Evaluations (CSE) are reviewed by the Clinical Director, regional ArkSTART team members, and Medical Director discuss Goals based on review of the CSE monthly through in person discussion as well as video conferencing technology.

• The National START Team will work with ArkSTART to develop metrics utilizing FEIS data that can be used to evaluate the work of START in improving family perceptions of the mental health care their family members receive.

o This was not addressed.

• Develop a plan and/or training to assure that the team leaders and coordinators have the skills and a clear understanding of START crisis contacts to assure that they are responding in person when necessary. This will include trainings around responses to individuals as well as team members as START is a system approach and responds to the crises of the whole team.

o ArkSTART developed and provided extensive training in FY18, including addressing a need for enhancing understanding of START. See detailed list of trainings in Addendum A.

• ArkSTART will continue outreach, training, and enhancement of the cross-system crisis plan to decrease reliance on ED and acute inpatient care. Data entry will also be critical to ensure that all crisis contacts are entered for every crisis.

o During the recent reporting period, crisis planning time was adequate for adults, but still low for children. Specific Goals for FY19 are provided in this report.

o Rates of psychiatric hospitalization following crisis contacts remains high, despite a clear reduction in emergency service use when comparing pre and post START enrollment.


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Findings

Following is an analysis of enrollment, demographic, and service outcome data for ArkSTART for FY18 (July 1, 2017-

June 30, 2018).

Enrollment trends, characteristics of persons served, emergency service trends, and service outcomes of those served

by ArkSTART are based on data entered into the START Information Reporting System (SIRS). When noteworthy,

elements are compared to national START trends.

Section I: Fiscal Year 2018 Program Enrollment

Data below reflect all individuals served by ArkSTART during this report period.

Table I. A: FY18 Census Summary

ArkSTART FY18 (n=261)

Variable Children Adults

Total Served during reporting period N (%) 84 (32%) 177 (68%)

FY18 New Referrals 55 52

Individuals inactivated 41 83

Stable functioning 6 (15%) 47 (57%)

Moved out of START region 2 (5%) 1 (1%)

No longer requesting services 8 (20%) 12 (14%)

Inappropriate for services 4 (10%) 1 (1%)

No contact 11 (27%) 8 (10%)

Long-term placement 10 (24%) 14 (17%)

Active Caseload at the end of reporting period 43 (31%) 94 (69%)

Table I. B: Source of Referral: Trends over Time

FY18 FY17 National START Trends

Variable (N) Children (n=55)

Adults (n=52)

Children (n=26)

Adults (n=54)

Children (n=828)

Adults (n=2109)

Referral Source (%) Case Manager 40% 52% 31% 54% 81% 69% Emergency Department/mobile

crisis - 2% - - 3% 7% Family Member 27% 19% 42% 11% 7% 5% Residential/Day Provider 5% 12% - 9% 1% 8% Hospital/ID Center 7% 6% - 15% 1% 3% Mental Health Practitioner 7% - 19% 4% 2% 2% Other (Behavior Analyst, law enforcement, schools) 13% 10% 8% 8% 5% 5%


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Table I. C: Reasons for enrollment (FY18 new enrollments only)-More than one option can be selected

Summary

Enrollment:

• ArkSTART served a total of 261 individuals in FY18. This included 84 children and 177 adults. Inactivation of Cases:

• Almost half of the 84 child cases were inactivated during the fiscal year, while 83 of the 177 adult cases were inactivated. These are larger percentages of open cases deactivated in a single fiscal year than is common.

• The ideal reason for inactivity is stability or the individual is doing well and no longer needs START services, which occurred for only 15% of child cases, and 57% of adult cases made inactivate during FY18. There are other instances in which people disengaged from START for other reasons (at times unknown). In some situations, a family member or other caregiver might disengage from services early on before having the opportunity to experience START related supports.

Source of Referral:

• A lower percentage of referrals to ArkSTART over FY17 and FY18 came from case managers, and more came from family members, especially for child referrals, though there was an increase in case manager referrals in FY18. Further, ArkSTART receives referrals from a wider range of sources than is typical in other START programs. In general, the relative contribution of referrals from various sources changes over time, as relationships with community partners change and systems are more engaged with the local START program members. This is a positive trend, and likely reflects outreach and education provided by the team to a wide range of community members.

Reason for Referral:

• For adult enrollees, reasons for referral were like those noted in the national data set.

• Aggression was a referral concern for most people enrolled in ArkSTART this fiscal year as is most always true for people with IDD who have significant behavioral health needs.

• The most atypical findings were related to children: concern about functional decline, mental health symptoms, and the high percentage with sexualized behavior.

• The following additional concerns were reported more for ArkSTART child enrollees vs national data reports: concern of need for diagnostic clarification and treatment planning help (40% vs 19%); concern over mental health symptoms (52% vs 34%); self-injurious behavior (47% vs 28%); risk of losing placing (29% vs 16%) and decreased daily functioning (42% vs 18%).

ArkSTART FY18 (n=107) National START Trends

Variable Children Adults children Adults

N 55 52 828 2109

Most Common Reasons for Enrollment (%) Aggression 89% 71% 91% 81% Family Needs Assistance 76% 23% 76% 37% Risk of losing placement 29% 19% 16% 22% Decreased Daily Functioning 42% 29% 18% 25% Dx and Treatment Planning 40% 23% 19% 23% Mental Health Symptoms 53% 46% 34% 56% Leaving Unexpectedly 7% 17% 25% 18% Suicidality 7% 12% 12% 18% Self-Injurious Behavior 47% 27% 28% 28% Sexualized Behavior 24% 17% 13% 11% Transition from Hospital 7% 10% 7% 9%


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Goals

Enrollment:

• Ongoing efforts should continue to maximize enrollment of new cases within the capacities of the program.

Source of Referral: • Expanding the scope and targets for linkage agreements may help to increase referrals from various sources.


• Regarding child enrollees, it is important to provide as much support as possible to help individuals remain with their families, and not need to move out of home. This was a concern for just under a third of child enrollees and needs special attention. It is worrisome that cases were inactivated due to moving into a long-term placement at a rate of 24% for children but also 17% of adults.

Inactivation of Cases:

• The ArkSTART Team should develop a survey to determine why stakeholders no longer want services after a period of enrollment to ensure that capacity has been built and that they are satisfied with services and support provided.

• ArkSTART should closely examine the reasons for the high rate of long term placement for their enrollees and develop strategies to keep more people in their communities and with family, to the greatest extent possible.


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Section II: Characteristics of Persons Served

Demographics Section II of this report provides demographic and diagnostic trend data for all individuals served by ArkSTART

(N=261) during FY18 (July 1, 2017-June 30, 2018). There are no significant differences in the demographics of active

individuals in FY18 compared to previous fiscal years. When relevant, the ArkSTART population is compared to other

START populations nationally.

Table II.A: Age, gender, race, level of ID, and living situation for children served in FY18

FY18 (n=261) Variable Children Adults N 84 177 Mean Age (Range) 13 (7-17) 33 (18-73) Gender (% male) 75% 54% Race White/Caucasian 75% 75% African American 19% 20% Asian 1% 1% Other 4% 2% Unknown/Missing 1% 2% Ethnicity (% Hispanic) 6% 3% Level of Intellectual Disability (%) No ID/Borderline 12% 5% Mild 29% 42% Moderate 32% 38% Severe-Profound 14% 12% None Noted 12% 2% Missing 1% 1% Living Situation (%) Family 86% 29% Enhanced Family Care/Foster Family 2% 1% Group Home and Community ICF/DD - 16% Independent/Supervised 4% 41% Psych. Hospital/IDD Center 8% 10% Other (Jail, Homeless, “Other”) - 2% Missing - 1%

Summary

• ArkSTART serves a relatively higher proportion of individuals with severe and moderate ID as compared with reports from the national data set.

• More ArkSTART adult enrollees were living with family and fewer resided in group homes, among those served this fiscal year. Many more adults served by ArkSTART, as compared with other START programs, were reported to be residing in an independent or supervised living situation, which is unusual given that they serve relatively fewer adults with a Mild ID diagnosis.

• One concerning statistic was the report that 8% of children served by ArkSTART were living in a psychiatric hospital or IDD center. This is much higher than reported by other START programs serving children.

Goals

• ArkSTART leadership should work on securing referrals of child cases prior to hospitalization and to focus more efforts on prevention of placement in these types of settings.


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Mental Health and Chronic Health Conditions

Table II.B: ArkSTART enrollees with mental health conditions reported at intake

ArkSTART FY18 (n=261) Variable Children Adults N 84 177 Mental Health Conditions (%) At least 1 diagnosis Mean Diagnoses (range)

75%

2.1 (1-5)

81%

1.7 (1-6) Most Common MH Conditions (%) Anxiety Disorders 19% 8% ADHD 40% 8% ASD 56% 17% Bipolar Disorders 17% 24% Depressive Disorders 24% 30% Disruptive Disorders 25% 24% OCD 10% 7% Personality Disorders 0% 11% Schizophrenia Spectrum Disorders 5% 31% Trauma/Stressor Disorders 6% 5%

Figure II.A: Frequency of most common mental health conditions for enrolled children (trends across START)

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Figure II.B: Frequency of most common mental health conditions for

enrolled adults (trends across START)

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Table II.C: ArkSTART enrollees with chronic medical conditions reported at intake

ArkSTART FY18 (n=261)

Variable Children Adults

N 84 177

Medical Diagnosis (%)

At least 1 diagnosis 44% 64%

Mean Diagnoses 1.6 (1-7) 2.3 (1-11)

Most Common Medical Conditions (%)

Cardiovascular 8% 25%

Endocrine 5% 17%

Gastro/Intestinal 22% 35%

Genitourinary 8% 10%

Immunology/Allergy 11% 6%

Musculoskeletal 3% 11%

Neurologic 51% 42%

Obesity 14% 6%

Pulmonary disorders 3% 10%

Sleep Disorder - 9%

Figure II.C: Frequency of most common medical conditions for enrolled children (trends across START)

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Figure IOD: Frequency of most common medical conditions for

enrolled adults (trends across START)

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Summary

o Mental Health Conditions: ArkSTART children were identified as having an Autism Spectrum Disorder (ASD) less often than typical for most START programs where this ranges from about 65-85% of new child referrals. Only 56% of the ArkSTART children had the designation. Rates for other mental health conditions among the children served by ArkSTART are like national START data.

o Adults served by ArkSTART are more likely to be diagnosed with schizophrenia related disorders and under diagnosed with anxiety disorders, based on national START data but also on research demonstrating that even in clinically referred high risk populations of people with IDD, anxiety and depression are much more common than psychotic disorders.

o Medical Conditions: ArkSTART enrollees have high rates of medical comorbidities. This is significant since people with IDD often have more health needs and do not receive adequate assessment and treatment for these conditions. Further, medical problems may be under-appreciated sources of distress that can either mimic mental illness or make it worse. Feeling ill may act as a setting event and lower the threshold for externalizing behavioral challenges.

o ArkSTART enrollees were reported to have more neurologic conditions than has been identified by other START programs (51% for child cases and 42% for adults) though this is consistent with research reports regarding these conditions in population-based studies. The rate for GI problems reported for children (22%) however seems low based on published data. Also, sleep disorders are more commonly seen in this population than reported here for children (none had this condition reported for ArkSTART child cases).

Goals

Mental Health Conditions:

• Ark START should link and collaborate with Developmental Evaluation Clinics and the local Autism Society to provide more education, and if possible, access to evaluations to identify the presence of ASD given the low rates reported.

• More training and outreach around adult mental health diagnoses, especially anxiety, trauma-related disorders, and the differential diagnosis of psychosis, could be helpful in the area of diagnostic uncertainty (which was a referral concern for many).

Medical Conditions:

• Provide more outreach and education about GI issues in children with IDD as a very common source of anxiety, externalizing behavior, and mood instability.

.


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Section III: Emergency Service Trends Table III.A: Emergency Service utilization

The figures below show the change in frequency between pre- and post-enrollment emergency service utilization for ArkSTART enrollees.

ArkSTART FY18 (n=261) Variable Children Adults N 84 177 Psychiatric Hospitalization Prior to enrollment, N (%) Mean Admissions (range) During START, N (%) Mean (range) Average length of stay (days) Emergency Department Visits Prior to enrollment, N (%) Mean Visits (range) During START, N (%) Mean (range)

33 (39%) 2.5 (1-10)

10 (12%) 1.8 (1-5) 10 days

33 (39%) 2.2 (1-9)

6 (7%)

1.8 (1-4)

73 (41%) 2.1 (1-10)

36 (20%) 2.1 (1-8)

8 days

73 (41%) 2.3 (1-10)

29 (16%) 1.9 (1-4)

Figure III.B: Change in frequency of pre and post START

enrollment emergency service utilization (adults)

Figure III.A: Change in frequency of pre and post START

enrollment emergency service utilization (children)


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Summary

• The change in ED and psychiatric hospitalization rates from pre to post ArkSTART enrollment was very encouraging for both children and adults. These data provide support to the observation in START programs nationally and in research on the START model, that receiving START services is associated with reduced emergency service use.

Goals

• Continue work to provide outreach and other planned services, to reduce emergency services use. The program should continue to focus on a decrease in crisis episodes when possible and continue to decrease recidivism in emergency service utilization.

Section IV: START Clinical Services Based on a tertiary care approach to crisis intervention, START service measures fall into three crisis intervention

modalities:

Primary (improved system capacity): Clinical Education Teams (CETs), community education, training,

and system linkage;

Secondary (specialized direct services to people at risk of needing emergency services): Intake and

assessment activities, Comprehensive Service Evaluations (CSE), outreach, clinical and medical consultation,

and Cross Systems Crisis Prevention and Intervention Planning (CSCPIP); planned therapeutic supports

(Resource Center and Therapeutic Coaching) 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 (includes

emergency therapeutic supports).

This section outlines utilization patterns in each of these services. The goal of START is to support and assist the

system in moving from tertiary care (emergency level of crisis intervention services) to primary intervention (able to

assist when vulnerable) and secondary services (getting expert assistance without the use of emergency department

utilization or psychiatric hospitalization). This is achieved by building capacity across the service system to prevent

and assist with potential problems rather than address crises later.

Primary Services Building system capacity to support individuals in their homes and communities.

The following is a summary of the primary service activities reported by ArkSTART in FY18. Primary START services

include system linkages, education, and community training. These services are part of the plan to improve the

capacity of the system so that improvements are effective and sustainable over time. Over the last year, the ArkSTART

team has engaged the community to provide training and education around the unique needs of individuals with IDD

and co-occurring behavioral health issues and continues to engage the system to become active participants in the

START learning community.


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Table IV.A Community training activities

ArkSTART FY18 Number of Activities (N) Community linkage/affiliation 47 Community-based training 70 Host Advisory Council Meeting 4 Provided Training (N) Day provider 15 Emergency services 0 Family 8 Other 5 Physician/medical personnel 3 Residential provider 17 School 5 State facilities (state hospitals, developmental centers) 16 Therapist/mental health providers 8 Transition Support/Planning-Developmental Center 3 Transition Support/Planning-Psychiatric Hospital 3 Total Community Outreach/Training Episodes (N) 201 Total Linkage/Collaboration Agreements Completed Since Program Inception (N) 43 Total Clinical Education Teams in FY18 (N) 11

In addition to the above-reported specific training and linkage activities, several more informal outreach efforts were

made. These included providing community partners with information about START and issues pertaining to the

population served. More information about these activities can be obtained from the ArkSTART Program Director.

The following is a list of Clinical Education Team Meetings (CETs) as part of the primary services provided by

ArkSTART during FY18. Additional trainings offered can be found in the report addendum.

Table IV. B.: Clinical Education Team Meetings Date Training Topic(s) Number in Attendance Overall Rating

(1-4) 08/3/17 Topic: Biopsychosocial Assessment of People with IDD

Presenters: Travis Gray and Angela Green

28 4

09/07/17 Topic: Reactive Attachment Disorder

Presenter: Kylee Hansen

31 3.86

10/5/17 Topic: Suicidality and IDD

Presenter: Ginny Reding

33 3.91

11/2/17 Topic: Rights of the Ward and Alternatives to Guardianship

Presenter: Disability Rights Arkansas

17 4

12/07/17 Topic: Sleep Disturbance

Presenter: Carrie Schatz

26 4

01/04/18 Topic: Psychological Needs Survey

Presenter: Brandi Rogers

33

3.9

02/01/18 Topic: When Grief Gets Complicated

Presenter: Chelsea Loy

35

4

03/01/18 Topic: Supporting Parents with IDD

Presenter: Kimmarie Quintana

28 3.9

04/05/18 Topic: Schizophrenia and IDD

Presenter: Joanne Thomas

27 4

04/26/18

Topic: Assessing Increases of Emotional & Behavioral Stress

Presenter: Ryan Carr

18

4

06/07/18 Topic: Transition Planning for Mental Wellness

Presenter: Kylee Hansen

31 3.9


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Table IV. C: National START Practice Groups

As part of the START model and the national START Professional Learning Community, ArkSTART personnel

participate regularly in national practice groups with other professionals. These forums are opportunities to gain

knowledge and skills needed to improve system capacity and share expertise across programs. The goal of these

groups is to ensure 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 Jill Hinton, Ph.D.

• Children’s Services Study Group facilitated by Karen Weigle, Ph.D.

• Resource Center Directors Study Group, facilitated by Bob Scholz, M.S., LMHC

• Medical Directors Study Group, facilitated by Karen Weigle, Ph.D. and Laurie Charlot, Ph.D.

• Team Leaders Study Group, facilitated by David O’Neal, MS, and Alyce Benson, MSW

• National Program Director forums held quarterly facilitated by Andrea Caoili, LCSW and Alyce Benson, MSW.

• National START Online Training Series, offered by the Center for START Services to START programs

• The START National Training Institute chaired by Joan B. Beasley, Ph.D., Director

Summary

• ArkSTART provided many outreach, training and consultation services during FY18 on an array of topics aimed at enhancing the capacity of community partners to understand the needs of individuals with IDD who have significant behavioral health needs.

• ArkSTART hosts very popular monthly Clinical Education Team (CET) meetings/training that have been recognized statewide and nationally. This is a highlight of their training offerings.

• ArkSTART continues to develop linkages with a wider range of providers and partners and has established relationships with more mental health providers over the past FY18.

Goals

• Continue the pattern of extensive, high quality outreach and training to the community at large.

• Work to provide CETs at locations around the state and/or ensure video conferencing attendance is available.

• Continue to engage emergency service providers and work to provide more specialized training to those partners. Also work to gain their attendance to the CETs.

Secondary Services Specialized direct services to people at risk of emergency service use

Secondary services help ensure that individuals are getting the supports they need to intervene effectively in times of

stress and avoid costly and restrictive emergency services.

The following planned, secondary services are offered by all START programs and time spent on these activities

is tracked in SIRS.


20

• Intake/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; and START action plan development.

• Outreach: Any time the START Coordinator provides informal education or outreach to the system of support related to general issues or those specific to the individual. 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.

• Clinical Consultation: Consultations provided by the Clinical Director with community team members who support individuals. Goals are given, and facilitation of goals and action plan development is done by the START Coordinator.

• Medical Consultation: Consultation provided by the START Medical Director regarding medication and other medical issues, includes collaboration with prescribing doctor. Goals are given, and facilitation of goals and action plan development is done by the START Coordinator.

• Cross System Crisis Planning: Completion of the Cross-Systems Crisis Intervention and Prevention Plan (CSCPIP) includes collecting and reviewing relevant information; brainstorming with the team; developing/writing the plan and distributing; reviewing and revising; and training and implementation the plan with the system of support.

• Crisis Follow-Up: Time spent following up after a crisis contact. This includes facilitating emergency service admissions and discharges, meetings with emergency service providers and follow-up on crisis plan Goals.

• Facilitation of Planned Therapeutic Supports (Resource Center, Therapeutic Coaching): Work/coordination related to preparing for and facilitating planned center based or in-home supports.

• Clinical Education Team (CET): Preparing for and holding a CET regarding the enrolled individual. Includes reviewing and identifying relevant Goals with Clinical Director and assisting system of support with implementing Goals.

• Comprehensive Service Evaluation (CSE): Completion of the CSE, including receiving and reviewing records; interviewing the individual and system of support; writing the CSE; and reviewing Goals through development of an action plan.

Table IV.D shows the percent of individuals enrolled in ArkSTART who received planned START services during the year. Since each individual enrolled in START is at a different stage of case activity and has unique strengths and needs, not all individuals received all planned services throughout the reporting period. Table IV.D: Provision of Planned START Clinical (Coordination) Services

ArkSTART Children Adults

N 84 177

Utilization of Planned Services (% of Individuals) Outreach

96%

97%

Intake/Assessment 96% 97%

CSCPIP 68% 82%

Clinical Consultation 70% 73%

Medical Consultation 38% 46%

Crisis Follow-Up 29% 27%


21

START Intake and Assessment

All individuals who are enrolled in START services participate in the Intake/Assessment process in which the START

team gathers important historical and biopsychosocial information about the individual and their system of support.

This process informs the next step, which is the development of a START Action Plan, outlining specific services and

resources that START should provide. Assessment tools used during at intake include the Aberrant Behavior Checklist

(ABC), Recent Stressors Questionnaire (RSQ), and START Action Plan. They are re-administered or updated on a

regular basis as long as the individual is enrolled and actively receiving START Services.

Table IV.E: Percentage of active individuals who received assessments/tools

START Tools Tool was completed

(Active) Up-to-date

START Action Plan 100% 97%

Aberrant Behavior Checklist (ABC) 100% 93%

Recent Stressors Questionnaire (RSQ) 100% N/A

Cross Systems Crisis Prevention and Intervention Plans (CSCPIPs) 96% 89%

Comprehensive Service Evaluations (CSEs) Completed 19% N/A

Aberrant Behavior Checklist (ABC)

The Aberrant Behavior Checklist (ABC) is a 58-item informant report psychopathology rating tool designed

specifically for use with individuals with IDD. (Aman, Burrow, & Wolford, 1997). The ABC is administered to START

service recipients at intake and again at 6-month intervals.

The ABC has been reported in the literature as an outcome measure, having demonstrated sensitivity to detecting

changes in psychopathology ratings over time. The ABC is used here to determine if use of START services is

associated with reduced psychopathology ratings over a 6 month or greater period of time. When using the ABC, the

authors suggest use of the subscales, and not a total scale score. Subscales were identified via a factor analytic process,

and three of these have been reported in the literature as sensitive to treatment effects, including the Irritability,

Hyperactivity and Lethargy scales so these are reported below for FY18 START cases in Arkansas.

For this analysis, only individuals enrolled in START services for least 6 months with at least two ABC scores were

included (N=164). The average time between the two administrations used in this analysis was 18 months. Results

show that average scores decreased as shown in Table IV.F. Currently, there are too few children to do a separate

analysis of children and adults.

Table IV.F: ABC Analysis

Mean Score

NH START (N=164) Percent with

Improvement Initial Most Recent t Stat

P(T<=t) one- tail

Hyperactivity/Noncompliance 65% 20.48 15.25 5.08 <0.00

Irritability/Agitation 65% 19.71 15.27 4.70 <0.00

Lethargy/Social Withdrawal 53% 10.88 9.20 2.13 <0.02

Alpha=0.05


22

Summary

• ArkSTART enrollees received a wide range of planned services in FY18. However, reported rates for time spent in CSCPIP work is low for children (68%). The completion rates for CSCPIPs are much higher, which may mean that plans are not being utilized as intended.

• The rates at which Comprehensive Service Evaluations were completed meets START standards and the team is commended.

• Individuals served by ArkSTART demonstrated reduced measures of psychopathology as evidenced by the ABC subscale scores reported above. This is consistent with data from other START programs.

• Though reduced ABC scores can be a very useful outcome measure, other factors may also be important in determining the effectiveness of interventions, including helping people remain with natural supports. Other data suggest that individuals served in ArkSTART demonstrate improved functioning based on the large reduction in ED visits and psychiatric inpatient stays noted above. Collectively, these outcome measures suggest the START model is helping significant numbers of enrollees.

• Despite the high rates of outreach provided, it is concerning that 24% of child cases and 17% of adult cases were reportedly inactivated this fiscal year due to placement into a long-term care facility.

Goals

• CSCPIP time tracking is lower than the percentage of completed and updated plans documented. This may be a data entry issue, or it could present an incorrect understanding of the crisis planning process. START CSCPIPs are organic, evolving documents that are facilitated by the START coordinator with the full commitment and participation of the individual’s team. It is important for the ArkSTART leadership team to examine the reason for incongruency and assure that clinical team members are engaging the system of support for enrollees.

• ArkSTART should continue to take regular data on outcomes associated with improved functioning and service effectiveness. As more components are being used, even greater reductions in psychopathology measured by the ABC would be an important indicator of the significance of these additions.

Tertiary Services Emergency interventions provided during a crisis

ArkSTART tertiary services include the time spent responding to crises, facilitating necessary emergency supports,

and transitioning individuals to facilities providing lower levels of care.

• A Crisis Contact is an emergency call received by the ArkSTART team that requires immediate triage and response, likely resulting in an in-person emergency assessment. Assessment can be conducted in several settings including: family home, residential setting, day program, hospital emergency department, etc. In some cases, the on-call coordinator may provide consultation to family or caregivers over the phone or may speak with the individual to help restore calm and avert the need for higher levels of intervention such as Mobile Crisis Management services or an ER visit.


23

Crisis Contacts

Table IV.G: FY18 Crisis Contacts

ArkSTART FY18 Variable Children Adults Crisis Contacts Number of Individuals with a contact

11

22

Number with Crisis Contacts 18 67 Range of Contacts (1-3) (1-13) Frequency of calls with each type of Intervention N (%)

In-Person Phone Consultation Missing

22% 72% 6%

52% 46% 1%

Average Length of In-Person Intervention 3.7 Hours 3.0 hours Crisis Disposition for each crisis contact N (%) Maintain Setting

83%

66%

Psychiatric Hospital Admission - 18% Emergency Department - 3% Medical Hospital Admission - - Crisis Stabilization - 4%

Other (Incarcerated, Referral to services, “Other”) 11% 3% Missing 6% 6%

Figure IV.A: Acute Crisis Contact Trends per FY

Summary

• The number of crisis contacts nearly doubled over the past fiscal year.

• Too few individuals received an in-person assessment, especially children in crisis, but also adults as the anticipated rate of in-person assessment for crisis contacts is about 75%.

• It is unclear why 18% of crisis contacts involving enrolled adults result in psychiatric hospitalization and a significant amount less are screened in the emergency department. It may be that individuals in the state of Arkansas are not screened at the emergency department prior to hospitalization.


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• Ark START is beginning to partner with several community-based agencies to provide Therapeutic Coaching services based on the START model so that in FY19 the impact of this service on reducing emergency service use can be evaluated to inform future program planning.

Goals

• ArkSTART leadership needs to meet and develop an action plan to address the low rates of in-person crisis assessments.

• ArkSTART leadership needs to closely monitor the use of the full range of available START service options for any individuals having repeated need for use of the 24-hour crisis line. This includes ensuring that outreach visits are occurring at a high frequency, and clinical consultation as well as Therapeutic Supports are being employed for individuals experiencing the most acute and ongoing challenges. Specifically:

o For any individual with repeated calls to the crisis line, a review should be conducted by the Clinical Director. The clinical director working with the coordinator should then take the following steps:

▪ If calling the crisis line when not in crisis, schedule phone calls to meet the person’s need for contact in a preventive manner.

▪ Update the CSCPIP with close involvement of the person’ system of care. ▪ Check the START plan and ensure it is in alignment with the high need profile of the cases

reviewed. ▪ Present the case to the medical director. ▪ Complete a CSE. ▪ Organize a systems meeting and review. ▪ If appropriate, schedule a CET. ▪ Develop a detailed action plan to reduce crisis events based on above and in conjunction with the

person’s system of care.

o Continued efforts should be made to educate, link with, and encourage full use of START crisis services by enrollees’ caregivers when help is needed., which has expanded to include therapeutic coaching services.


25

Conclusions and Goals for Fiscal Year 2019

Conclusions

During this fiscal year, ArkSTART served a total of 261 individuals and collaborated with 78 service providers across

52 counties in Arkansas.

A key accomplishment was that ArkSTART received a 2-Year National Certification from the Center for START on May

3, 2018

Beginning in January 2018, ArkSTART began their first Professional Learning Community (PLC) for In-Home

Therapeutic Coaching. The PLC was a 12-week training curriculum developed by the Center for START Services

designed to train therapeutic coaches to provide supports to individuals in their home settings and their systems who

are experiencing stress by assuring safety and stability, providing assessment, intervention, and planning. All

participants of the PLC completed all requirements and graduated in May 2018. ArkSTART anticipates hosting

additional PLC in the upcoming year.

This past year, several members of the ArkSTART team attended the START National Training Institute in Boston, MA.

The ArkSTART medical director Dr. Leslie Smith presented at several sessions at the Institute. ArkSTART also

recognized for a second year in a row by receiving the 2nd place award with the poster presentation titled “The 8

“P’s”: Partnership of Patient and Physician in Prescribing Practice and the Potential Plethora of Pitfalls.”

ArkSTART provided many trainings this year and conducted a significant amount of outreach. There remain concerns

regarding relatively high long-term placement rates. Implementation of START therapeutic supports could be very

helpful in future for reducing this and especially in supporting children to remain with their families.

The program will complete an action plan based on the Goals from this report.

Goals for FY19

Program Enrollment

Enrollment:

• Ongoing efforts should continue to maximize enrollment of new cases within the capacities of the program.

Source of Referral: • Expanding the scope and targets for linkage agreements may help to increase referrals from various sources.


• Regarding child enrollees, it is important to provide as much support as possible to help individuals remain with their families, and not need to move out of home. This was a concern for just under a third of child enrollees and needs special attention. It is worrisome that cases were inactivated due to moving into a long-term placement at a rate of 24% for children but also 17% of adults.

Inactivation of Cases:

• The ArkSTART Team should develop a survey to determine why stakeholders no longer want services after a period of enrollment to ensure that capacity has been built and that they are satisfied with services and support provided.


26

• ArkSTART should closely examine the reasons for the high rate of long term placement for their enrollees and develop strategies to keep more people in their communities and with family, to the greatest extent possible.

Characteristics of Persons Served

• ArkSTART leadership should work on securing referrals of child cases prior to hospitalization and to focus more efforts on prevention of placement in these types of settings.

Mental Health Conditions:

• Ark START should link and collaborate with Developmental Evaluation Clinics and the local Autism Society to provide more education, and if possible, access to evaluations to identify the presence of ASD given the low rates reported.

• More training and outreach around adult mental health diagnoses, especially anxiety, trauma-related disorders, and the differential diagnosis of psychosis, could be helpful in the area of diagnostic uncertainty (which was a referral concern for many).

Medical Conditions:

• Provide more outreach and education about GI issues in children with IDD as a very common source of anxiety, externalizing behavior, and mood instability.

Emergency Service Trends:

• Continue work to provide outreach and other planned services, to reduce emergency services use. The program should continue to focus on a decrease in crisis episodes when possible and continue to decrease recidivism in emergency service utilization.

START Clinical Services

Primary Services:

• Continue the pattern of extensive, high quality outreach and training to the community at large.

• Work to provide CETs at locations around the state and/or ensure video conferencing attendance is available.

• Continue to engage emergency service providers and work to provide more specialized training to those partners. Also work to gain their attendance to the CETs.

Secondary Services

• CSCPIP time tracking is lower than the percentage of completed and updated plans documented. This may be a data entry issue, or it could present an incorrect understanding of the crisis planning process. START CSCPIPs are organic, evolving documents that are facilitated by the START coordinator with the full commitment and participation of the individual’s team. It is important for the ArkSTART leadership team to examine the reason for incongruency and assure that clinical team members are engaging the system of support for enrollees.

• ArkSTART should continue to take regular data on outcomes associated with improved functioning and service effectiveness. As more components are being used, even greater reductions in psychopathology measured by the ABC would be an important indicator of the significance of these additions.


27

Tertiary Services

• ArkSTART leadership needs to meet and develop an action plan to address the low rates of in-person crisis assessments.

• ArkSTART leadership needs to closely monitor the use of the full range of available START service options for any individuals having repeated need for use of the 24-hour crisis line. This includes ensuring that outreach visits are occurring at a high frequency, and clinical consultation as well as Therapeutic Supports are being employed for individuals experiencing the most acute and ongoing challenges. Specifically:

o For any individual with repeated calls to the crisis line, a review should be conducted by the Clinical Director. The clinical director working with the coordinator should then take the following steps:

▪ If calling the crisis line when not in crisis, schedule phone calls to meet the person’s need for contact in a preventive manner.

▪ Update the CSCPIP with close involvement of the person’ system of care. ▪ Check the START plan and ensure it is in alignment with the high need profile of the cases

reviewed. ▪ Present the case to the medical director. ▪ Complete a CSE. ▪ Organize a systems meeting and review. ▪ If appropriate, schedule a CET. ▪ Develop a detailed action plan to reduce crisis events based on above and in conjunction

with the person’s system of care.

o Continued efforts should be made to educate, link with, and encourage full use of START crisis services by enrollees’ caregivers when help is needed., which has expanded to include therapeutic coaching services.


28

ADDENDUM A Details regarding training events in FY18

Date Length Location Training Topic (s) Number in

Attendance

Overall

Rating

06/02/17 1.25 Little Rock Christian LRCS Crisis Plan Training for c-095 , Sensory Integration 5 4

06/06/17 2 Ouachita Co. Sheriff’s Office Importance of Data Collection 8 3.62

06/28/17 8 ArkSTART Conference 4th Annual Conference on Co-Occurring Disabilities: Trauma- CON 128 3.77

07/05/17 1 York Williams Child Development

Center

“What is START?” Trainers: Ryan Carr 11 4

07/12/17 2 Jenkins Memorial CSCPIP C-101 Trainers: Ryan Carr 12 4

07/13/17 1 UCP Day Hab Behavioral Charades Trainers: Matt McEuen 7 4

07/19/17 2 Arkadelphia HDC Behavior Support Planning (BSP): Best Practices

Trainers: Ginny Reding, Carrie Schatz

11 4

07/19/17 1 Arkadelphia HDC Medical Issues as Behavioral Problems, Trainers: Ginny Reding 6 3.83

7/20/2017 2 BOST, Inc. Ft. Smith What is ArkSTART and Deciphering Nonverbal Communication:

Behavioral Charades, Trainers: Megan Brosh, Kylee Hansen, Whitney

Emerson

29 4

08/04/17 1.5 Lonoke Exceptional School Behavioral Charades, Trainers: Matt McEuen and Travis Gray 23 4

08/09/17 2 AHDC Mental Health & IDD, Trainer: Ginny Reding 13 3.6

8/28/17 1.5 Central Arkansas Disability Positive Behavior Supports Trainers: Travis Gray 6 4

9/8/2017 1 CADS Behavioral Charades Presenter: Travis Gray and Ryan Carr 4 4

09/8/17 1 CADS PBSP – Karen WeiglePresenter: Travis Gray 4 4

09/08/17 1 CADS Sensory IntegrationPresenter: Travis Gray and Ryan Carr 4 4

9/11/2017 1 CADS Behavioral CharadesPresenter: Travis Gray 5 4

09/11/17 1 CADS PBSP – Karen Weigle, Presenter: Travis Gray 5 4

09/11/17 1 CADS Sensory Integration, Presenter: Travis Gray 5 4

09/12/17 1.5 Millcreek Behavioral Health Discussion of ArkSTART program and services review of handout


15 N/A

09/12/17 1 Timberidge- Fordyce, AR What is ArkSTART? Presenter: Suzy Norris 15 4

09/15/17 2 NWA Arkstart Office National Online Training; Inclusion, Host Kylee Hansen 5 4

09/26/17 2 SAHDC-Warren, AR Alternative Therapies for IDD Clients with Past Trauma

Presenter: Suzy Norris and Ryan Carr

18 4

10/05/17 1 Civitan Services Information to MH Providers regarding IHTS, Presenter: Carrie Schatz 4 N/A

10/11/17 1.5 AHDC Bipolar Disorder and IDD, Presenter: Ginny Reding 20 3.53

10/11/17 1.5 AHDC Bipolar Disorder and IDD, Presenter: Ginny Reding 15 3.64

10/12/17 .5 Counseling Associates Inc. Russellville What is ArkSTART, Presenter: Whitney Emerson 12 3.73

10/19/17 3 York/Williams Daycare, Mitchellville Behavioral Charades, Presenter: Suzy Norris 11 UKN


29

10/20/17 1 NW Office National Online Training- Trauma in Childhood, Host: Kylee Hansen 5 4

10/23/17 3 NW Office Autism Spectrum Disorders (ASD), Presenter: Renee Holmes, Host:

Kylee Hansen

14 4

10/26/17 1 Pinnacle Pointe Hospital Information to MH facility regarding IHTS, Presenter: Carrie Schatz 4 N/A

11/08/17 2 AHDC Depression & IDD, Presenter: Ginny Reding 9 3.78

11/08/17 2 AHDC Depression & IDD, Presenter: Ginny Reding 5 4.00

11/9/2017 1 DHS-Fort Smith What is ArkSTART, Presenter: Kylee Hansen 7 4

11/10/17 2 First Step

Hot Springs

Brief What is ArkSTART (outreach), Presenter: Ginny Reding and

Whitney Emerson

9 N/A

11/30/17 2 NW ArkSTART office Host Different types of therapies for people with I/DD, Presenter: Joe Young 2 4

12/12/17 2 Preferred Family Health What is ArkSTART? NWA Team 8 4

12/29/17 3 St. Francis ArkSTART Systems

Patty Brewer, Joanne Thomas, Kimmarie Quintana, Angela Green

9 NA

1/25/18 1 hr Ozark Guidance Center, Springdale AR What is ArkSTART, Presenters: Megan Brosh and Kylee Hansen

[NW System of Care]

UKN

N/A

1/30/18 1:40 Pathfinder, Inc. Bentonville AR Behavioral Charades, Presenters: Megan Brosh and Kylee Hansen 9 4

1/30/18 1:40 Pathfinder, Inc. Bentonville AR Behavioral Charades, Presenters: Megan Brosh and Kylee Hansen 10 4

1/22/18 2 hr Henderson State University Mental Health and IDD, Presenters: Chelsea Loy and Ginny Reding 10 4

02/12/18 1.5 hr Hector High School Autism, Presenter: Travis Gray 16 3

02/16/18 45 min Northwest ArkSTART office National Online Training Series 2 4

02/22/18 1 hr Above and Beyond Care “When Mourning Gets Complicated” Presenter: Chelsea Loy 10 3.7

3/8/2018 2 hr Lifestyles, Inc. What is ArkSTART? Bx Charades + Autism

Presenter: Megan Brosh/Craig Olienyk/Kylee Hansen

12 3.8

3/13/18 2 hr Arkadelphia HDC Using Alternative Therapies with Individuals with IDD


8 3.5

3/13/18 2 hr Arkadelphia HDC Sensory Integration and Its Impact … Through Adulthood


9 3.89

03/15/18 1 hr. HDC (Caddo Valley) Aberrant Sexual Expression, Presenter: Chelsea Loy 4 3.75

03/15/18 2 hr HDC (Caddo Valley) Supporting Parents with IDD Presenter: Chelsea Loy 7 3.86

3/20/18 1 hr Millcreek BH Exploring Medical Bases for Behavioral Issues


28 3.68

3/20/18 1 hr Millcreek BH Exploring Medical Bases for Behavioral Issues


21 3.78

3/27/18 2 hr Arkadelphia HDC Effects of Trauma on Individuals with ID, Presenter: Ginny Reding 11 3.73

3/27/18 2 hr Arkadelphia HDC Effects of Trauma on Individuals with ID, Presenter: Ginny Reding 6 3.83

3/27/18 45min Arkansas State Hospital What is ArkSTART? Presenter: Angela Green 24 3.8

3/28/18 2 hr Group Living, Inc. Effects of Trauma on Individuals with ID, Presenter: Ginny Reding 39 3.7

04/09/18 2 hr NE-18 home Hallucinations and Delusions in Schizophrenia 6 3


30

Presenter: Kimmarie Quintana

04/12/18 1.25 hr AHDC Healing from Trauma and Learning to Thrive, Presenter: Chelsea Loy 12 3.92

04/17/18 1 hr Millcreek BH Autism Awareness, Presenter: Ginny Reding 16 3.78

04/17/18 1 hr Millcreek BH Autism Awareness, Presenter: Ginny Reding 9 3.75

04/20/18 1 hr Day Spring

Van Buren, AR

National Online Training Series

Presenter: Kylee Hansen, Megan Brosh, Craig Olienyk

4 4

04/25/18 2 hr Grand Prairie Job Center Behavioral Charades- deciphering non-verbal communication with IDD

clients, Presenter: Suzy Norris

6 4

05/04/18 1.5 hr. Mack’s Heber Springs What is ArkSTART, Presenter: Travis Gray 15 4

05/15/18 1.25 hr. Millcreek BH Trauma in Childhood, Presenter: Ginny Reding 5 4

05/16/18 45 min DDPA ArkSTART: Evidence Informed Outcomes & Moving Forward

Presenter: Whitney Emerson & Angela Green

179 4

05/19/18 1 hr. GPJC Behavioral Charade, Presenter: Ginny Reding, Suzy Norris 3 4

05/19/18 2 hrs. GPJC Effects of Trauma on Individuals with IDD


3 4

05/19/18 2 hrs. GPJC Healing from Trauma and Learning to Thrive


3 4

05/22/18 2 hrs. AHDC Trauma in Childhood, Presenter: Ginny Reding 6 3.67

05/23/18 2 hrs. Group Living, Inc. Healing from Trauma and Learning to Thrive


35 3.73

6/5/18 1 hr. Bryant Boys and Girls Club Deciphering Nonverbal Communication

Presenter: Travis Gray & Chelsea Loy

37 3.95

6/5/18 1 hr. Bryant Boys and Girls Club Deciphering Nonverbal Communication

Presenter: Travis Gray & Chelsea Loy

28 3.93

06/19/18 1 hr. Millcreek in Fordyce Deciphering Nonverbal Communication

Presenter: Chelsea Loy & Ryan Carr

6 4

06/19/18 1 hr. Millcreek in Fordyce Deciphering Nonverbal Communication

Presenter: Chelsea Loy & Ryan Carr

3 4

06/28/18 1 hr. Group Living, Inc. Deciphering Nonverbal Communication, Presenter: Chelsea Loy 10 4

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