Tennessee Launches Effort for Crisis Response and Prevention for Individuals with IDD

/ February 2, 2021

By Michelle Bagby

“Help begins with providing oxygen.”
   – Dr. Joan Beasley, director, Center for START Service

Think back to a time in your life when you experienced an extremely stressful situation. Not your average stress that you’ve become used to dealing with, but an intense, life-altering moment when your body kicked into survival mode. A scary situation where you felt helpless. How did your body feel in that moment? A lyric by Eminem comes to mind: “palms are sweaty, knees are weak, arms are heavy.” Time stood still, while chaos swirled around you.

Now, come back to the present and notice how your body feels. Maybe your muscles are tense, maybe your heart rate is elevated, your breath may be shallow. You are re-experiencing the stress in a small way. If you have an Apple watch or device monitoring your heart rate, it’s likely telling you to breathe at this point. Let’s go with that. Take a deep breath through your nose, filling your lungs completely with air. Hold it for a few seconds and then exhale slowly out of your mouth (repeat if needed). Feel your muscles relax, and the tension leave your body. Now, don’t you feel better? It’s amazing what oxygen can do to relax us when our bodies are experiencing stress.

Crisis is defined as a time of intense difficulty, trouble or danger. Crisis is stressful. Crisis is even more stressful when you feel you have no way to ease the crisis. When a person or a group of people are experiencing a crisis, “oxygen” is needed to stabilize the situation. The person or group need to know that help has arrived, and they can finally breathe. Once the situation is a little more comfortable, and the immediate crisis is resolved, the person or group can move forward to recover and take steps to stabilize and prevent future crises.

Those with IDD are at increased risk

The need for “oxygen” to stabilize a crisis applies to individuals with intellectual and developmental disabilities as well. Individuals with IDD are at an increased risk for crisis. There are several reasons for this increased risk associated with IDD diagnoses, such as issues with executive functioning or their ability to control or regulate their emotional response, having experienced adverse events or trauma, dealing with medical conditions, communication difficulties or having limited coping skills. As many as 30%-50% of people with IDD have a co-occurring mental health disorder. This is more than double the percentage of mental health disorders in the general adult population. The increased risk for crisis and increased prevalence of co-occurring mental health disorders make it crucial that individuals with IDD and their support teams (family/paid caregivers, service providers, case managers or independent support coordinators, school staff, etc.) have effective tools and resources to prevent and stabilize crisis.

A new source of “oxygen” is on the way for individuals with IDD and their support teams. The Tennessee START Assessment & Stabilization Teams, or as we call it TN START AST, will be a new statewide resource for individuals with IDD who have complex behavioral or mental health needs. The TN START Assessment and Stabilization Teams will provide prevention and stabilization through 24/7 crisis response, stabilization planning, training, education, consultation, and formalized systemic partnerships. This effort is a collaboration between the Tennessee Department of Intellectual and Developmental Disabilities and the Center for START Services (https://www.centerforstartservices.org/). START (Systematic, Therapeutic, Assessment, Resources & Treatment) is a comprehensive model of service supports that optimizes independence, treatment, and community living for individuals with IDD and behavioral health needs.

TN START AST will work with eligible individuals and their support teams to conduct a comprehensive assessment of the needs of the person, develop a person-centered cross-systems stabilization plan, and provide training and support in order to reach sustained stabilization for the individual and their entire system of care. These supports will be initially available to children and adults receiving or eligible for Medicaid waiver services. The primary aim is to help individuals remain engaged in their daily routine in their home and community while ensuring that their person-centered services and supports are right for them. A cross-systems stabilization plan is a written plan specific to the person for preventing and responding to crisis. It is developed with the person’s support team and relevant members of the crisis system such as local law-enforcement or mobile crisis providers. As part of the stabilization plan, the Assessment and Stabilization Team facilitator will respond early to potential crisis situations and work alongside the support team to guide decision-making with the aim of preventing escalation and the need for higher levels of intervention, such as police or mobile crisis involvement. If a higher level of intervention is unavoidable, the facilitator will remain involved throughout any transitions (such as admission to a behavior respite facility or psychiatric hospitalization) that may occur. This includes participating in treatment team meetings and helping the individual and their support team develop an effective discharge plan and properly prepare for their return home.

Creating change throughout the system

TN START AST also aims to provide oxygen to the entire system of care for individuals with IDD. The system of care includes other state departments, emergency service providers such as law enforcement and mobile crisis, hospitals, mental health providers,  IDD service providers such as residential or clinical providers, managed care organizations, educators, etc. The team will be involved in ongoing evaluation of the current crisis and the support or service system by collecting feedback from individuals, families and service providers and using that feedback to enhance the system. TN START AST is working to establish formalized partnerships with service providers system-wide to outline how we can work together to better support individuals with IDD who have complex behavioral or mental health needs.

Mobile crisis providers or other crisis entities such as hospitals or law enforcement can contact TN START AST for assistance with persons who have or are suspected to have an intellectual or developmental disability. The teams will work alongside mobile crisis or others to assist in stabilizing the person and provide consultation for additional resources, supports and services that may benefit the person. TN START AST will also bring local emergency or crisis service providers and support teams together to develop and implement effective stabilization plans to prevent and stabilize crises. TN START AST will continue efforts to provide information and education through clinical consultation, regional education events, and training for communities and service providers to strengthen existing supports and services.

TN START AST will be available in early 2021. Referrals for TN START AST can be made by anyone. For more information or updates on implementation and the referral process, please visit  https://www.tn.gov/didd/for-consumers/assessment-stabilization-teams.html .

I am extremely grateful to Michelle for sharing this information, but I’m even more grateful for the efforts of DIDD, the Tennessee Council on Developmental Disabilities and the Center for START Services to bring this initiative to our state. I talk with families frequently whose loved ones have had great difficulties getting appropriate crisis mental health services. And I know provider agencies often struggle with this as well. My hope is that TN START AST (as much as I hate acronyms) will be a blessing to many, many individuals in Tennessee. And even though it’s initially limited to those enrolled or eligible for Medicaid Waivers, I hope the training and education that will take place will create a ripple effect to improve crisis and prevention services for everyone in our state. Thank you so very much!

Michelle Bagby smilingMichelle Bagby is the statewide coordinator of Behavioral and Mental Health Services for the Tennessee Department of Intellectual and Developmental Disabilities. Michelle is a licensed behavior analyst and holds a master’s degree in clinical psychology from Middle Tennessee State University. Michelle has more than 15 years of clinical experience working with individuals with intellectual and developmental disabilities and mental/behavioral health needs. Michelle has been with DIDD since 2016 and began working within the Behavior Analysis Unit at the Middle Tennessee Regional Office and has since been promoted to her current central office position.  Michelle has had a variety of past clinical experience, including providing behavior analysis services for children with IDD and their caregivers in home and community settings, working as a mental health specialist at Vanderbilt Psychiatric Hospital, and working as a residential counselor at a residential treatment center for juvenile sex offenders.

February 2, 2021

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