Short Term Acute Residential Treatment (START) provides a residential treatment alternative to psychiatric hospitalization for adults with serious mental illness (SMI) who do not require a locked facility and may also have co-occurring substance use disorders. START is designed to provide safe and effective, community-based, crisis residential treatment at a much lower cost than treatment in a psychiatric hospital. The program is designed to return residents to the community with their acute symptoms stabilized and under control in the shortest amount of time possible.
START programs serve individuals who are over 18 years of age and in psychiatric crisis of sufficient severity to indicate hospitalization. START programs cannot accommodate individuals who are actively violent or in need of restraints, individuals requiring only primarily substance abuse treatment, or those with unstable, nonpsychiatric medical conditions requiring more than outpatient care. The average length of stay in START programs is less than 10 days and discharge planning begins at the time of admission.
START programs are typically located in residential neighborhoods within large homes, and each home can house between 11 and 16 clients. A core feature of START is adherence to the principles of psychosocial rehabilitation, including an emphasis on the patient’s active involvement in treatment planning, goal setting, and planning for discharge as early as possible in the treatment process. Services include individual, family, milieu, and group therapy; community meetings; psychiatric evaluation; life-skills education groups; integrated substance-abuse treatment for those with dual diagnoses; task-oriented groups; and recreational/social activities. When indicated, medications are provided and monitored to further assist individuals in the recovery process.
START programs are designed to provide a homelike atmosphere where the relationship between staff and residents is recognized as a powerful tool. The programs require a well-educated, multidisciplinary team who provide an accepting and nurturing environment in the provision of care, treat residents respectfully, and emphasize recovery. Staff members collaborate with the residents and their significant others to develop the most effective treatment and discharge plans. A staff psychiatrist visits the program a minimum of three times per week to provide medication management for all the residents and is on call 24/7. Nursing staff are available on site to address any medical needs. Peer Specialists who have lived experience with SMI serve as role models. Each START site trains a number of graduate students in psychology, social work, counseling, and marriage and family therapy each year. Clinical supervision is provided by a licensed psychologist.