Short Term Acute Residential Treatment (START)
The START programs (Short Term Acute Residential Treatment, also referred to as crisis residential programs) are located throughout San Diego County and offer an alternative to hospitalization for adults who are suffering an acute psychiatric crisis that is not manageable on an outpatient basis. CRF's START programs are the only integrated system of crisis residential programs in the United States that have been recognized by SAMHSA as evidence-based and listed in the National Registry of Evidence-based Programs and Practices (http://nrepp.samhsa.gov/ProgramProfile.aspx?id=145). They are CARF accredited as Mental Health Crisis Stabilization programs, licensed by the Department of Social Services, and certified by the Department of Healthcare Services. In a community-based, homelike environment, the multidisciplinary team of Master's prepared clinicians, nurses, psychiatrists and peers specialize in the psychosocial rehabilitation of each individual who comes through the door.
Ranging in size from eleven to sixteen beds, the programs are designed to discover the unique needs and preferences of each individual, engage and build on the personal strengths of each, and tailor an individualized service plan to address those needs. Built around a bio-psychosocial approach, the programs ensure that each resident is connected to a variety of social service supports within their own community to aid the transition into successful living beyond the START programs. The average length of stay is 9 days.
A typical day in the program begins with breakfast, followed by a Community Meeting in which staff and clients gather to discuss the day's schedule and any community issues. Clients meet individually with counselors to discuss mental health, substance abuse, and transition issues. They also participate in clinical and psycho-educational groups twice daily. Clinical interventions include Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Motivational Interviewing (MI). Clients have an opportunity to meet with the psychiatrists on staff and receive medication education and services from the nursing staff.
The community aspect of the programs is key. Unlike in a hospital or institutional setting, a team of clients prepare all meals which are served family style. To reduce isolation and build community, clients also share responsibility with staff for shopping, meal planning, housekeeping, laundry, and other such tasks as part of the process of rehabilitation.
Esperanza and Del Sur Crisis Center specialize in serving the unique needs of monolingual Spanish-speaking clients. All programs have the capacity to provide interpreter services for other languages, as well as American Sign Language. Clients with special needs related to mobility can be treated at Vista Balboa, Esperanza and Halcyon Center.
Anyone may refer a client by contacting any of the START Programs to find an available opening in the START system. A Fact Sheet designed to inform potential clients about the program is available at http://www.communityresearchfoundation.org/pages.php?from=about&id=58. The programs are predominantly funded by the County of San Diego, and no one is refused service due to inability to pay. The programs accept Medi-Cal, Medi-Cal/Medicare, and have contracts to serve individuals insured by Kaiser, Aetna, Healthnet and the VA.