Frontline Initiative Trauma-Informed Care

Trauma-Informed Care and the START Model


Lacey Eaton, MA, LPC-I, is assistant director and team lead for the STARTprogram at MHMR Tarrant in FortWorth, Texas. She can be reached at 817-569-5656.

The START (Systemic, Therapeutic, Assessment, Resources and Treatment) Model is used in many parts of the country. It enhances and supports existing care systems. It is specifically for people with IDD who also have mental health concerns or a behavioral concern. It often utilizes trauma-informed care. The goal is to identify barriers and bridge gaps in services and supports to people we serve. Primary and secondary interventions are intended to reduce emergency calls. Using a positive, person-centered approach, START works to improve current systems of support, both natural and paid. It can also help identify new, appropriate resources.

Typical referrals to START may be individuals who are displaying aggressive behaviors. In the START model, we see aggressive behaviors as a form of communication. When a person is unable to communicate effectively with words, we have to listen to their behavior. When we listen to behaviors, we find that many people we serve are trying to communicate that they are in pain, are depressed or anxious, or are not happy with something. Presenting symptoms may be attributed to IDD/ ASD rather than a mental health component that may stem from trauma. Mental illness does exist in people with IDD/ASD; it just may manifest differently.

People we serve may be more vulnerable to stress and have more limited coping skills. Many have suffered one or more traumatic experiences in their lives. A traumatic event may be a “simple” change in residence. It may be a death in the family. It can be more serious physical or emotional abuse. We must pay attention to signs of trauma exposure. The START model encourages continued education and training in order to serve as a resource to the community.

Since trauma is common to the people we serve, it is important that we understand what trauma looks like. Different approaches may help support a person and their system. It is important to understand that early trauma can physically affect the chemistry of the brain and can affect the cognitive function of an individual. If you combine mental illness with an IDD, the ability to identify and cope with the trauma can be very difficult. When it comes to experiencing trauma, it is important that the entire support system is involved.

START helps in a way that brings the whole system together and shares with the team everything that has been observed and discovered about the individual. Ideally, DSPs are included on this team. The START team works together to make recommendations for services and supports based on client needs. DSPs can play an important role on the team because of their work with the individual. They also play an important role in carrying out intervention and prevention activities determined by the team. The team meets regularly to keep the system communicating effectively. The team can also provide support for the DSP.

The Center for START Services provides technical support, clinical expertise, and training and consultation services that support the development of —

  • Comprehensive evaluation of services and systems of care (local and state)
  • A systems linkage approach to service provision
  • Expert assessment and clinical Support
  • Outcomes-based research and evaluation
  • Short-term therapeutic resources and opportunities
  • Cross systems crisis prevention and intervention planning
  • Family support, education and outreach
  • Interdisciplinary collaboration

By supporting development of the cornerstones of the START model as outlined above, START programs and their participants experience an array of benefits including —

  • Reduced use of emergency services and state facility/hospital stays
  • High rates of satisfaction by families and care recipients
  • Cost-effective service delivery
  • Increased community involvement and crisis expertise in communities
  • Strengthened linkages that enrich systems, increase resources, and fill in service gaps

Resources can be found at The Center for START Services.