North Carolina Systemic, Therapeutic, Assessment, Resources and Treatment (NC START)

North Carolina Systemic, Therapeutic, Assessment, Resources and Treatment (NC START) is a statewide community crisis prevention and intervention program for individuals age six and above with intellectual/developmental disability and co-occurring complex behavioral and/or mental health needs. START crisis prevention and intervention services are provided through clinical systemic consultation, training, education, therapeutic respite, crisis response and therapeutic couching. The model works to improve the lives of the individuals served and their families by providing services and supports using a person-centered, positive, multidisciplinary, cost-effective, systemic, and evidence-informed approach.

The START program model was implemented in 1988 by Dr. Joan Beasley and her team. The initiative originated in the Center for START Services at the Institute on Disability/UCED at the University of New Hampshire. In 2016 the START model was identified as best practice by the National Academy of Sciences Institute of Medicine.

START was implemented in NC as a statewide program, throughout all 100 counties. There are three NC START teams - one team for each region of the state:
NC START West Asheville Kannapolis/Concord: 888-974-2937; Referrals: 888-974-2937
NC START Central Durham: 919-865-8730, 800-662-7119 x8730; Referrals: 919-865-8730
NC START East New Bern Wilmington: 888-962-3782; Referrals: 888-962-3782

Click here to view the NC START Overview by Dr. Jill Hinton - (Video, External link).

NC START is intended to be a short-term service, lasting from 12 to 18 months depending on support needs of the individual. NC START services are available to individuals meeting the following criteria:

• Documented IDD or TBI diagnosis prior to age 22
• Co-occurring Mental health diagnosis and/or complex behavioral needs

NC START does not serve individuals with an active substance use disorder.

NC START provides services through state funding and Innovation’s waiver services. Innovation’s waiver services provided by NC START are Crisis respite and Therapeutic consultative services.

NC START Services components include:

• NC START Coordinator
• Resource Center crisis and planned respite (Respite is provided to active NC START members only, age 18 and up)
• Consultation
• Training and outreach
• Therapeutic Coaching (adult and child)

Once an individual receiving NC START Services is determined to be stable, services with NC START will be inactivated. Other reasons an individual may be inactivated are loss of contact (NC START is not able to engage with the individual or family); services are declined; long term hospitalization; move to another state; or the person receiving services is deceased. An individual that has been inactivated can return to NC START for services if needed. Reactivation can occur if the individual experiences a significant loss in stability and the request is received within three years or less after inactivation. For individuals who have been inactive with NC START for more over three years will be processed as a new referral.

Resource Centers

NC START Resource Centers are community based therapeutic programs that support active NC START participants ages 18 and older. Each START team has one Resource Center to provide therapeutic crisis respite and crisis prevention respite to eligible adults receiving NC START services. Each Resource Center has four beds: two planned respite beds and two crisis respite beds. Planned therapeutic respite is available in the Resource Centers for eligible adults living in unlicensed residential settings and receiving START services. Crisis therapeutic respite is available in the Resource Centers when clinically indicated for individuals receiving START services.
**NC START is not a respite provider and does not provided services to individuals needing respite only.

START Services for Children

NC START services are available to children ages six through twenty. Children eligible for NC START services can receive Therapeutic Coaching - a short-term service intended to enhance other services by working with them to support the individual. Coaching is provided in both a planned and crisis capacity. Therapeutic Coaches provides mentoring, observation, assessment, and support in the child’s home. Therapeutic Coaching does not take the place of any other service, but works in conjunction with other services to support the individual, and to identify strengths and vulnerabilities of a support system, while working alongside individuals, families, and care providers to promote growth and overall wellbeing. 

Making a Referral

Referrals to NC START can be made by anyone who knows to the individual, with an understanding of the individual’s status, treatment, support and behavioral history, and consent for referral.

Referrals for adults can be made at any time to the appropriate NC START team using the contact information listed above.

Referrals for children not experiencing a crisis at the time of referral should be made to the LME-MCO during regular business hours for NC START Central and West teams. For NC START East contact the team referral line.

After business hours for children in crisis, contact the LME-MCO crisis line for referrals to NC START Central and West teams. For NC START East contact the team crisis referral line.                       

Click here LME-MCO contact information.