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Colorado START Coordination Evaluation Report

June 25, 2019


In 2014, the University Center of Excellence on Developmental Disabilities at the University Of Colorado School Of Medicine completed a state-wide study that identified gaps in services for individuals with an intellectual or developmental disability who experience a behavioral health issue and recommended several initiatives to enhance services to these individuals. Consequently, Colorado’s legislature passed House Bill 15-1368, which instructed the Colorado Department of Health Care Policy and Financing (HCPF) to establish the Cross-System Response for Behavioral Health Crises Pilot Project (Pilot) to help address service gaps for individuals who have both an Intellectual or Developmental Disability (I/DD) and a mental health or behavioral health disorder.

The goal of the Pilot program was to provide crisis intervention, stabilization, and follow-up services to these individuals who may require services not available through an existing Home and Community Based Services (HCBS) waiver or covered under the Colorado Capitated or Fee for Service behavioral health care system.

The Pilot

Rocky Mountain Health Plans received the award for the Pilot contract through HCPF. Key contractual partners on Colorado’s Western Slope are STRiVE (service and case management agency in Mesa County) and Mind Springs (the community behavioral health services provider). Partners on the Front Range are Foothills Gateway, Inc., (service and case management agency in Larimer County) and SummitStone Health Partners (SHP), the mental health provider in Larimer County.

The Pilot was active August 2016 – March 2019. START services were implemented within the pilot for a specific caseload January 2018 – June 2019. The active part of the START services was supported by STRiVE and Foothills Gateway, without financial support from the Pilot.

The Pilot’s implementation team selected the START model for implementation because it is designed to meet the needs identified in the gap analysis. The team also wanted an evidence based/informed model that enhanced expertise and linkages across systems to provide effective community-based support and treatment to children and adults with developmental disabilities and behavioral health disorders.

Colorado START is Born

Colorado START (CoSTART) is a lifespan program, supporting children and adults and their support networks. Staff focus on:

  • Conducting a comprehensive assessment;
  • Developing plans to minimize crises;
  • Supporting individuals to build skills; and,
  • Providing support and training for families and support staff, as well as the broader community.

The team responds to immediate crises jointly – along with professionals at the mental health centers. CoSTART spends significant time linking community service systems, such as law enforcement, hospitals, schools, state facilities and other local agencies.

While the program is small with minimal financial resources, STRiVE and Foothills Gateway have a strong commitment to continuing START. Individuals enrolled have experienced many successes in the reduction of crises and in the development of new adaptive skills.

The CoSTART evaluation results demonstrate the following outcomes:
  • The use of emergency services (hospitalizations and ER visits) declined one year post CoSTART enrollment from 31 percent of enrollees to 14 percent;
  • Reports of challenging behaviors also declined one year post CoSTART enrollment.   All enrollees demonstrated statistically significant improvements in functioning one year post enrollment; and,
  • There was a substantial reduction in hospitalizations/emergency department visits during START enrollment. Total savings include:
    • $65,228 for psychiatric/emergency department visits
    • $7,740 in medical hospitalizations/emergency room visits
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