National START team recommends Sedgwick County pilot to improve crisis care for people with intellectual and developmental disabilities

County disability-services staff and consultants from the National Center for START Services on Tuesday told commissioners that START — a 35-year-old evidence-based model for crisis prevention and intervention for people with intellectual and developmental disabilities (IDD) — appears to fit Sedgwick County’s system and could reduce costly emergency and inpatient use for a small group of high-need individuals.

“We made the recommendations back to the community that indeed it looks like the start model is a really, really good fit for, for your community,” Dr. Karen Wiegley, acting director of the National Center for START Services at the University of New Hampshire, said during the briefing. Jeanette Livingston, deputy director of CDDO Services, said the county’s application for state grant dollars to begin a START team will appear on the commission’s agenda next week and added, “We’re not asking for additional county dollars.”

Why it matters: national START evaluations show the model can lower emergency-department visits, psychiatric hospitalizations and arrests for the small subset of people with dual IDD and mental-health diagnoses who disproportionately drive local system costs. County and consultant presenters said that roughly 1% of a typical population can account for a large share of Medicaid spending; Dr. Luke Renard of the START center reported nationally that about 1% of the population can consume roughly 19% of Medicaid resources.

What the evaluation found: consultants said Sedgwick County already provides many services but lacks specialized, consistently available IDD-focused mental-health crisis capacity. The START team model combines a trained multidisciplinary team (including psychiatry and psychology consultation), 24-hour crisis response, outreach and coaching, and an on-demand resource center as a step-down alternative to hospital or jail. The consultants reviewed local data, held stakeholder interviews and produced a written report that staff said will be released publicly shortly.

Costs and potential savings: presenters offered cost comparisons from other START programs. In one example from program data, an individual with repeated ED visits and inpatient admissions generated far higher acute-care costs before START; the START-team cost was described as roughly $12,000 per year for that person in the example, producing multi-year savings relative to repeated hospital and ED use. County presenters said their Medicaid-based analysis showed roughly $5 million in psychotropic medication costs for the Medicaid population in 2023 and that those costs and repeat acute care use are potential areas for savings if the model reduces recidivism.

Next steps and funding: staff said the State of Kansas made $2 million in one-time general-fund awards available statewide to support IDD crisis interventions; Sedgwick County received a portion of that funding for evaluation and planning and will seek commission approval next week for a grant application to implement a START team through an RFP process. Consultants and staff said the likely implementation approach is to procure a vendor that will hire team staff and contract with the National Center for START Services for training and outcomes tracking; the vendor would then bill Medicaid and other streams as the program scales.

Questions and community coordination: commissioners asked about sustainability, overlap with Comcare and the county’s CDDO network, the prospect of a local resource center or step-down facility, and the state’s role. Staff said managed-care organizations and state officials have been contacted and that Parsons State Hospital’s capacity issues highlight the need for community alternatives. No vote to create a START team was recorded at the meeting; staff described the current item as a planning step and an upcoming agenda item for grant approval.