START NOW for Professionals
START NOW Program for professionals integrates research, theory and clinical experience. Training materials are available to address patient anxiety, stress and depression while encouraging self-empowerment, change and acceptance.
About
START NOW integrates research, theory and clinical experience. It is designed to be a strengths-based approach, focusing on an accepting and collaborative clinical style. At the same time, this approach places the primary responsibility for change on the participant. This intervention was also designed to take into account the pragmatic factors of a variety of care delivery settings, which frequently face limited treatment resources.
Originally developed for correctional environments, it has been adapted for use in other settings that face similar resource constraints and extensive need for effective, reliable, manual-guided treatment for individuals living with impairments of impulse control, emotion regulation and management of interpersonal relationships.
The underlying theme is that, while many of the people to whom we provide care present in different environments at different times in their lives, they have skills deficits that can be addressed wherever they may present.
START NOW incorporates cognitive behavioral therapy, motivational interviewing, neurocognitive modifications, trauma-sensitive care, gender-specific guidance, focusing skills and functional analysis in a highly structured, nonjudgmental approach to skills building.
- All materials are freely available and in the public domain.
- Spanish and French versions are available.
- START NOW is currently used in 26 U.S. states, D.C., and 10 countries.
Structure and Design
- 32 sessions divided into four skill-based units
- Twice weekly for 16 weeks (recommended) or one time per week for 32 weeks
START NOW is designed specifically for psychiatric settings:
- Concepts and language are simplified given potential cognitive or educational limitations
- Numerous images included in the participant workbook—especially useful with TBI or verbally limited participants
- Illustrative examples and coping behaviors are contextually relevant
- Detailed session-by-session facilitator manual includes numerous tips for engaging difficult-to-engage participants: e.g., shaping by reinforcing any movement toward the desired behavioral change
Presentations
Facilitator Training Video
Learn about Carilion Clinic’s START NOW approach to teach skill-building to those with impairments of impulse control, emotion regulation and management of interpersonal relationships. The comprehensive program training is intended for facilitators.
Setting: Correctional
The START NOW Skills program was originally designed for use specifically in correctional facilities to treat offenders with behavioral disorders and associated behavioral problems. It was developed to meet the needs for a situationally and cognitively appropriate broad-ranged, manual-guided treatment for behaviorally disordered offenders. Correctional systems currently find themselves at a challenging crossroads between the trends to downsize prisons and budgets (Patel, 2011) while reducing recidivism rates, and providing effective care for mentally ill offenders once cared for at state mental health facilities. Although the process of deinstitutionalizing individuals with mental illness began in 1955 (Fagin, 1985), this process continues today with an increasing number of these individuals involved with the criminal justice system and no indication of a decline in that trend (Thigpen, 2007). Based on data obtained from the Bureau of Justice Statistics, there are over 320,000 (about 16 percent) mentally ill offenders in the nation’s prisons and jails in need of mental health treatment. The need for mental health treatment among the incarcerated is great; however, treatment resources within correctional settings are often quite limited (Trestman, Appelbaum, Metzner 2015). There is a need for effective and economical therapies to treat incarcerated individuals with significant mental health issues.
There are gender-specific modules for incarcerated men and for women.
Male Correctional Setting - English
Female Correctional Setting - English
Male Correctional Setting - Spanish
Female Correctional Setting - Spanish
Male Correctional Setting - French
Female Correctional Setting - French
Setting: Forensic
In collaboration with the Forensics Executive Committee of the National Association of State Mental Health Program Directors, we adapted START NOW for use in forensic psychiatric hospitals. A separate version of the Participant Workbooks now exists for that purpose, with vignettes specifically adapted for those environments. Most notably, a Mixed Gender Group version was developed for this context.
Given the varied forensic settings, there are separate modules for male-only groups, female-only groups, and mixed gender groups.
Male Forensic Setting - English
Female Forensic Setting - English
Mixed Forensic Setting - English
Male Forensic Setting - Spanish
Female Forensic Setting - Spanish
Mixed Forensic Setting - Spanish
Setting: Community
In 2017 and 2018, work was conducted at Carilion Clinic and the Virginia Tech Carilion School of Medicine to adapt START NOW for use with community populations, notably those in outpatient-based opioid treatment programs. Focus groups were held with participants in a pilot trial of START NOW to optimize this version. A parallel set of Participant Workbooks is available for use in those settings. Given the nature of most ambulatory settings, only one set of Workbooks is provided; gender-specific issues are to be addressed as appropriate by the Facilitators.
Community Setting - English
Community Setting - Spanish
Training and Support Materials
Here you will find materials for Quality Assurance, practice exercises, focusing exercises, satisfaction questionnaires, and suggested ideas for outcome data to be collected for evaluation purposes.
Training and Support Videos - English
Training and Support Materials - English
Training and Support Materials - Spanish
Training and Support Materials - French
Published and Unpublished Work References
Stadler, C., Freitag, C. M., Popma, A., Nauta-Jansen, L., Konrad, K., Unternaehrer, E., Ackermann, K., Bernhard, A., Martinelli, A., Oldenhof, H., Gundlach, M., Kohls, G., Prätzlich, M., Kieser, M., Limprecht, R., Raschle, N. M., Vriends, N., Trestman, R. L., Kirchner, M., & Kersten, L. (2024). START NOW: a cognitive behavioral skills training for adolescent girls with conduct or oppositional defiant disorder - a randomized clinical trial. Journal of child psychology and psychiatry, and allied disciplines, 65(3), 316–327. https://doi.org/10.1111/jcpp.13896
Albert Yi-Que Truong, MDa Anita S. Kablinger, MD, CPIa,b Cheri W. Hartman, PhDa,b David W. Hartman, MDa,b Jennifer L. West, MSc Alexandra L. Hanlon, PhDc Alicia J. Lozano, MSc Robert S. McNamara, PhDb Richard W. Seidel, PhDb Robert L. Trestman, PhD, MDa,b* (2023). Non-inferiority Clinical Trial of Adapted START NOW Psychotherapy for Office-Based Opioid Treatment.
aVirginia Tech Carilion School of Medicine, bCarilion Clinic Psychiatry & Behavioral Medicine, cCenter for Biostatistics and Health Data Science, Virginia Polytechnic Institute and State *Corresponding author
Trestman, R.L. et al. Dr. Robert Trestman – Start Now: An Effective Mental Health Intervention. Scientia 2021; doi: 10.33548/SCIENTIA747. Published online October 20, 2021. https://doi.org/10.33548/SCIENTIA747
Truong, A. Y., Saway, B. F., Bouzaher, M. H., Rasheed, M. N., Monjazeb, S., Everest, S. D., Giampalmo, S. L., Hartman, D., Hartman, C., Kablinger, A. S., & Trestman, R. L. (2021). Systematic content analysis of patient evaluations of START NOW psychotherapy reveals practical strategies for improving the treatment of opioid use disorder. BMC psychiatry, 21(1), 23. https://doi.org/10.1186/s12888-020-03024-x
Kersten, L. (2018). Aggression and Antisocial Behavior in Underserved Populations: Towards a Comprehensive Treatment Approach (Doctoral dissertation, University of Basel). https://edoc.unibas.ch/63964/
Frisman, L. K., Lin, H.J., Rodis, E.T., Grzelak, J., and Aiello, M. (2017). Evaluation of CT's ASIST program: Specialized services to divert higher risk defendants. Behavioral sciences and the law, 35(5-6), 550-561. https://www.ncbi.nlm.nih.gov/pubmed/28881041
Cislo, A., Trestman, R.L. Psychiatric Hospitalization after Participation in START NOW. Letters to the Editor. Psychiatric Services 2016; 67:143; doi: 10.1176/appi.ps.201500456. Published online January 4, 2016. Available at: https://doi.org/10.1176/appi.ps.201500456
Kersten, L., Cislo, A.M., Lynch, M., Shea, K., Le, H., Trestman, R.L. Evaluating START NOW: A Skills-Based Psychotherapy for Inmates with Behavioral Disorders. Psychiatric Services in Advance (doi: 10.1176/appi.ps.201400471). Published online August 17, 2015. https://ps.psychiatryonline.org/doi/abs/10.1176/appi.ps.201400471
Shelton, D., Sampl, S, Kesten, K., Zhang, W., Trestman, R.L. Treatment of Impulsive Aggression in Correctional Settings. Behavioral Sciences and the Law, 27:787-800, 2009. https://www.ncbi.nlm.nih.gov/pubmed/19784944
Sampl, S., Wakai, S., Trestman, R.L., Keeney, E.M. (2008). Functional Analysis of Behavior in Corrections: Empowering Inmates in Skills Training Groups. Journal of Behavioral Analysis of Offender and Victim Treatment and Prevention, 1(4), 42-51. http://psycnet.apa.org/fulltext/2014-55092-004.html
