START NOW: Setting Workbooks & Facilitator Manual
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 Population Unit 1 - Correctional Setting Male Population Unit 2 - Correctional Setting Male Population Unit 3 - Correctional Setting Male Population Unit 4 - Correctional Setting Female Population Unit 1 - Correctional Setting Female Population Unit 2 - Correctional Setting Female Population Unit 3 - Correctional Setting Female Population Unit 4 - Correctional Setting
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 Population Unit 1 - Forensic Setting Male Population Unit 2 - Forensic Setting Male Population Unit 3 - Forensic Setting Male Population Unit 4 - Forensic Setting Female Population Unit 1 - Forensic Setting Female Population Unit 2 - Forensic Setting Female Population Unit 3 - Forensic Setting Female Population Unit 4 - Forensic Setting Mixed Population Unit 1 - Forensic Setting Mixed Population Unit 2 - Forensic Setting Mixed Population Unit 3 - Forensic Setting Mixed Population Unit 4 - Forensic Setting
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.
Facilitator Manual
The purpose of this Facilitator Manual is to provide a theoretical and practical background to START NOW and to present detailed “lesson plans” for each START NOW session. The intent is to support efficient implementation and sustainability utilizing (typically) masters-prepared clinicians as group facilitators.
