The Support Team Assisted Response (STAR) program represents an innovative approach to mental health crisis intervention, sending behavioral health clinicians and EMT/paramedics to crisis calls as an alternative to traditional 911 responses. This program addresses mental health crises with a focus on harm reduction and trauma-informed care, providing a more appropriate response for individuals experiencing mental health emergencies. By understanding the principles of trauma-informed care and evidence-based crisis intervention, STAR offers a model for how communities can better support individuals in mental health crisis.
The STAR Program Model
The STAR program was developed to address limitations in traditional 911 systems when responding to mental health crises. Before STAR, Denver's 911 system could only address calls through traditional means like sending police, firefighters, or emergency medical services (EMS). STAR created a fourth option specifically designed for mental health, substance use, and related crises.
When someone calls 911 for a mental health crisis, substance use issue, welfare check, or homelessness, their call can be routed to STAR. The program sends a mobile unit consisting of a behavioral health professional and an EMT/paramedic to provide immediate assistance. This specialized team approach ensures that individuals in crisis receive appropriate clinical care rather than potentially punitive law enforcement responses.
The STAR model recognizes that mental health crises require different approaches than other types of emergencies. By deploying professionals with behavioral health expertise, the program can address the underlying causes of crisis rather than just managing symptoms or containing behaviors.
Trauma-Informed Approach
When the STAR mobile unit arrives, the interaction is grounded in a harm reduction, trauma-informed philosophy. The team, dressed in street clothes rather than uniforms that might trigger associations with law enforcement, provides direct clinical de-escalation and community service connections.
This trauma-informed approach recognizes that individuals in crisis may have experienced trauma in previous interactions with emergency services. By presenting as non-threatening clinicians rather than armed officers, STAR team members can establish rapport more effectively and reduce the potential for re-traumatization.
Key elements of the trauma-informed approach used by STAR include:
- Safety: Creating physical and emotional safety for individuals in crisis
- Trustworthiness: Building trust through consistent, respectful communication
- Peer support: Where appropriate, involving individuals with similar lived experiences
- Collaboration: Working with the individual rather than imposing solutions
- Empowerment: Supporting the individual's autonomy and choice in the process
- Cultural, historical, and gender issues: Recognizing how these factors influence the individual's experience
These elements help create an environment where individuals feel respected and heard, increasing the likelihood of positive outcomes from the crisis intervention.
Evidence-Based Crisis Intervention Techniques
While the source materials don't specify the exact evidence-based techniques used by STAR teams, crisis intervention generally incorporates several established approaches:
- De-escalation: Techniques to reduce immediate agitation and risk
- Active listening: Providing undivided attention and reflecting understanding
- Validation: Acknowledging the individual's feelings and experiences
- Problem-solving: Collaboratively identifying immediate needs and solutions
- Risk assessment: Evaluating the potential for harm to self or others
- Resource connection: Linking individuals with appropriate ongoing support
STAR teams likely employ these evidence-based strategies to help individuals regain emotional regulation and address immediate needs. The presence of both a behavioral health professional and an EMT/paramedic allows for comprehensive assessment and response to both psychological and medical aspects of the crisis.
Harm Reduction Philosophy
The STAR program operates with a harm reduction philosophy, which recognizes that: - Change is a process that occurs over time - Abstinence may not be immediately achievable or desirable for all individuals - Small positive changes can be significant steps toward improved well-being - Judgment-free approaches are more effective than punitive ones
In practice, this means that STAR teams meet individuals where they are, without demanding immediate changes in behavior or lifestyle. Instead, they focus on reducing immediate harm while supporting the individual toward their own goals for improvement.
This approach is particularly valuable for individuals with substance use issues, those experiencing homelessness, or others facing complex challenges where immediate change may not be feasible or appropriate.
Services Provided by STAR Teams
STAR teams provide a range of services designed to address immediate needs and connect individuals with ongoing support:
- Clinical de-escalation: The behavioral health professional uses evidence-based techniques to help the individual regain emotional regulation
- Community service connections: The team links individuals with appropriate resources based on their specific needs
- On-demand resources: STAR provides immediate practical assistance such as water, food, clothing, and basic living supports
- Referrals to wraparound behavioral health services: This includes short-term case management and connections to longer-term care
The combination of immediate practical support and clinical intervention allows STAR teams to address both the acute crisis and underlying needs that may have contributed to the situation.
Benefits of the STAR Model
The STAR program offers several potential benefits for individuals experiencing mental health crises:
- Appropriate response: Mental health crises are addressed by clinicians with specialized training rather than law enforcement
- Reduced hospitalizations: By providing immediate support and connections to services, STAR may help prevent unnecessary emergency room visits
- Trauma-informed care: The approach acknowledges the potential impact of trauma on individuals and avoids re-traumatization
- Harm reduction: The program prioritizes reducing immediate harm while working toward positive long-term outcomes
- Community connection: STAR teams link individuals with ongoing support services rather than addressing only the immediate crisis
Research on similar programs suggests that alternatives to traditional law enforcement responses for mental health crises can lead to: - Improved outcomes for individuals in crisis - Reduced use of emergency services - Better connections to appropriate care - Increased satisfaction with crisis response experiences - Reduced costs for the healthcare system
Program Implementation and Expansion
The STAR program was implemented in Denver as a response to the recognition that traditional emergency services were not always the most appropriate responders to mental health crises. The success of this model has led to interest in similar programs in other communities.
The ultimate measure of success for STAR programs is their ability to resolve crises and connect people with services. This outcome-focused approach contrasts with traditional emergency response models that may prioritize immediate containment over addressing underlying issues.
Implementation considerations for similar programs include: - Developing appropriate referral pathways and protocols - Training staff in trauma-informed care and crisis intervention - Establishing relationships with community service providers - Creating data collection systems to evaluate outcomes - Securing sustainable funding sources
Addressing Systemic Issues
While STAR programs provide valuable crisis response services, they also highlight systemic issues in how communities address mental health and social needs. The existence of such programs suggests recognition that:
- Traditional emergency services are not always the best responders to mental health crises
- Many crises stem from unmet social needs rather than criminal behavior
- A public health approach to crisis response can be more effective than a law enforcement approach -