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The Leadership Institute: How it Works and the SART System

How Does The Leadership Institute Work and What Is SART?


The Leadership Institute works by establishing two SART processes. SART is an acronym for screening, assessment, referral, and treatment.  There two SART processes – one for preventing perinatal substance exposure (Perinatal SART) and one for providing early intervention services to high-risk children (Children’s SART) share the acronym but are quite different.

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Perinatal SART

Screen: Screen all pregnant women for substance use. Screening asks the question, “Who might be using alcohol, tobacco, or other drugs?” Largely, early identification of pregnant women at risk from substance use is accomplished by making screening a fixed part of primary prenatal care.

Assess: Those women who screen positive are given a field assessment to determine if they are in fact using alcohol, tobacco, or other drugs. An assessment asks, “Who is using?”

Refer: Those women who are determined to be using substances are referred for a full assessment and appropriate treatment.

Treatment: Those women who are referred to treatment receive quality, fender-specific treatment that is appropriate for their circumstances.

Children’s SART

Screen: Screen all children ages 0-5 using the Ages and Stages Questionnaire (ASQ) and the Ages and Stages Questionnaire: Social/Emotional (ASQ:SE). This process often begins with the children in foster care but widens to include the entire community.

Assess: Those children who screen positive are given a full assessment at a Children’s Center. The report from this assessment guides treatment.

Refer: The family of those children who require treatment will be assisted by a Family Resource Specialist to ensure that no child falls through the gap between assessment and treatment.

Treatment: The children receiving treatment are followed up through the Children’s Center to ensure the key treatment and evaluation question is answered – Are the children getting better? In communities with limited treatment resources, the process will include efforts to build treatment capacity.

How is a Perinatal SART©  Established?
Establishing a Perinatal SART© process involves several stages that unfold over a period of approximately 18 months, though, obviously, there is considerable variability among the communities with regard to how quickly they implement the process.  Every effort begins with a vision.  Here is a typical vision for the implementation of a Perinatal SART© process:

In Butte County, every baby will be born free of the effects of alcohol, tobacco, and drug exposure.  We will educate and unify the community to establish a comprehensive, effective program of screening, assessment, referral and treatment for at-risk women and children.

That is a vision of the end state – a SART process fully implemented.  How to get there? The development and implementation of a Perinatal SART© process occurs in six stages.

I.              Building Awareness and Resolve

II.             Leadership Team Formation and Preparation

III.            Leadership Institute – Initial Planning

IV.            Building Community Support

V.             Formal Plan Development

VI.            Full Implementation

How is a Children’s SART Established?                                                        

The road leading to a SART process for high-risk children proceeds through four stages:

I.  Design
II.  Implementation Planning
III. Start-Up of the Children’s Center
IV. Technical Assistance  - Clinical and Organizational

Here is how two communities expressed their aspirations for their Children’s SART© process:

San Bernardino County is committed to providing all high-risk children the services and support they need to reach their full potential.  We agree to do this in a collaborative spirit, respecting the county’s diversity and the challenges inherent in the geography of our community. 

The community of San Luis Obispo County is dedicated to ensuring that all children will:

  • receive any interventions, treatment and support they may need to reach their highest level of growth and development;

  • live safely in their homes, succeed in school, and have meaningful friendships: and,

  • Grow up to be healthy, strong, and resilient citizens of our community.

If that is what a community hopes to accomplish here, briefly, is how.

Design
The design phase begins with a 3 ½ day planning session – The Leadership Institute very much in the style of the Leadership Institute which helps begin the process for developing a Perinatal SART© process. The design process of discussion, analysis and writing ultimately produces a document which describes a model of care for young children most often children between the ages of zero and five.

Implementation Planning: The Children’s Center
The design phase provides all the basic concepts and leads to implementation planning which addresses the specifics of how screening, assessment, referral and treatment will be provided.  Each of these aspects of the Children’s SART process requires careful planning but the assessment function is of particular importance.

The development of a Children’s Center to house a transdisciplinary team is no small undertaking both organizationally and financially.  Some communities because of their geographic size of required the development of more than one Children’s Center.  Some communities have a wealth of clinical talent and staffing the Children’s Center is a matter of choosing the best and other communities may struggle to find competent professionals interested in joining the effort.  The Children’s Center must be financially sustainable in this part of the planning receives particularly close attention.

Start-Up of the Children’s Center
The clinical staff of the Children’s Center participates in a Clinical Institute offered in partnership with the Children’s Research Triangle in Chicago.  The Clinical Institute is a four-day hands-on experience beginning in Chicago where the staff of the Children’s Center work side-by-side with experienced professionals at the Children’s Research Triangle. Shortly thereafter members of the Children’s Research Triangle visit the newly developed Children’s Center to coach the staff as they work with their first patients.

We strongly recommend a controlled startup phase during which time the number of children seen by the staff of the Children’s Center is intentionally kept low to ensure that the clinical and administrative processes function properly. 

Technical Assistance - Clinical and Organizational
During the first few months clinical and organizational technical assistance is made available on an as needed basis.  Experience has taught that more rather than less technical assistance is needed. The Children’s Center represents a significant investment for the community and going the extra mile to insurer its proper functioning as proved to be a wise choice.