Individuals with intellectual disability (ID) experience high rates of psychiatric disorders, and coinciding high rates of emergency service use. The current study seeks to explore strategies to improve outcomes by reporting a one-year prospective investigation among 41 individuals (Mean age = 32 years, SD = 12) with ID and mental health needs who received specialized supports from the I-START program (Iowa Systemic, Therapeutic, Assessment, Resources and Treatment) operating in a rural region of Iowa. To supplement these data, a qualitative case study details the application of the START model. Results indicate that individuals supported by the I-START program experienced significant reductions in informant-reported problem behaviors and fewer psychiatric emergency department visits and hospitalizations over time. Findings illustrate the benefits of START in improving outcomes for individuals with ID and mental needs as well as their systems of support.