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The Short-Term Assessment of Risk and Treatability (START)

A Prospective Validation Study in a Forensic Psychiatric Sample

British Columbia Mental Health and Addictions; Simon Fraser University, tnicholls{at}forensic.bc.ca

Johann Brink

British Columbia Mental Health and Addictions; University of British Columbia; Simon Fraser University

Sarah L. Desmarais

British Columbia Mental Health and Addictions; Simon Fraser University

Christopher D. Webster

British Columbia Mental Health and Addictions; University of Toronto; Simon Fraser University

Mary-Lou Martin

St. Joseph’s Healthcare Hamilton; McMaster University

A new assessment scheme-the Short-Term Assessment of Risk and Treatability (START)- presents a workable method for assessing risks to self and others encountered in mentally and personality disordered clients. This study aimed to demonstrate (a) prevalence and severity of risk behaviors measured by the START, (b) psychometric properties of START, (c) similarities and differences in START scores across different mental health professionals, and (d) concurrent validity of START with diverse negative outcomes. Treatment team members completed the 20-item, dynamically focused START for 137 forensic psychiatric inpatients. Prevalence and severity of START risk domains were measured for 51 patients detained in the hospital for 1 year. Results revealed high rates of generally low-level adverse events. With some exceptions, START scores were meaningfully associated with outcomes measured by a modified Overt Aggression Scale.

Key Words: forensic assessment • forensic psychiatric patients • structured professional judgment • violence • suicide • self-harm • risk to self and others

Assessment, Vol. 13, No. 3, 313-327 (2006)
DOI: 10.1177/1073191106290559


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