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Short-Term Assessment of Risk and Treatability (START)

Physicians, nurses, social workers and other direct care staff are routinely called up to assess the risk for violent behaviour in hospital, as well as in community-based patients.  In this capacity, they are required to make decisions and provide recommendations regarding the admission, discharge and management of persons who may pose a risk of violence to self or others.  This remains a challenging task, with divergent approaches and instruments available to assist with these decisions.  Traditional approaches in 'risk assessment' have focused largely on long-term, individual risk factors while neglecting to consider clients' strengths or external/environmental triggers.  The START represents a refinement in risk assessment by ensuring a more balanced consideration of the patient in that it provides for the differential coding of both patient strengths and needs, while allowing for the recording of case specific risk factors.

The START is a concise clinical guide for the dynamic assessment of short-term (i.e. weeks to months) risk for violence (to self and others) and treatability.  

START guides clinicans toward an integrated, balanced opinion to evaluate the patient's risk across seven domains:

This structured professional guide is intended to inform clinical interventions and assist in treatment and risk management plans.  The START, utilized in conjunction with other assessment and observation tools, provides a means to gain a more balanced and contextualized understanding of a patient's recent level of functioning, as well as historical and dynamic factors related to risk and treatment needs.

The START is intended for interdisciplinary use, and each of the 20 items is assessed according to succinct descriptions provided in the published manual.  START Manuals are available for purchase through BC Mental Health and Substance Use Services, using the link above.

The START was developed for use with adults with mental, personality and substance related disorders, and is expected to have relevance to correctional, civil, and forensic patients in the community or institutional settings.  The START is the result of collaboration between diverse professions and has been implemented in numerous hospitals, correctional settings, and out-patient care facilities around the world.  It has been translated into 8 languages, with additional translations currently underway.  As of January 2016, over 5,200 START manuals have been sold to civil psychiatric, forensic psychiatric and correctional organizations around the world, and has been incorporated into clinical practice and large-scale research programs in fifteen countries (i.e. Sweden, Australia, Ireland, etc.).  To date, well over 1,500 mental health professionals have been trained by the START authors, through workshops held around the world.

The START Manual can be purchased through BC Mental Health and Substance Use Services for $60.00 CAD plus delivery charges here

The START Summary Sheet is available here

For information about START training, please click here

For more information regarding START training, materials, and research, please contact us at start@forensic.bc.ca

To see a list of current START publications, please click here

Webster, C. D., Martin, M. L., Brink, J., Nicholls, T. L., & Desmarais, S. (2009). Manual for the Short-Term Assessment of Risk and Treatability (START) (Version 1.1). Port Coquitlam, BC: Forensic Psychiatric Services Commission and St. Joseph’s Healthcare.