A Clinical and Risk Profile of Forensic Psychiatric Patients: Treatment Team STARTs in a Canadian Service

Abstract

Current best practice guidelines recommend clinicians consider clients’ strengths as well as their deficits (APA, 2006; Department of Health, 2007). The Short-Term Assessment of Risk and Treatability (START) is one of the few structured professional judgment (SPJ) measures that facilitate this balanced approach to assessment and treatment planning. START is a concise clinical guide for the assessment and management of seven short-term (i.e., weeks to months) risk estimates (violence, self-harm, suicide, substance abuse, unauthorized leave, self-neglect, and being victimized) that occur at elevated rates in populations of individuals living with mental illness and personality disorders. Research on START has focused to some extent on assessments completed by research assistants. This study examined the implementation of START into a large forensic psychiatric service and reports on the psychometric properties of the measure when completed by multidisciplinary treatment teams. All START forms completed over a one-year period were evaluated (N= 1057). Results indicate good structural reliability and excellent dispersion across the items, scales, and risk estimates. Few differences were noted by patient gender. Signature risk signs were much more common than expected (27%). It is notable that few patients were determined to be high risk on any of the seven risk estimates, with the exception of substance abuse. Overall, the results provide preliminary evidence for the success of the implementation and the value of the START for informing needs and treatment planning in forensic services.