The predictive validity of clinical ratings of the Short-Term assessment of risk and treatability (START)

Abstract

With the increased need to assess and manage risk in inpatient settings, the Short-Term Assessment of Risk and Treatability (START) was implemented on a civil psychiatric unit. The goal of the present study was to examine the tool's predictive validity when completed by clinical teams as part of routine practice. Data were collected for 34 patients hospitalized for a minimum of 30 days prior to and after a START evaluation. Several challenging behaviors, such as aggression towards others, self-harm, and substance abuse were assessed using the START Outcomes Scale (Nicholls et al., 2007 Nicholls, T. L., Gagnon, N., Crocker, A. G., Brink, J. H., Desmarais, S. L. and Webster, C. D. 2007. START Outcome Scale SOS, Vancouver, , Canada: BC Mental Health & Addiction Services. [Google Scholar] ). Results from multilevel logistic regression and Receiver Operating Characteristics analyses lend partial support for the predictive validity of the START. A limited set of START items combined was significantly better at predicting the challenging behaviors than the original total Strength and Vulnerability scales. Results are discussed in terms of the clinical use of risk assessment.