Short-Term Assessment of Risk and Treatability (START): the case for a new structured professional judgment scheme

Authors

  • Christopher D. Webster Ph.D.,

    Corresponding author
    • Senior Research Consultant/Professor, Forensic Psychiatric Services Commission, British Columbia Mental Health and Addiction Services, University of Toronto/Simon Fraser University, Canada.
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  • Tonia L. Nicholls Ph.D.,

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    • Senior Research Fellow, Forensic Psychiatric Services Commission, British Columbia Mental Health and Addiction Services. Adjunct Professor of Psychology, Simon Fraser University.

  • Mary-Lou Martin R.N., M.Ed., M.Sc.N.,

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    • Clinical Nurse Specialist/Associate Clinical Professor, St. Joseph's Healthcare Hamilton, McMaster University.

  • Sarah L. Desmarais M.A.,

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    • Forensic Psychiatric Services Commission, British Columbia Mental Health and Addiction Services, Simon Fraser University.

  • Johann Brink M.B., Ch.B., F.C.Psych. (S.A.), F.R.C.P.C.

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    • Director of Research/Clinical Associate Professor, Forensic Psychiatric Services Commission, British Columbia Mental Health and Addiction Services, University of British Columbia.


Abstract

The Short-Term Assessment of Risk and Treatability (START) is a new structured professional judgment scheme intended to inform multiple risk domains relevant to everyday psychiatric clinical practice (e.g. risk to others, suicide, self-harm, self-neglect, substance abuse, unauthorized leave, and victimization). The article describes the processes involved in establishing an interdisciplinary approach to risk assessment and management. The authors present a review of the rationale for START, including the value of dynamic variables, the importance of strengths, and the extent to which clinicians must be attentive to multiple risk domains, reflecting theoretical and scientific evidence of the overlap among risks. Using the development, validation, and implementation of START as an example, the authors describe the processes by which other researchers, clinicians, and administrators could adapt existing assessment schemes or create new ones to bridge some remaining gaps in the risk assessment and management continuum. Copyright © 2006 John Wiley & Sons, Ltd.

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