The Predictive Validity of the Short-Term Assessment of Risk and Treatability (START) for Multiple Adverse Outcomes in a Secure Psychiatric Inpatient Setting.
The Short-Term Assessment of Risk and Treatability (START) aims to assist mental health practitioners to estimate an individual's short-term risk for a range of adverse outcomes via structured consideration of their risk ("Vulnerabilities") and protective factors ("Strengths") in 20 areas. It has demonstrated predictive validity for aggression but this is less established for other outcomes. We collated START assessments for N = 200 adults in a secure mental health hospital and ascertained 3-month risk event incidence using the START Outcomes Scale. The specific risk estimates, which are the tool developers' suggested method of overall assessment, predicted aggression, self-harm/suicidality, and victimization, and had incremental validity over the Strength and Vulnerability scales for these outcomes. The Strength scale had incremental validity over the Vulnerability scale for aggressive outcomes; therefore, consideration of protective factors had demonstrable value in their prediction. Further evidence is required to support use of the START for the full range of outcomes it aims to predict.
St Andrew's Academic Department, Northampton, UK King's College London Institute of Psychiatry, Psychology & Neuroscience, London, UK.
Laura E
LE
O'Shea
St Andrew's Academic Department, Northampton, UK King's College London Institute of Psychiatry, Psychology & Neuroscience, London, UK.
Marco M
MM
Picchioni
St Andrew's Academic Department, Northampton, UK Abertay University, Dundee, UK g.dickens@abertay.ac.uk.
Geoffrey L
GL
Dickens
D000328:Adult; D000374:Aggression / Q000523:psychology*; D000987:Antisocial Personality Disorder / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D015331:Cohort Studies; D003134:Commitment of Persons with Psychiatric Disorders; D019548:Crime Victims / Q000523:psychology*; D005260:Female; D006778:Hospitals, Psychiatric; D006801:Humans; D008297:Male; D008875:Middle Aged; D010552:Personality Assessment / Q000706:statistics & numerical data*; D011446:Prospective Studies; D065840:Protective Factors; D011594:Psychometrics / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000706:statistics & numerical data*; D012309:Risk-Taking; D016728:Self-Injurious Behavior / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D013405:Suicide / Q000523:psychology*; D016896:Treatment Outcome; D055815:Young Adult; D000092864:Suicide Prevention
START; aggression/violence; protective factors; risk assessment; self-harm; self-neglect; vulnerability