The predictive validity of the short-term assessment of risk and treatability (START) in a secure forensic hospital: risk factors and strengths

There has been an increased interest among researchers and clinicians to understand the violence risk factors that are important in inpatient psychiatric settings, as well as to improve the accuracy of inpatient violence risk assessments. The Short-Term Assessment of Risk and Treatability (START) is a structured violence risk assessment instrument designed to assess multiple risk domains and protective factors that are pertinent to inpatient psychiatric care and treatment. Unlike many structured risk assessment instruments, the START is comprised solely of dynamic factors. Using a sample of 50 inpatients, the present study sought to examine the predictive validity of the START Risk and Strength scales for inpatient aggression in a high-security forensic psychiatric hospital during a 1-month follow-up period. The Risk scale predicted interpersonal violence, verbal threats, and any inpatient aggression, whereas the Strength scale predicted interpersonal violence and any inpatient aggression. The results suggest that short-term inpatient violence risk appraisals using the START are significantly predictive whether risk factors or strengths are considered.