Short-to medium-term risk assessment in psychiatric hospitals is a topic of clinical relevance that deserves attention from the research community. In this paper, the Short Term Assessment of Risk and Treatability, or START (Webster, Martin, Brink, Nicholls, & Middleton, 2004), a new structured instrument for judgment of dynamic risk and treatment factors is briefly described. Internal reliability properties are analyzed and the predictive validity for severe violence in a Norwegian high secure psychiatric hospital is investigated. The results indicate that the START has promise as a valid tool for short-term violence risk assessment. The authors make an argument for the importance and relevance of dynamic risk and strength factors in the short to medium term.

Our objective was to describe and analyze the implementation process of the Short Term Assessment of Risk and Treatability in a forensic high secure unit in Norway. A stepwise implementation procedure was used and an educational package on practical use of the START in the clinic was developed. A questionnaire about START was given to the staff at the end of the first implementation phase and semi-structured qualitative interviews with staff on the content of security decision processes were carried out. Also, a log of the actual number of completed START scorings was made, including the number of ratings and the regularity of these ratings finished within this time frame. After six months' implementation the questionnaire showed that 74% of the staff agreed that the evaluations made on the basis of START were interdisciplinary. Seventy-three percent also agreed that START contributed significantly to a more systematic risk assessment and management, and 79% said the START was useful as a tool in risk assessments and treatment planning. Informants from the interview study described how the START structured their clinical judgement. At the same time, the START fulfilled their wish to address both the patients' strengths and risks. The START continued to be in regular use after the more intensive implementation process.Our results indicate that the implementation of START had led to interdisciplinary security decisions with a broader perspective of the patients' situation.

BackgroundOver the last decade, the Short-Term Assessment of Risk and Treatability (START) has provided a strong evidence base to predict a range of problem behaviors. The implementation of START and adaptation of the services to the use of START have so far been sparsely described in the literature. The purpose of this study was to describe the continuation and the interdisciplinarity of risk assessments through the two phases.MethodsOver a period of 10 years, the forensic mental health services at Brøset has implemented START in two phases: initially with implementing the instrument (2005–2009) and secondarily by customizing the instrument to everyday treatment and planning (since 2009). This implementation was based on data from 887 START assessments for 181 patients over a decade (2005–2015).ResultsThe results showed that the number of START assessments has been stable throughout the past 10 years and the interval between the ratings has decreased significantly (p<0.05). The involvement by diversity of professionals has increased significantly over the two implementation phases.ConclusionThis study also addressed the continuity and organization of the implementation process and presented an overview of how START has been widespread in the service through treatment. The results showed an increased multidisciplinary participation and a continuing rate of assessments as the implementation progressed from assessment to a combined assessment–treatment phase.