Single-item predictive validity of the Short-Term Assessment of Risk and Treatability (START) for violent behaviour in outpatient forensic psychiatry

Abstract

The single-item predictive validity of the Short-Term Assessment of Risk and Treatability (START) has not been thoroughly investigated, although this has great clinical relevance for the selection of treatment targets. Furthermore, it remains unclear whether the characteristic START additions of scoring strengths next to vulnerabilities and selecting key items, add incremental predictive validity. Finally, predictive validity has primarily been studied in inpatient settings and included mainly patients with a psychotic disorder. We analysed data from a mixed diagnostic sample of 195 forensic psychiatric outpatients with a 3-month and 170 patients with a 6-month follow-up period, using logistic regression analysis. The occurrence of violent or criminal behaviour was established based on the case manager's recordings in the patient's file. Only 5 of the 20 START items were found to have predictive validity: Impulse Control, Attitudes, Material Resources, Rule Adherence and Conduct. The last three were the only items for which incremental predictive validity was found with respect to scoring it as a strength and a vulnerability. Selection of key items did not add to the predictive validity. While possibly having therapeutic significance, the scoring of strength next to vulnerability and the selection of key items, may not be beneficial for risk assessment.

Unidimensionality of the Strengths and Vulnerabilities Scales in the Short-Term Assessment of Risk and Treatability (START)

“…Most studies of predictive validity test the association of the total scores on the two START scales with violent outcomes but some more concise variations of the START have also been tested in this way including the accuracy of individual items (O'Shea & Dickens, 2015;Paetsch et al, 2019). In particular, Braithwaite et al (2010) examined the predictive validity of the overall START (all twenty items) and compared this overall predictive validity with that for various shortened "optimized scales" related to violence and the other outcomes.…”

Testing the Reliability and Construct Validity of Short-Term Assessment of Risk and Treatability (START) in Non-Western Forensic Psychiatric Inpatients

“…This outcomes (Paetsch et al, 2019). It is also of note that this may uniquely reflect the perceptions of the Thai mental health professionals.…”

“…The significant structural relationships between two START subscales may suggest a construct validity (Atkinson et al, 2011;Tavakol & Wetzel, 2020), which it has so far not been considered and examined. Several researchers and clinicians have supported the increment validity of the START for incorporating the strength subscale into the risk assessment framework (Braithwaite et al, 2010;Desmarais et al, 2012;O'Shea, Picchioni, & Dickens, 2016;Paetsch, van Os, Troquete, & van den Brink, 2019). The concept of incorporating the protective factor or the START strength subscale is debated at a fundamental level in terms of whether it is a unique entity or is simply the reverse of a risk factor or START vulnerability subscale (Haines et al, 2018).…”

Assessing the Alignment of Short‐Term Assessment of Risk and Treatability (START) with NANDA‐I Taxonomy in Forensic Care Settings

“…Furthermore, Kikuchi et al [16] found START being a feasible and valid tool that allows staf to plan treatment and promote the recovery of forensic patients. Te predictive validity of START varies considerably; for instance, Paetsch [17] revealed that only fve of the START items had predictive validity for the occurrence of violence in the following six months. Terefore, the potential limitations of START in capturing the full range of outcomes should be carefully considered, and it should not be solely relied upon.…”