Structured risk assessment for reduction of multiple risk outcomes in a secure mental health setting: Use of the START

Abstract

In this small sample, START did not achieve its primary purpose of significant reduction in adverse behaviours. Although our sample size was informed by a power calculation, we may have over-estimated the size of anticipated change. Further, the 3-month comparison periods before and after the assessment follow-up period were rather short. Accordingly, we recommend more research on the value of this tool in practice rather than discontinuing its use. Copyright © 2017 John Wiley & Sons, Ltd.

Short‐term clinical risk assessment and management: Comparing the Brockville Risk Checklist and Hamilton Anatomy of Risk Management

“…Just because the tools inform the treatment teams that someone is at higher risk to act aggressively or self‐harm in the short term does not mean that the teams are actively using the information to implement changes to alleviate that risk. A recent study examined this with the START (Gunenc, O'Shea, & Dickens, 2018) but did not find a significant impact of the tool's scores on subsequent management actions by the treatment team. In these two studies, we can infer that subsequent management strategies were not entirely effective, otherwise we should have seen weaker AUC values across the two samples that reflected the management and prevention of potential aggression for those considered higher risk at time 1.…”

Effects of Implementing the Short-Term Assessment of Risk and Treatability for Mechanical Restraint in a Forensic Male Population: A Stepped-Wedge, Cluster-Randomized Design

“…To our knowledge, the study by Gunenc et al ( 17 ) is the only one that focused on the benefits and outcomes of START in a forensic inpatient setting. They expected to find a reduction in adverse behaviors (physical and verbal aggression, self-harm, victimization, self-neglect, unauthorized leave, and substance abuse); however, they found no significant changes in physical or verbal aggression over time.…”

“…The implementation of START in clinical practice to focus on the patient's strengths and vulnerabilities has been assumed to provide enhanced opportunities to predict and prevent severe violence and self-harm. Scientific reports of using START alone or comparing START with other risk assessment tools in secure mental health settings have been published (11,(15)(16)(17)(18). Previous research has primarily focused on its validation and predictive ability (19,20).…”

Assessing the risk of self-harm: the impact of safety interventions on the predictive validity of risk assessment in secure care

“…The patients' demographic characteristics need also to be considered when exploring the ability of START to accurately predict self-harm. The evidence discussed explored the predictive validity of START in samples that included mostly or exclusively male participants (Abidin et al, 2013;Braithwaite et al, 2010;Dickens and O'Shea, 2015;Gray et al, 2011;Gunenc et al, 2018;Inett et al, 2014;Marriott et al, 2017;O'Shea et al, 2016). However, SPJ tools, such as the HCR-20 and START, are stronger predictors of risk behaviours in women compared to men (O'Shea and O'Shea et al, 2013;O'Shea et al, 2014aO'Shea et al, , 2014b.…”

“…A significant positive association emerged between strength total score and the SRE for self-neglect with strength-based interventions and between vulnerability total score and SRE for unauthorised leave with vulnerability-based interventions. More recently, Gunenc et al (2018) compared the frequency of risk behaviours in the three months before and after START assessment in 50 forensic psychiatric patients to determine whether the START assessment was successfully used to prevent a range of risk behaviours, including self-harm. The findings revealed a trend for fewer violent episodes following the assessment.…”