START Assessment Tool

Short-Term Assessment of Risk and Treatability (START)

[To order the START manual, download the pdf order form here.
  For a printable START Summary Sheet, download the pdf here.]

Physicians, nurses, social workers and other front-line health care providers are routinely called upon to assess the risk for violent behaviour in hospital as well as in community-based patients. In this capacity, they are required to make decisions and provide recommendations regarding the admission, transfer, discharge, and management of persons who may pose a risk of violence to self or others.

This remains a challenging task, with divergent approaches and instruments available.
Traditional approaches have focused largely on individual risk factors while neglecting to consider clients’ strengths or external/environmental triggers. These approaches have been concerned mainly with long-term risk to others.

The Short-Term Assessment of Risk and Treatability (START; Webster, Martin, Brink, Nicholls, & Desmaris, 2009) is a 20-item clinical guide for the dynamic assessment of seven risk domains (violence to others, suicide, self-harm, self-neglect, unauthorized absence, substance use, and victimization). The START represents a refinement in the assessment of dynamic risk factors in that it provides for the differential coding of both patient strengths and needs, while allowing for the recording of case-specific risk factors. The START is meant for interdisciplinary use and each of the 20 items is assessed according to succinct descriptions provided in the published manual.

The START is intended for use with adults with mental, personality and substance related disorders. It is relevant to inpatient and community psychiatric, forensic, and correctional populations.

The START manual is available for purchase from BC Mental Health & Addiction Services, for C$40 plus shipping. Download the order form here.