The Role of Client Strengths in Assessments of Violence Risk Using the Short-Term Assessment of Risk and Treatability (START)

Abstract

Despite significant advances in the field of violence risk assessment, we are limited in our understanding regarding the utility of existing measures for predicting violence risk over brief time frames (i.e., weeks to months) as well as by our focus on factors that increase risk to the neglect of those which may reduce risk or protect against future violence. To address these knowledge gaps, this study evaluated the use of a structured professional guide, the Short-Term Assessment of Risk and Treatability (START; Webster, Martin, Brink, Nicholls, & Middleton, 2004), in assessing short-term violence risk (i.e., up to one year) and, specifically, the role of client strengths in this process. Research assistants completed file-based START assessments for four 3-month intervals for 30 male forensic psychiatric inpatients. Information pertaining to aggressive incidents was obtained from files. Overall, results supported the usefulness of the START in assessing short-term violence risk. Assessments evidenced validity in predicting future violence, particularly over the short-term (i.e., up to 9 months). Although ratings of client strengths did not contribute uniquely to the prediction of violence risk, results support their clinical utility in risk management.

Keywords:

• START
• violence risk assessment
• structured professional
• judgment
• short-term risk
• strength/protective factors

Acknowledgments

The views expressed herein are those of the authors and do not necessarily reflect those of any other agency. Sarah L. Desmarais is now at the Florida Mental Health Institute, University of South Florida.

The first and second authors wish to acknowledge the support of the Social Sciences and Humanities Research Council of Canada and the Michael Smith Foundation for Health Research. The third author is a Michael Smith Foundation for Health Research Career Scholar and a Canadian Institutes of Health Research New Investigator. All authors are grateful for the financial support provided by BC Mental Health and Addiction Services.

Notes

¹In Canada, all individuals found Not Criminally Responsible on account of Mental Disorder (NCRMD; i.e., Canada's insanity defence, see Desmarais, Hucker, Brink, & De Freitas, 2008) are under the authority of the Review Board and appear before the Board at least once per year for a review of their progress and legal status.