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A prospective validation study of the START:AV

Marilyn A. Sher (Woodlands Consulting and Therapy, Norwich, UK)
Lucy Warner (Adolescent Service, St Andrews Healthcare, Northampton, UK)
Anne McLean (Adolescent Service, St Andrews Healthcare, Northampton, UK)
Katharyn Rowe (Adolescent Service, St Andrews Healthcare, Northampton, UK)
Ernest Gralton (Adolescent Developmental Disabilities, St Andrews Healthcare, Northampton, UK)

The Journal of Forensic Practice

ISSN: 2050-8794

Article publication date: 8 May 2017




The purpose of this paper is to explore the validity and reliability of the Short-Term Assessment of Risk and Treatability: Adolescent Version (START:AV) to determine if it has predictive accuracy in relation to physical aggression, severe verbal aggression, property damage and self-harm, in a medium secure setting. In addition, the authors hoped to provide some of the first descriptive data available for the START:AV among a UK adolescent population in a medium secure adolescent unit.


The sample consisted of 90 female and male adolescents, with and without developmental disabilities. It was important to explore the measure’s predictive accuracy across specific population groups, such as between males and females, as well as those with developmental disabilities, and those without.


Some significant relationships were found between the START:AV and adverse outcomes. For instance, total strength and vulnerability scores were predictive for verbal and physical aggression. Differences in predictive validity were evident when comparisons were made between males and females, with relationships being evident amongst the male population only. When splitting the male sample into developmental disability and non-developmental disability groups, significant relationships were found between strength and vulnerability scores and verbal and physical aggression.

Practical implications

A number of practical implications are considered, such as the START:AV is relevant for use with adolescents in hospital settings and the significant inverse relationship between strength scores and negative outcomes supports the importance of considering protective/strength factors when working with at risk youths.


There is currently limited validation data for the START:AV in the UK or elsewhere.



The authors would like to thank all the clinical staff and service users who supported the pilot and contributed to all the START:AV’s.


Sher, M.A., Warner, L., McLean, A., Rowe, K. and Gralton, E. (2017), "A prospective validation study of the START:AV", The Journal of Forensic Practice, Vol. 19 No. 2, pp. 115-129.



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Copyright © 2017, Emerald Publishing Limited

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