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

Alessandra Girardi (Department of Research and Innovation, St Andrew’s Healthcare, Northampton, UK)
Elanor Lucy Webb (Department of Research and Innovation, St Andrew’s Healthcare, Northampton, UK)
Ashimesh Roychowdhury (St Andrew’s Healthcare, Northampton, UK)

The Journal of Forensic Practice

ISSN: 2050-8794

Article publication date: 2 February 2021

Issue publication date: 25 February 2021

294

Abstract

Purpose

Self-harm is a cause of concern for health-care professionals. The Short-Term Assessment of Risk and Treatability (START) is a short-term assessment instrument used to rate the likelihood of risk behaviours, including self-harm. As result of the assessment, interventions that are implemented to reduce the risk of self-harm may reduce the strength of the predictive validity of a risk assessment tool. The aim of this study was explore the impact of risk management interventions on the capacity of START to predict self-harm. It was predicted that the interventions would weaken the ability of START to predict self-harm in patients who received the intervention.

Design/methodology/approach

Secondary analysis of routinely collected data in a large sample of women in an inpatient secure care setting. Demographic and clinical information, self-harm episodes, safety management interventions and START assessments were extracted and used to build an anonymous database.

Findings

START significantly predicted self-harm in those with and without the safety management intervention. However, the strength of the predictive validity was smaller in those who received the intervention compared to those without.

Practical implications

The results suggest that the implementation of safety management interventions needs to be taken into account when assessing future risk of self-harm.

Originality/value

To the best of the authors’ knowledge, this is the first study to explore the impact of safety management interventions on the predictive validity of START in a large sample of women.

Keywords

Acknowledgements

The authors would like to thank Kristina Brenisin for her support during the initial phases of the database development.The authors declare that there is no conflict of interest.

Citation

Girardi, A., Webb, E.L. and Roychowdhury, A. (2021), "Assessing the risk of self-harm: the impact of safety interventions on the predictive validity of risk assessment in secure care", The Journal of Forensic Practice, Vol. 23 No. 1, pp. 63-74. https://doi.org/10.1108/JFP-10-2020-0043

Publisher

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Emerald Publishing Limited

Copyright © 2021, Emerald Publishing Limited

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