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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.

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.

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.

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

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.

The purpose of this paper is to provide wider research evidence for the use of the Short Dynamic Risk Scale (SDRS) in risk management with individuals who have an Intellectual Disability (ID) and reside in a secure psychiatric inpatient setting. The outcomes are supportive of previous research, showing that outcomes on the SDRS are related to maladaptive behaviours recorded for individual with ID.

All participant data taken from the hospital healthcare reporting system were entered into a PASW database. The ratings for each of the SDRS and Short-Term Assessment of Risk and Treatability (START) items were entered and totalled, with a separate total score for the SDRS with the additional three items. In order to capture the behavioural monitoring data, average severities weightings of each of the Overt Aggression Scale-modified for neuro-rehabilitation (OAS-MNR) categories for the three weeks following completion of the individual’s SDRS were calculated and recorded. In addition, average severity weightings reflecting the presence of sexualised behaviour (St Andrew’s Sexual Behaviour Assessment (SASBA) in the subsequent three weeks following SDRS completion was included. Using the most recent START assessment completed allowed for analysis of the predictive ability of the START of the same behavioural data.

A series of Spearman’s correlations were run to determine the relationship between outcomes on the SDRS and engagement in risk behaviours as rated by the OAS-MNR scales. There was a moderate positive correlation between all 11-items of the SDRS and OAS-MNR recordings. A series of Spearman’s correlations were conducted to determine the relationship between outcomes on the START Vulnerability items and engagement in risk behaviours as rated by the OAS-MNR scales. There was a weak negative correlation between all individual START vulnerability item ratings and OAS-MNR recordings.

The current pilot study provides wider research evidence for the use of the SDRS in risk management with individuals who have an ID and reside in a secure psychiatric inpatient setting.

This paper compares outcomes on the START and SDRS in relation to an individual’s risk recordings to support identification of whether either have practical and clinical utility. To the authors’ knowledge, this has not been completed before.

Offenders with intellectual disability (ID) have been largely neglected in past forensic literature on assessment of dynamic risk factors. The purpose of this paper is to evaluate the predictive validity of the Short-Term Assessment of Risk and Treatability (START), in a sample of males with IDs in a low-secure hospital (n=28).

A prospective analysis was conducted, with START scores as the predictor variables, and the number of recorded aversive incidents as the outcome measure.

Receiver operating characteristic analysis demonstrated that total START risk scores had a significant high predictive accuracy for incidents of physical aggression to others (area under the curve (AUC)=0.710, p<0.001) and property damage/theft (AUC=0.730, p<0.001), over a 30-day period, reducing to medium predictive validity over a 90-day period. Medium predictive validity was also identified for incidents of verbal aggression, suicide, self-harm, and stalking and intimidation. START strength scores were also predictive of overt aggression (AUC=0.716), possible reasons for this are explored.

The small sample size limits the generalisability of the findings, and further research is required.

The paper offers preliminary support for the use of the START with ID offenders in low-secure settings. Given the lack of validation of any previous dynamic risk assessment tools, multi-disciplinary teams in such settings now have the option to use a tool which has potentially good validity with an ID population.

This study represents the first attempt to examine the predictive validity of the START with ID offenders, and a step forward in the understanding of dynamic risk factors for violence in this population. The significant predictive relationship with incidents of physical aggression and property damage offers clinicians a preliminary evidence base supporting its use in low-secure settings.

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.

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 purpose of this paper is to develop a psychological outcome tool which reflects the relationship between clusters of items on the Short Term Assessment of Risk and Treatability (START) risk assessment and different categories of psychological progress in male inpatient psychiatric services.

A principal component analysis (PCA) was conducted on data from 135 male psychiatric rehabilitation patients’ START risk assessments.

PCA identified four strength psychology quadrants which were explained by a five-factor structure and four vulnerability quadrants which were explained by a four-factor structure. The development of the psychology quadrant, its usefulness in establishing a treatment pathway and areas of future research are also discussed.

Developing accessible, transparent outcome measures using evidence-based practice is highly relevant within the field of mental health rehabilitation.

The PCL‐R has been heralded as the ‘unparalleled’ (Salekin et al, 1996) risk assessment tool for assessing risk of violent and non‐violent recidivism. In the UK, the PCL‐R looks likely to become an industry standard assessment in psychological evaluation of individuals thought to have a dangerous and severe personality disorder. However, current knowledge about the PCL‐R is unsatisfactory, and a number of issues need to be addressed before clinicians can be confident in the use of this measure. This paper highlights these issues from the perspective of the practising clinician. Questions are raised about the theoretical, methodological and treatment implications of the use of the PCL‐R. Future research needs are established in this context of caution over the use of the measure in routine clinical and academic assessment.

The purpose of this study was to explore the predictive validity of the revised Problem Identification Checklist (PIC‐R) in predicting inpatient and community violence using a retrospective design. The Historical Scale (H‐Scale) of the HCR‐20 was employed to control for static risk factors. The predictive accuracy between predictors and outcome measures was evaluated using Receiver Operating Characteristics (ROC) analysis. The PIC‐R significantly predicted inpatient violence (AUC range 0.77‐0.92) over a 12‐month follow‐up period but did not predict community violence. Conversely, the H‐Scale significantly predicted community violence (AUC 0.82) but did not predict inpatient violence over a 12‐month follow‐up period. The findings offer preliminary validation for the predictive accuracy of the PIC‐R for violence in a UK inpatient population. Additionally, the findings suggest that short‐term risk of violence within a psychiatric inpatient population may be more related to dynamic and clinical risk variables rather than to static ones.

The purpose of this paper is to explore the violence risk assessment practices in Israel by social workers, clinical criminologists, and marriage and family therapists using a Web-based survey.

A Web-based survey and participation letter were translated into Hebrew and distributed to members of the Israel Association of Social Workers, the Israel Society of Clinical Criminology and the Israel Association for Marital and Family Therapy following the Dillman Total Design Survey Method.

The sample was composed of 34 professionals, who reported using structured instruments to predict and manage the likelihood of violence in over half of their risk assessments over both their lifetime and the past 12 months. Younger female respondents who entered their profession more recently were more likely to use instruments during the risk assessment process. There appeared to be a trend toward decreased use of actuarial instruments and increased use in structured professional judgment instruments.

The first national survey of violence risk assessment practices by behavioral healthcare professionals in Israel was conducted. This study revealed the risk assessment utility trends in Israel, finding that compared to professionals in North America, South America, Europe, East Asia and Australia, professionals in Israel conducted fewer risk assessments and used structured instruments less often, highlighting concern about the lack of reliance on evidence-based techniques in the country.

The purpose of this paper is to establish gaps in training, involve staff in the implementation process by incorporating their views on what is helpful and what can be improved, as well as provide information that might be helpful to other sites who are considering implementing the START:AV.

The current study is the first to examine a START:AV implementation and survey a multi-disciplinary team on their views about implementation in a medium secure service for adolescents in the UK. The survey was adapted from the one used by Collins et al. (2008). Once surveys were received the qualitative information was collated to explore themes, and frequency analysis was undertaken on the quantitative information.

The staff survey on the implementation of the START:AV highlighted a number of strengths and challenges. There was significant support for the START:AV in relation to it being a dynamic assessment to measure change, that focuses equally on strengths and vulnerabilities, making the process individualised. Users of the START:AV reported that the process of rating the START:AV as a team improved communication, teamwork, generated discussion and improved the detailed understanding of the patient being rated. Staff felt it was generally straightforward to use in terms of strengths and vulnerability ratings, but some difficulties emerged regarding making finer distinctions in ratings as well as completing risk formulations, highlighting further training needs. There was also some confusion about differentiating between certain strengths and vulnerabilities, leading to “double ratings”. Other difficulties highlighted centred on time and increasing workload.

The main limitation of the study relates to the low response rate to the survey (31 per cent).

Recommendations for implementation and evaluation of new risk assessment procedures are made.

The current study is the first to examine a START:AV implementation and survey a multi-disciplinary team on their views about implementation in a medium secure service for adolescents in the UK.

This paper aims to describe the issues in risk assessment and management of autism spectrum disorders in secure hospital settings with reference to best practice guidance.

The author undertook a review of the current literature on risk management in autism spectrum disorders and has drawn on clinical experience to highlight key issues.

Risk assessment and management needs to be tailored to individuals. Characteristics of offences differ compared to other mental disorders. Underlying factors for offending differ from other mental disorders and may be misinterpreted.

Risk assessment in autism spectrum disorders should take into account individual characteristics and be informed by specialist assessments. Management should be based on a formulation informed by assessments and by recognising individual characteristics.

The paper highlights important issues in risk assessment and management of patients with autism spectrum disorders particularly in secure hospital settings.