Risk Assessment: START Manuals
The Short-Term Assessment of Risk and Treatability (or START) is a clinical guide used to evaluate a client's or patient’s level of risk for aggression. It can also evaluate how likely they are to respond well to treatment.
BC Mental Health and Substance Use Services and St. Joseph’s Healthcare Hamilton co-developed the START guide. You can purchase copies from BCMHSUS. Training for health care professionals is also available.
Approaches to risk assessment
Health care professionals often assess people to determine their risk for aggressive or adverse events. They use these assessments to make recommendations about admitting, discharging and managing individuals who may be a safety risk (e.g. suicide, self-harm, victimization of others, substance use, and more).
There are various approaches and tools available to help with these decisions. Traditional approaches focus on long-term, individual risk factors. These factors are typically based on unstructured clinical opinions or static, historical information, e.g. prior criminal history or age at first offence. These approaches neglect a person’s strengths. They also ignore the changing factors and circumstances that contribute to a person’s risk level.
START: A balanced perspective on risk
With these limitations in mind, clinicians and researchers at BC Mental Health and Substance Use Services, in collaboration with colleagues at St. Joseph's Healthcare, developed START (Short Term Assessment of Risk and Treatability). The measure is a structured clinical assessment tool. It provides a balanced and accurate snapshot of an individual’s risk for several outcomes (e.g. self-harm and aggression). It can also assess how well they respond to treatment.
START is different from other assessment tools. It focuses on dynamic (changing) variables and the person's strengths, not just their vulnerabilities. It also captures other unique, client-specific risks based on the person's recent level of functioning.
Who is the START Manual for?
You might find START useful if you’re a health care professional who works with adults with mental, personality and substance-use related disorders. The tool can be used in inpatient and community settings and is particularly helpful in correctional or forensic settings.
What to expect
The START instrument is made up of 20 items relevant to treatment and risk management, for example, substance use, mental state, social skills, and coping. Each item is rated as both a vulnerability and a strength to yield a risk estimate for each of the following outcomes:
- Violence to others
- Suicide
- Self-harm
- Self-neglect
- Unauthorized absence (failure to return from a day pass)
- Substance use
- Risk of being victimized
- General offending
Once you have completed the assessment, you can begin treatment planning. Treatment can be further refined with subsequent assessments. Administering this assessment repeatedly is a convenient way of tracking changes in a person’s functioning, including their vulnerabilities, strengths and risk of self-harm or aggression.
Purchase a START Manual
The START manual is $60 CAD plus delivery.
- Order a START Manual (PDF)
Request training
We offer customized half-day, full-day and two-day training sessions (see Start Summary Sheet (PDF)), including virtual training and consultation. We determine the length of the training based on your staff’s expertise and the size of the group you plan to train. We recommend keeping groups to 30-50 people to allow for more interactive discussion.
Contact us at start@phsa.ca to organize a training workshop.
START for adolescents
If you work with adolescents, you may be interested in the adolescent version of START.
Academic references to START
See Start Publications (PDF).