Short-Term Assessment of Risk and Treatability (START)

The Short-Term Assessment of Risk and Treatability (START) is a structured professional judgment measure designed to comprehensively assess risk of multiple adverse outcomes common among persons with mental illness and/or criminal justice involvement (e.g., violence, suicide, non-suicidal self-injury, victimization). START comprises 20 dynamic items (i.e., changeable) assessed concurrently both as vulnerabilities and as strengths. The assessment supports the development of risk management and treatment planning aimed at ameliorating future risk through bolstering the individual’s strengths (e.g., building on demonstrated insight into their substance abuse) and ameliorating their vulnerabilities (e.g., reducing contact with peers/family members who use illicit drugs). Since its development via an interdisciplinary clinical team in the mid-2000s, the START has become one of the most widely adopted and researched risk assessment and treatment planning instruments. Use of the START has been found to be both practical and valid. The START adds to the risk assessment field in four main ways: its comprehensive assessment of interconnected risks; its focus on treatment-relevant, dynamic variables; its equitable integration of both strengths and vulnerabilities; and its ability to facilitate treatment planning. This chapter provides an overview of the development and features of the measure, the extant literature, and recommended implementation of the START. A case example is used to demonstrate real-world application.