St Andrews trials Adolescent short term risk assessment tool: START
Long term tools' capabilites in the short term
Risk assessment forms an essential part of a clinician’s role in forensic settings. The process has developed massively in recent years but most of this has been concentrated on adult tools. Popular and widely used tools include the HCR-20 published by Webster et al which follows the structured Professional Judgement (SPJ) model. Adolescent versions such as the Structured Assessment of Violence Risk in Youth (SAVRY: Borum et al, 2003) which is based on the literature highlighting factors that place adolescents at greater risk of violence. The way these factors impact upon each other and the different contexts issues can arise under are all brought into consideration. These assessment tools place an emphasis on assessing long term risk and are not designed to assess the risk of violence in the short term in secure settings. Despite some aspects of tools showing limited capability to assess these risks, the only tool specifically designed to assess in the short term is the START (Short Term Assessment of Risk and Treatability, Webster et al 2004).
START
The adult version of START also recognised the complicated nature of risk and that the risk assessment process is not clear cut but needs to incorporate interactions and traits of individuals. The tool explores seven risk domains, many of which overlap or interact. Twenty two items are then rated for strengths and risks. Initial evidence suggests the tool is valid in assessing short term risk in an adult forensic population (Nicholls et al 2006).
START for adolescents
Despite 2,888 adolescent offenders being detained in secure settings and prisons in the UK in December 2008 there is no validated tool which studies short term risk in adolescents. The models that do exist focus on assessing the risk of violence alone and ignore other areas relevant to individuals in secure settings. Other exiting tools such as SAVRY require time to complete efficiently which in emergency admission situations is simply not available.
In secure settings, violence is potentially a daily reality so tools which enable professionals to accurately assess risk will benefit those at risk from themselves and others. Based on the early success of START, St Andrews is trialling the adolescent version in its Service for Adolescents to ascertain whether it can be used as a useful tool for this group of service users