The Short-Term Assessment of Risk and Treatability Scale: Reliability and Validity in a Thai Forensic Psychiatric Inpatient Setting

Main Article Content

Weerapong Sanmontree
Peera Wongupparaj

Abstract

The Short-Term Assessment of Risk and Treatability (START) scale is deemed the most appropriate instrument for assessing risks and for managing violent behaviors due to its balanced perspective between protective factors (i.e., strength) and dynamic risk (i.e., vulnerability). Although several facets of reliability and validity of this tool are strong, its reliability, validity, and implementation in the Asian population lacks investigation. This study aimed to examine inter-rater reliability, internal consistency reliability, construct validity and predictive validity of the START in the Thai context. The participants consisted of 118 Thai forensic psychiatric inpatients hospitalized at a public hospital. Trained mental health professionals (i.e., psychiatrists, forensic nurses, clinical psychologists, social workers, and occupational therapists) assessed each participant across the 20 domains with 40 items of the Thai START. Each domain was rated for both degrees of strength and vulnerability on two three-point scales (0-1-2) format. Inter-rater and internal consistency reliabilities and the construct and predictive validities were used to examine psychometric properties of the scale. The main finding demonstrated the good-to-excellent level of inter-rater reliability, an acceptable level of internal consistency reliability. The data supported two relational constructs (i.e., strength vs vulnerability subscales) of the Thai START. The poor-to-excellent predictability of the Thai START items on violent behaviors was also evident. This study also provided the guideline for implementing the tool in non-Western forensic psychiatric populations. Thus, the Thai START is a promising tool for understanding, predicting, and managing violent/challenging behavior in forensic psychiatric inpatients.

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Sanmontree, W., & Wongupparaj, P. (2023). The Short-Term Assessment of Risk and Treatability Scale: Reliability and Validity in a Thai Forensic Psychiatric Inpatient Setting. The Journal of Behavioral Science, 18(1), 84–99. Retrieved from https://so06.tci-thaijo.org/index.php/IJBS/article/view/259283
Section
Research Articles

References

Abidin, Z., Davoren, M., Naughton, L., Gibbons, O., Nulty, A., & Kennedy, H. G. (2013). Susceptibility (risk and protective) factors for in-patient violence and self-harm: prospective study of structured professional judgement instruments START and SAPROF, DUNDRUM-3 and DUNDRUM-4 in forensic mental health services. BMC Psychiatry, 13(1), 197. doi:10.1186/1471-244X-13-197

Atkinson, T. M., Rosenfeld, B. D., Sit, L., Mendoza, T. R., Fruscione, M., Lavene, D., . . . Basch, E. (2011). Using confirmatory factor analysis to evaluate construct validity of the Brief Pain Inventory (BPI). Journal of pain and symptom management, 41(3), 558-565. doi:10.1016/j.jpainsymman.2010.05.008

Braithwaite, E., Charette, Y., Crocker, A. G., & Reyes, A. (2010). The Predictive Validity of Clinical Ratings of the Short-Term Assessment of Risk and Treatability (START). International Journal of Forensic Mental Health, 9(4), 271-281. doi:10.1080/14999013.2010.534378

Brown, T. A. (2015). Confirmatory factor analysis for applied research, 2nd ed. New York, NY, US: The Guilford Press.

Burgess, E. W. (1928). Factors determining success or failure on parole. In A. A. Bruce, E. W. Burgress, & A. J. Harno (Eds.), The workings of the indeterminate sentence law and the parole system in Illinois (pp. 221-234). Springfield, IL: State Board of Parole.

Cartwright, J. K., Desmarais, S. L., Hazel, J., Griffith, T., & Azizian, A. (2018). Predictive validity of HCR-20, START, and static-99R assessments in predicting institutional aggression among sexual offenders. Law and Human Behavior, 42(1), 13-25. doi:10.1037/lhb0000263

De Beuf, T. L. F., de Ruiter, C., & de Vogel, V. (2020). Staff Perceptions on the Implementation of Structured Risk Assessment with the START:AV: Identifying Barriers and Facilitators in a Residential Youth Care Setting. International Journal of Forensic Mental Health, 1-18. doi:10.1080/14999013.2020.1756994

De Beuf, T. L. F., de Ruiter, C., Edens, J. F., & de Vogel, V. (2021). Taking “the boss” into the real world: Field interrater reliability of the Short-Term Assessment of Risk and Treatability: Adolescent Version. Behavioral Sciences & the Law, n/a(n/a). doi:https://doi.org/10.1002/bsl.2503

de Ruiter, C., & Nicholls, T. L. (2011). Protective Factors in Forensic Mental Health: A New Frontier. International Journal of Forensic Mental Health, 10(3), 160-170. doi:10.1080/14999013.2011.600602

Desmarais, S. L., Nicholls, T. L., Read, J. D., & Brink, J. (2010). Confidence and accuracy in assessments of short-term risks presented by forensic psychiatric patients. The Journal of Forensic Psychiatry & Psychology, 21(1), 1-22. doi:10.1080/14789940903183932

Desmarais, S. L., Nicholls, T. L., Wilson, C. M., & Brink, J. (2012). Using dynamic risk and protective factors to predict inpatient aggression: reliability and validity of START assessments. Psychological Assessment, 24(3), 685-700. doi:10.1037/a0026668

DiStefano, C., & Morgan, G. B. (2014). A Comparison of Diagonal Weighted Least Squares Robust Estimation Techniques for Ordinal Data. Structural Equation Modeling: A Multidisciplinary Journal, 21(3), 425-438. doi:10.1080/10705511.2014.915373

Douglas, T., Pugh, J., Singh, I., Savulescu, J., & Fazel, S. (2017). Risk assessment tools in criminal justice and forensic psychiatry: The need for better data. European psychiatry : the journal of the Association of European Psychiatrists, 42, 134-137. doi:10.1016/j.eurpsy.2016.12.009

Fazel, S., Singh, J. P., Doll, H., & Grann, M. (2012). Use of risk assessment instruments to predict violence and antisocial behaviour in 73 samples involving 24 827 people: systematic review and meta-analysis. BMJ : British Medical Journal, 345, e4692. https://doi.org/10.1136/bmj.e4692

Flora, D. B., & Curran, P. J. (2004). An Empirical Evaluation of Alternative Methods of Estimation for Confirmatory Factor Analysis With Ordinal Data. Psychological Methods, 9(4), 466-491. doi:10.1037/1082-989X.9.4.466

George, D., & Mallery, P. (2010). SPSS for Windows Step by Step: A Simple Guide and Reference 17.0 Update (10 ed.). Boston: Pearson.

Gill Matthew, J., & Brookes, S. (2017). The psychology quadrant: an outcome measure based on the START risk assessment. Journal of Forensic Practice, 19(1), 14-22. doi:10.1108/JFP-03-2016-0018

Haines, A., Brown, A., Javaid, S. F., Khan, F., Noblett, S., Omodunbi, O., . . . Whittington, R. (2018). Assessing Protective Factors for Violence Risk in U.K. General Mental Health Services Using the Structured Assessment of Protective Factors. International Journal of Offender Therapy and Comparative Criminology, 62(12), 3965-3983. doi:10.1177/0306624x17749449

Heilbrun, K., Yasuhara, K., & Shah, S. (2010). Violence risk assessment tools: Overview and critical analysis. In Handbook of violence risk assessment. (pp. 1-17). New York, NY, US: Routledge/Taylor & Francis Group.

Hogan, N. R., & Olver, M. E. (2018). A Prospective Examination of the Predictive Validity of Five Structured Instruments for Inpatient Violence in a Secure Forensic Hospital. International Journal of Forensic Mental Health, 17(2), 122-132. doi:10.1080/14999013.2018.1431339

Hui, C. H., & Triandis, H. C. (1985). Measurement in Cross-Cultural Psychology:A Review and Comparison of Strategies. Journal of Cross-Cultural Psychology, 16(2), 131-152. doi:10.1177/0022002185016002001

Hvidhjelm, J., Brandt-Christensen, M., Delcomyn, C., Møllerhøj, J., Siersma, V., & Bak, J. (2022). Effects of Implementing the Short-Term Assessment of Risk and Treatability for Mechanical Restraint in a Forensic Male Population: A Stepped-Wedge, Cluster-Randomized Design. Front Psychiatry, 13, 822295. https://doi.org/10.3389/fpsyt.2022.822295

Hurducas, C. C., Singh, J. P., de Ruiter, C., & Petrila, J. (2014). Violence Risk Assessment Tools: A Systematic Review of Surveys. International Journal of Forensic Mental Health, 13(3), 181-192. doi:10.1080/14999013.2014.942923

Kikuchi, A., Soshi, T., Kono, T., Koyama, M., & Fujii, C. (2021). Validity of Short-Term Assessment of Risk and Treatability in the Japanese Forensic Probation Service [Original Research]. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.645927

Lowder, E. M., Desmarais, S. L., Rade, C. B., Johnson, K. L., & Van Dorn, R. A. (2019). Reliability and Validity of START and LSI-R Assessments in Mental Health Jail Diversion Clients. Assessment, 26(7), 1347-1361. doi:10.1177/1073191117704505

McArdle, J. J. (1996). Current Directions in Structural Factor Analysis. Current Directions in Psychological Science, 5(1), 11-18. doi:10.1111/1467-8721.ep10772681

Messick, S. (1989). Validity. In R. Linn (Ed.), Educational measurement (pp. 13-104). New York: American Council on Education & Macmillan Publishing.

Monahan, J. (2008). Structured risk assessment of violence. In R. I. Simon & K. Tardiff (Eds.), Textbook of violence assessment and management (p. 17–33). American Psychiatric Publishing, Inc.

Nicholls, T. L., Brink, J., Desmarais, S. L., Webster, C. D., & Martin, M.-L. (2006). The Short-Term Assessment of Risk and Treatability (START):A Prospective Validation Study in a Forensic Psychiatric Sample. Assessment, 13(3), 313-327. doi:10.1177/1073191106290559

Nonstad, K., Nesset, M. B., Kroppan, E., Pedersen, T. W., Nøttestad, J. A., Almvik, R., & Palmstierna, T. (2010). Predictive Validity and Other Psychometric Properties of the Short-Term Assessment of Risk and Treatability (START) in a Norwegian High Secure Hospital. International Journal of Forensic Mental Health, 9(4), 294-299. doi:10.1080/14999013.2010.534958

O’Shea, L. E., Picchioni, M. M., & Dickens, G. L. (2016). The Predictive Validity of the Short-Term Assessment of Risk and Treatability (START) for Multiple Adverse Outcomes in a Secure Psychiatric Inpatient Setting. Assessment, 23(2), 150-162. doi:10.1177/1073191115573301

O'Shea, L. E., & Dickens, G. L. (2014). Short-Term Assessment of Risk and Treatability (START): Systematic review and meta-analysis. Psychological Assessment, 26(3), 990-1002. doi:10.1037/a0036794

Paetsch, A., van Os, T. W. D. P., Troquete, N. A. C., & van den Brink, R. H. S. (2019). Single-item predictive validity of the Short-Term Assessment of Risk and Treatability (START) for violent behaviour in outpatient forensic psychiatry. The Journal of Forensic Psychiatry & Psychology, 30(4), 630-641. doi:10.1080/14789949.2019.1581831

Rogers, R. (2000). The Uncritical Acceptance of Risk Assessment in Forensic Practice. Law and Human Behavior, 24(5), 595-605. doi:10.1023/A:1005575113507

Singh, J. P., Desmarais, S. L., Hurducas, C., Arbach-Lucioni, K., Condemarin, C., Dean, K., . . . Otto, R. K. (2014). International Perspectives on the Practical Application of Violence Risk Assessment: A Global Survey of 44 Countries. International Journal of Forensic Mental Health, 13(3), 193-206. doi:10.1080/14999013.2014.922141

Strauss, M. E., & Smith, G. T. (2009). Construct validity: advances in theory and methodology. Annual review of clinical psychology, 5, 1-25. doi:10.1146/annurev.clinpsy.032408.153639

Tavakol, M., & Wetzel, A. (2020). Factor Analysis: a means for theory and instrument development in support of construct validity. Int J Med Educ, 11, 245-247. doi:10.5116/ijme.5f96.0f4a

Viljoen, J. L., Beneteau, J. L., Gulbransen, E., Brodersen, E., Desmarais, S. L., Nicholls, T. L., & Cruise, K. R. (2012). Assessment of Multiple Risk Outcomes, Strengths, and Change with the START:AV: A Short-Term Prospective Study with Adolescent Offenders. International Journal of Forensic Mental Health, 11(3), 165-180. doi:10.1080/14999013.2012.737407

Viljoen, S., Nicholls, T., Greaves, C., de Ruiter, C., & Brink, J. (2011). Resilience and Successful Community Reintegration among Female Forensic Psychiatric Patients: A Preliminary Investigation. Behavioral Sciences & the Law, 29(5), 752-770. doi:https://doi.org/10.1002/bsl.1001

Webster, C. D., Martin, M. L., Brink, J., Nicholls, T. L., & Desmarais, S. L. (2009). Manual for the Short Term Assessment of Risk and Treatability (START)(Version 1.). BC Mental Health, St. Joseph’s Healthcare, British Columbia.

Webster, C. D., Martin, M. L., Brink, J., Nicholls, T. L., & Middleton, C. (2004). Manual for the Short Term Assessment of Risk and Treatability (START). Version 1.0, Consultation edition. St. Joseph’s Healthcare, Hamilton, Ontario, Canada, and Forensic Psychiatric Services Commission, Port Coquitlam, British Columbia, Canada.

Whittington, R., Bjørngaard, J. H., Brown, A., Nathan, R., Noblett, S., & Quinn, B. (2014). Dynamic relationship between multiple START assessments and violent incidents over time: a prospective cohort study. BMC Psychiatry, 14(1), 323. doi:10.1186/s12888-014-0323-7

Whittington, R., Pollak, C., Keski-Valkama, A., Brown, A., Haines-Delmont, A., Bak, J., Hvidhjelm, J., Almvik, R., & Palmstierna, T. (2022, 2022/04/03). Unidimensionality of the Strengths and Vulnerabilities Scales in the Short-Term Assessment of Risk and Treatability (START). International Journal of Forensic Mental Health, 21(2), 175-184. https://doi.org/10.1080/14999013.2021.1953193

Wilson, C. M., Desmarais, S. L., Nicholls, T. L., & Brink, J. (2010). The Role of Client Strengths in Assessments of Violence Risk Using the Short-Term Assessment of Risk and Treatability (START). International Journal of Forensic Mental Health, 9(4), 282-293. doi:10.1080/14999013.2010.534694

Zhong, S., Yu, R., Cornish, R., Wang, X., Fazel, S., Chen, C., Li, C., Zhang, D., Wang, J., Li, S., Zhang, S., Zhu, X., Lv, Y., Wu, Z., & Fo, V. g. (2021). Assessment of violence risk in 440 psychiatric patients in China: examining the feasibility and acceptability of a novel and scalable approach (FoVOx). BMC Psychiatry, 21(1), 120. https://doi.org/10.1186/s12888-021-03115-3

Zhou, J., Witt, K., Xiang, Y., Zhu, X., Wang, X., & Fazel, S. (2016). Violence risk assessment in psychiatric patients in China: A systematic review. Aust N Z J Psychiatry, 50(1), 33-45. doi:10.1177/0004867415585580