The START


The Short-Term Assessment of Risk and Treatability (START) Manual

The Short-Term Assessment of Risk and Treatability (START; Webster, Martin, Brink, Nicholls, & Desmarais, 2009) is a structured professional judgement risk assessment measure used to assess a person’s risk across a variety of outcomes (violence, suicide, victimization, etc.). Moreover, START is used extensively in developing an individual’s treatment plan – it is the primary risk assessment tool used at the Forensic Psychiatric Hospital.

START contains 20 dynamic (changing) items relevant to treatment and risk management, such as substance use, mental state, social skills, and coping. Whereas many risk assessment tools focus exclusively on risk factors/an individual’s deficits, START focuses on both an individual’s vulnerabilities (risk factors) and strengths (protective factors).

The START Manual was developed for use with adults with mental, personality and substance-related disorders, and will be helpful for correctional, forensic and other patients and clients in both inpatient and community settings. It is one of the most well-researched and widely-adopted inpatient risk assessment/treatment planning instruments (Nicholls et al., 2021; O’Shea & Dickens, 2014). For example, the START has been:

  • Implemented in >22 countries
  • Translated into nine languages
  • Distributed via > 8,000 manuals
  • Subject to >75 empirical validations

If you are interested in purchasing a manual or learning more, please email us at start@phsa.ca.


Case Formulation Study

This study sought to examine how the use of a case formulation, a comprehensive narrative composed by the research team after conducting a risk assessment, can aid in creating individualized treatment plans for patients. In essence, this study aimed to bridge the gap between risk assessment and risk management. Two similar units were used as the base for this study. Chosen at random, one unit continued with treatment as usual, whereas the other unit was given education sessions on how to complete case formulations. Care team members were also asked in focus groups how they felt about case formulations, best modes of practice, and how to efficiently implement case formulations into everyday care. A case study paper is currently being written; this paper will detail how a case formulation done for a specific individual had a major impact on the patients’ continuity of care. ​