Dynamic relationship between multiple START assessments and violent incidents over time: a prospective cohort study

BMC Psychiatry

Beverley Quinn⁵  Stephen Noblett²  Rajan Nathan²  Andrew Brown⁴  Johan Håkon Bjørngaard³  Richard Whittington¹ 

[1] Forensic Department and Research Centre Bröset, St. Olav’s University Hospital, Trondheim, Norway;Secure Division, Mersey Care NHS Trust, Liverpool, UK;Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway;Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK;CAMEO Early Intervention Service, Cambridgeshire & Peterborough NHS Trust, Peterborough, UK

关键词: Forensic psychiatry;    Risk assessment;    Violence;   

Others  :  1092038
DOI  :  10.1186/s12888-014-0323-7

 received in 2014-05-23, accepted in 2014-11-07,  发布年份 2014

【 摘 要 】

Background

Dynamic risk factors need to be assessed repeatedly over time rather than at a single time point to examine the relationship with violence. This predictive validity study sought to examine the degree of dynamic change in risk assessed in a group of mentally disordered offenders and the relationship between change and the occurrence of violence.

Methods

Routine structured assessments of Strengths and Vulnerabilities on the Short-Term Assessment of Risk and Treatability (START) instrument (n = 475) were linked prospectively with 275 violent incidents using logistic regression in a sample of 50 patients.

Results

Stability within patients estimated using the intra-class correlation coefficient was high (>.80) for both Strengths and Vulnerabilities. In the overall sample, a 10 point increase in START Vulnerabilities score was associated with a three-fold increased risk of violence (OR = 3.1; 95% CI, 1.47-7.46) but there was no association for Strengths score (OR = 0.91, 95% CI, 0.34-2.47). When examined within patients, both Vulnerabilities (OR = 1.77, 95% CI, 0.56-5.54) and Strengths (OR = 2.26, 95% CI, 0.38-13.42) were associated with an increased risk of violence but in both cases precision was low due to reduced sample sizes.

Conclusions

Risk factors which are considered to have the capacity to fluctuate dynamically did not do so substantially in this group of mentally disordered offenders. When fluctuations did occur there was some tentative evidence that they are associated with violent outcomes and could guide the use of prevention measures.

【 授权许可】

   
2014 Whittington et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Douglas K, Skeem J: Violence risk assesment: getting specific about being dynamic. Psychol, Public Policy and Law 2005, 11(3):347-383.
• [2]Mossman D: Assessing predictions of violence: Being accurate about accuracy. J Consult Clin Psychol 1994, 62(4):783-792.
• [3]Whittington R, Hockenhull J, McGuire J, Leitner M, Barr W, Cherry MG, Flentje R, Quinn B, Dundar Y, Dickson R: A systematic review of risk assessment strategies for populations at high risk of engaging in violent behaviour: update 2002–8.Health Technol Assess 2013, 17(50).
• [4]Webster CD, Martin M-L, Brink J, Nicholls TL, Desmarais SL: Manual for the Short Term Assessment of Risk and Treatability (START) (Version 1.1). B C Mental Health & Addiction Services, Port Coquitlam, Canada; 2009.
• [5]Braithwaite E, Charette Y, Crocker AG, Reyes A: The Predictive Validity of Clinical Ratings of the Short-Term Assessment of Risk and Treatability (START). Int J Forensic Mental Health 2010, 9(4):271-281.
• [6]Desmarais SL, Nicholls TL, Wilson CM, Brink J: Using dynamic risk and protective factors to predict inpatient aggression: Reliability and validity of START assessments. Psychol Assess 2012, 24(3):685-700.
• [7]Gray NS, Benson R, Craig R, Davies H, Fitzgerald S, Huckle P, Maggs R, Taylor J, Trueman M, Williams T, Snowden R: The Short-Term Assessment of Risk and Treatability (START): A Prospective Study of Inpatient Behavior. Int J Forensic Mental Health 2011, 10(4):305-313.
• [8]Kroppan E, Nesset MB, Nonstad K, Pedersen TW, Almvik R, Palmstierna T: Implementation of the Short Term Assessment of Risk and Treatability (START) in a forensic high secure unit. Int J Forensic Mental Health 2011, 10(1):7-12.
• [9]Nonstad K, Nesset MB, Kroppan E, Pedersen TW, Nøttestad JA, Almvik R, Palmstierna T: Predictive validity and other psychometric properties of the Short-Term Assessment of Risk and Treatability (START) in a Norwegian high secure hospital. Int J Forensic Mental Health 2010, 9(4):294-299.
• [10]Viljoen S, Nicholls T, Greaves C, de Ruiter C, Brink J: Resilience and successful community reintegration among female forensic psychiatric patients: A preliminary investigation. Behav Sci Law 2011, 29(5):752-770.
• [11]Doyle M, Lewis G, Brisbane M: Implementing the Short-Term Assessment of Risk and Treatability (START) in a forensic mental health service. Psychiatr Bulletin 2008, 32(11):406-408.
• [12]Crocker AG, Jessor R, Turbin MS: START changing practice: Implementing a risk assessment and management tool in a civil psychiatric setting. Int J Forensic Mental Health 2011, 10:13-28.
• [13]Nicholls TL, Brink J, Desmarais SL, Webster CD, Martin M-L: The Short-Term Assessment of Risk and Treatability (START): A prospective validation study in a forensic psychiatric sample. Assessment 2006, 13(3):313-327.
• [14]Chu CM, Thomas SDM, Ogloff JRP, Daffern M: The short- to medium-term predictive accuracy of static and dynamic risk assessment measures in a secure forensic hospital. Assessment 2013, 20(2):230-241.
• [15]Heilbrun K, Yasuhara K, Shah S: Violence Risk Assessment Tools: Overview and Critical Analysis. In Handbook of Violence Risk Assessment. Edited by Otto R, Douglas K. Routledge, London; 2011.
• [16]Wilson CM, Desmarais SL, Nicholls TL, Hart SD, Brink J: Predictive Validity of Dynamic Factors: Assessing Violence Risk in Forensic Psychiatric Inpatients. Law Hum Behav 2013, 37(6):377-388.
• [17]Rabe-Hesketh S, Skrondal A: Multilevel and longitudinal modeling using Stata. Stata Press, College Station, TX; 2008.
• [18]Singh JP, Grann M, Fazel S: A comparative study of violence risk assessment tools: A systematic review and metaregression analysis of 68 studies involving 25,980 participants. Clin Psychol Rev 2011, 31(3):499-513.