Catherine M. Wilson

Using Dynamic Risk and Protective Factors to Predict Inpatient Aggression: Reliability and Validity of START Assessments.

The Short-Term Assessment of Risk and Treatability (START; C. D. Webster, M. L. Martin, J. Brink, T. L. Nicholls, & S. L. Desmarais, 2009; C. D. Webster, M. L. Martin, J. Brink, T. L. Nicholls, & C. Middleton, 2004) is a relatively new structured professional judgment guide for the assessment and management of short-term risks associated with mental, substance use, and personality disorders. The scheme may be distinguished from other violence risk assessment instruments because of its inclusion of 20 dynamic factors that are rated in terms of both vulnerability and strength. This study examined the reliability and validity of START assessments in predicting inpatient aggression. Research assistants completed START assessments for 120 male forensic psychiatric patients through review of hospital files. They also completed Historical-Clinical-Risk Management-20 (HCR-20; C. D. Webster, K. S. Douglas, D. Eaves, & S. D. Hart, 1997) and Hare Psychopathy Checklist: Screening Version (PCL:SV; S. D. Hart, D. N. Cox, & R. D. Hare, 1995) assessments. Outcome data were coded from hospital files for a 12-month follow-up period using the Overt Aggression Scale (OAS; S. C. Yudofsky, J. M. Silver, W. Jackson, J. Endicott, & D. W. Williams, 1986). START assessments evidenced excellent interrater reliability and demonstrated both predictive and incremental validity over the HCR-20 Historical subscale scores and PCL:SV total scores. Overall, results support the reliability and validity of START assessments and use of the structured professional judgment approach more broadly, as well as the value of using dynamic risk and protective factors to assess violence risk.

Violence Against Teachers: Prevalence and Consequences

Data collected from 731 teachers were used to examine the consequences of violence directed toward teachers while in the workplace. Analyses showed that the majority of respondents (n = 585, 80.0%) had experienced school-related violence—broadly defined—at one point in their careers. Serious violence (actual, attempted, or threatened physical violence) was less common, but still common enough to be of concern (n = 202, 27.6%). Violence predicted physical and emotional effects, as well as teaching-related functioning. In addition, a model with fear as a potential mediator revealed that both fear and violence were independently predictive of these negative outcomes. Finally, analyses showed that, in general, women reported higher levels of physical symptoms compared to men. We discuss the implications of violence against teachers in terms of personal consequences and the implications for mental health professionals working in an educational setting.

The Role of Client Strengths in Assessments of Violence Risk Using the Short-Term Assessment of Risk and Treatability (START)

Despite significant advances in the field of violence risk assessment, we are limited in our understanding regarding the utility of existing measures for predicting violence risk over brief time frames (i.e., weeks to months) as well as by our focus on factors that increase risk to the neglect of those which may reduce risk or protect against future violence. To address these knowledge gaps, this study evaluated the use of a structured professional guide, the Short-Term Assessment of Risk and Treatability (START; Webster, Martin, Brink, Nicholls, & Middleton, 2004), in assessing short-term violence risk (i.e., up to one year) and, specifically, the role of client strengths in this process. Research assistants completed file-based START assessments for four 3-month intervals for 30 male forensic psychiatric inpatients. Information pertaining to aggressive incidents was obtained from files. Overall, results supported the usefulness of the START in assessing short-term violence risk. Assessments evidenced validity in predicting future violence, particularly over the short-term (i.e., up to 9 months). Although ratings of client strengths did not contribute uniquely to the prediction of violence risk, results support their clinical utility in risk management.