Implementation of the Short Term Assessment of Risk and Treatability (START) in a Forensic High Secure Unit

Abstract

Listen

Translate article

Our objective was to describe and analyze the implementation process of the Short Term Assessment of Risk and Treatability in a forensic high secure unit in Norway. A stepwise implementation procedure was used and an educational package on practical use of the START in the clinic was developed. A questionnaire about START was given to the staff at the end of the first implementation phase and semi-structured qualitative interviews with staff on the content of security decision processes were carried out. Also, a log of the actual number of completed START scorings was made, including the number of ratings and the regularity of these ratings finished within this time frame. After six months’ implementation the questionnaire showed that 74% of the staff agreed that the evaluations made on the basis of START were interdisciplinary. Seventy-three percent also agreed that START contributed significantly to a more systematic risk assessment and management, and 79% said the START was useful as a tool in risk assessments and treatment planning. Informants from the interview study described how the START structured their clinical judgement. At the same time, the START fulfilled their wish to address both the patients’ strengths and risks. The START continued to be in regular use after the more intensive implementation process.Our results indicate that the implementation of START had led to interdisciplinary security decisions with a broader perspective of the patients’ situation.