Physicians, nurses, social workers, and other front-line health care providers are routinely called upon to assess patients’ risk for violent behaviour in hospital as well as in community-based settings. In this capacity, they are required to make decisions and provide recommendations regarding the admission, transfer, discharge, and management of people who may pose a risk of violence to self or others. This remains a challenging task, with divergent approaches and assessment instruments available. Traditional approaches have focused largely on individual risk factors while neglecting to consider clients’ strength or external/environmental triggers. These approaches are concerned mainly with long-term risk to others. The Short-Term Assessment of Risk and Treatability at the BC Mental Health and Addiction Services (BCMHAS) is a 20-item clinical guide for the dynamic assessment of seven risk domains (violence to others, suicide, self-harm, self-neglect, unauthorized absence, substance abuse, and victimization). The START represents a refinement in the assessment of individuals with mental disorders and personality dysfunction in that it provides for the differential coding of both patient strengths and needs, while allowing for the recording of case-specific risk factors. The START is meant for interdisciplinary use and each of the 20 items is assessed according to succinct descriptions provided in the published manual. START ensures that the evaluations and management of risk are documented, transparent, and defensible. BCMHAS provides START training to mental health professionals. To date, well over 1000 mental health professionals have been trained by BCMHAS. In addition to workshops for direct care staff, several talks and updates were provided (e.g., FPSC annual conference, the case management forum, and the Physician Education Day).
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