Abstract
| Original language | English |
|---|---|
| Pages (from-to) | 397-406 |
| Number of pages | 10 |
| Journal | Journal of Psychiatric and Mental Health Nursing |
| Volume | 22 |
| Issue number | 6 |
| Early online date | 28 Jun 2015 |
| DOIs | |
| Publication status | Published - Aug 2015 |
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How short should short-term risk assessment be? Determining the optimum interval for START reassessment in a secure mental health service. / Dickens, Geoffrey L.; O’Shea, Laura E.
In: Journal of Psychiatric and Mental Health Nursing, Vol. 22, No. 6, 08.2015, p. 397-406.Research output: Contribution to journal › Article
TY - JOUR
T1 - How short should short-term risk assessment be? Determining the optimum interval for START reassessment in a secure mental health service
AU - Dickens, Geoffrey L.
AU - O’Shea, Laura E.
PY - 2015/8
Y1 - 2015/8
N2 - The Short-Term Assessment of Risk and Treatability (START) guides assessment of potential adverse outcomes. Assessment is recommended every 3 months but there is no evidence for this interval. We aimed to inform whether earlier reassessment was warranted. We collated START assessments for N = 217 adults in a secure mental health hospital, and subsequent aggressive, self-harm, self-neglect and victimization incidents. We used receiver operating characteristic analysis to assess predictive validity; survival function analysis to examine differences between low-, medium-, and high-risk groups; and hazard function analysis to determine the optimum interval for reassessment. The START predicted aggression and self-harm at 1, 2 and 3 months. At-risk individuals engaged in adverse outcomes earlier than low-risk patients. About half warranted reassessment before 3 months due to engagement in risk behaviour before that point despite a low-risk rating, or because of non-engagement by that point despite an elevated risk rating. Risk assessment should occur at appropriate intervals so that management strategies can be individually tailored. Assessment at 3-month intervals is supported by the evidence. START assessments should be revisited earlier if risk behaviours are not prevented; teams should constantly re-evaluate the need for restrictive practices.
AB - The Short-Term Assessment of Risk and Treatability (START) guides assessment of potential adverse outcomes. Assessment is recommended every 3 months but there is no evidence for this interval. We aimed to inform whether earlier reassessment was warranted. We collated START assessments for N = 217 adults in a secure mental health hospital, and subsequent aggressive, self-harm, self-neglect and victimization incidents. We used receiver operating characteristic analysis to assess predictive validity; survival function analysis to examine differences between low-, medium-, and high-risk groups; and hazard function analysis to determine the optimum interval for reassessment. The START predicted aggression and self-harm at 1, 2 and 3 months. At-risk individuals engaged in adverse outcomes earlier than low-risk patients. About half warranted reassessment before 3 months due to engagement in risk behaviour before that point despite a low-risk rating, or because of non-engagement by that point despite an elevated risk rating. Risk assessment should occur at appropriate intervals so that management strategies can be individually tailored. Assessment at 3-month intervals is supported by the evidence. START assessments should be revisited earlier if risk behaviours are not prevented; teams should constantly re-evaluate the need for restrictive practices.
U2 - 10.1111/jpm.12232
DO - 10.1111/jpm.12232
M3 - Article
VL - 22
SP - 397
EP - 406
JO - Journal of Psychiatric and Mental Health Nursing
JF - Journal of Psychiatric and Mental Health Nursing
SN - 1351-0126
IS - 6
ER -