Implementation of the START:AV in a secure adolescent service
| DOI | https://doi.org/10.1108/JFP-04-2013-0021 |
| Published date | 05 August 2014 |
| Pages | 184-193 |
| Date | 05 August 2014 |
| Author | Marilyn A. Sher,E. Gralton |
| Subject Matter | Health & social care,Criminology & forensic psychology,Forensic practice |
Implementation of the START:AV in a
secure adolescent service
Marilyn A. Sher and E. Gralton
Marilyn A. Sher is a Principal
Forensic and Clinical
Psychologist, based at
Psychology Department,
St Andrews Healthcare,
Northampton, UK.
Dr E. Gralton is a Consultant
Forensic Psychiatrist, based at
Adolescent Service,
St Andrews Healthcare,
Northampton, UK.
Abstract
Purpose – The purpose of this paper is to establish gaps in training, involve staff in the implementation
process by incorporating their views on what is helpful and what can be improved, as well as provide
information that might be helpful to other sites who are considering implementing the START:AV.
Design/methodology/approach – The current study is the first to examine a START:AV implementation
and survey a multi-disciplinary team on their views about implementation in a medium secure service for
adolescents in the UK. The survey was adapted from the one used by Collins et al. (2008). Once surveys
were received the qualitative information was collated to explore themes, and frequency analysis was
undertaken on the quantitative information.
Findings – The staff survey on the implementation of the START:AV highlighted a number of strengths
and challenges. There was significant support for the START:AV in relation to it being a dynamic assessment
to measure change, that focuses equally on strengths and vulnerabilities, making the process individualised.
Users ofthe START:AVreported that theprocess of rating the START:AVas a team improvedcommunication,
teamwork, generated discussion and improved the detailed understanding of the patient being rated. Staff
felt it was generally straightforward to use in terms of strengths and vulnerability ratings, but some difficulties
emerged regarding making finer distinctions in ratings as well as completing risk formulations, highlighting
further training needs. There was also some confusion about differentiating between certain strengths
and vulnerabilities, leading to “double ratings”. Other difficulties highlighted centred on time and increasing
workload.
Research limitations/implications – The main limitation of the study relates to the low response rate
to the survey (31 per cent).
Practical implications – Recommendations for implementation and evaluation of new risk assessment
procedures are made.
Originality/value – The current study is the first to examine a START:AV implementation and survey a
multi-disciplinary team on their views about implementation in a medium secure service for adolescents
in the UK.
Keywords Risk assessment, Adolescent, Implementation, Offenders, START:AV,
Secure adolescent service
Paper type Research paper
Introduction
Methods for undertaking assessments of risk have developed in recent years, and the
acknowledgement that it is neither a static, nor risk-focused process is evident. Structured
professional judgement tools, such as the Structured Assessment of Violence Risk in Youth
(SAVRY, Borum et al., 2002), are made up of a number of risk factors identified through
research, that are considered to have a relationship to violence, and also provide an opportunity
to add additional case specific risk indicators (Adamson et al., 2011). The SAVRY (Borum et al.,
2002) and then the Short-term Assessment of Risk and Treatability (START, Webster et al.,
2009) were some of the first to recognise the importance of considering strengths in informing
risk. Following initial success of the START with adult populations (Nicholls et al., 2006;
Nonstad, 2008), the START:AV was developed for adolescent client groups.
PAGE 184
j
JOURNAL OF FORENSIC PRACTICE
j
VOL. 16 NO. 3 2014, pp. 184-193, CEmerald Group Publishing Limited, ISSN 2050-8794 DOI 10.1108/JFP-04-2013-0021
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