Short-Term Assessment of Risk and Treatability (START)

Short-Term Assessment of Risk and Treatability (START)


10 Hours | 10 CEs (CEUs)

Program Description

This self-paced training program on Short-Term Assessment of Risk and Treatability (START) is presented by Drs. Tonia Nicholls and Sarah Desmarais.

It provides training in the Short-Term Assessment of Risk and Treatability, a 20-item clinical guide for the dynamic assessment of seven risk domains. START represents a refinement in the assessment of risk in that it provides for the differential coding of both patient strengths and vulnerabilities while allowing for the recording of case-specific factors. START guides clinicians toward an integrated, balanced opinion to evaluate the client’s risk across multiple domains and to guide treatment and management decisions. Clinicians are routinely required to make decisions and provide recommendations regarding the admission, discharge, and management of persons who may pose a risk of violence to self or others. This remains a challenging task, with divergent approaches and measures available to assist with these decisions. Traditional approaches have focused largely on individual risk factors while neglecting to consider patients’ strengths or external/environmental triggers, and have been concerned mainly with long-term risk to others.

The program reviews the literature that bears on the development of START and supports its utility as a clinical evaluation and planning guide and as a research tool. Additionally, it briefly describes the development, design, format, and implementation of START, and provide results from existing and ongoing research. It focuses on how START can inform decision-making regarding internalized and externalized aggression, as well as other risks relevant to maintaining staff and client safety.

– Understand the role of static and dynamic strength / risk factors in risk assessment and risk management.
– Become increasingly familiar with the role of strengths and vulnerabilities in client management and safety planning
– Learn how to administer, interpret, and implement START assessments.

The fee for this training program is $250 and includes all materials.

Intended Audience

This training program is intended for nurses, psychiatrists, psychologists, social workers, parole officers, probation officers, and other allied mental health professionals. Additionally for those mental health professionals that work with adults with mental, personality and substance-related disorders and has been demonstrated to have relevance to correctional, civil, and forensic patients in the community or institutional settings. This training program is for beginner, intermediate, and advanced level clinicians.

About Drs. Sarah Desmarais and Tonia Nicholls

Dr. Tonia L. Nicholls is an Associate Professor, Department of Psychiatry, University of British Columbia, Adjunct Professor, Department of Psychology, Simon Fraser University, and Distinguished Scientist at the Forensic Psychiatric Services Commission, BC Mental Health & Substance Use Services. In 2015 she received a Canadian Institutes of Health Research (CIHR) Foundation Scholar Award. Her research has been funded by from the Social Sciences and Humanities Research Council of Canada, the Canadian Institutes of Health Research (CIHR), and the Mental Health Commission of Canada. She has published over 100 articles, books and chapters and is a co-author of the START and the START: Adolescent Version. Her scholarly work earned her three ‘Brain Star’ awards from the Institute of Neurosciences, Mental Health, and Addictions (CIHR), the American Psychological Association Award for Distinguished Professional Contributions, the Canadian Psychological Association President’s New Researcher Award and the Chad Buckle Visiting Fellowship in New Zealand. Dr. Nicholls’ research examines the intersections of law and mental health related to the provision of services to marginalized populations (e.g., homeless mentally ill individuals, forensic psychiatric patients, civil psychiatric patients, inmates). She is particularly interested in the assessment and treatment of violence and criminality and the development and implementation of evidence-based practices that support patient-centred, trauma-informed, strengths-based care.

Her publications have covered diverse topics including inpatient aggression in psychiatric settings, women in conflict with the law, psychopathy, the potential contribution of protective factors to the violence risk assessment field, and intimate partner violence. She has been active in knowledge exchange, publishing several manuals to inform evidence-based practice and being actively engaged in large-scale implementations and evaluations including measures to inform: violence risk assessments (Short-Term Assessment of Risk and Treatability (START), Webster, Martin, Brink, Nicholls, & Middleton, 2004; Webster, Martin, Brink, Nicholls, & Desmarais, 2009; START: Adolescent Version (START:AV) Abbreviated Manual, Nicholls, Viljoen, Cruise, Desmarais, & Webster, 2010; START:AV full manual, Viljoen, Nicholls, Cruise, Desmarais, & Webster, 2014), mental health screening in correctional settings (Jail Screening Assessment Tool (JSAT), Nicholls, Roesch, Olley, Ogloff, & Hemphill, 2005) and assessments and safety planning with women coping with or escaping intimate partner abuse (Decision-making In Abusive Relationships Interview (DIARI, Nicholls, Hilterman, Tengstrom, 2010). In 2007, she received a Michael Smith Foundation for Health Research Career Scholar award (2007-2013). She also presently holds a Canadian Institutes of Health Research (CIHR) New Investigator salary award (2011-2016). Dr. Nicholls has published 93 chapters, articles and books, presented >85 workshops in Canada, the US, and Europe, and has been invited to give keynote lectures for several national and international organizations including IAFMHS, ANZAPPL, Correctional Service of Canada, and the gender institute of CIHR.

Dr. Sarah L. Desmarais is an Associate Professor of Psychology at North Carolina State University and the 2015 recipient of the College of Humanities and Social Sciences Outstanding Junior Faculty Award. She completed her graduate training in forensic psychology at Simon Fraser University, and postdoctoral fellowships in public health and psychology at the University of British Columbia. Prior to coming to North Carolina State University, she was an Assistant Professor at the University of South Florida jointly appointed in the departments of Mental Health Law & Policy and Community & Family Health. Dr. Desmarais works on issues at the nexus of the behavioral health and criminal justice systems. She has more than 50 peer-reviewed publications on topics including risk assessment, mental illness, substance use, and violence. Funded by the National Institute of Mental Health, the National Institute on Drug Abuse, the Department of Defense, the Department of Veterans Affairs, Florida’s Department of Children and Families, and the Bristol Meyers Squibb Foundation, her current research is focused on the development, implementation and evaluation of evidence-based practices for the prevention of criminal justice involvement among adolescents and adults with mental illnesses. Dr. Desmarais is a co-author of the Short-Term Assessment of Risk and Treatability (START) and the Short-Term Assessment of Risk and Treatability: Adolescent Version (START:AV), structured professional guides for assessing and managing risks associated with behavioral health problems. She has contributed to the development of related resources including the START Outcome Scale (SOS), the START User Feedback Survey, and the START Instructors’ Guide and Workbook. Dr. Desmarais trains and consults with mental health and criminal justice professionals worldwide on the implementation of START, START:AV, and other risk assessment approaches.

Upon completion of this course, participants should be able to:


  • Describe the role of static and dynamic strength in risk assessment
  • Describe risk factors in risk assessment and risk management
  • Describe the of strengths in client management and safety planning
  • Describe the vulnerabilities in client management and safety planning
  • Demonstrate how to administer START Assessments
  • Demonstrate how to interpret START Assessments
  • Demonstrate how to implement START assessments
  • Describe the empirical and theoretical rationale for assessing multiple and overlapping adverse outcomes (e.g., violence to others, suicide, self-harm, self-neglect, substance abuse)
  • This course is excellent for professionals in the forensic mental health field.


    Participants will learn the empirical and theoretical rationale for assessing multiple and overlapping adverse outcomes (e.g., violence to others, suicide, self-harm, self-neglect, substance abuse) using a single instrument.

    START Assessment

    Participants will become familiar with the item anchors such that they will be able to validly and reliably code the 20 START items for both strengths and vulnerabilities.

    Case Coding

    Participants will learn to integrate the knowledge and skills learned in the previous videos by using a “hands on” approach through group coding of a case vignette.


    Participants will learn about the implementation and integration of the START into everyday practice both in institutional and community services, highlighting its potential utility in the assessment of risk, but also in the development of integrated treatment plans and risk management strategies.

    “I enjoyed the relaxed presentation styles of the presenters and the relevant and informative information presented. Thank you.”

    “The information was imparted well and with authority and it was helpful to have the practice examples. This was a great training.”

    “The resource materials were easily accessible and relevant and the entire training process was super simple. Thanks!”

    Continuing Education Credit

    This Distance Learning Course is a Home Study Training Program. To earn CEs you are required to complete all course materials, quizzes, and the evaluation. No partial credit is available. A score of 70% is required to proceed; you will be able to re-take any quiz on which you score less than 70%. Participants will earn 10 CE hours upon completion of these requirements. Each participant will be able to download and print the CE certificate upon completion of the final evaluation.

    Board Approvals: APA, ASWB, CPA, NBCC. Click here for state and other regional board approvals.

    Your satisfaction with our programs, products and services is important to us; however, because these are immediately made available to you upon registration and payment, we do not issue refunds. Should you find that a particular program, product or service is not the right fit for you, we will assist you in crediting your registration towards another one of our offerings that might better suit you.

    We specialize in training groups — from a handful to hundreds — and are happy to contact you to discuss your group training needs.

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