The Short-Term Assessment of Risk and Treatability Scale: Reliability and Validity in a Thai Forensic Psychiatric Inpatient Setting

The Short- Term Assessment of Risk and Treatability (START) scale is deemed the most appropriate instrument for assessing risks and for managing violent behaviors due to its balanced perspective between protective factors (i.e., strength) and dynamic risk (i.e., vulnerability). Although several facets of reliability and validity of this tool are strong, its reliability, validity, and implementation in the Asian population lacks investigation. This study aimed to examine inter-rater reliability, internal consistency reliability, construct validity and predictive validity of the START in the Thai context. The participants consisted of 118 Thai forensic psychiatric inpatients hospitalized at a public hospital. Trained mental health professionals (i.e., psychiatrists, forensic nurses, clinical psychologists, social workers, and occupational therapists) assessed each participant across the 20 domains with 40 items of the Thai START. Each domain was rated for both degrees of strength and vulnerability on two three-point scales (0-1-2) format. Inter-rater and internal consistency reliabilities and the construct and predictive validities were used to examine psychometric properties of the scale. The main finding demonstrated the good- to- excellent level of inter-rater reliability, an acceptable level of internal consistency reliability. The data supported two relational constructs (i.e., strength vs vulnerability subscales) of the Thai START. The poor-to-excellent predictability of the Thai START items on violent behaviors was also evident. This study also provided the guideline for implementing the tool in non-Western forensic psychiatric populations. Thus, the Thai START is a promising tool for understanding, predicting, and managing violent/challenging behavior in forensic psychiatric inpatients.