10 Hours | 10 CEs

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

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.

Learning Objectives

Upon completion of this course you will 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)

Presented By

Sarah L. Desmarais, PhD

Sarah L. Desmarais, Ph.D., is a professor of psychology at North Carolina State University. She received her Ph.D. from the Law and Forensic Psychology Program at Simon Fraser University and completed postdoctoral training in population and public health at the University of British Columbia. Dr. Desmarais’ research examines the assessment and treatment of risks and needs associated with criminal behavior, violence, and terrorism. She has more than 120 peer-reviewed publications in journals including the Law and Human Behavior, Criminal Justice and Behavior¸ and American Journal of Public Health. Her research has been funded by grants and contracts from agencies including the Canadian Institutes of Health Research, National Institute of Mental Health, the National Institute on Drug Abuse, National Institute of Justice, and the MacArthur Foundation. Her work has been featured in media outlets such as the Washington Post, Last Week Tonight with John Oliver, and The Atlantic. 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 agencies worldwide on the implementation of START, START:AV, and other strategies to support evidence-based practices and decision-making in behavioral health and criminal justice settings.

Tonia L. Nicholls, PhD

Dr. Tonia L. Nicholls is a 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.

Collect Badges, Earn Certificates

This is a badge-earning course, which means it will help you earn a certificate that can be showcased on digital platforms like LinkedIn.

  • Intended Audience

    This self-paced course is intended for mental health and other allied professionals.

  • Experience Level

    This self-paced course is appropriate for beginner, intermediate, and advanced level clinicians.

  • CE / CPD Credit

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

Course Preview


  • 1


    • Review Before Proceeding

  • 2

    Course Materials

    • START Item Explanations

    • START Risk Estimate Definitions

    • Case Study - Mr. V

    • Coding Notes - Mr. V

    • Summary Sheet - Mr. V

    • Summary Sheet - Blank

    • Coding Notes - Blank

  • 3

    An Introduction and Summary of Research Evidence

    • Lesson 1 Video

    • de Ruiter & Nicholls (2011)

    • Lesson Quiz

  • 4

    Applying the START

    • Lesson 2 Video

    • Nicholls et al. (2008)

    • Webster et al., (2006)

    • Lesson Quiz

  • 5

    Current Status of the START

    • Lesson 3 Video

  • 6

    Scoring Strengths and Vulnerabilities

    • Lesson 4 Video

    • START Manual

    • Lesson Quiz

  • 7

    START Items 1 - 5

    • Lesson 5 Video

    • Lesson Quiz

  • 8

    START Items 6 - 10

    • Lesson 6 Video

    • Lesson Quiz

  • 9

    START Items 11 - 17

    • Lesson 7 Video

    • Lesson Quiz

  • 10

    START Items 18 - 21

    • Lesson 8 Video

    • Lesson Quiz

  • 11

    Specific Risk Assessments: The Seven START Risk Domains

    • Lesson 9 Video

    • Lesson Quiz

  • 12

    Course Evaluation

    • Course Evaluation

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  • CE Credit

    Earn CE credit for meaningful professional training that will elevate your practice

  • Convenience & Flexibility

    Learn at your own pace, from wherever you might be!

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