START Unique Features — MRCPsych Paper B MCQ

Correct answer: C — A structured professional judgement guide rating 20 dynamic areas as both Strengths and Vulnerabilities before estimating seven short-term adverse outcomes

Explanation lettering: D = shown as B · B = shown as C · C = shown as D

START is a structured professional judgement instrument for short-term risk assessment and management. Its distinctive feature is that each of 20 dynamic areas is rated separately as a Strength and a Vulnerability. These ratings inform clinical estimates across seven domains: violence to others, self-harm, suicide, substance misuse, victimisation, unauthorised leave and self-neglect. It is therefore neither a purely actuarial nor a static instrument. Option C describes the 20-item Psychopathy Checklist–Revised more closely. Option D resembles the HCR-20, which combines historical, clinical and risk-management factors and focuses on violence. Options A and E describe actuarial approaches based predominantly on historical or static variables, including tools designed for violent or sexual recidivism.

Reference: O'Shea LE, Picchioni MM, Dickens GL. The Predictive Validity of the Short-Term Assessment of Risk and Treatability (START) for Multiple Adverse Outcomes in a Secure Psychiatric Inpatient Setting. Assessment. 2016;23(2):150–162. https://pubmed.ncbi.nlm.nih.gov/24796344/