[startgroup] Re: START time frames
- From: "Desmarais, Sarah" <sdesmarais@xxxxxxxxxxxxxx>
- To: <startgroup@xxxxxxxxxxxxx>
- Date: Sun, 19 Jul 2009 10:32:52 -0700
Hi Mike,
In our service and in training we suggest that START assessments are conducted
every 3 months (as an outer limit) and that item ratings reflect what has
happened since the last START assessment, or the past 2-3 months for an initial
START assessment. Version 1.1 now provides some clarification regarding this
issue on pp. 25-26:
Time Frames
Any risk assessment should be anchored in an evaluation of relevant historical
factors. Although dynamic in nature, assessors are prompted to consider both
current and historical information in their START assessments. Strength and
vulnerability ratings of 0, 1, or 2 on the START items will normally be based
on functioning over the past two to three months or since the previous START
assessment. Key and critical items capture information regarding current or
past functioning which may be particularly relevant to treatment and risk
management planning. Identification of signature risk signs will require an
indepth review of historical information, but may describe current or past
functioning. Specific risk estimates will forecast over weeks to a maximum of
three months as specified in the START Time Frame. Current Management Measures
are also future-oriented, describing those strategies that will be used until
the end of the START Time Frame or as necessary (e.g., times of crisis,
transition, or other change in circumstance).
Sarah L. Desmarais, Ph.D.
Junior Research Scientist, Forensic Psychiatric Hospital
BC Mental Health & Addiction Services
Post Doctoral Research Fellow, School of Population and Public Health
Postdoctoral Teaching Fellow, Department of Psychology
University of British Columbia
________________________________
From: startgroup-bounce@xxxxxxxxxxxxx on behalf of Mike Doyle
Sent: Sat 18/07/2009 9:10 AM
To: startgroup@xxxxxxxxxxxxx
Subject: [startgroup] Re: SV: Re: START
Hi Kare
Yes, I was disappointed about not being able to stay longer in Edinburgh, but
new role has placed a number of restrictions on my time. In any case I believe
the conference went very well. At least next year I won't be expected to nip
back to the office after a day!
Our original form takes about 25 minutes the first time, although extended
format with evidence boxes etc takes 1 hour +.
I guess there may be a threshold at which the START becomes impractical as a
'brief clinical guideline'. Many staff mistake the 'short term' aspect as
meaning it takes a short time to complete and I seem to recall some mention in
the early days that it could be done in 8 minutes!
I am also interested to hear what time period people use to rate items; e.g.
previous week, month, 2-months etc., as this is obviously crucial to the rating
and dynamic nature of the tool.
Thanks for your response.
Mike
----- Original Message -----
From: Kare.Nonstad@xxxxxxxxx
To: startgroup@xxxxxxxxxxxxx
Sent: Wednesday, July 15, 2009 10:05 AM
Subject: [startgroup] SV: Re: START
Hi Mike. Sorry You had to leave Edinburgh so soon. Isn`t it allways
tempting to try to make a good thing do even more? I have had to curb my
enthusiasm repeatedly in my ideas to make the START jump trough flaming rings
etc. I like Your model, though. There is a need for developing some kind of
meta-model concerning our branch of psyciatry.
We probable are a chatty bunch here in Trondheim, as in my experience,
a START meeting takes about an hour, maybe one and a half if we do the
treatment plan in the same meeting. This is in the beginning of the patients
stay, after a couple of STARTs, we usually make it in approx. 45 minutes. Maybe
we should look into this.
Kåre
________________________________
Fra: startgroup-bounce@xxxxxxxxxxxxx
[mailto:startgroup-bounce@xxxxxxxxxxxxx] På vegne av Mike Doyle
Sendt: 14. juli 2009 22:30
Til: startgroup@xxxxxxxxxxxxx
Emne: [startgroup] Re: START
Thanks Chris, Sarah and Steve for your helpful responses.
I think the items are ideal areas for consideration when assessing
strengths and risks, but also for the assessment of physical, psychological,
social and political needs. As you know we are piloting the START to do this as
part of applying the health career model.
Initial feedback was good but the e-proforma we used (which included
evidence boxes, formulation and intervention sections), was felt to take too
long and many never fully completed it. In a sense we 'overcooked' the process
as previous version was broadly welcomed! Therefore, attempting to make
adjustments to make the process more efficient and practically useful. Will
feedback to the group in due course.
Another query; on average how long do people find the START takes to
complete?
Thanks again.
Mike
----- Original Message -----
From: christopher webster
<mailto:christopherwebster@xxxxxxxxxxxx>
To: startgroup@xxxxxxxxxxxxx
Sent: Friday, July 10, 2009 5:52 PM
Subject: [startgroup] Re: START
Hi Mike,
Not sure I can add much. But, obviously, the HCR-20
provided a platform for us.And having a couple of senior, very
experienced,nurses (Mary-Lou and Connie) made the essential difference.
Somewhat later, as I explained in a paper given at the Montreal IAFMHS meeting
on our joint behalf, I realized that a dictionary of synonyms and antonyms
could have saved us some work. I really do,though, believe that the only way to
set up an SPJ device that has any hope of working is to establish a small group
of colleagues willing to work together assiduously until the task is done. It
is not a task for a committee and it is not a task for an individual person. It
should, of course, be a topic to be studied and researched in its own right.
Thanks, Roger, for getting this going! Cheers(We
should be a formidable presence in Vcvr) Chris.
----- Original Message -----
From: Mike Doyle <mailto:mj.doyle1@xxxxxxxxxxxx>
To: startgroup@xxxxxxxxxxxxx
Sent: Thursday, July 09, 2009 4:15 PM
Subject: [startgroup] START
Nice one Roger!
Looking forwarwd to networking with alll on the list.
First query; where did the 20 items of the START come
from?
Thanks
Mike
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