Doug Johnston, MD (left) and Chris Racine, MD (right) reviewing a FRST screening.

Assessing the risk of violence in behavioral health patients can be tricky, especially when the patient is admitted to the emergency department (ED) and there isn’t an opportunity for a comprehensive violence risk assessment. To make the assessment process more efficient, Dr. Chris Racine, lead psychiatrist of emergency psychiatry at Maine Medical Center, has implemented the use of the Fordham Risk Screening Tool (FRST). FRST is an effective and quick screening tool used to assess violence risk in medical settings. FRST helps staff better understand a patient’s mental state and determine the best way to mitigate risk during the patient’s care.

Only a small minority of behavioral health patients engage in violent behavior, but when they do it can affect their care, their safety and the safety of others, including their caregivers. Identification of people with mental illness who are at risk of significant violence is essential to psychiatric practice. In a fast-paced environment like the ED, staff need to be able to assess patients more quickly. Using FRST, clinicians and frontline staff can make decisions around violence risk, while reducing potential bias. Staff in the ED now use the tool daily, and Chris and his colleagues are gathering data to see how the screening correlates with violence. Chris believes the tool can be rolled out to other local health systems, and he’s using the data to make the tool scalable. Additionally, he’s focused on expanding strategies to help mitigate the number of violent incidents.

Chris was part of MaineHealth’s Innovation Fall Ignite 2021 funding cycle. He has used FRST at MMC’s ED on more than a thousand patients, trained dozens of clinicians and presented at the National Update on Behavioral Emergencies (NUBE) Conference.

“Using the FRST has been a great tool that has helped me to get a sense of a patient’s violence risk. It’s easy to use and helps inform my decision-making regarding safety.”

– Gemma Atticks LCSW, Social Work III, Acute Psychiatry Unit

Next Steps

Chris is seeking funds to continue his data collection and rollouts to more EDs.


  • Chris Racine, MD, MPH, Lead Psychiatrist, Emergency Psychiatry
  • Tania Strout, PhD, RN, MS, Vice Chair for Research, Emergency Medicine
  • Douglas Johnston, MD, Psychiatric Resident
  • Linda Durst, MD, Chair, Department of Psychiatry