Violence risk assessment and women: predictive accuracy of the HCR-20 in a civil psychiatric sample

Gender responsivity in the assessment and treatment of offenders

Risk assessment tools used to assess justice-involved women have been predominantly developed using male offenders, with validations for females having mixed results. Female-specific risk assessment tools are not well established, and validations are limited. In terms of treatment, either programmes in various jurisdictions have been developed specifically for females, or addendums are available to assist in the facilitation of programmes initially developed for male offenders. The efficacy of these has been varied with gender-responsive programmes proving to be more successful in the reduction of reoffending if justice-involved women follow a gender-specific pathway to offending than if they follow a non-gender-specific pathway. This paper discusses gender differences in offending and provides an overview of assessment and treatment of justice-involved women in Australia, the UK, New Zealand and Canada. The assessment and treatment practices for justice-involved women are viewed through an evidence-based lens, and opportunities for future development are identified.

The criminogenic profile of violent female offenders incarcerated in Western Australian prisons as per the Level of Service/Risk, Need, Responsivity (LS/RNR) and Violence Risk Scale (VRS)

Female offender risk assessment is predominantly based on criminogenic factors that predict reoffending in males. Research indicates there are criminogenic factors specific to female offenders, and certain factors linked to offending for both sexes have greater impact on female offenders. This paper extends current research using a Western Australian sample to determine whether findings are replicated with an Australian cohort. Gender differences in the criminogenic profile of 1704 violent offenders (9% female), assessed using the Level of Service/Risk, Need, Responsivity (LS/RNR) and Violence Risk Scale (VRS), were analysed using a matched sample study design. There were significant gender differences on all components of the LS/RNR, except criminal history. In the subsequent matched study, these differences varied, and females scored significantly lower on all VRS-SV items, except age. Gender differences in violence risk scores were clear, providing support for gender-responsive assessment and treatment of violent female offenders, with further validation needed.

Predicting violence risk and recidivism in female parolees: A state-wide sample

Historically, research on violence risk assessments has primarily focused on male psychiatric patients and/or inmates, with minimal attention given to female patients and/or inmates-two populations likely to differ with regard to violence risk conceptualization. To date, there is no known measure of violence risk specifically tailored to predicting risk for this population that is accurate, brief, and cost-effective. As such, the current study exclusively focused on the predictive ability of the Iowa Violence and Victimization Instrument (IVVI) for female parolees over a 30-month follow-up period. Results indicated not only was the IVVI comparable across genders, its predictive power was comparable to more established measures (i.e., Violence Risk Appraisal Guide-Revised, HCR-20 V3). Results also found the IVVI may have greater usefulness with prediction of violent and felony property offenses, but limited usefulness for predicting misdemeanor property and drug offenses. Taken together, findings gathered from the current study suggest while women are reoffending at lower rates than men, yet there are fewer gender differences in risk factors for engaging in violence than expected.

Predictive accuracy of the Historical-Clinical-Risk Management-20 for violence in forensic psychiatric wards in Japan

BACKGROUND

Most structured assessment tools for assessing risk of violence were developed in Western countries, and evidence for their effectiveness is not well established in Asian countries.

AIMS

Our aim was to examine the predictive accuracy of the Historical-Clinical-Risk Management-20 (HCR-20) for violence in forensic mental health inpatient units in Japan.

METHODS

A retrospective record study was conducted with a complete 2008-2013 cohort of forensic psychiatric inpatients at the National Center Hospital of Neurology and Psychiatry, Tokyo. Forensic psychiatrists were trained in use of the HCR-20 and asked to complete it as part of their admission assessment. The completed forms were then retained by the researchers and not used in clinical practice; for this, clinicians relied solely on national legally required guidelines. Violent outcomes were determined at 3 and 6 months after the assessment. Receiver operating characteristic analysis was used to calculate the predictive accuracy of the HCR-20 for violence.

RESULTS

Area under the curve analyses suggested that the HCR-20 total score is a good predictor of violence in this cohort, with the clinical and risk sub-scales showing good predictive accuracy, but the historical sub-scale not doing so. Area under the curve figures were similar at 3 months and at 6 months.

CONCLUSIONS

Our results are consistent with studies previously conducted in Western countries. This suggests that the HCR-20 is an effective tool for supporting risk of violence assessment in Japanese forensic psychiatric wards. Its widespread use in clinical practice could enhance safety and would certainly promote transparency in risk-related decision-making. Copyright © 2016 John Wiley & Sons, Ltd.

Clinical characteristics and outcomes on discharge of women admitted to a Medium Secure Unit over a 4-year period

There are limited data on women in Medium Secure settings. This study aimed to address this by assessing the characteristics of 45 consecutive admissions to the female ward of a Medium Secure Unit in the United Kingdom over a four-year period. Data on demographics, clinical outcomes and from HONOS-Secure/HONOS and HCR-20 assessments were prospectively collected. Psychiatric diagnoses were recorded using ICD-10 criteria. Data on quality of life from WHO-QoL-BREF surveys were analysed. There was a high proportion of ethnic minorities (57.8%), high rates of childhood and adult abuse and low socioeconomic status. 62.2% of the patients had schizophrenia, 57.8% had multiple diagnoses. The median length of stay at discharge was 465.5 days. There were statistically significant reductions in rates of self-harm and HoNOS-Secure/HoNOS and HCR-20 scores following intervention. Scores on WHO-QoL-BREF compared favourably to a large-scale sample with mental health difficulties. Many characteristics of this sample were comparable to samples from similar populations. However the particularly high proportion of ethnic minorities suggested that the profile of our patients differs from nationwide samples. Intervention by our service was associated with reduced self-harm and improvements in well-defined clinical outcomes and quality of life measures using validated scales.

Characteristics of START assessments completed in mental health jail diversion programs

Many different instruments have been developed to assist in the assessment of risk for violence and other criminal behavior. However, there is limited evidence regarding how these instruments work in the 'real world'. Even less is known about how these instruments might work for assessing risk in jail diversion populations, whether in research or practice. To address these knowledge gaps, the present study examined the characteristics of risk assessments completed by program staff (n=10) on 96 mental health jail diversion clients (72 men and 24 women) using the Short-Term Assessment of Risk and Treatability (START). The findings provide preliminary support for the reliability and validity of START assessments completed in jail diversion programs, the first evidence of the transportability of START outside psychiatric settings, and further evidence regarding the reliability and validity of START assessments completed in the field. They additionally support the consideration of an eighth, general offending risk domain in START assessments.