Violence Risk Assessment with the HCR-20V3 in Legal Contexts: A Critical Reflection

Risk and protective factors in risk assessment: Predicting inpatient aggression in adult males detained in a forensic mental health setting

Structured clinical risk assessments represent a preferred means of assessing levels of aggression risk at different times and in different individuals. Increasing attention has been given to capturing protective factors, with sound risk assessment critical to high-secure forensic mental health care. The aim was to assess the predictive value of the HCR-20v3 for aggression risk and the long-term care pilot version of the SAPROF (the SAPROF-LC-pilot) in a high-secure forensic mental health inpatient population and to determine the incremental value of protective over risk factors. Participants were adult males detained in a high secure forensic mental health service, with a primary diagnosis of schizophrenia and/or personality disorder. The focus was on examining hospital based aggression (self- and other-directed) at two time points; up to 6 months (T1) and between 7 and 12 months (T2). The HCR-20V3 and SAPROF-LC-pilot demonstrated good predictive validity but with variability across subscales and aggression types/periods. Historical factors of the HCR-20V3 and External factors of the SAPROF-LC-pilot failed to predict, aside from a medium effect at T1 for verbal aggression and self-harm, for Historical factors. There was evidence for protective factors adding to prediction over risk factors alone, with the integration of protective and risk factors into a risk judgement particularly helpful in improving prediction accuracy. Protective factors contributed to risk estimates and particularly if integrated with risk factors. Combining risk and protective factors has clear predictive advantages, ensuring that protective factors are not supplementary but important to the aggression assessment process.

Predicting violence in female forensic inpatients with substance use disorders - the utility of a gender-responsive assessment

Introduction

Given that risk assessment tools are commonly based on male samples, the applicability to justice-involved women remains to be clarified. This study aimed at assessing (1) the predictive validity of the HCR-20 V3, the prevailing, yet primarily male-based violence risk assessment instrument, and (2) the incremental validity of the FAM, a gender-responsive supplement, for both inpatient violence and violent recidivism in justice-involved women.

Methods

The sample included 452 female forensic inpatients with substance use disorder discharged from German forensic psychiatric care between 2001 and 2018.

Results

ROC analyses revealed good predictive accuracy for the HCR-20 V3 while the FAM failed to provide incremental validity. Further, binary logistic regression determined several predictors of violence including personality disorder, covert/manipulative behavior, suicidal behavior/self-harm, and problematic intimate relationship.

Discussion

These findings support the applicability of the HCR-20 V3 in justice-involved women with substance use disorder, while highlighting the clinical relevance of the FAM in supporting a gender-informed risk management.

Using the VERA-2R, professional and organisational aspects

Introduction

Violent extremism risk assessments of individuals suspected or convicted of terrorism are relevant for legal decisions, in prison and probation settings, and in inter-professional risk collaboration. These risk assessment reports by professionals should be applicable to and usable for the different judicial contexts. Informal and formal clinical practice evaluations, in the form of practitioners feedback and standardised evaluation of professional violent extremism risk reports are needed to gain insight in the use and quality of violent extremism risk assessments.

Methods

In this study we examined how forensic professionals from three different countries (Sweden, Belgium and the Netherlands) use the VERA-2R in different judicial contexts. We also investigated which organizational aspects are important for the use of the VERA-2R. We focused on the perspective of the forensic professionals and their judicial organisations. We did a standardised survey among 86 VERA-2R trained professionals and a standardised interview with 20 executives and managers of organizations working with the VERA-2R.

Results

This study showed that professionals find the VERA-2R useful for structuring information and speaking a common risk language. However, using the VERA-2R comes with a variety of challenges, both on the professional and organisational level. VERA-2R trained professionals had few opportunities to use the instrument and when they did, they were not always offered regular supervision, intervision and booster training. Also, organisational issues in collaboration between judicial partner organisations and the lack of risk transfer information to professionals came to light.

Discussion

More research on the topic of risk transfer is needed. Policy implications are advised, for example the development of booster trainings, more organizational support, regulations on re-assessments, providing expertise and knowledge to indirect stakeholders and clear writing guidelines.

Evaluating the HCR-20V3 violence risk assessment measure with mentally disordered offenders and civil psychiatric patients in China

The current prospective risk assessment study evaluated the application of the Chinese translation of the Historical-Clinical-Risk Management-20 Version 3 (HCR-20V3 ) in a sample of 152 offenders with mental disorders and civil psychiatric patients. The ratings of the presence and relevance of risk factors were compared, as well as summary risk ratings (SRRs), both across offenders and civil psychiatric patients, and across male and female sub-samples. Interrater reliability was consistently "excellent" for the presence and relevance of risk factors and for SRRs. Concurrent validity analyses indicated that HCR-20V3 was strongly correlated with Violence Risk Scale (from r = 0.53 to 0.71). The results of predictive validity analyses provided strong support for the bivariate associations between the main indices of HCR-20V3 and violence within 6 weeks, 7-24 weeks, and 6 months; SRRs added incrementally to both relevance and presence ratings across three follow-up lengths.

Personality Assessment in Legal Contexts: Introduction to the Special Issue

This special issue addresses a major gap in the literature by providing comprehensive, credible reviews of the psychometric evidence for and legal status of some of the most commonly-used psychological and personality assessment measures used in forensic evaluations. It responds to Neal and colleagues' (2019) call for research to improve the state of and access to knowledge about psychological assessments in legal contexts, and encourages critical thinking about forensic assessment in the spirit of improvement. These articles offer clarity about the strengths and weaknesses of a number of assessment instruments to inform psychologists' preparation for expert testimony, lawyers' preparation for direct and cross-examination, judges' evidence admissibility determinations, and scholars' future research. We assembled teams of authors with different perspectives and areas of expertise to review each tool fairly, including several adversarial collaborations. Articles on the Rorschach and R-PAS, MMPI-3, PCL-R, MCMI-IV and MACI-II, PAI and PAI-A, SIRS-2, HCR-20^V3, TSI and TSI-2, and the MacCAT-CA, ECST-R, and CAST*MR are included. To increase visibility, accessibility, and impact, this issue is published as free access, meaning the articles are available to download without charge. We anticipate these articles will be widely read and useful to scholars and practitioners in both psychology and law.