Use of Violence Risk Assessments Tools a Growing Global Phenomenon

ijfmhThe use of psychological assessment instruments for evaluations of risk is a growing phenomenon around the world. This is the bottom line of a recently published article in International Journal of Forensic Mental Health. Below is a summary of the research and findings as well as a translation of this research into practice.

Featured Article | International Journal of Forensic Mental Health | 2014, Vol. 13, No. 3, 193-206

International Perspectives on the Practical Application of Violence Risk Assessment: A Global Survey of 44 Countries

Authors

Jay P. Singh, Sarah L. Desmarais, Cristina Hurducas, Karin Arbach-Lucioni, Carolina Condemarin, Kimberlie Dean, Michael Doyle, Jorge O. Folino, Verónica Godoy-Cervera, Martin Grann, Robyn Mei Yee Ho, Matthew M. Large, Louise Hjort Nielsen, Thierry H. Pham, Maria Francisca Rebocho, Kim A. Reeves, Martin Rettenberger, Corine de Ruiter, Katharina Seewald, & Randy K. Otto

Abstract

Mental health professionals are routinely called upon to assess the risk of violence presented by their patients. Prior surveys of risk assessment methods have been largely circumscribed to individual countries and have not compared the practices of different professional disciplines. Therefore, a Web-based survey was developed to examine methods of violence risk assessment across six continents, and to compare the perceived utility of these methods by psychologists, psychiatrists, and nurses. The survey was translated into nine languages and distributed to members of 59 national and international organizations. Surveys were completed by 2135 respondents from 44 countries. Respondents in all six continents reported using instruments to assess, manage, and monitor violence risk, with over half of risk assessments in the past 12 months conducted using such an instrument. Respondents in Asia and South America reported conducting fewer structured assessments, and psychologists reported using instruments more than psychiatrists or nurses. Feedback regarding outcomes was not common: respondents who conducted structured risk assessments reported receiving feedback on accuracy in under 40% of cases, and those who used instruments to develop management plans reported feedback on whether plans were implemented in under 50% of cases. When information on the latter was obtained, risk management plans were not implemented in over a third of cases. Results suggest that violence risk assessment is a global phenomenon, as is the use of instruments to assist in this task. Improved feedback following risk assessments and the development of risk management plans could improve the efficacy of health services.

Keywords

Violence, risk assessment, survey, international, mental health

Summary of the Research

A total of 2135 mental health professionals around the world were surveyed with respect to their risk assessment practices. The majority of the respondents were women (60.3%) and the average age of respondents was 43.9 years (SD = 11.0), with an average of 15.9 years (SD = 10.7) spent in practice. “Approximately half of their time in the past 12 months was spent on clinical activities, most often in forensic psychiatric hospitals followed by private practice and correctional institutions. Additional professional responsibilities over the past 12 months included administrative duties and teaching, with comparatively less time spent on research activities” (p. 198). Mental health professionals were contacted through web-based surveying, in a variety of languages, to examine the similarities and differences in risk assessment practices. The majority of participants were psychologists given that one of the inclusion criteria was that participants have previous training and practice in assessment.

Assessment Instruments Being Used

Two primary approaches to risk assessment have been identified: the actuarial approach, which combines protective and risk factors for violence in a mechanical, statistically-based way within a particular population of interest, and the structured professional judgment (SJP) approach, which provides an evidence-based structure within which the evaluator may use clinical discretion. The three most commonly used instruments for violence risk assessments identified in this study were the Historical, Clinical, Risk Management-20 (HCR-20), the Psychopathy Checklist-Revised (PCL-R), and the Psychopathy Checklist: Screening Version (PCL:SV) over both a lifelong and twelve-month time period. More than any other instrument, the HCR-20 was used to conduct, develop, and monitor risk for violence assessments and risk management plans. Personality instruments, such as the PCL-R, do not accurately predict violence as well as tools specifically designed for violence risk assessment but may still be helpful in the overall evaluation of an individual;’s risk for violence. In Europe, the HKT-30 (an instrument that is based on the HCR-20 but adds an additional 10 factors to consider) and the FOTRES were used almost exclusively.

Overall, both actuarial methods and SJP approaches had success and popularity among professionals. This research underscores that the decision regarding which of the two approaches to use should be based on the particular characteristics of the individual being evaluated as well asthe specific environment in which the professional works. Participants using SJP methods rated them as very helpful for their assessments. SJP tools like the HCR-20 or the HKT-30 appear to be more useful in international settings as actuarial approaches are impacted more by local factors than are SJP instruments, causing greater variability in probabilities of violence risk.

Implementation of Assessment Tools

“In terms of professional discipline, psychologists reported using instruments to structure their violence risk assessments more often than did psychiatrists or nurses both over their lifetime and in the past 12 months. Nurses reported more often obtaining feedback on whether their risk management plans had been implemented and that their risk management plans were implemented more often than psychologists or psychiatrists. Finally, psychologists reported taking significantly longer to conduct both unstructured violence risk assessments and structured violence risk assessments” (p. 199)

These authors “found that respondents who used instruments to develop management plans frequently did not know whether their plans had been implemented (44.6%) and, amongst those who did, proposed plans were not implemented in over a third of cases (34.6%)” (p. 202-203). Execution of risk assessment and management plans is necessary to manage risks.

Global Trends and Practices in Risk Assessment

“Compared to North America, Europe, and Australasia, respondents in Asia and South America reported completing a smaller proportion of risk assessments with the aid of an instrument” (p. 199). This highlights the differences in professional practices and differences across different countries. In addition, the lack of representation of these countries in the development of risk assessment research and practice may contribute to the slower adoption of these clinical practices in these countries. Other cultural restrictions included unauthorized translation of foreign materials or lack of awareness for instruments that are commercially available.

As the need for quality violence risk assessment grows on a global scale, it will be important to identify appropriate tools for risk assessments in South America and Asia.

Translating Research into Practice

This survey has two primary implications for practice: (1) we need to Improve communication regarding the quality and follow up of violence risk assessment and management plans, and (2) we need more information regarding how cultural factors impact the usage and quality of violence risk assessments throughout different countries.

Risk assessments provide a primary means of communication for mental health professionals. As such, there must be a continuum of channels for communication to ensure the clinical assessment is used to its fullest potential. If a mental health professional is required to perform assessments with no direct follow up or no follow through, then assessments lose their utility. Only one-third of participants reported receiving feedback on the accuracy of their assessments. “Social psychology research demonstrates that judgment accuracy increases when decision-makers receive feedback about their performance” (p. 202). It is important to receive feedback on the accuracy of assessments to determine whether additional training, education, or experience is needed. On the other hand, identifying professionals with strong assessment skills could help train other professionals to improve their skills. The main goal is to strengthen assessment skills and become experienced using these tools which will help improve the predictive validity of risk assessments.

“Moving forward, clinical training programs in these areas may wish to incorporate modules on violence risk assessment tools, funding agencies may wish to issue grants to encourage the development of novel instruments in native languages or the authorized translations of available tools, and there needs to be increased discussion in the field about the strengths and limitations of the contemporary literature and best-practice recommendations in international settings” (p. 203). Cultural differences across countries can be controlled to an extent as more collective research is transformed into international, unified models of clinical practice.

Other Interesting Tidbits for Researchers and Clinicians

Participants in this survey reported an average of 435.5 violence risk assessments in their lifetime with the use of a structured instrument for over half of those assessments. On average, about 35 violence risk assessments were performed within a twelve-month time frame. The time to conduct a structured assessment took an average of 7.8 hours while an unstructured assessment took an average of 2.8 hours. This 5-hours difference is significant but structured assessments offer more valid and reliable conclusions.

Younger participants and participants who had shorter careers were more likely to use structured violence risk assessments than older participants or participants with longer careers. This could be evidence towards a shifting philosophy in clinical practice that strives for the use of Structured Professional Judgment approaches.

Join the Discussion

As always, please join the discussion below if you have thoughts or comments to add!

Special Contributor

PatrickAndreaContributions to this post were made by Andrea Patrick.

Andrea Patrick is a first year masters student studying Forensic Psychology at John Jay College of Criminal Justice. In the future, she hopes to be directly working with forensic populations providing risk assessments and clinical evaluations.

Please Join Us for a 3-hr Live Webinar on the HCR-20 Version 3

HCR20We are pleased to announce a 3-hour live webinar on the newly revised Version 3 of the HCR-20 to be led by threat assessment expert and lead author of the measure, Dr. Kevin Douglas. The webinar will be held on 3 different dates and offered at 2 different times on each date. We are limiting space in each session so participants will have the opportunity to interact with Dr. Douglas and ask questions regarding the development, use, and implementation of this risk assessment instrument. If you are interested in learning more about this important risk assessment instrument or are considering adopting it for use in your clinical practice, please join us for this webinar.

About the HCR-20 Version 3

The HCR-20 is the most commonly used violence risk assessment measure across 44 different countries. It helps professionals in correctional, mental health, and forensic settings make decisions about who poses higher versus lower risk for violence, either within institutions or in the community, and to devise and monitor violence risk management plans. The HCR-20 (Version 2) has been evaluated in more than 100 studies and implemented or evaluated in at least 32 countries.

Version 3 of the HCR-20 was recently released. Version 3 maintains the basic features of Version 2, but has additional features that will help decision makers to determine which risk factors are most relevant at the individual level, how to produce a meaningful case formulation, how to develop helpful risk management plans, and how to make decisions about level of violence risk. In addition, some of the items have changed from Version 2 to Version 3.

About Dr. Kevin Douglas

Douglas, Kevin.jpgKevin S. Douglas is Associate Professor and Associate Chair, Department of Psychology, Simon Fraser University. He is also a Guest Professor of Applied Criminology at Mid-Sweden University, and a Senior Research Advisor at the University of Oslo. Dr. Douglas received his law degree in 2000 from the University of British Columbia, and his Ph.D. in clinical (forensic) psychology from Simon Fraser University in 2002. He received a Michael Smith Foundation for Health Research Career Scholar Award (2005-2010), and was the recipient of the Saleem Shah Award for Early Career Excellence in Psychology and Law (2005), awarded jointly by the American Psychology-Law Society and the American Academy of Forensic Psychology. His research has been funded by the National Science Foundation (USA), Canadian Institutes of Health Research, Social Sciences and Humanities Research Council of Canada, and the Michael Smith Foundation for Health Research. His research addresses violence risk assessment and management, the association between various mental and personality disorders (i.e., psychosis; psychopathy) and violence, and dynamic (changeable, treatment-relevant) risk factors. He is co-author of the Historical-Clinical-Risk Management-20 (HCR-20) violence risk assessment measure, which has been translated into 18 languages and is used broadly around the world (roughly 35 countries) in correctional, forensic, and psychiatric settings to help guide decisions about violence potential and how to reduce it. Dr. Douglas is lead author on the latest (third) revision of the HCR-20, called the HCR:V3. More recently, he has been conducting research on other violence-related adverse experiences, including suicide-related behavior, and being victimized by violence. On these topics, Dr. Douglas has authored over 100 journal articles, books, or book chapters.

About the Webinar

This is a 3-hour live webinar that allows for interaction with Dr. Douglas. Participants will receive a certificate of completion as well as 3 Continuing Education credits for attending.

Dates and Times

November 5th, 2014 | 9:00am (PST)/Noon (EST)     OR     1:00pm (PST)/4:00pm (EST)

November 10th, 2014 | 9:00am (PST)/Noon (EST)     OR     1:00pm (PST)/4:00pm (EST)

November 12th, 2014 | 9:00am (PST)/Noon (EST)     OR     1:00pm (PST)/4:00pm (EST)

Learning Objectives

This 3-hour live webinar will:

• Describe the revision process for the development of Version 3 and outline the changes that differentiate Version 2 from Version 3

• Provide an overview of the items and a discussion regarding how the measure can be used in practice (implementation issues)

• Provide an opportunity to interact with Dr. Douglas and ask questions

Cost

The cost for this webinar is $149

Registration

Registration for this 3-hour live webinar is now open. Interested participants can register by clicking the “Register Now!” button below.

 

Register Now

Please use the buttons below to share this post and we look forward to seeing you there!!

Causal Attributions Influence Scores on the HCR-20

ijfmhCasual attributions—judgments about the internal or external cause of an individual’s actions—influence scores on the HCR-20. This is the bottom line of a recently published article in International Journal of Forensic Mental Health. Below is a summary of the research and findings as well as a translation of this research into practice.

Featured Article | International Journal of Forensic Mental Health | 2014, Vol. 13, No. 1, 8-17

Investigating the Influence of Causal Attributions on Both the Worksheet and Checklist Versions of the HCR-20

Authors

Jennifer Murray, School of Life, Sport and Social Sciences, Edinburgh Napier University, Sighthill Campus, Sighthill Court, Edinburgh, Scotland
Kathy E. Charles, School of Life, Sport and Social Sciences, Edinburgh Napier University, Sighthill Campus, Sighthill Court, Edinburgh, Scotland
David J. Cooke, Department of Psychology, Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow, Scotland
Mary E. Thomson, Newcastle Business School, Northumbria University, City Campus East, Newcastle Upon Tyne, England

Abstract

Attribution theories suggest that when assessing an individual’s actions, judgments are made about the cause of these behaviours and often these judgments focus on internal or external causal explanations. The current research investigated the effects of internal and external attribution on the scoring of the HCR-20 and the possibility of differences in scoring between two ways of using the HCR-20 (using the HCR-20 as a worksheet versus checklist). No differences were present in the scoring between the checklist versus worksheet. Attribution effects were present within the Historical Scale, Clinical Scale, and overall scoring of the HCR-20. Ratings were higher within the internal attribution condition than the external one, indicating that judgments made using the HCR-20 are subject to attribution effects in a similar manner as unaided violence risk assessments.

Keywords

attribution, decision-making, clinical judgment, HCR-20, violence risk assessment

Summary of the Research

“Attribution theories posit that in order to understand the cause of our own or others’ behaviors, we will apply either an internal or an external explanation for the behaviour. When an internal cause is attributed to an individual’s behavior, such as personality or temperament, the individual is often considered to be in control of or responsible for their behavior. Conversely, when the cause of an individual’s behavior is attributed externally, for example, as a result of the environment, the behavior is considered to be less in the individual’s control and their level of responsibility for the outcome is therefore perceived to be low.

The current research aimed to investigate whether the HCR-20 would be affected by attribution effects [and] whether the way in which it is completed will affect the outcome of the risk assessment” (p. 8).

“The HCR-20 is one of the most widely researched, commonly used, and leading structured professional judgment (SPJ) violence risk assessment tools…SPJ tools, such as the HCR-20, do not aim to predict future violence, but instead aim to guide the clinician through the risk assessment using risk factors derived from both empirical and practice-based evidence and inform suitable risk management plans and interventions” (p. 9).

“The HCR-20 should be completed in conjunction with the HCR-20 manual and a ‘worksheet’ is often used to facilitate this. The worksheet guides the user in gathering information, to consider the presence and relevance of risk factors associated with the case, consider different hypothetical scenarios of violence (best-, most realistic-, worst-case scenarios), develop risk management strategies suitable to the case, and finally to document their summary judgments. Spaces are provided underneath each risk item where the clinician can provide evidence from the case sup- porting his or her assertions of whether the item is present, to what extent and whether its presence (or lack of) is of relevance to the risk assessment. In presenting and combining the evidence in this way, it is thought that decision making will potentially be less biased. However, not all clinicians use the worksheet in practice, or indeed the manual (this is not best practice, however, as the manual should be used to guide all assessments); the HCR-20 is at times used purely as a checklist, where the 20 factors are numerically coded on a 0–2 scale. In both the checklist and worksheet formats, the assessor should also formulate a final risk judgment indicating whether the person poses a low, moderate, or high risk” (p. 10).

“Attribution bias occurs when judgments are made about a person or situation but greater or lesser weight is placed on internal or external factors, skewing the viewpoint formed…When information relating to an individual’s internal state, such as mood or personality, is focused upon, internal causal theories about their behavior tend to be formed (internal attribution) and their actions are attributed on something internal to that person. If, on the other hand, external or situational factors are focused on, the individual’s behavior is attributed to something external to them and outside of their control (external attribution)” (p. 10).

Studies on attribution have “found that individuals whose behavior was described to imply more control over their actions (i.e., internally attributed) were considered more dangerous and to have committed a more serious crime than when the individual was described to emphasize the role of external factors on their behavior (i.e., externally attributed), despite the description of the crimes and key features of the individual remaining constant across the internal/external conditions. In order to investigate these attribution effects in relation to more modern risk assessment practice, it is crucial to identify whether attributionally manipulated in- formation influences the scoring of SPJ tools, such as the HCR-20, or whether this effect is confined to unaided clinical judgments” (p. 11).

“The current research [aimed] to investigate the effects of internally and externally manipulated attributional information on the scoring of the HCR-20, and whether this differs across completing the HCR-20 as a checklist or using the worksheet format… A 2×2 independent groups design was used, with the independent variables being the two modes of completion for the HCR-20 (checklist versus worksheet) and the two attributionally manipulated crime-based scenarios (internal versus external). The dependent variable was the numeric responses to the items measured on the HCR-20” (p. 11).

Participants were 40 master’s level psychology students who had an average of 17.5 years of education.

“A significant main effect of attributional manipulation was found for the Historical scale, the Clinical scale, and for the overall scoring of the HCR-20…Participants scored the offender significantly higher in the internal manipulation than in the external one for the Historical and Clinical scales and for the overall HCR-20 score. No main effect of attribution was found in the scoring of the Risk Management scale” (p. 13).

“No main effect of the ‘version’ of the HCR-20 used (checklist versus worksheet) was apparent in any of the three scales or the overall HCR-20 score, indicating no differences” (p. 13).

Differences across attributional manipulations appeared to be most prominent for the following items: Previous Violence, Substance Use Problems, Psychopathy, and Personality Disorder on the Historical scale; Negative Attitudes and Unresponsiveness to Treatment on the Clinical scale; and Exposure to Destabilizers on the Risk Management scale.

Translating Research into Practice

“The finding that individuals completing the HCR-20 as a checklist rated the offender to be a ‘high risk’ more often in the internal manipulation than in the external one provides further evidence that attribution influences assessments of violence. These findings are of paramount importance as they highlight that even when using an SPJ tool, judgments can still be affected by attribution bias.

The current findings identified a number of areas where attribution effects may be more present within the HCR-20; both in terms of scale level and item level. As the HCR-20 is divided into three scales (Historical, Clinical, and Risk Management) the scales most affected by attribution can be identified. Attribution effects were present in the Historical and Clinical scales, but not in the Risk Management scale. In both of the affected scales, numerical judgments of risk were higher in the internal manipulation than in the external one” (p. 15).

In terms of item-level differences in attribution-related scoring, it is important for clinicians to be aware of those items in which attribution effects are most prominent (i.e., Previous Violence, Substance Use Problems, Psychopathy, Personality Disorder, Negative Attitudes, Unresponsiveness to Treatment, and Exposure to Destabilizers) so that they might be mindful of these as a means of reducing attribution effects on these items and the overall judgment of risk that is made. Bearing these attribution effects in mind will help clinicians improve their decision making and risk formulation using the HCR-20.

“The current findings further indicate that the scoring of the HCR-20 does not differ as a function of the checklist versus worksheet modes of completion. This finding is encouraging in terms of applying the findings of existing research, which utilized the HCR-20 as a checklist, to clinical practice…In addition, the present findings support and strengthen those of earlier research findings in the area, in that internally manipulated scenarios are rated higher in terms of risk than externally manipulated ones. Thus, attribution effects are not confined to only unaided judgments of violence risk assessment, but apply also to those made using SPJ tools” (p. 16).

Other Interesting Tidbits for Researchers and Clinicians

“These findings, however, should be considered with caution as it is clear that the effect size, and therefore practical significance/magnitude, of the findings are small. The statistical significance should therefore be considered with some tentative appraisal when discussing the magnitude of this finding, and the overall strength of meaning behind it. Indeed, future research should investigate various levels of clinical expertise and use various vignettes in order to assess the robustness of these findings; ideally with larger sample sizes. However, the current findings could be viewed as a first step towards systematically investigating the effect of known decision-making biases and errors on the completion of the HCR-20” (p. 15).

“Concerning the scoring of the HCR-20 when used as a check-list compared to the worksheet, no significant differences were found. This would appear to be a positive indication for the applicability of existing research (which largely utilizes the HCR-20 as a checklist) to practice, where it is the fuller worksheet adjunct to the HCR-20 manual that should be used. It can therefore be proposed that existing research investigating the HCR-20 is indeed applicable and generalizable to practice” (p. 16).

Join the Discussion

As always, please join the discussion below if you have thoughts or comments to add!

Upcoming Training Dates for Risk Assessment Workshops

Consolidated Continuing Education & Professional Training (CONCEPT) is pleased to offer Continuing Education (CE) credit for workshops provided by our partner, ProActive ReSolutions, who will be holding several upcoming in-person workshops on violence risk assessment and management. Workshop dates are listed below.

As always, online training on risk assessment and management is available at any time. Descriptions of our risk assessment and management training programs can be found on our Programs page as well as below.

In-Person Training Workshops

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  • Advanced Violence Risk Assessment and Management Workshop for Higher Education

Dates: May 25-29, 2015
Location: Burlington, Ontario, Canada
Instructors: Drs. Stephen Hart, Laura Guy, & Kelly Watt
More Information: Click here for further information about this training course, including schedule, course objectives, and description. 

Click here to Register for CE Credits for this Workshop | 30 CEs | $125

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Online Training Programs

  • Foundations of Threat Assessment

The Foundations of Threat Assessment training program accommodates varying levels of experience in threat assessment and risk management and focuses on the most common forms of violence (e.g., general violence, intimate partner violence, stalking).

This Foundations of Threat Assessment training program provides an opportunity to learn new skills and build on existing skills in assessing and managing risk for violence. In addition, general principles of threat assessment and risk management as well as best practices supported by researchers and practitioners around the world are discussed.

More information about this training program can be found here.

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  • Advanced Issues in the Assessment of Risk for Violence: Case Formulation

This training program will provide practitioners with a summary of the most up-to-date research findings relevant to violence and sexual violence, provide an overview of the most recent clinical guidance on risk assessment and management using a structured professional judgement approach, and give practitioners the opportunity to advance their practice in respect of clinical interviewing skills, risk formulation, risk management planning, and risk communication through relevant exercises and case studies.

More information about this training program can be found here.

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  • Assessment of Risk for Violence using the HCR-20 Version 3

This training program on the Evaluation of Risk for Violence using the HCR-20 Version 3 was developed by Drs. Stephen Hart and Kevin Douglas and is presented in partnership with ProActive ReSolutions.

This training program focuses on the revised HCR-20 (now called HCR:V3) in the U.S. and describes why and how the HCR-20 was revised; how Version 3 differs from its predecessors; initial research validation of Version 3; what its risk factors are and how to rate them; and how to complete case formulation and risk management planning using Version 3. Participants will also have the opportunity to complete the HCR:V3 on a practice case.

More information is available about this training program here.

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  • Evaluation of Risk for Sexual Violence using the RSVP

This training program on the Evaluation of Risk for Sexual Violence using the RSVP was developed by Dr. Stephen Hart and is presented in partnership with ProActive ReSolutions.

The Risk for Sexual Violence Protocol (RSVP) is a set of structured professional guidelines that can also be considered a psychological test. This training program describes the RSVP and takes the trainee through a series of video modules on the use of the RSVP for guiding judgements of risk for sexual violence. The trainee also works through three case studies to practice applying the RSVP to case formulation.

More information about this training program can be found here.

Use of the HCR-V3 in Criminal, Civil, and Pretrial Settings

ijfmhTaylor & Francis has made the recently published Special Issue of the International Journal of Forensic Mental Health available for free download until the end of the year. Check out these great articles on the HCR-20 Version 3.

Introduction to the Special Issue of the HCR-20 Version 3

Author

Kevin S. Douglas

Abstract

The HCR-20 Version 3 (HCR-20V3) was published in 2013, after several years of development and revision work. It replaces Version 2, published in 1997, on which there have been more than 200 disseminations based on more than 33,000 cases across 25 countries. This article explains (1) why a revision was necessary, (2) the steps we took in the revision process, (3) key changes between Version 2 and Version 3, and (4) an overview of HCR-20V3‘s risk factors and administration steps. Recommendations for evaluating Version 3 are provided.

 

Historical-Clinical-Risk Management-20, Version 3 (HCR-20V3): Development and Overview

Authors

Kevin S. Douglas
Stephen D. Hart
Christopher D. Webster
Henrik Belfrage
Laura S. Guy
Catherine M. Wilson

Abstract

The HCR-20 Version 3 (HCR-20V3) was published in 2013, after several years of development and revision work. It replaces Version 2, published in 1997, on which there have been more than 200 disseminations based on more than 33,000 cases across 25 countries. This article explains (1) why a revision was necessary, (2) the steps we took in the revision process, (3) key changes between Version 2 and Version 3, and (4) an overview of HCR-20V3‘s risk factors and administration steps. Recommendations for evaluating Version 3 are provided.

 

Interrater Reliability and Concurrent Validity of the HCR-20 Version 3

Authors

Kevin S. Douglas
Henrik Belfrage

Abstract

We evaluated the interrater reliability and concurrent validity of the HCR-20 Version 3 (HCR-20V3). Three sets of ratings were completed by experienced clinicians for 35 forensic psychiatric patients, for both HCR-20 Versions 2 and 3. Reliability analyses focused on ratings of the presence of Version 3 risk factors, presence of Version 3 risk factor sub-items, relevance ratings for Version 3 risk factors, and Version 3 summary risk ratings for future violence. Concurrent validity analyses focused on the correlational association between Versions 2 and 3 in terms of the number of risk factors present. Findings indicated that Versions 2 and 3 were strongly correlated (.69 – .90). Interrater reliability was consistently excellent for the presence of risk factors and for summary risk ratings. The majority of relevance and sub-item ratings were in the good to excellent range, although there was a minority of such ratings in the fair or poor categories. Findings support the concurrent validity and interrater reliability of HCR-20V3. Implications for use of HCR-20V3 by professionals and agencies are discussed.

 

The Validity of Version 3 of the HCR-20 Violence Risk Assessment Scheme Amongst Offenders and Civil Psychiatric Patients

Authors

Diane S. Strub
Kevin S. Douglas
Tonia L. Nicholls

Abstract

The current study presents an empirical evaluation of the performance of the third version of the HCR-20. This prospective research project was conducted using a sample of 106 offenders and psychiatric patients who were transitioning out of institutions and into the community. Results provided strong support for the bivariate associations between the ratings of the presence and relevance of risk factors, as well as summary risk ratings, and violence at 4 to 6 weeks and 6 to 8 months. Although relevance ratings did not add incrementally to presence ratings, summary risk ratings added incrementally to both. Findings were not moderated by either sub-sample or gender. Version 3 of the HCR-20 was highly correlated with Version 2. Associations with violence were comparable between instruments. Findings were supportive of these basic elements of Version 3.

 

Adapting the HCR-20V3 for Pre-trial Settings

Authors

Shannon Toney Smith
Shannon E. Kelley
Allison Rulseh
Karolina Sörman
John F. Edens

Abstract

The present study investigated the use of the HCR-20V3 (Douglas, Hart, Webster, & Belfrage, 2013) among a sample of 84 male inmates in a pre-trial correctional facility. Overall, results indicated that the newly revised instrument can be adapted for use in a pre-trial context, although some scoring obstacles (e.g., participants’ uncertain legal status) were encountered when attempting to rate certain HCR-20V3 items. Also, some group differences in risk ratings were found when comparing our sample to HCR-20V3 data collected from external psychiatric inpatient and post-adjudication samples. Implications for clinical forensic practice are reviewed, focusing on modifications that may be helpful or necessary for use in pre-trial settings.

 

The HCR-20 Version 3: A Case Study in Risk Formulation

Author

Caroline Logan

Abstract

The third edition of the HCR-20 (HCR-20V3, Douglas, Hart, Webster, et al., 2013) consolidates essential recent thinking about risk assessment and management using the structured professional judgement approach. As with the preceding Risk for Sexual Violence Protocol (Hart, Kropp, Laws et al., 2003), risk factors for violence are now assessed for their relevance as well as presence, scenario planning has a central place in anticipating the nature, severity, imminence and likelihood of future harm, and risk management strategies must incorporate a combination of treatment, supervision, monitoring and victim safety planning interventions and recommendations. However, the key process now proposed for linking the assessment and overall management of risk is risk formulation—the act of understanding the underlying mechanism of an individual’s harm potential in order to develop sensitive and proportionate hypotheses to facilitate change (embodied within the risk management plan). In this paper, the process of risk formulation is described and illustrated with a case study—Paul. A brief report of the risk assessment, formulation and management recommendations for Paul illustrate the key features of what is recommended in the new version of this internationally renowned violence risk guide. However, empirical research into risk formulation remains outstanding.

Professional Training on the HCR-V3

CONCEPT is pleased to offer online professional training on the development, administration, scoring, interpretation, and clinical implementation of the HCR-V3. The training program takes approximately 20 hours to complete. Professionals are taken through the development of Version 3 and the rationale for revision and update of this instrument. The training program describes why and how the HCR-20 was revised, how Version 3 differs from its predecessors, initial research validation of the HCR-V3, what its risk factors are and how to rate them, how to formulate a case and engage in risk management planning using the HCR-V3. The program includes both didactic and interactive components and allows the opportunity to apply the HCR-V3 to a clinical case.  More information on this professional training program is available here.

Use of the HCR-V3 in The Netherlands, Germany, England, and Wales

ijfmhTaylor & Francis has made the recently published Special Issue of the International Journal of Forensic Mental Health available for free download until the end of the year. Check out these great articles on the HCR-20 Version 3.

Introduction to the Special Issue of the HCR-20 Version 3

Author

Kevin S. Douglas

Abstract

The HCR-20 Version 3 (HCR-20V3) was published in 2013, after several years of development and revision work. It replaces Version 2, published in 1997, on which there have been more than 200 disseminations based on more than 33,000 cases across 25 countries. This article explains (1) why a revision was necessary, (2) the steps we took in the revision process, (3) key changes between Version 2 and Version 3, and (4) an overview of HCR-20V3‘s risk factors and administration steps. Recommendations for evaluating Version 3 are provided.

 

The Use of the HCR-20V3 in Dutch Forensic Psychiatric Practice

Authors

Vivienne de Vogel
Ellen van den Broek
Michiel de Vries Robbé

Abstract

In this article, the applicability of the recently published HCR-20V3 for violence risk assessment in forensic psychiatric practice is discussed. This revision of the HCR-20 is the result of a multi-year development process based on worldwide empirical research, clinical expertise and consultation. Recently, the HCR-20V3 was implemented in Dutch forensic psychiatric practice by a research team that was also involved in beta-testing and pilot research into the interrater reliability and predictive validity of the first HCR-20V3 Draft version. This paper presents results of this beta-testing and the pilot study, as well as results from a recently conducted survey into the clinical value and applicability of the Dutch HCR-20V3. Overall, the results demonstrate that the HCR-20V3 is a promising revision with sound psychometric properties and improvements compared to the prior version of the HCR-20 for violence risk assessment and management. Furthermore, the first impressions of 192 workshop participants about the HCR-20V3 were positive. To illustrate the applicability of the HCR-20V3 for risk assessment and management in forensic clinical practice, a detailed forensic case study is presented.

 

The HCR-20V3 in Germany

Authors

Sebastian Kötter
Fritjof von Franqué
Manfred Bolzmacher
Sabine Eucker
Barbara Holzinger
Rüdiger Müller-Isberner

Abstract

This article describes the contributions of the German workgroup to the second revision of the HCR-20 (HCR-20V3). In 2009, a beta-testing of draft 1 of the HCR-20V3 was conducted. The results were considered in the revision process of draft 1. In 2013, an interrater reliability study of the German translation of draft 2 of the HCR-20V3 was conducted. After a two-day workshop five raters (psychologists) without experience in structured professional judgment each rated the same 30 cases. The selected cases covered a range of diagnoses and risk levels. Intraclass Correlation Coefficients (ICCs) and the percentage of agreement were calculated for each item, each sub item, and the Summary Risk Ratings (SRRs). The interrater reliability of the SRRs (ICC = .86) was excellent. For the item-level ratings of the risk factors, the mean ICC for the H scale items and sub-items was .65, which would be “good.” The average item-level ICC of the C scale items (.66) and R scale items (.73) would be categorized similarly. There were some ratings with lower reliability. Possible reasons (lack of variance, or misunderstanding from the training procedure) are discussed.

 

Predicting Post-Discharge Community Violence in England and Wales Using the HCR-20V3

Authors

Michael Doyle
Laura Archer Power
Jeremy Coid
Constantinos Kallis
Simone Ullrich
Jenny Shaw

Abstract

Structured guidelines are fundamental for risk assessment, formulation and decision-making in medium secure forensic psychiatric services in the UK. The most commonly used guideline for violence risk assessment in the UK is the HCR-20, so it is important that the new version of the HCR-20 (HCR-20V3) is validated in UK samples. The aims of this study were to investigate if the HCR-20V3 has satisfactory interrater reliability and predictive validity for community violence. A prospective confidential inquiry design was used. The HCR-20V3 demonstrated very good inter-rater reliability and significantly predicted community violence at six and twelve months post-discharge, with ROC AUCs of .73 and .70 respectively. Implications for future research and practice are discussed.

 

Professional Training on the HCR-V3

CONCEPT is pleased to offer online professional training on the development, administration, scoring, interpretation, and clinical implementation of the HCR-V3. The training program takes approximately 20 hours to complete. Professionals are taken through the development of Version 3 and the rationale for revision and update of this instrument. The training program describes why and how the HCR-20 was revised, how Version 3 differs from its predecessors, initial research validation of the HCR-V3, what its risk factors are and how to rate them, how to formulate a case and engage in risk management planning using the HCR-V3. The program includes both didactic and interactive components and allows the opportunity to apply the HCR-V3 to a clinical case.  More information on this professional training program is available here.

 

Free Article: Assessing Risk for Violence using SPJ Guidelines

jfppThe Journal of Forensic Psychology Practice, published by Taylor & Francis, has made the following article available free of charge until the end of 2014. To access the article please click the title of the article below. To download a PDF of the article, please click here.

Assessing Risk of Violence Using Structured Professional Judgment Guidelines

Authors:

Laura S. Guy, PhD, Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts
Ira K. Packer, PhD, ABPP, Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts
William Warnken, PsyD, ABPP Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts

Abstract:

Violence risk assessments are conducted routinely in psychiatric and correctional settings. One method with demonstrated relia- bility and validity for assessing risk of violence is the structured professional judgment (SPJ) model. In this article, we provide an overview of the SPJ model and a brief review of the empirical literature supporting its use. We present a clinical case example to demonstrate the use of the HCR-20, the most well-researched SPJ tool, with a psychiatric patient being considered for increased hospital privileges and discharge to the community. We conclude with recommendations for clinical practice using an SPJ tool when assessing risk of violence.

KEYWORDS structured professional judgment, HCR-20, risk assessment, forensic assessment, violence

Professional Training on the HCR-V3

CONCEPT is pleased to offer online professional training program on the development, administration, scoring, interpretation, and clinical implementation of the HCR-V3. The training program takes approximately 20 hours to complete. Professionals are taken through the development of Version 3 and the rationale for revision and update of this instrument. The training program describes why and how the HCR-20 was revised, how Version 3 differs from its predecessors, initial research validation of the HCR-V3, what its risk factors are and how to rate them, how to formulate a case and engage in risk management planning using the HCR-V3. The program includes both didactic and interactive components and allows the opportunity to apply the HCR-V3 to a clinical case.  More information on this professional training program is available here.

A Clinical Case Study using the HCR-20 Version 3 (Video)

hcr-20 v3The HCR-20 is the most commonly used violence risk assessment instrument across 44 countries, with over 100 evaluation studies in 32 countries. Version 3 of the HCR-20 was released in 2013 and since that time professionals and organizations have begun the process of implementing Version 3 into their clinical practice and clinical service provision.

Administration and Development of the HCR-V3

Drs. Kevin Douglas and Stephen Hart (authors of the HCR-V3) have been training individuals and organizations on the development of the HCR-V3 as well as the Administration, Scoring, and Interpretation of this instrument and the structured professional judgment approach to threat assessment and risk management. Free videos providing an overview of these issues are available here.

Clinical Implementation Issues

At the International launch of the HCR-V3 in Edinburgh, Scotland in April 2013 Dr. Henrik Belfrage (also an author of the HCR-V3) spoke about the successful clinical implementation of the HCR-V3. This video is available here.

Case Study

Also at the International launch for the HCR-V3, Dr. Caroline Logan discussed a case study wherein she completed a risk assessment using the HCR-23 and spoke about the importance of using the HCR-V3 to structure the formulation of any case. In this video, she provides clinical examples and a description of the process of case formulation and consideration of relevant risk factors.

Professional Training on the HCR-V3

CONCEPT is pleased to offer a video-on-demand professional training program on the development, administration, scoring, interpretation, and clinical implementation of the HCR-V3. The training program takes approximately 20 hours to complete. Professionals are taken through the development of Version 3 and the rationale for revision and update of this instrument. The training program describes why and how the HCR-20 was revised, how Version 3 differs from its predecessors, initial research validation of the HCR-V3, what its risk factors are and how to rate them, how to formulate a case and engage in risk management planning using the HCR-V3. The program includes both didactic and interactive components and allows the opportunity to apply the HCR-V3 to a clinical case.  More information on this professional training program is available here.

Practical Guidance to Successful Clinical Implementation of the HCR-20 Version 3 (Video)

hcr-20 v3According to a recent survey, the HCR-20 is the most commonly used violence risk assessment measure across 44 different countries. The HCR-20 assists professionals in correctional, mental health, and forensic settings make decisions about who poses higher versus lower risk for violence, either within institutions or the community, and to devise and monitor risk management plans. The HCR-20 (Version 2) has been evaluated in more than 100 studies and implemented or evaluated in at least 32 countries.

Version 3 of the HCR-20 was recently published. With the release of the newest version of this important risk assessment measure comes the task of implementing the HCR-20 Version 3 (HCR-V3) into clinical practice. The HCR-V3, like its predecessors, promotes a structured professional judgement approach to the evaluation of risk for violence. Version 3 maintains the basic features of Version 2, but has additional features that will help decision makers determine which risk factors are more relevant at the individual level, how to produce a meaningful case formulation, ow to develop risk management plans, and how to make decisions about level of violence risk.

In this video, taken at the International launch for the HCR-V3 in Edinburgh, Scotland in April 2013, Professor Henrik Belfrage of Sweden speaks about how to successfully implement the HCR-V3 into clinical  practice.

CONCEPT Online Training Now Available for the HCR-V3 

CONCEPT has developed video-based online professional training on the HCR-V3. Drs. Kevin Douglas and Stephen Hart (authors of the HCR-V3) presented a 2-day workshop for the North American launch of Version 3 in June 2013 at Fordham University in New York City. CONCEPT was on hand to capture this 2-day workshop on the development, administration, scoring, and interpretation of the HCR-V3 and to develop it into an online training program. The online training program incorporates both didactic and interactive components and allows the opportunity to apply the HCR-V3 to a sample case. This training program takes approximately 20 hours to complete. More information on this online training opportunity is available here.

Predictive Validity of the SAVRY Differs Across Ethnic Subgroups

Psychology, Public Policy, and LawThe SAVRY demonstrated moderate predictive ability for general and violent recidivism in an Australian cohort of young male offenders; however, the predictive validity of the SAVRY significantly differed across ethnic subgroups. This is the bottom line of a recently published article in Psychology, Public Policy, and Law. Below is a summary of the research and findings as well as a translation of this research into practice.

Featured Article | Psychology, Public Policy, and Law | 2014, Vol. 20, No. 1, 31-45

The Utility of the SAVRY Across Ethnicity in Australian Young Offenders

Authors

Stephane M. Shepherd, Monash University
Stefan Luebbers, Monash University
Murray Ferguson, Monash University
James R. P. Ogloff, Monash University
Mairead Dolan, Monash University

Abstract

This research identified the presence and severity of salient risk factors for violence and assessed the predictive validity of the Structured Assessment of Violent Risk in Youth (SAVRY) for an Australian young male offender cohort held in detention. As the bulk of previous research has focused on European and North American Caucasian youth, comparisons were made between participants from Australian ethnic subgroups: English-Speaking Background (ESB), Culturally and Linguistically Diverse (CALD), and Indigenous and Torres Strait Islanders (IND). The study found the instrument to moderately predict general and violent recidivism across the larger cohort and the SAVRY Risk Rating was able to differentiate between times to reoffense. However, the predictive validity differed significantly across ethnic subgroups with moderate to strong predictive accuracy for the ESB group, poor predictive accuracy for the CALD group, and only particular SAVRY scores attained significant accuracy for the IND group. Findings on subgroup risk factors were considered in light of contemporary understandings of the unique experiences and trajectories of minority youth. Future investigation is necessary to differentiate and characterize the risk factors and offending patterns of the ethnicities within the CALD classification.

Keywords

youth violence, risk assessment, recidivism, ethnicity, juvenile offending

Summary of the Research

This research examined the presence and severity of salient risk factors as well as the predictive validity of the Structured Assessment of Violence Risk in Youth (SAVRY) for a group of 175 detained Australian young male offenders. Offenders were divided into 3 cultural categories: those who self-identified as English Speaking Background (ESB; n = 84), Culturally and Linguistically Diverse (CALD; n = 59), or Indigenous groups and Torres Strait Islanders (IND; n = 32). SAVRY total scores, domain scores, and item scores were examined for the total group as well as for the cultural subgroups.  In addition, follow-up data were collected for 139 of these offenders for at least 6 months after release from detention.

“Results showed that both the Indigenous and ESB groups had significantly higher Total and Historical Domain scores compared with the CALD group. Overall, the Indigenous group had the highest mean scores for the SAVRY total score, Historical Domain, and Socio/Contextual Domain, whereas the ESB group had the highest mean Individual/Clinical Domain score of the three groups. There were no significant differences for protective factor scores across groups” (p. 34).

“During the follow-up period, 104 (74.8%) of the total sample was charged by police for any new offense [General Recidivism (GR)] and 82 (59.0%) for a new violent offense [Violent Recidivism (VR)]. Indigenous participants reoffended (GR: 86.2%, VR: 69.0%) at higher rates than ESB (GR: 72.5%, VR: 58.0%) and CALD (GR: 70.7%, VR: 53.7%) participants. The leading re-offense categories for the total sample included: Theft offenses 43.6%, Assault 27.9%, Property Damage 11.5%, and Drug Offenses 6.7%. There were no significant differences in the proportion of general or violent reoffending across the ethnic groupings” (p. 35).

“For participants rated as high risk, 85.1% generally reoffended, with 70.3% reoffending violently. In contrast, of participants given a low risk rating, 47.6% reoffended generally and 38.1% reoffended violently” (p. 35).

With respect to the predictive validity of the SAVRY for the overall sample, results indicated that both the Total Score and the Summary Risk Rating significantly predicted future general recidivism and violent recidivism at a moderate level.

With respect to the predictive validity of the SAVRY for each of the three cultural subgroups, results indicates that the Total Score, Summary Risk Rating, and Domain scores were predictive of both general and violent recidivism in the ESB group whereas none of these scores were predictive of general or violent recidivism in the CALD group. Results for the IND group were mixed, with scores on the Socio/Contextual domain, Individual domain, and Protective factor domain showing some predictive validity for general recidivism in this group and the Total Score, Summary Risk rating, and Historical domain scores showing some predictive validity for violent recidivism in this group.

Translating Research into Practice

“The study provided evidence for the utility of the SAVRY in predicting general and violent recidivism. The overall Total Score was able to moderately forecast both forms of re-offense reflecting previous validation literature. The SAVRY Summary Risk Rating was found to be associated with both forms of recidivism and time at risk. Participants who received a low Risk Rating were less likely to reoffend and exhibited the highest mean survival time. Conversely High-Risk offenders had higher re-offense rates and their times at risk were significantly lower than Low-Risk offenders for both general and violent recidivism” (p. 39).

When the predictive validity of the SAVRY was examined across different ethnic subgroups, SAVRY scores were unable to predict any category of recidivism for the culturally and ethnically diverse group. The authors speculate that these results may be explained by the extreme heterogeneity of the grouping, which comprised participants from a number of diverse ethnicities. Caution is advised when using the SAVRY to predict violent recidivism in culturally and linguistically diverse groups until the characteristics of the group membership are further explored.

These results serve to underscore the general point that risk assessment instruments may not demonstrate equivalent predictive utility for general or violent recidivism across different groups. Clinicians who use these instruments to evaluate individuals should be mindful of the degree to which the personal characteristics of the evaluee reflect those of the validation samples for the risk assessment instrument.

Other Interesting Tidbits for Researchers and Clinicians

The results section also presents data on the SAVRY item scores and SAVRY domain scores for each of the three ethnic groups, which may provide useful information for determining appropriate risk management strategies and interventions.

Join the Discussion

As always, please join the discussion below if you have thoughts or comments to add!