Chapter 2 Flashcards
What is the HCR-20?
first SPJ measure developed to assess general violence among adults
approximately 90 studies have investigated its reliability or predictive validity
validated for use in inpatient and outpatient settings with forensic psychiatric, civil psychiatric, and correctional populations
offers a systematic way to reassess risk whenever the decision-making context changes or if there are fluctuations in risk management issues or the severity of clinical factors
inclusion of 20 risk factors
What categories exist of the 20 risk factors of the HCR–20?
Historical, Clinical, and Risk management domains
10 historical, largely static, risk factors
–> fall into three general categories
o problems in adjustment or living
o problems with mental health
o and past antisocial behaviour
–> professional must conduct an exhaustive review of background documents and ideally interview individuals who know the person being assessed
10 potentially changeable, dynamic risk factors
–> 5 concern current clinical status (e.g., negative attitudes and active symptoms of major illness)
o requires a clinical interview with the person being assessed
o only 16% of research studies included assessments with multiple information sources
–> 5 concern future situational risk factors (e.g., lack of plan feasibility and treatment noncompliance)
o should judge their relevance with respect to the development of future risk management strategies
–> three-level scale
• (low) the factor is of low relevance to the individual’s risk for violence
• (moderate) the factor is relevant to some degree
• (high) the factor is present, and its role in causing violence or impairing the effectiveness of risk management strategies is likely to be substantial
• intended to facilitate development of risk management and intervention plans
How is the presence of items rated in the HCR-20?
o Each item is rated on a 3-point scale
o three-level response format fo
- -> (Y) = 2the factor is definitely or conclusively present
- -> (P) = 1the factor is possibly or partially present, or the risk factor is present, but the information is weak, contradictory, or inconclusive
- -> (N) = 0 the factor is absent, or the professional perceives no evidence the factor is present
What are the risk estimates of the HCR-20 based on?
(a) the assessment of the previous, current, or anticipated future presence of the risk factors
(b) the relative importance of the risk factors for a given individual; and
(c) the degree of intervention estimated to be necessary to prevent violence
What is the most current version of the HCR-20?
o revised version of the HCR-20, called the HCR: Version 3, is currently being developed
Why are clinicans in forensic settings often under pressure?
- expectations of general public
- professional role to predict and manage risk
What is the main goal of risk assessment?
To protect the publich
to treat indiviudals in least restrictive environment
What is the risk-needs assessment?
Integrating the risk of reoffending with appropriate interventions to manage and reduce risk
What is the recommendation by the Department of Health in regards of using tools?
Recommend the use of tools which follow the Structured Clincial (or Professional) Judgement approach
How many Versions of the HCR-20 exist and when revised?
Three versions
Second was published 1997, and third proposed in 2003
How should the HCR-20 be completed and what is the consequence?
With the manual + worksheet
Worksheet guides user in gathering info, conside presence + relevance of risk factors, hypothetical scenarios of violence, develop management strategies, + document summary judgement
Judgement will be less biased when presenting + combining evidence this way
What is the HCR-20V3 and who is it for?
comprehensive set of professional guidelines for the assessment and management of violence risk
violence risk = actual, attempted, or threatened infliction of bodily harm of another person
applicable to all adults aged 18+ that pose a risk for future violence
What is the purpose of the HCR-20V3 and why was the original version revised?
To assist professionals in estimating the persons’ likelihood of future violence and determine most appropriate treatment and management strategies
Changed to enhance decision making, risk formulation + management + modify and revise items according to current literature (–> essential recent thinking)
Who can administer the HCR-20V3?
Professionals that are trained, have pervious experience with SPJ, and are familiar with study of violence
What is the final judgement of the HCR.20V3 and how should it be presented?
Final judgement should be levels of probability considered in terms of imminence, time frames and in relation to individualized factors (–> management plan)
presented in categories (low, moderate, high)
What is the reliability and validity of HCR-20V3?
good levels of validity + reliability
predicitvie validity as good as any other assessment measure (e.g., actuarial)
To which instrument can the HCR-20V3 be added to increase incremetnal predictive validity?
PCL-R (converse not true!)
How are Version 2 and 3 of the HCR-20 related?
Have good concurrent validity
continuity of concept (= produce comparable decisions about risk level, and generally, the number of risk factors indetified across measures are similar)
Main change in HCR-20V3?
Risk factors for violence are now assesed for their relevance + presence & scenario planning has central place in anticipating nature, severity, imminence and likelihood of future harm
risk formulation = Key process now proposed for linking assessment and overall management of risk
What are the limiations of HCR-20V3?
Small sample size used in research
Neglect of validation of use in females
Omits protective factors (may need to use SAPROF additionally)
How is the Relevance of items scored?
In categories without scores (i.e., high - low)
What are the end scores of HCR-20 and how should they be presented?
A total score (0-40)
An individual score
Presented as risk and protective factors rather than numbers
Which items on their own in the HCR-20 could imply high risk?
Substance abuse, psychopathy, poor insight, difficulty inhibiting one’s behaviour, noncompliance with remediation
What is a risk formulation and how is it done?
Risk formulation identifies primary risk factors and describes their relevance
Start with general statement about level of risk, then describe primary risk factors –> root of causes for violence, identify causal roles of risk factors, explain function of violence
What is scenario planning and how applied?
Scenario planning = used in situations where there is a degree of uncertainty about the outcome
Each scenario is a story about offences the individual may commit with focus on future + past
3-5 scenarios are norm to present
Assessor develops a detailed description of: nature, pattern, severity, imminence, and likelihood of possible offending/ future harm
What is the risk management plan and how applied?
Identifies any risks and explains how they may be manged so that likelihood decreases
Comments on factors such as professional service plans, living situation, monitoring, personal support, and stress
Focus on dynamic factors that can be amendable to change
Gives concrete recommendation about treatment
What is the gender difference in violence between men and women?
Women display very similar risk factors but different pattern of violence
Men: more severe violence + directed at other patients
Women: more directed toward self or members of staff
could be due to diagnostic differences
–> understimation of violence in women + overestimation in men
How is the applicability of the HCR-20 in practice?
Clinical sub-scale did not produce signficiant predictions (other scales did)
predicitive efficacy highest for short period (1 year) and declines for longer period (5 years)
good predictor of violent and non-violent offending following release
