Chapter 2 Flashcards

1
Q

What is the HCR-20?

A

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

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2
Q

What categories exist of the 20 risk factors of the HCR–20?

A

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

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3
Q

How is the presence of items rated in the HCR-20?

A

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
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4
Q

What are the risk estimates of the HCR-20 based on?

A

(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

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5
Q

What is the most current version of the HCR-20?

A

o revised version of the HCR-20, called the HCR: Version 3, is currently being developed

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6
Q

Why are clinicans in forensic settings often under pressure?

A
  • expectations of general public

- professional role to predict and manage risk

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7
Q

What is the main goal of risk assessment?

A

To protect the publich

to treat indiviudals in least restrictive environment

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8
Q

What is the risk-needs assessment?

A

Integrating the risk of reoffending with appropriate interventions to manage and reduce risk

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9
Q

What is the recommendation by the Department of Health in regards of using tools?

A

Recommend the use of tools which follow the Structured Clincial (or Professional) Judgement approach

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10
Q

How many Versions of the HCR-20 exist and when revised?

A

Three versions

Second was published 1997, and third proposed in 2003

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11
Q

How should the HCR-20 be completed and what is the consequence?

A

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

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12
Q

What is the HCR-20V3 and who is it for?

A

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

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13
Q

What is the purpose of the HCR-20V3 and why was the original version revised?

A

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)

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14
Q

Who can administer the HCR-20V3?

A

Professionals that are trained, have pervious experience with SPJ, and are familiar with study of violence

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15
Q

What is the final judgement of the HCR.20V3 and how should it be presented?

A

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)

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16
Q

What is the reliability and validity of HCR-20V3?

A

good levels of validity + reliability

predicitvie validity as good as any other assessment measure (e.g., actuarial)

17
Q

To which instrument can the HCR-20V3 be added to increase incremetnal predictive validity?

A

PCL-R (converse not true!)

18
Q

How are Version 2 and 3 of the HCR-20 related?

A

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)

19
Q

Main change in HCR-20V3?

A

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

20
Q

What are the limiations of HCR-20V3?

A

Small sample size used in research
Neglect of validation of use in females
Omits protective factors (may need to use SAPROF additionally)

21
Q

How is the Relevance of items scored?

A

In categories without scores (i.e., high - low)

22
Q

What are the end scores of HCR-20 and how should they be presented?

A

A total score (0-40)
An individual score

Presented as risk and protective factors rather than numbers

23
Q

Which items on their own in the HCR-20 could imply high risk?

A

Substance abuse, psychopathy, poor insight, difficulty inhibiting one’s behaviour, noncompliance with remediation

24
Q

What is a risk formulation and how is it done?

A

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

25
Q

What is scenario planning and how applied?

A

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

26
Q

What is the risk management plan and how applied?

A

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

27
Q

What is the gender difference in violence between men and women?

A

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

28
Q

How is the applicability of the HCR-20 in practice?

A

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