Field validity of the HCR-20 in forensic medium security units in Flanders

ABSTRACT

Structured risk assessment has become a part of routine practice in forensic settings. However, little attention has been paid to the clinical applicability of existing tools. The present research focused on the performance of the Historical Clinical Risk Management-20 (HCR-20) – one of the most commonly used tools for structured professional judgment – in the daily practice of three medium security units in Flanders. Areas under the curve for the prediction of violent recidivism during (N = 168) and after (N = 105) medium security treatment were non-significant. In addition, analyses showed that the HCR-20 was mainly of interest in identifying low-risk individuals. Further research measuring different aspects of predictive validity in applied settings is recommended.

KEYWORDS:

• Risk assessment
• structured professional judgment
• HCR-20
• forensic psychiatry
• field validity

Acknowledgements

We wish to thank the forensic units, clinicians and clients that participated in the study, namely Sint-Kamillus (Bierbeek), OPZC Rekem and Sint-Jan-Baptist (Zelzate).

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. In one case, nationality was missing.

2. Violent index offences (n = 155) comprised homicide/manslaughter (n = 40), sexual assaults (n = 12), verbal violence (n = 32) and other assaults (n = 71). Many of the offenders with non-violent index offences had a history of convictions for a violent offence. Taken together, 94.6% (n = 194) of the population had violently offended either as an index or a prior offence.

3. Information at the prosecution level was not available in the present study. However, the low sentencing rates in case of reported incidents may be explained due to the mandatory supervision of the CPS, which allows the prosecutor to re-incarcerate the internee within a rather flexible procedure without contradictory debate that is immediately carried out, thereby avoiding the lengthy and lingering procedure of a new trial, which would in most cases result in yet another internment measure.

4. SPJ was missing for three patients, so ICC was calculated on 23 cases.

Additional information

Funding

This project was funded by Limburg Sterk Merk (LSM) and the Public Psychiatric Care Centre Rekem (OPZC Rekem).