The predictive validity of the HCR-20 following clinical implementation: does it work in practice?

Abstract

This prospective study describes the predictive validity of the Historical Clinical Risk Management-20 Scale (HCR-20) when applied to clinical practice among 109 male mentally disordered offenders in a high secure forensic hospital. Data on violent incidents including reconvictions were collected from multiple sources. The results imply that the implemented HCR-20s did not predict future violence regardless of setting (community vs inpatient) nor time (short vs long term) except for serious incidents. This may indicate that the implemented HCR-20s informed risk management through systematic tailoring of care and treatment plans. Evidence supporting this interpretation was found in a reduction in violent incidents and offending when compared to an earlier study with a similar cohort. Alternatively, the completion of a violence risk assessment by clinicians rather than researchers may have affected the quality of completed assessments. Further research is required to better understand the complex mechanisms underlying the translation of identified risk factors into risk management.

Keywords:

• HCR-20
• violence risk assessment
• forensic psychiatry
• predictive validity

Notes

1. This term refers to the consultant psychiatrist responsible for the care and treatment of persons detained under criminal justice legislation in Scotland.

2. Within the context of this study, the index offence is the criminal act that led to the person’s detention in a secure hospital, or incarceration in prison prior to a transfer to a secure hospital.