Assessing risk for inpatient physical violence in a female forensic psychiatric sample – comparing HCR-20v2 with the female additional manual to the HCR-20v2

Abstract

Purpose and aim: Out from the sparse literature on risk assessment for violence committed by women the Female Additional Manual (FAM) was developed to be a complement to the HCR-20v2. The aim of this study was to investigate and compare the psychometrics of the HCR-20v2 with and without the FAM on risk for inpatient physical violence for female forensic psychiatric patients. Methods: The participants were 100 female patients admitted to forensic psychiatric care in a highsecurity clinic, assessed by clinicians with the HCR-20v2 during their admission. Researchers performed the FAM, both retrospectively and prospectively. The follow-up period was 12 months before being discharged. Results: Four main results were found; first, many risk factors were present although the summary risk ratings were mainly low to moderate. Secondly, the reliability was in general good, where the HCR-20v2 mainly showed higher reliability without than with the FAM, indicating that FAM risk factors did equal or did not contribute to a higher reliability. Third, the internal validity was higher for the HCR-20v2 than for the FAM. Risk factors correlated stronger with the summary risk ratings for the HCR-20v2 than for the FAM. Fourth, the validity for inpatient physical violence was high for the total score of both the HCR-20v2 and the FAM, but contradictory to previous finding the validity for summary risk ratings was not significant. Conclusions: The results support the use of HCR-20v2 when assessing risk for inpatient violence for female forensic psychiatric patients, but with only some support for adding or changing risk factors according to the FAM.

Predicting violence in female forensic inpatients with substance use disorders – the utility of a gender-responsive assessment

“…However, incorporating the FAM items into the HCR-20 V3 did not improve its predictive accuracy for any violent outcome, even resulting in a decreased AUC value. This finding aligns with prior studies on inpatient violence ( 35 , 45 ). Also, it supports earlier findings emphasizing the reduced effectiveness of the FAM when applied in conjunction with the most recent version of the HCR-20, given its original purpose was to supplement the second version of the HCR-20 ( 27 ).…”

“…Also, it coincides with recent findings on justice-involved women accentuating the enhanced effectiveness of HCR-20 Version 3 over Version 2 in evaluating recidivism among females ( 27 ). Likewise, it supports prior studies ( 35 , 45 ) using the HCR-20 V2 to predict inpatient violence in female forensic patients. Concerning the binary logistic regression results of the HCR-20 V3 items, most significant predictors were found for the clinical and risk management scales while for the historical scale only previous violence, violent attitudes, personality disorder and past problems with supervision/treatment were found significant risk factors.…”

“…Extensive research confirms robust predictive accuracy in diverse populations (30). However, studies on its effectiveness with justice-involved women have yielded inconsistent findings (31)(32)(33)(34)(35)(36). A meta-analysis by Rossdale (4) concluded low to moderate effect sizes, while demonstrating that only two of the 12 investigated studies incorporated the third version of the HCR-20.…”

“…To address this issue, the Female Additional Manual (FAM) ( 8 ) was designed as a gender-responsive supplement to the HCR-20. While primary studies could only demonstrate the clinical relevance of the FAM ( 27 , 35 ), at present insufficient research is available to permit conclusive statements on its predictive accuracy ( 38 ). Further, existing studies are lacking specificity concerning the variety of mental disorders.…”

Generalización de la consistencia interna del Historical- Clinical-Risk Management-20 (HCR-20) en población penitenciaria: Un meta-análisis

“…La escala Historical- Clinical-Risk Management-20 (HCR-20;Webster, Eaves, Douglas, y Wintrup, 1995) es uno de los instrumentos más usados para la evaluación del riesgo de violencia en las instituciones penitenciarias, además de una de las herramientas sistemáticas predictivas más exitosas para medir el alcance del peligro y enfocar con ello la gestión preventiva (Arai, Takano, Nagata, y Hirabayashi, 2017;Arbach y Andrés-Pueyo, 2007;Sada et al, 2016), incluso en muestra psiquiátrica (Strand y Selenius, 2019). El HCR-20 presenta cuatro versiones (la versión 1, 2, 3 y FAM).…”