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

Jeandarme, Inge; Pouls, Claudia; Laender, Jan De; Oei, T.I.; Bogaerts, Stefan

doi:10.1080/1068316x.2016.1258467

Cited by 24 publications

(33 citation statements)

References 46 publications

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“…In keeping with two recent studies suggesting limited predictive validity for the HCR-20 in real-world clinical forensic settings,10 11 the study by Jeandarme et al 12 concludes that the HCR-20 was not effective as a predictive tool for violence in a medium secure forensic setting. Following analysis of HCR-20s on admission and at discharge, AUCs for the prediction of violent recidivism during and after treatment were non-significant.…”

Section: Interpretation Of the Findingssupporting

confidence: 52%

“…Another study, examining prerelease HCR-20 assessments over 6 years at a US forensic hospital, revealed that none of the scales or subscales predicted recidivism better than chance 11. Hence, a recent study in a Belgian medium secure forensic psychiatry setting12 is of particular interest. Its main findings, that the HCR-20 did not predict violent recidivism during and after treatment, warrant appraisal by all forensic psychiatrists, psychologists and others working in forensic mental health.…”

Section: What Is Already Known About This Topicmentioning

confidence: 99%

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HCR-20 shows poor field validity in clinical forensic psychiatry settings

Tully¹

2017

Evid Based Mental Health

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Section: Interpretation Of the Findingssupporting

confidence: 52%

Section: What Is Already Known About This Topicmentioning

confidence: 99%

HCR-20 shows poor field validity in clinical forensic psychiatry settings

Tully¹

2017

Evid Based Mental Health

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“…Second, it has been developed specifically in forensic psychiatric patients, whereas other common approaches have been developed using heterogeneous samples from criminal justice and forensic psychiatry, and risk factors and baseline risks differ from prison [36] or general psychiatry populations [2] . Hence, it is not surprising that field studies show considerable shrinkage in the predictive accuracy of tools such as the HCR-20 in forensic samples [37] . Third, there may be clinical benefits of a freely available and quicker risk assessment in that resources can be redirected towards clinical care and risk management.…”

Section: Discussionmentioning

confidence: 99%

Prediction of violent crime on discharge from secure psychiatric hospitals: A clinical prediction rule (FoVOx)

et al. 2018

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BackgroundCurrent approaches to assess violence risk in secure hospitals are resource intensive, limited by accuracy and authorship bias and may have reached a performance ceiling. This study seeks to develop scalable predictive models for violent offending following discharge from secure psychiatric hospitals.MethodsWe identified all patients discharged from secure hospitals in Sweden between January 1, 1992 and December 31, 2013. Using multiple Cox regression, pre-specified criminal, sociodemographic, and clinical risk factors were included in a model that was tested for discrimination and calibration in the prediction of violent crime at 12 and 24 months post-discharge. Risk cut-offs were pre-specified at 5% (low vs. medium) and 20% (medium vs. high).ResultsWe identified 2248 patients with 2933 discharges into community settings. We developed a 12-item model with good measures of calibration and discrimination (area under the curve = 0.77 at 12 and 24 months). At 24 months post-discharge, using the 5% cut-off, sensitivity was 96% and specificity was 21%. Positive and negative predictive values were 19% and 97%, respectively. Using the 20% cut-off, sensitivity was 55%, specificity 83% and the positive and negative predictive values were 37% and 91%, respectively. The model was used to develop a free online tool (FoVOx).InterpretationWe have developed a prediction score in a Swedish cohort of patients discharged from secure hospitals that can assist in clinical decision-making. Scalable predictive models for violence risk are possible in specific patient groups and can free up clinical time for treatment and management. Further evaluation in other countries is needed.FundingWellcome Trust (202836/Z/16/Z) and the Swedish Research Council. The funding sources had no involvement in writing of the manuscript or decision to submit or in data collection, analysis or interpretation or any aspect pertinent to the study.

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“…Structured professional judgment tools take a long time to complete, for example 15 person-hours to complete an initial HCR-20 (6). They often have low to moderate validity in field studies (7), have often been developed in prison, rather than hospital, settings, and using methods to derive them which are dated. Further, there have been low standards in reporting, including few performance measures, authorship bias (8), wide variations in what constitutes 'high' risk (9), and their underlying risk factors are based on heterogeneous samples and do not incorporate new evidence on risk (10).…”

mentioning

confidence: 99%

A Clinical Feasibility Study of the Forensic Psychiatry and Violence Oxford (FoVOx) Tool

et al. 2019

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Background: Risk assessment informs decisions around admission to and discharge from secure psychiatric hospital and contributes to treatment and supervision. There are advantages to using brief, scalable, free online tools with similar accuracy to instruments currently used. We undertook a study of one such risk assessment, the Forensic Psychiatry and Violence Oxford (FoVOx) tool, examining its acceptability, feasibility, and practicality. Methods:We completed the FoVOx tool on all discharges from six secure psychiatric hospitals in one region in England over two years. We interviewed 11 senior forensic psychiatrists regarding each discharge using a standardized questionnaire. Their patient's FoVOx score was compared to clinical risk assessment, and the senior clinicians were asked if they considered FoVOx scores accurate and useful. A modified thematic analysis was conducted, and clinicians were surveyed about current risk assessment practice on discharge.Results: Of 90 consecutive discharges, 84 were included in the final analysis. The median FoVOx probability score was 11% risk of violent recidivism in two years after discharge. We estimated that 12 (14%) individuals reoffended since discharge; all were in the medium or high risk FoVOx categories. Clinical assessment of risk agreed with the FoVOx categories in around half the cases. Clinicians were more likely to provide lower risk categories compared with FoVOx ones. FoVOx was considered to be an accurate representation of risk in 67% of cases; clinicians revised their view on some patient's risk assessment after being informed of their FoVOx scores. Completing FoVOx was reported to be helpful in the majority of cases. Reasons included improved communication with other agencies, reassurance to clinical teams, and identifying additional factors not fully considered. 10 of the 11 respondents reported that FoVOx was practical, and seven of 11 reported that they would use it in the future, highlighting its brevity and speed of use compared to existing risk assessment tools.Conclusions: Senior clinicians in this regional forensic psychiatric service found the FoVOx risk assessment tool feasible, practical, and easy to use. Its use addressed a lack of consistency around risk assessment at the point of discharge and, if used routinely, could assist in clinical decision-making.

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

Cited by 24 publications

References 46 publications

HCR-20 shows poor field validity in clinical forensic psychiatry settings

HCR-20 shows poor field validity in clinical forensic psychiatry settings

Prediction of violent crime on discharge from secure psychiatric hospitals: A clinical prediction rule (FoVOx)

A Clinical Feasibility Study of the Forensic Psychiatry and Violence Oxford (FoVOx) Tool

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