Gender-Sensitive Violence Risk Assessment: Predictive Validity of Six Tools in Female Forensic Psychiatric Patients

Abstract

Most violence risk assessment tools have been validated predominantly in males. In this multicenter study, the Historical, Clinical, Risk Management-20 (HCR-20), Historical, Clinical, Risk Management-20 Version 3 (HCR-20 V3), Female Additional Manual (FAM), Short-Term Assessment of Risk and Treatability (START), Structured Assessment of Protective Factors for violence risk (SAPROF), and Psychopathy Checklist-Revised (PCL-R) were coded on file information of 78 female forensic psychiatric patients discharged between 1993 and 2012 with a mean follow-up period of 11.8 years from one of four Dutch forensic psychiatric hospitals. Notable was the high rate of mortality (17.9%) and readmission to psychiatric settings (11.5%) after discharge. Official reconviction data could be retrieved from the Ministry of Justice and Security for 71 women. Twenty-four women (33.8%) were reconvicted after discharge, including 13 for violent offenses (18.3%). Overall, predictive validity was moderate for all types of recidivism, but low for violence. The START Vulnerability scores, HCR-20 V3 , and FAM showed the highest predictive accuracy for all recidivism. With respect to violent recidivism, only the START Vulnerability scores and the Clinical scale of the HCR-20 V3 demonstrated significant predictive accuracy.

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

“…Specifically, research has shown that the historical subscale might be of less importance to discriminate for recidivism since forensic psychiatric patients in general have many of the historical risk factors [29]. However, the results from the present study showed that the women had high rates of historical risk factors, which is in line with the previous study of the FAM [22,23,27,28], although the historical subscale discriminated for inpatient violence while both the clinical and risk management subscales did not. Subsequently, these results speak for that clinicians that assess female psychiatric patients, with many historical risk factors, need to take these risk factors more seriously when it comes to judging the summary risk rating for violence, if not the risk might be considered lower than it should and not enough risk management will be put in place.…”

“…There are few studies done on the FAM [22,23,27,28], as well as on risk factors for women in general [2,18,19,22], and our findings will add to that body of knowledge. The present study supports the use of HCR-20v2 when assessing risk for inpatient physical violence among women admitted to highsecurity forensic psychiatric care in Sweden, and specifically the outcome in terms of number of risk factors present as a measure of risk for inpatient violence rather than the summary risk rating.…”

“…When comparing the female patients with male patients, all the historical risk factors in the FAM except H9 Personality disorders and H10 Prior supervision failure were significantly more prevalent among the women than among the men [22]. In addition, neither the FAM nor the FAM combined with the HCR-20v2 were reported to be significant predictors for future violence [28].…”

“…Besides, the outcome of risk for violence outside and inside the institution, as it is within the HCR-20v2, the FAM can also be applied in the risk assessment for self-harm, risk of further victimization as well as general criminality [25]. To our knowledge there are only a few studies published in English on the FAM [22,27,28]. All of these studies were based on women admitted to forensic psychiatric care in the Netherlands.…”

Developing a risk/need assessment tool for women offenders: a gender-informed approach

“…If a matching approach had not been used and the assessment tool was not found to be valid for use with men offenders, it would have been unclear if this was a function of gender or Indigenous ancestry. Furthermore, scholars have indicated that research on women offenders and risk assessment tools that incorporate a direct comparison to a matched sample of men offenders are needed (de Vogel et al, 2019). As such, men and women were matched on indigenous identity, age at admission, static risk rating, dynamic need rating, and the most serious offense on the sentence (violent vs non-violent).…”