Use and perceived utility of structured violence risk assessments in English medium secure forensic units

Khiroya, Reena; Weaver, Tim; Maden, Tony

doi:10.1192/pb.bp.108.019810

Cited by 86 publications

(61 citation statements)

References 6 publications

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“…While the use of SCJ measures appears to be increasing in psychiatric settings, 6 there is currently no clear evidence that such instruments outperform the predictive accuracy of actuarial tools.…”

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confidence: 99%

“…4 Furthermore, questionnaire surveys suggest that some form of structured risk assessment is currently used by over 80% of forensic psychologists in the United States 5 and in over 80% of forensic and 70% of general psychiatric hospitals in the United Kingdom. 3,6 Generally, structured risk assessment tools adopt 1 of 2 approaches: actuarial prediction or structured clinical judgment (SCJ). Actuarial risk assessment tools are composed of weighted factors found to have been empirically associated with the likelihood of future offending.…”

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confidence: 99%

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Structured Assessment of Violence Risk in Schizophrenia and Other Psychiatric Disorders: A Systematic Review of the Validity, Reliability, and Item Content of 10 Available Instruments

Singh

Serper

Reinharth

et al. 2011

Schizophrenia Bulletin

123

110

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Objectives: To undertake a systematic review on structured violence risk assessment tools in individuals with schizophrenia. Methods: A systematic search was conducted from 1990 to 2011 to identify violence risk assessment tools and studies examining their predictive validity. Item content of the identified instruments was analyzed, and areas under the curve (AUC) from the studies were extracted. In addition, an 11-item checklist was developed to assess the utility and psychometric properties of these tools. Results: Ten risk assessment tools designed to predict community violence in psychiatric patients were identified, but only 2 studies reporting predictive validity estimates in patients with schizophrenia were found (median AUC 5 0.69; interquartile range 5 0.60-0.77). When inclusion criteria was broadened to include studies measuring accuracy for any diagnostic group, mixed evidence of predictive validity was found, with median AUCs ranging from 0.62 to 0.85 depending on the population. Item content included mostly clinical, sociodemographic, and criminal history factors. As only 1 tool included a neurobiological item, a structured review of brain-based and cognitive risk factors for violence was included, and 3 clusters (neurocognitive ability, neurocognitive awareness, and attitudinal cognition) were identified. Conclusions: While a number of violence risk assessment tools exist that can be used to predict the likelihood of community violence in psychiatric patients, there is currently little direct evidence for their utility in individuals with schizophrenia. In addition, there is large variation in item content between instruments, and further research is necessary to determine whether the inclusion of alternative factors could improve risk assessment.Key words: psychotic disorders/forensic psychiatry/crime/ review/antisocial/neurocognitive Introduction Current treatment guidelines published by the American Psychiatric Association 1 and the UK's National Institute for Health and Clinical Excellence 2 recommend that violence risk be assessed for individuals diagnosed with schizophrenia. While unstructured assessments of risk, in which mental health professionals use their clinical experience to make subjective judgments as to whether an individual is likely to offend, remain common, 3 a recent metareview (a systematic overview of systematic reviews and meta-analyses) identified over 120 structured instruments that have been designed for use in predicting violence in psychiatric and correctional populations. 4 Furthermore, questionnaire surveys suggest that some form of structured risk assessment is currently used by over 80% of forensic psychologists in the United States 5 and in over 80% of forensic and 70% of general psychiatric hospitals in the United Kingdom. 3,6 Generally, structured risk assessment tools adopt 1 of 2 approaches: actuarial prediction or structured clinical judgment (SCJ). Actuarial risk assessment tools are composed of weighted factors found to have been empirically associated with ...

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confidence: 99%

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confidence: 99%

Structured Assessment of Violence Risk in Schizophrenia and Other Psychiatric Disorders: A Systematic Review of the Validity, Reliability, and Item Content of 10 Available Instruments

Singh

Serper

Reinharth

et al. 2011

Schizophrenia Bulletin

123

110

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“…It is important, therefore, to be able to identify those most at risk so that relevant care and treatment strategies can be best focused (Griffin and Vettor, 2012;Walji et al, 2013). Sexual violence risk assessment instruments are, however, rather infrequently used in inpatient hospital units, where generic violence risk assessments are more commonly used (Khiroya et al, 2009), particularly the HCR-20 (Webster et al, 1997).…”

Section: Introductionmentioning

confidence: 99%

Predictive validity of the HCR‐20 for violent and non‐violent sexual behaviour in a secure mental health service

O’Shea

Thaker

Picchioni

et al. 2015

Criminal Behav Ment Health

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Prediction of violent sexual behaviour may be regarded as well within the scope of the HCR-20 as a structured professional judgement tool to aid violence risk prediction, but we found that it also predicts behaviours that may be of concern but fall below the violence threshold. High negative predictive values suggest that HCR-20 scores may have some utility for screening out patients who do not require more specialist assessment for inappropriate sexual behaviour. Copyright © 2015 John Wiley & Sons, Ltd.

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“…Recent surveys indicate the increasing use of structured professional judgement approaches to managing violence and related risks in UK forensic mental health services (Khiroya 2009). Schemes such as the Historical, Clinical, Risk Management -20 (HCR-20;Webster 1997) (Table 1) are now commonly used as clinical guidelines to help organise multidisciplinary risk assessment and management.…”

Section: Articlementioning

confidence: 99%

Staging the HCR-20: towards successful implementation of team-based structured professional judgement schemes

Haque¹,

Webster²

2012

Adv. psychiatr. treat

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SummaryStructured professional judgement risk management schemes such as the Historical, Clinical, Risk Management - 20 (HCR-20) can be described as clinical guidelines produced by a collaborative process between mental health clinicians and researchers. The purpose is to provide clinicians with a framework to guide interventions designed to manage specific risks such as violence against others. The use of evidence-based clinical methods, especially in a multidisciplinary setting, is now commonly considered a best-practice approach when managing violence and related risks. This article describes some of the practical implementation challenges that may arise when using schemes such as the HCR-20 in multi-disciplinary team meetings.

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Use and perceived utility of structured violence risk assessments in English medium secure forensic units

Cited by 86 publications

References 6 publications

Structured Assessment of Violence Risk in Schizophrenia and Other Psychiatric Disorders: A Systematic Review of the Validity, Reliability, and Item Content of 10 Available Instruments

Structured Assessment of Violence Risk in Schizophrenia and Other Psychiatric Disorders: A Systematic Review of the Validity, Reliability, and Item Content of 10 Available Instruments

Predictive validity of the HCR‐20 for violent and non‐violent sexual behaviour in a secure mental health service

Staging the HCR-20: towards successful implementation of team-based structured professional judgement schemes

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