De Vogel, van den Broek, & de Vries (2014). The use of the HCR-20 V3 in Dutch forensic psychiatric practice

An adequate violence risk assessment provides insight into risk and protective factors (1) and concrete guidelines for risk management and treatment (2). This can aid in preventing violent recidivism. The structured professional approach uses systematic collection (1), reviewing (2), combining (3), weighing (4) and integrating (5) information on risk factors.

The historical, clinical, risk management-20 version 2 (HCR-2o) is used for assessment of risk for future violence. The case conferences are used to develop risk management plans and to assist in decision-making regarding leave or entry into a new treatment phase. The risk management items and the final risk judgements are always coded for the context that applies for the coming year (1) and the ‘what-if’ context if mandatory treatment would be ended right away by court (2). This makes it easier for treatment staff to explain whether treatment is still necessary.

Treatment aimed at reducing violent recidivism should focus on reducing risk factors and reinforcing protective factors. There is a need for a more gender-sensitive risk assessment. The female additional manual (FAM) is an additional tool to the HCR-20 for assessing risk of violence in female offenders.

The HCR-2o has good interrater reliability and strong predictive validity for violent recidivism and incidents of violence during treatment for male violent and sexual offenders. It is sensitive to change and shows improvements on dynamic risk and protective factors.

There are seven steps of the HCR-20 V3:

1. Case information
   This step includes gathering information about the individual of interest from sources (e.g. clinical files, previous psychological reports, treatment evaluations).
2. Presence of risk factors
   This step includes describing which risk factors are present in the individual of interest.
3. Relevance of risk factors
   This step includes describing the relevance of the risk factors of the individual of interest. This includes describing the factors that are most important to consider when making plans about monitoring (1), treatment (2), supervision (3) or victim safety planning (4).
4. Risk formulation
   This step is intended to facilitate the clinician’s conceptualization of the root of a person’s problem with an eye toward intervention. The risk formulation requires evaluators to integrate separate risk factors into a conceptual meaningful framework that explains a person’s violence.
5. Risk scenarios
   This step represents a future-oriented formulation (i.e. what might a person do in the future and why).
6. Management strategies
   This step includes translating the information from step 2, 3, 4 and 5 into a risk management plan.
7. Conclusory opinions
   This step includes drawing conclusions about the individual for risk of future violence.

There are several principles of risk management strategies:

1. Risk principle
   This principle states that high risk cases should receive high intensity risk management and low risk cases should receive management of lower intensity.
2. Need principle
   This principle states that management efforts should target dynamic risk factors deemed important for lowering the risk for a specific patient.
3. Responsivity principle
   This principle states that programs should be delivered in a manner that matches the learning styles of those receiving them.

Risk management plans consist of several activities:

1. Monitoring / surveillance
   The goal of monitoring is to evaluate changes in risk over time so that risk management strategies can be revised when needed. It focuses on surveillance and not on control or restriction of liberties.
2. Treatment
   The goal of treatment is to improve deficits in the individual’s psychosocial adjustment or functioning.
3. Supervision
   The goal of supervision is to make it more difficult for the individual to engage in further violence. Supervision consists of restrictions of the individual’s rights and freedoms.
4. Victim safety planning
   This involves improving a potential victim’s security resources (i.e. target hardening).