Henrik Belfrage

Prediction of violence using the HCR-20: a prospective study in two maximum-security correctional institutions

The HCR-20 and the PCL:SV were used in a prospective study of 41 long-term sentenced offenders in two correctional, maximum-security institutions. The aim was to test the validity of these instruments in the prediction of institutional violence. All assessments were made by a comprehensive examination of the offenders’ files, completed with clinical interviews ranging from 1 to 3 hours. The mean follow-up time was 8 months. Our results show high predictive validity for the HCR-20’s clinical and risk management items, but for almost none of its historical items. The results suggest that violence inside correctional institutions can be predicted with a certain degree of validity by using the HCR-20 and the PCL:SV, even within a selective ‘high-risk’ group of offenders such as that under study here.

Actuarial Assessment of Risk for Violence - Predictive Validity of the VRAG and the Historical Part of the HCR-20

This article explores the predictive validity of two actuarial risk assessment instruments among mentally disordered offenders in Sweden: the historical part (H-10) of a historical, clinical, and risk management factors instrument (HCR-20) and the Violence Risk Appraisal Guide (VRAG). Actuarial scores were obtained retrospectively in two populations: one group of violent offenders with personality disorders and one with violent offenders diagnosed with schizophrenia. The predictive accuracy was evaluated with receiver operating characteristic analysis using a violent reconviction within 2 years from release or discharge as the criterion variable. Both scales fared better in the group of personality-disordered offenders than in the group of offenders with schizophrenia, and the H-10 fared better than the VRAG in both offender groups. The study found that historical data maintain a robust predictive validity in a population of personality-disordered offenders, whereas clinical and risk management factors may be of greater importance in offender populations in which major mental disorders are prevalent.

Clinical and risk management factors in risk prediction of mentally disordered offenders : more important than historical data? A retrospective study of 40 mentally disordered offenders assessed with the HCR-20 violence risk assessment scheme

Purpose: The predictive validity of the risk prediction instrument HCR-20 was studied.Methods: Two matched groups of discharged forensic psychiatric patients, one who had recidivated into violent c ...

Implementing the HCR-20 scheme for risk assessment in a forensic psychiatric hospital: Integrating research and clinical practice

This article describes the process of implementing the HCR-20 into clinical practice at two Swedish forensic psychiatric hospitals. Since the instrument is fairly new, the interrater reliability was checked in a very comprehensive way. Seven clinicians undertook the task of assessing 43 violent offenders admitted to a forensic psychiatric hospital. These assessments were done independently of each other; no discussions of the cases were allowed between the assessors. The outcome is very encouraging, with a high internal consistency and high interrater reliability overall. The whole process of implementing a research instrument into clinical practice is described, how it was done, and what experiences were found.

Suicide attempts and impulse control disorder are related to low cerebrospinal fluid 5-HIAA in mentally disordered violent offenders.

Objective: The aim of this study was to investigate the relationship between low cerebrospinal fluid 5‐hydroxyindoleacetic acid (CSF 5‐HIAA) and aggressive acts in mentally disordered violent offenders.

Comparison of hcr-20 scores in violent mentally disordered men and women: Gender differences and similarities

Abstract Retrospective risk assessments based on the HCR-20 violence risk assessment scheme were performed on 63 female patients and 85 male patients at two special forensic psychiatric hospitals. The aim was to compare risk factors for violence in mentally disordered women with their male counterparts, and to study to what extent the HCR-20, which is mainly based on research on men, can be used in a female forensic psychiatric population. The results show that the HCR-20 displays very similar risk factors for violence in women as in men, but the nature of violence is somewhat different between the sexes. Implications of the findings are discussed.

Reliability and Validity Evaluation of the Psychopathy Checklist: Screening Version (PCL:SV) in Swedish Correctional and Forensic Psychiatric Samples.

This study evaluated the structural reliability, construct-related validity, and cultural validity generalization of the Hare Psychopathy Checklist: Screening Version (PCL:SV) in a sample of more than 560 male and female Swedish forensic psychiatric treatment patients, forensic evaluation patients, and criminal offenders. Structural reliability was excellent for most indices. PCL:SV scores were higher for males than females for total and Part 1 scores (interpersonal/affective features) but not for Part 2 (behavioral features). With some exceptions, PCL:SV scores were meaningfully related to aggression to others, a measure of risk for violence, substance use problems, personality disorder (positive), and psychosis (negative). Correlations between PCL:SV and aggression were larger for females than males, although the difference was smaller when personality disorder was held constant. The structural reliability and pattern of validity coefficients were comparable in these Swedish samples to other non-North American samples. Implications for the cross-cultural manifestation and correlates of psychopathy are discussed.

Platelet monoamine oxidase activity in mentally disordered violent offenders

The activity of monoamine oxidase (MAO) in blood platelets among criminals undergoing forensic psychiatric examinations was studied. As compulsiveness, disturbed perceptions of reality, etc. are states not known to be related to MAO and yet possibly cause aggressiveness and violence among psychotic patients, we divided the patients into 2 groups, psychotic and nonpsychotic offenders. There was lower MAO activity among violent offenders than among nonviolent offenders. The difference between the violent and nonviolent offenders became greater when the subjects with a history of psychosis were removed. Furthermore, in the group of psychotic offenders, there was no statistical difference between violent and nonviolent individuals in this regard.

Historical-Clinical-Risk Management-20, Version 3 (HCR-20V3): Development and Overview

The HCR-20 Version 3 (HCR-20V3) was published in 2013, after several years of development and revision work. It replaces Version 2, published in 1997, on which there have been more than 200 disseminations based on more than 33,000 cases across 25 countries. This article explains (1) why a revision was necessary, (2) the steps we took in the revision process, (3) key changes between Version 2 and Version 3, and (4) an overview of HCR-20V3s risk factors and administration steps. Recommendations for evaluating Version 3 are provided.

Assessment and management of risk for intimate partner violence by police officers using the Spousal Assault Risk Assessment Guide

Intimate partner violence (IPV) is a crime that is present in all countries, seriously impacts victims, and demands a great deal of time and resources from the criminal justice system. The current study examined the use of the Spousal Assault Risk Assessment Guide, 2nd ed. (SARA; Kropp, Hart, Webster, & Eaves, 1995), a structured professional judgment risk assessment and management tool for IPV, by police officers in Sweden over a follow-up of 18 months. SARA risk assessments had significant predictive validity with respect to risk management recommendations made by police, as well as with recidivism as indexed by subsequent contacts with police. Risk management mediated the association between risk assessment and recidivism: High levels of intervention were associated with decreased recidivism in high risk cases, but with increased recidivism in low risk cases. The findings support the potential utility of police-based risk assessment and management of IPV, and in particular the belief that appropriately structured risk assessment and management decisions can prevent violence.