Michiel de Vries Robbé

Protective Factors for Violence Risk in Forensic Psychiatric Patients: A Retrospective Validation Study of the SAPROF

The Structured Assessment of PROtective Factors for violence risk (SAPROF) has recently been developed as a strengths-based addition to the assessment of risk for future violent behavior (de Vogel, de Ruiter, Bouman, & de Vries Robbé, 2009). Following the Structured Professional Judgment (SPJ) model, the positive and predominantly dynamic factors in the SAPROF were designed to counterbalance the assessment of risk as measured by risk assessment instruments, such as the HCR-20. The present retrospective study provides a first validation of the SAPROF in a Dutch sample of 126 forensic psychiatric patients. Analyses showed good interrater reliability, good predictive validity for non-recidivism of violence after clinical treatment for both the SAPROF total score and the SAPROF Final Protection Judgment and good predictive validity for violent recidivism for a combined HCR-20 - SAPROF total score. The predictive validity of the combined HCR-20 - SAPROF measure significantly outperformed the predictive validity of the HCR-20 in this study. Repeated assessments of the same patients over time demonstrated a significant improvement of SAPROF scores during treatment. Overall, the results provide evidence for the relationship between the presence of protective factors and non-recidivism of violence and for the additional value of protective factors in the assessment of risk for future violence. Moreover, the sensitivity of SAPROF scores to change provides support for the usefulness of the instrument in planning and evaluating treatment interventions.The Structured Assessment of PROtective Factors for violence risk (SAPROF) has recently been developed as a strengths-based addition to the assessment of risk for future violent behavior (de Vogel, de Ruiter, Bouman, & de Vries Robbe, 2009). Following the Structured Professional Judgment (SPJ) model, the positive and predominantly dynamic factors in the SAPROF were designed to counterbalance the assessment of risk as measured by risk assessment instruments, such as the HCR-20. The present retrospective study provides a first validation of the SAPROF in a Dutch sample of 126 forensic psychiatric patients. Analyses showed good interrater reliability, good predictive validity for non-recidivism of violence after clinical treatment for both the SAPROF total score and the SAPROF Final Protection Judgment and good predictive validity for violent recidivism for a combined HCR-20 - SAPROF total score. The predictive validity of the combined HCR-20 - SAPROF measure significantly outperformed the predictive validit...

Risk factors and protective factors: a two-sided dynamic approach to violence risk assessment

The complementary use of risk- and protective factors has been one of the major advances in violence risk assessment in recent years. The present study investigates the value of this two-sided approach. The HCR-20 and the SAPROF were coded retrospectively for a sample of 188 patients with a history of violent or sexual offending, discharged from forensic psychiatric treatment. No moderating effect was found for type of offending history. The combined evaluation of risk- and protective factors was found to have good predictive validity for violent recidivism after treatment. Especially, the dynamic factors of both tools proved good predictors of (desistance from) violence at short- and long-term follow-up. Protective factors showed to provide incremental predictive validity over the use of risk factors alone. In addition, evidence was found for an interaction effect between risk- and protective factors. Implications of these findings for treatment planning and risk management are discussed.

Changes in dynamic risk and protective factors for violence during inpatient forensic psychiatric treatment: Predicting reductions in postdischarge community recidivism

Empirical studies have rarely investigated the association between improvements on dynamic risk and protective factors for violence during forensic psychiatric treatment and reduced recidivism after discharge. The present study aimed to evaluate the effects of treatment progress in risk and protective factors on violent recidivism. For a sample of 108 discharged forensic psychiatric patients pre- and posttreatment assessments of risk (HCR-20) and protective factors (SAPROF) were compared. Changes were related to violent recidivism at different follow-up times after discharge. Improvements on risk and protective factors during treatment showed good predictive validity for abstention from violence for short- (1 year) as well as long-term (11 years) follow-up. This study demonstrates the sensitivity of the HCR-20 and the SAPROF to change and shows improvements on dynamic risk and protective factors are associated with lower violent recidivism long after treatment.

Assessing Protective Factors for Sexually Violent Offending With the SAPROF

The Structured Assessment of Protective Factors for violence risk (SAPROF) has recently been developed as a risk assessment tool to focus solely on protective factors for (sexual) violence risk. Research on protective factors for sexual offending is very limited and most risk assessment tools for adult sexual offenders do not incorporate protective factors. The current study investigates the applicability and predictive validity of the SAPROF for forensic psychiatric patients who have sexually offended. For a sample of 83 hands-on sexual offenders, risk assessments were carried out retrospectively with the SAPROF, the Historical Clinical Risk Management–20 (HCR-20) and the Sexual Violence Risk–20 (SVR-20). Results show good interrater reliability and negative correlations between the SAPROF and both risk tools. Predictive validities of the SAPROF protective factors for reconvictions of general and sexual violence were good for short-term (1-3 year) as well as for long-term follow-up (15 year). Moreover, the SAPROF remained a statistically significant predictor of future violence and sexual violence even after controlling for the HCR-20 and the SVR-20. Implications of these findings and recommendations for future research are discussed.

The Use of the HCR-20V3 in Dutch Forensic Psychiatric Practice

In this article, the applicability of the recently published HCR-20V3 for violence risk assessment in forensic psychiatric practice is discussed. This revision of the HCR-20 is the result of a multi-year development process based on worldwide empirical research, clinical expertise and consultation. Recently, the HCR-20V3 was implemented in Dutch forensic psychiatric practice by a research team that was also involved in beta-testing and pilot research into the interrater reliability and predictive validity of the first HCR-20V3 Draft version. This paper presents results of this beta-testing and the pilot study, as well as results from a recently conducted survey into the clinical value and applicability of the Dutch HCR-20V3. Overall, the results demonstrate that the HCR-20V3 is a promising revision with sound psychometric properties and improvements compared to the prior version of the HCR-20 for violence risk assessment and management. Furthermore, the first impressions of 192 workshop participants about the HCR-20V3 were positive. To illustrate the applicability of the HCR-20V3 for risk assessment and management in forensic clinical practice, a detailed forensic case study is presented.In this article, the applicability of the recently published HCR-20V3 for violence risk assessment in forensic psychiatric practice is discussed. This revision of the HCR-20 is the result of a multi-year development process based on worldwide empirical research, clinical expertise and consultation. Recently, the HCR-20V3 was implemented in Dutch forensic psychiatric practice by a research team that was also involved in beta-testing and pilot research into the interrater reliability and predictive validity of the first HCR-20V3 Draft version. This paper presents results of this beta-testing and the pilot study, as well as results from a recently conducted survey into the clinical value and applicability of the Dutch HCR-20V3. Overall, the results demonstrate that the HCR-20V3 is a promising revision with sound psychometric properties and improvements compared to the prior version of the HCR-20 for violence risk assessment and management. Furthermore, the first impressions of 192 workshop participants about...

A European Perspective on Risk Assessment Tools

Assessing the level of violence risk is a vital task for mental health professionals working with offenders and (forensic) psychiatric patients. Many tools are available to aid the assessment process, each with a specific focus and purpose. Especially the structured professional judgement risk assessment tools are considered useful in guiding clinical practice and decision-making. In addition to assessing static and dynamic risk factors, the assessment would benefit from also incorporating the evaluation of strengths. These protective factors offer further insight into current functioning and the likelihood of violent behaviour. Moreover, they provide promising treatment targets. A well-balanced assessment including historical and changeable risk factors as well as protective factors should result in an insightful overview of the most important factors relevant for the violence risk potential of a specific individual in his or her assessed context. This assessment leads to a better understanding of future violence risk, conclusions regarding the level of risk and security needed and recommendations for intervention and risk management. Final conclusions drawn from the assessment should be made according to risk scenario narratives regarding the specific type of violent behaviour that seems most likely and that needs to be prevented for the individual case through tailored intervention. A case example is provided to demonstrate the use of a combined risk- and strength-based assessment in clinical practice. The chapter concludes with general recommendations regarding the organization of the risk assessment process and the incorporation of risk assessment and risk management in daily forensic care.

Inpatient violence in a Dutch forensic psychiatric hospital

Purpose Inpatient violence can have a major impact in terms of traumatic experiences for victims and witnesses, an unsafe treatment climate, and high-financial costs. Therefore, the purpose of this paper is to gain more insight into patterns of violent behavior, so that adequate preventive measures can be taken. Design/methodology/approach Data on inpatient violence in a Dutch forensic psychiatric hospital between 2008 and 2014 were extracted from hospital files on 503 patients. Findings More than half of all the patients (n=276, 54.9 percent) displayed verbal aggression on at least one occasion, whereas 27.2 percent of all patients (n=137) exhibited one or more incidents of physical violence. Female patients were responsible for more physically violent episodes than male patients. Patients admitted with a civil court order exhibited more violent behavior than patients with a criminal court order. Violent patients with a civil commitment had a significantly longer length of stay than non-violent patients with a civil commitment. More violence was found to take place on the earlier days of the week. Originality/value This study points at important differences between groups of forensic inpatients in frequency and type of inpatient violent behavior and in temporal factors. Interventions aimed at reducing the number of violent incidents should take these differences into account. Further research is necessary to gain more insight into the background of inpatient violence.