The Business of Practice

General Violence Risk: A Structured Professional Judgment Approach

Violence is when… A person engaged in an act (or omission) with some degree of willfulness that caused or had the potential to cause physical or psychological harm to another person or persons.

 

 

General Violence Risk: A Structured Professional Judgment Approach

General Violence Risk

Violence is not rare; it is a pervasive social problem that takes many distinct forms. Diverse professions are commonly tasked with identifying situations for increased violence risk and individuals who may pose this risk. Then, these professionals are tasked with providing necessary and appropriate recommendations to protect public safety.

Individuals without comprehensive training and experience are less able to accurately perform risk assessments for violence compared to professionals with a well-developed skill set. Therefore, individuals must consider improving their skills.

Historical Clinical Risk Management 20 (HCR-20)

The HCR-20 is the world’s leading violence risk assessment instrument. It is a set of professional guidelines which aids in conducting risk assessments and developing and monitoring risk management plans. It is intended to help professionals determine the risk for psychological and physical interpersonal violence by examining 20 items related to an individual’s history (H), clinical presentation (C), and risk management problems (R). 

The HCR-20 does not use algorithms, cutoffs, or formulas; instead, it utilizes a Structure Professional Judgment (SPJ)  approach. It aims to improve and clarify areas of risk assessments, offer guidance on summary risk ratings, and assist in the planning and implementation of risk management. This method provides structure, consistency, discretion, and flexibility. The HCR-20 guides professionals through the conceptualization of violence with an emphasis on intervention and how to manage risk.

Over the years, the authors of the HCR have modified it to reflect changes and growth within the field, making “V3” the third version. This version has been subjected to extensive clinical testing and empirical evaluation, making it more valuable than previous versions. The HCR-20 V3 integrates new insight and novel concepts, prevents evaluators from considering too broad or redundant items, and provides specifications in the assessment process.

Pros & Cons of the HCR-20

Pros
  • Research has shown that the HCR-20 performs as well as any other violence risk assessment instrument, perhaps even better.
  • It is used in 35 countries and has been translated into 20 languages
  • Professionals can use it to monitor a person’s risk over time by reevaluating dynamic factors.

Cons
  • Most research has been conducted by well-trained evaluators or authors of the tool, raising concern for potential bias (although, currently, no bias has been found).
  • There are limited published studies on the HCR-20 V3 from non-Western countries. 
  • It is not suggested for use with juveniles (other assessment tools have been developed to consider developmental maturity while assessing risk with this population).
  • It is slightly better for evaluating the risk for violence in men than in women. However, these gender differences are minor and primarily limited to historical factors.

Administration

Gathering Information
Including primary source information, collateral interviews, record reviews, and other available and relevant information. 
 
Determine the Presence of Risk Factors 
Using a multi-level response format, the evaluator reflects the certainty of their opinion.
 
Assess the Relevance of Risk Factors 

A risk factor is relevant if it... 

  • Contributes to past violence
    • For example, an individual’s lack of stable housing has previously led them to engage in violent behavior to obtain means for survival.
  • Influences a decision to act violently
    • For example, medication noncompliance may result in an individual becoming symptomatic and engaging in aggressive acts in the community.
  • Impairs one’s ability to employ non-violent problem-solving techniques
    • For example, the individual’s recent acts of violence suggest a lack of problem- and emotion-focused coping strategies.
  • Is necessary to manage to mitigate risk
    • For example, an individual’s response to treatment. 

Are you interested in visualizing the administration procedure better? Then, you can download a free rating sheet that evaluators use to summarize their findings!  

 

Qualifications for using the HCR-20

  • Considerable professional skill and judgment
  • Knowledge of violence
  • Expertise in individual assessment - including training and experience in interviewing
  • Expertise in mental disorders

Career Enhancement

Psychology is a field of life-long learning. Despite this, learning after earning a degree is often overlooked. Completing training in violence risk assessment and management propels professional development, transforming mental health generalists into specialists thanks to content from leading subject matter experts.


Research has indicated that the use of risk assessment instruments has increased. This increase has equated to increased diversity of professionals conducting these violence risk evaluations. However, the quality of these assessments fluctuates as not all evaluators are appropriately trained. 


Learning the HCR-20 will set you apart from other professionals and complete evaluations in a manner consistent with best practice. In addition, you can showcase digital credentials to prospective employers and clients on platforms like LinkedIn, making you more marketable for employment in various settings. Such as in-patient psychiatric units, assisted outpatient treatment teams, and primary and secondary institutions.

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