More Than a Buzz Word: Culturally Relevant Risk Factors and the HCR-20

Alicia Nijdam-Jones; Fordham University, Bronx, NY, USA; University of Manitoba, Winnipeg, Canada
Eric Garcia-Lopez; Instituto Nacional de Ciencias Penales, Mexico City, Mexico; Facultad de Ciencias Juridicas, Universidad de Castilla-La Mancha, Toledo, Spain
Libertad Merchan Rojas; Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
Aura Ruiz Guarneros; Instituto Nacional de Ciencias Penales, Mexico City, Mexico
Barry Rosenfeld; Fordham University, Bronx, NY, USA

This prospective study investigated the predictive validity of a culturally adapted version of the Historical-Clinical-Risk Management-20 (HCR-20-V3) with a sample of 114 incarcerated males in a medium-security prison in Mexico City. The goal was to integrate a culturally responsive approach to violence risk assessment by incorporating culturally relevant risk factors identified by forensic mental health professionals in Latin America who conduct violence risk assessments. These risk factors related to problematic family and peer relationships, machismo, normalization of violence, and economic disadvantage. Data collection for HCR-20-V3 ratings involved clinical interviews and a review of institutional documents; data on aggressive incidents were collected through document review, self-report follow-up interviews, and guard reports. Participants who engaged in institutional violence during the 3-month follow-up period were given significantly higher scores on several culturally relevant risk factors than those who did not engage in institutional violence. Although the culturally adapted HCR-20-V3 items did not provide incremental validity to the original HCR-20-V3 items, the culturally adapted HCR-20-V3 total score produced an area under the ROC curve of .73-.74. The findings provide evidence that the culturally adapted HCR-20-V3 has strong predictive validity and the utility of adapting culturally relevant risk factors for the assessment of violence risk.

Violence risk assessment; forensic assessment; institutional violence; prison; cross-cultural validity

“Culture is integral to an individual’s decision-making processes. Cultural factors may therefore influence when or why someone does or does not engage in violence as well as the anticipated social response to aggression…The need to utilize culturally validated tools is also highlighted by the ethical principles of psychologists (American Psychological Association, 2017) as well as the standards for educational and psychological testing (American Educational Research Association et al., 2014)…The Supreme Court of Canada recently ruled that the Correctional Service of Canada (CSC) must respect and be responsive to cultural differences, and if the CSC intends to continue to use several forensic risk assessment measures with Indigenous offenders, their cross-cultural invariance and generalizability must be empirically established (Ewert v. Canada, 2018)…Concerns about cross-cultural validity in risk assessment tools is not limited to Indigenous offenders in Canada…Unfortunately, despite high rates of Latinx adults involved in the criminal justice system in the United States and Latin America countries, there is little research specifically examining whether adaptations are needed to improve the cultural relevance of risk assessment tools when applied to members of these cultural groups…” (p. 39-40).

“…This project was a prospective examination of whether the adaptation and inclusion of culturally relevant risk factors improved the predictive validity over the original 20 risk factors in the HCR-20-V3 (Douglas et al., 2013, 2015), a structured professional judgment violence risk assessment tool, in a sample of male offenders incarcerated in a Mexico City prison…it was hypothesized that the participants who engaged in violence would score significantly higher on the culturally adapted HCR-20-V3 risk factors (e.g., problematic family and peer relationships, machismo, normalization of violence, and economic disadvantage) than those who did not engage in institutional violence during the 3-month follow-up period. Additionally, it was hypothesized that there would be a positive and statistically significant relationship between the cultural risk factors and institutional violence during a 3-month follow-up period, and that the culturally adapted risk factors would provide incremental validity to the original HCR-20-V3 in predicting violence” (p. 41-42).

“Participants were 114 inmates incarcerated in El Reclusorio Varonil Preventivo Oriente (Reclusorio Oriente), a medium-security prison located in Mexico City. To take part in this study, participants needed to speak Spanish fluently, were over 18 years of age at the time of consent, and had been incarcerated for a minimum of one month prior to study participation…This study found that although the inclusions of culturally relevant risk factors did not provide incremental variance over the original risk factors in the prediction of violence among incarcerated adults in Mexico, four of the six culturally relevant risk factors were associated with increased rates of violence…This is the first study to adapt the HCR-20-V3 to be used in a Spanish-speaking country and it provides evidence that a culturally adapted version of the HCR-20-V3 may have utility in violence risk assessment for institutional violence within a Mexican prison” (p. 42-29).

“…Analyses demonstrated that several of the original HCR-20-V3 items significantly differed between the two groups…cultural risk factors that reflected the unique emic considerations that Latin American forensic mental health professionals identified as important within this cultural context…were also significant predictors of institutional aggression. In fact, several of the culturally relevant risk factors, such as problems with familismo, indirect and direct violence exposure, and machismo attitudes had comparable or larger effect sizes than well-established risk factors for violence, such as history of violence, antisocial behavior, and personality disorder. Although together, these risk factors did not increase the predictive variance of the HCR-20, the cultural adaptation makes the instrument more culturally responsive and may be informative for risk management and risk-reduction interventions…” (p. 49).

“…This study demonstrated that when it comes to violence risk assessment, although risk factors traditionally assessed are predictive of institutional violence, several culturally relevant risk factors may also be useful to understanding violence risk. Being aware of the presence of these cultural factors allows for more culturally sensitive risk management and risk-reduction interventions. For example, being aware of cultural risk factors may inform risk-reduction interventions to target these factors, such as identifying and changing machismo attitudes in therapy or targeting appraisals and cognitions around exposure to violence that may justify or normalize violent behavior. Additionally, if the evaluator recognizes the cultural construct of familismo among their client whose family exerts a negative influence on their behavior, the evaluator may be able to make treatment recommendations specific to this to aid in building community resources with individuals who provide more prosocial role models. Although these interventions may also be provided for other common risk factors, it is culturally incompetent to ignore the evaluee’s unique cultural beliefs, norms, and context and the impact they have on their violence risk” (p. 50).

“More research is needed into how to best synthesize these risk factors into violence risk assessments using the HCR-20…it could be possible to include these culturally relevant risk factors as additional indicators for several of the original HCR-20-V3 risk factors when working with offenders in Mexico. As the culturally adapted risk factors were separated to facilitate separate analyses from the original risk factors in the present study, future research should examine whether these cultural risk factors could be incorporated into existing risk factors as additional indicators. For instance, indicators for the problems with Familismo could potentially be considered while coding Problems with Relationships (H3), and the Normalization of Violence…indicators could be considered when scoring the Traumatic Experiences (H8) item. Similarly, the culturally relevant Machismo Attitudes item could fall under the umbrella of Violent Attitudes (H9)…Additionally, although the culturally relevant risk factors were developed to be specific to the Latin American context, they are highly correlated with existing items…Therefore, including the culturally relevant risk factors as indicators for the original (and related) items will permit overlap of these constructs while also providing guidance to the evaluator to consider these unique cultural considerations while scoring these items and informing treatment decisions to manage violence risk” (p. 50-51).

“Most forensic assessment measures studied in cross-cultural contexts employ an etic approach, whereby the measure is merely translated into another language and then evaluated to determine whether it has adequate psychometric properties…The etic perspective assumes the universality of a construct and enables the examination of the generalizability of the construct across cultures…To maximize utility and accuracy, researchers have proposed that violence risk assessment should also incorporate culturally relevant risk factors and adaptations using an emic perspective…The emic approach emphasizes culture as an “integral part of human behavior” (Helfrich, 1999, p. 133) and aims to identify culturally specific or relevant influences on an individual’s psychological cognitions, assumptions, and behaviors. Neither perspective is superior to the other, and cross-cultural researchers often integrate the two approaches…” (p. 41).  “THE HCR-20-V3 (Douglas et al., 2013) is a structured professional judgment violence risk assessment tool that guides clinicians to rate the presence and relevance of 20 specific risk factors, including historical factors (Historical scale), the individual’s current clinical presentation (Clinical scale), and areas of future problems that may increase the individual’s violence risk (Risk Management scale). Developed in Canada, the HCR-20 aids in the assessment of violence risk in psychiatric and offender populations…Clinicians utilize the HCR-20-V3 guidelines to generate a risk formulation and summary risk ratings to guide risk-reduction interventions, and to estimate the individual’s future risk of violence using summary risk ratings and qualitative descriptors (low, moderate, or high)…” (p. 43).