FREE Special Issue on the HCR-20 Version 3

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The HCR-20 Version 3 (HCR-20^V3) 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-20^V3‘s risk factors and administration steps. Recommendations for evaluating Version 3 are provided.

Authors

Abstract

The HCR-20 Version 3 (HCR-20^V3) 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-20^V3‘s risk factors and administration steps. Recommendations for evaluating Version 3 are provided.

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In this article, the applicability of the recently published HCR-20^V3 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-20^V3 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-20^V3 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-20^V3. Overall, the results demonstrate that the HCR-20^V3 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-20^V3 were positive. To illustrate the applicability of the HCR-20^V3 for risk assessment and management in forensic clinical practice, a detailed forensic case study is presented.

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This article describes the contributions of the German workgroup to the second revision of the HCR-20 (HCR-20^V3). In 2009, a beta-testing of draft 1 of the HCR-20^V3 was conducted. The results were considered in the revision process of draft 1. In 2013, an interrater reliability study of the German translation of draft 2 of the HCR-20^V3 was conducted. After a two-day workshop five raters (psychologists) without experience in structured professional judgment each rated the same 30 cases. The selected cases covered a range of diagnoses and risk levels. Intraclass Correlation Coefficients (ICCs) and the percentage of agreement were calculated for each item, each sub item, and the Summary Risk Ratings (SRRs). The interrater reliability of the SRRs (ICC = .86) was excellent. For the item-level ratings of the risk factors, the mean ICC for the H scale items and sub-items was .65, which would be “good.” The average item-level ICC of the C scale items (.66) and R scale items (.73) would be categorized similarly. There were some ratings with lower reliability. Possible reasons (lack of variance, or misunderstanding from the training procedure) are discussed.

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We evaluated the interrater reliability and concurrent validity of the HCR-20 Version 3 (HCR-20^V3). Three sets of ratings were completed by experienced clinicians for 35 forensic psychiatric patients, for both HCR-20 Versions 2 and 3. Reliability analyses focused on ratings of the presence of Version 3 risk factors, presence of Version 3 risk factor sub-items, relevance ratings for Version 3 risk factors, and Version 3 summary risk ratings for future violence. Concurrent validity analyses focused on the correlational association between Versions 2 and 3 in terms of the number of risk factors present. Findings indicated that Versions 2 and 3 were strongly correlated (.69 – .90). Interrater reliability was consistently excellent for the presence of risk factors and for summary risk ratings. The majority of relevance and sub-item ratings were in the good to excellent range, although there was a minority of such ratings in the fair or poor categories. Findings support the concurrent validity and interrater reliability of HCR-20^V3. Implications for use of HCR-20^V3 by professionals and agencies are discussed.

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Structured guidelines are fundamental for risk assessment, formulation and decision-making in medium secure forensic psychiatric services in the UK. The most commonly used guideline for violence risk assessment in the UK is the HCR-20, so it is important that the new version of the HCR-20 (HCR-20^V3) is validated in UK samples. The aims of this study were to investigate if the HCR-20^V3 has satisfactory interrater reliability and predictive validity for community violence. A prospective confidential inquiry design was used. The HCR-20^V3 demonstrated very good inter-rater reliability and significantly predicted community violence at six and twelve months post-discharge, with ROC AUCs of .73 and .70 respectively. Implications for future research and practice are discussed.

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The current study presents an empirical evaluation of the performance of the third version of the HCR-20. This prospective research project was conducted using a sample of 106 offenders and psychiatric patients who were transitioning out of institutions and into the community. Results provided strong support for the bivariate associations between the ratings of the presence and relevance of risk factors, as well as summary risk ratings, and violence at 4 to 6 weeks and 6 to 8 months. Although relevance ratings did not add incrementally to presence ratings, summary risk ratings added incrementally to both. Findings were not moderated by either sub-sample or gender. Version 3 of the HCR-20 was highly correlated with Version 2. Associations with violence were comparable between instruments. Findings were supportive of these basic elements of Version 3.

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The present study investigated the use of the HCR-20^V3 (Douglas, Hart, Webster, & Belfrage, 2013) among a sample of 84 male inmates in a pre-trial correctional facility. Overall, results indicated that the newly revised instrument can be adapted for use in a pre-trial context, although some scoring obstacles (e.g., participants’ uncertain legal status) were encountered when attempting to rate certain HCR-20^V3 items. Also, some group differences in risk ratings were found when comparing our sample to HCR-20^V3 data collected from external psychiatric inpatient and post-adjudication samples. Implications for clinical forensic practice are reviewed, focusing on modifications that may be helpful or necessary for use in pre-trial settings.

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The third edition of the HCR-20 (HCR-20^V3, Douglas, Hart, Webster, et al., 2013) consolidates essential recent thinking about risk assessment and management using the structured professional judgement approach. As with the preceding Risk for Sexual Violence Protocol (Hart, Kropp, Laws et al., 2003), risk factors for violence are now assessed for their relevance as well as presence, scenario planning has a central place in anticipating the nature, severity, imminence and likelihood of future harm, and risk management strategies must incorporate a combination of treatment, supervision, monitoring and victim safety planning interventions and recommendations. However, the key process now proposed for linking the assessment and overall management of risk is risk formulation—the act of understanding the underlying mechanism of an individual’s harm potential in order to develop sensitive and proportionate hypotheses to facilitate change (embodied within the risk management plan). In this paper, the process of risk formulation is described and illustrated with a case study—Paul. A brief report of the risk assessment, formulation and management recommendations for Paul illustrate the key features of what is recommended in the new version of this internationally renowned violence risk guide. However, empirical research into risk formulation remains outstanding.