Static and Dynamic Assessment of Violence Risk Among Discharged Forensic Patients

Abstract

This study evaluated the predictive validity of structured instruments for violent recidivism among a sample of 82 patients discharged from a maximum security forensic psychiatric hospital. The incremental predictive validity of dynamic pre–post change scores was also assessed. Each of the Historical-Clinical-Risk Management-20 Version 3 (HCR-20 V3 ), Psychopathy Checklist–Revised, Short-Term Assessment of Risk and Treatability, Violence Risk Scale (VRS), and Violence Risk Appraisal Guide–Revised was rated based on institutional files. The study instruments significantly predicted community-based violent recidivism (area under the curve [AUC] = 0.68-0.85), even after controlling for time at risk using Cox regression survival analyses. Dynamic change scores computed from the HCR-20 V3 Relevance ratings and from the VRS also demonstrated incremental predictive validity, controlling for baseline scores. The findings provided support for the use of the study instruments to assess violence risk and for the consideration of dynamic changes in risk—provided that valid means of assessment are employed.