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An audit of the quality of HCR-20 violence risk assessments in a low secure service

Published online by Cambridge University Press:  09 December 2015

Piyal Sen ,
Simone Lindsey ,
Nilanjan Chatterjee ,
Rajesh Rama-Iyer  and
Marco Picchioni
Piyal Sen*
Affiliation:
Consultant Forensic Psychiatrist, St Andrew’s Essex and Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neurosciences, London, UK
Simone Lindsey
Affiliation:
Assistant Psychologist, St Andrew’s Essex, UK
Nilanjan Chatterjee
Affiliation:
Consultant Psychiatrist in Learning Disability, Weston Super Mare, previously Higher Trainee in Learning Disability, East of England Deanery, UK
Rajesh Rama-Iyer
Affiliation:
Senior Speciality Doctor, St Andrew’s Essex, UK
Marco Picchioni
Affiliation:
Senior Lecturer, Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neurosciences, and Consultant Forensic Psychiatrist, St Andrew’s Northampton, UK
*
Correspondence to: Dr Piyal Sen, St Andrew’s Essex, Pound Lane, Benfleet, Essex SS12 9JP. E-mail: [email protected]; [email protected]
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Abstract

Introduction

The HCR-20 is one of the most popular structured clinical judgement tools used in forensic settings; yet, there are no published tools to assess the quality of its use. This study used the CAI-V, a tool to assess the competency of those carrying out risk assessment, to develop a quality tool for the use of HCR-20.

Method

The audit was carried out between July 2012 and July 2013 on all patients resident in St Andrew’s Essex, a low secure unit. The results of the first audit led to an action plan for clinical improvement, subsequently re-audited a year later.

Results

Most of the HCR-20 ratings scored in the competent range in both audits, but the greatest weakness was identified in the treatment planning section. The re-audit showed improvement, but there remained areas for development.

Discussion

The audit highlighted broad areas of improvement like the need for full multidisciplinary involvement, more attention to formulation, and the need for greater consultation and information gathering from outside professionals and family members. The quality tool developed could be adapted to the requirements of any service, and used accordingly.

Keywords

Violencerisk assessmentHCR-20quality
Type
Original Research Article
Information
Journal of Psychiatric Intensive Care , Volume 11 , Supplement S1 , December 2015 , e3
Copyright
Copyright © NAPICU 2015 

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References

Ægisdóttir, S., White, M.J., Spengler, P.M., Maugherman, A.S., Anderson, L.A., Cook, R.S., Nichols, C.N., Lampropoulos, G.K., Walker, B.S., Cohen, G. and Rush, J.D. (2006) The meta-analysis of clinical judgment project: fifty-six years of accumulated research on clinical versus statisti cal prediction. The Counselling Psychologist. 34(3): 341–382.CrossRefGoogle Scholar
Andrews, L.B. and Burruss, J.W. (2004) Core Competencies for Psychiatric Education: Defining, teaching and assessing resident competence. Washington DC: American Psychiatric Publishing.Google Scholar
Appelbaum, P.D. and Gutheil, T.G. (2006) Clinical Handbook of Psychiatry and the Law, 4th edition. Philadelphia: Lippincott, Williams and Wilkins.Google Scholar
Bowers, I., Stewart, D., Papadopoulos, C., Dack, C., Ross, J., Khanom, H. and Jeffery, D. (2011) Inpatient violence and aggression: a literature review. Report from the Conflict and Containment Reduction Research Programme: Institute of Psychiatry, Kings College, London.Google Scholar
Brundtland, G.H. (2002) Violence prevention: a public health approach. JAMA. 288(13): 1580.Google ScholarPubMed
Campbell, M.A., French, S. and Gendreau, P. (2009) The prediction of violence in adult offenders: a meta-analytic comparison of instruments and methods of assessment. Criminal Justice and Behaviour. 36: 567–590.CrossRefGoogle Scholar
Coid, J., Yang, M., Ullrich, S., Zhang, T., Sizmur, S., Farrington, D. and Rogers, R. (2011) Most items in structured risk assessment instruments do not predict violence. Journal of Forensic Psychiatry & Psychology. 22(1): 3–21.CrossRefGoogle Scholar
Daffern, M.D. (2007) The predictive validity and practical utility of structured schemes used to assess risk for aggression in psychiatric inpatient settings. Aggression & Violent Behaviour. 12(1): 116–130.CrossRefGoogle Scholar
Department of Health (2007) Best practice in managing risk. London: HMSO.Google Scholar
DeRubies, R.J., Brotman, M.A. and Gibbons, C.J. (2005) A conceptual and methodological analysis of the nonspecific argument. Clinical Psychology: Science & Practice. 12: 174–183.Google Scholar
De Vries Robbé, M., de Vogel, V. and Stam, J. (2012) Protective factors for violence risk: the value for clinical practice. Psychology. 3: 1259–1263.CrossRefGoogle Scholar
Dolan, M.C. and Fullam, R. (2007) The validity of the Violence Risk Scale second edition (VRS-2) in a British forensic inpatient sample. Journal of Forensic Psychiatry & Psychology. 18(3): 381–393.CrossRefGoogle Scholar
Doyle, M., Dolan, M. and McGovern, J. (2002) The validity of North American risk assessment tools in predicting in-patient violent behaviour in England. Legal & Criminological Psychology. 7(2): 141–154.CrossRefGoogle Scholar
Douglas, K.S., Hart, S.D., Webster, C.D. and Belfrage, H. (2013) HCR-20v3: assessing risk for violence: user guide. Burnaby, Canada: Mental Health, Law, and Policy Institute, Simon Fraser University.Google Scholar
Fazel, S., Singh, J.P., Doll, H. and Grann, M. (2012) Use of risk assessment instruments to predict violence and antisocial behaviour in 73 samples involving 24827 people: systematic review and meta-analysis. BMJ. 345: e4692.CrossRefGoogle Scholar
Gardner, W., Lidz, C.W., Mulvey, E.P. and Shaw, E.C. (1996) Clinical and actuarial predictions of violence in patients with mental illness. Journal of Consulting and Clinical Psychology. 64(3): 602–609.CrossRefGoogle Scholar
Haque, Q. and Webster, C.D. (2013) Structured professional judgement and sequential redirections. Criminal Behaviour & Mental Health. 23: 241–251.CrossRefGoogle ScholarPubMed
Khiroya, R., Weaver, T. and Maden, T. (2009) Use and perceived utility of structured violence risk assessments in English medium secure forensic units. Psychiatric Bulletin. 33: 129–132.CrossRefGoogle Scholar
Krug, E.G., Mercy, J.A., Dahlberg, L.L. and Zwi, A.B. (2002) The world report on violence and health. Lancet. 360: 1083–1088.CrossRefGoogle ScholarPubMed
Langton, C., Hogue, T.E., Daffern, M. and Howells, K. (2009) Prediction of institutional aggression among personality disordered forensic patients using actuarial and structured clinical risk assessment tools: prospective evaluation of the HCR-20, VRS, Static-99, and Risk Matrix 2000. Psychology, Crime and Law. 15: 635–659.CrossRefGoogle Scholar
McNiel, D.E., Hung, E.K., Cramer, R.J., Hall, S.E. and Binder, R.L. (2011) An approach to evaluating competence in assessing and managing violence risk. Psychiatric Services. 62(1): 90–92.CrossRefGoogle ScholarPubMed
Monahan, J. (1993) Limiting therapist exposure to Tarasoff liability: guidelines for risk containment. American Psychologist. 48: 242–250.CrossRefGoogle Scholar
Monahan, J., Steadman, H.J., Silver, E., Appelbaum, P.S., Clark Robbins, P., Mulvey, E.P., Roth, L.H., Grisso, T. and Banks, S. (2001) Rethinking risk assessment: the MacArthur study of mental disorder and violence. New York: Oxford University Press.CrossRefGoogle Scholar
National Collaborating Centre for Mental Health (2009) Antisocial Personality Disorder: Treatment, management and prevention. NICE guidelines CG77. National Institute for Health and Clinical Excellence.Google Scholar
National Institute for Mental Health in England (2004) Mental Health Policy Implementation Guide: Developing positive practice to support the safe and therapeutic management of aggression and violence in mental health in-patient settings. Department of Health.Google Scholar
O’Shea, L.E., Mitchell, A.E., Picchioni, M.M. and Dickens, G.L. (2013) Moderators of the predictive efficacy of the Historical, Clinical and Risk Management-20 for aggression in psychiatric facilities: systematic review and meta-analysis. Aggression & Violent Behaviour. 18: 255–270.CrossRefGoogle Scholar
Reynolds, K. and Miles, H.L. (2009) The effect of training on the quality of HCR-20 violence risk assessments in forensic secure services. Journal of Forensic Psychiatry & Psychology. 20(3): 473–480.CrossRefGoogle Scholar
Simon, R.I. (2003) Commentary: think fast, act quickly, and document (maybe). Journal of American Academy of Psychiatry & the Law. 31: 65–67.Google ScholarPubMed
Simon, R.I. (2008) Clinically-based risk management of potentially violent patients. In Simon, R.I., Tardiff, K. (eds). Textbook of Violence Assessment and Management. Arlington: American Psychiatric Publishing, pp 555–566.Google Scholar
Singh, J.P. (2013) The international risk survey (IRiS) project: perspectives on the practical application of violence risk assessment tools. Paper presented at the annual conference of the American Psychology-Law Society, Portland, Oregon.Google Scholar
Singh, J.P., Grann, M. and Fazel, S. (2011) A comparative study of violence risk assessment tools: a systematic review and meta-regression analysis of 68 studies involving 25,980 participants. Clinical Psychology Review. 31: 499–513.CrossRefGoogle Scholar
Vojt, G., Thomson, L.D.G. and Marshall, L.A. (2013) The predictive validity of the HCR-20 following clinical implementation: does it work in practice? Journal of Forensic Psychiatry & Psychology . 24(3): 371–385.CrossRefGoogle Scholar
Webster, C.D., Douglas, K.S., Eaves, D. and Hart, S.D. (1997) HCR-20: Assessing risk for violence, version 2. Burnaby, Canada: Mental Health, Law, and Policy Institute, Simon Fraser University.Google Scholar
Wilson, T.D. (2011) Redirect: The surprising new science of psychological change. New York: Penguin Books.Google Scholar
Yang, M., Wong, S.C.P. and Coid, J. (2010) The efficacy of violence prediction: a meta-analytic comparison of nine risk assessment tools. Psychological Bulletin. 136(5): 740–767.CrossRefGoogle ScholarPubMed