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This study evaluated the predictive validity of the HCR-20 (Historical, Clinical, and Risk Management) violence risk assessment scheme and the Psychopathy Checklist: Screening Version (PCL:SV). Files of 193 civilly committed patients were coded. Patients were followed up in the community for an average of 626 days. Receiver operating characteristic analyses with the HCR-20 yielded strong associations with violence (areas under curve [AUCs] = .76-.80). Persons scoring above the HCR-20 median were 6 to 13 times more likely to be violent than those scoring below the median. PCL:SV AUCs were more variable (.68-.79). Regression analyses revealed that the HCR-20 added incremental validity to the PCL:SV and that only HCR-20 subscales predicted violence. Implications for risk assessment research, and the clinical assessment and management of violence, are discussed.

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A Therapeutic Community (TC) treatment program for adult male offenders is summarized and treatment outcome data are discussed. Psychopaths showed less clinical improvement, displayed lower levels of motivation and were discharged from the program earlier than nonpsychopaths. There were significant positive treatment effects for the non-psychopaths and a mixed group. Psychopathy Checklist scores (Hare, 1985) consistently postdict and predict treatment outcome and attrition from the program.9Criminal psychopaths commit 3.5 times more violent crimes than do non-psychopaths (Hare & McPherson, 1984). Once incarcerated psychopaths also display more violent and aggressive behaviors (Hare & McPherson, 1984; Wong, 1984) and are frequently segregated or referred for treatment (McCord, 1982). They are also more likely to violate conditional releases (Hart, Kropp, & Hare, 1988; Wong, 1984). In many clinical and legal circles, psychopaths are generally seen as untreatable, although the issue is far from settled (Suedfelt & Landon, 1978;Wong, Elek, & Ogloff, 1988). Despite their notorious criminal histories and high recidivism rates, they are just as likely as the non-psychopaths to secure conditional releases (Wong, 1984). Criminal psychopaths, therefore, present significant clinical, legal and administrative concerns that must be addressed by those working within the criminal justice system. This article describes a treatment outcome study of a Therapeutic Community (TC) treatment program designed to treat personality disordered individuals, many of whom are psychopaths. Cleckley (1976) (Hare, 1980b andSchroeder, Schroeder, &Hare, 1983;Raine, 1985; Wong, 1984 and. Hare (1 983) showed a strong agreement between DSM-I11 diagnosis of subjects with Antisocial Personality Disorder (301.7) and psychopaths identified using the PCL ratings (Hare, 1980b). However, as the DSM-111 and the recent revision, the DSM-111-R, both focus almost exclusively on antisocial behaviors, they may not readily identify individuals who may fit the personality characteristics of psychopathy, but who, for one reason or another, manage to avoid early or frequent contact with the judicial system (Hare, 1983). For the present study, the PCL ratings were used for subject selection. THE ASSESSMENT OF PSYCHOPATHY The Therapeutic Community (TC)The T C concept was developed by Jones (1963 and1982) who stressed that one approach to rehabilitate inmates is to provide them with an environment in which they can learn to take responsibility for their behaviors. To this end, positive peer group influences are mobilized, in addition to therapeutic inputs from staff to bring about behavioral changes (see also Vorrath and Brendtro, 1974). The central method of intervention in the T C program is the daily group meeting which includes all patients and staff. This 'large group' functions both as a forum for therapy, as well as a setting for developing unit rules. Personal and other living problems that the inmates have been experiencing are encouraged to be brought up ...

Considerable research has attempted to delineate the demographic and clinical characteristics of high-risk psychiatric patients and identify salient modifiable aspects of aggression prone environments. Recently, there has also been increased interest in the development and testing of structured schemes for the assessment of risk for aggression within inpatient psychiatric settings. Although some of these methods show acceptable predictive validity, their ability to inform day-to-day treatment and management decisions is limited. The current research was designed to identify existing and novel risk factors that would assist staff to identify and manage the risk for aggression in psychiatric inpatient populations. Results showed that assessments supported by structured risk measures were more accurate than unaided clinical judgements based only on nurses' clinical experience and knowledge of the patient alone. Seven test items emerged that were maximally effective at identifying acute psychiatric patients at risk for engaging in inpatient violence within 24 hours; these items have been combined in the development of the Dynamic Appraisal of Situational Aggression. Empirical analyses and clinical experience support the efficacy of the instrument in assisting clinical staff in the identification and management of inpatient aggression.