The present study examined risk for inpatient aggression, including treatment-related changes in risk, using a battery of 5 forensic instruments. The relative contributions of different types of risk factors to the assessment of risk for inpatient outcomes were also assessed. The Historical-Clinical-Risk Management-20V3, Short-Term Assessment of Risk and Treatability, Violence Risk Scale, Violence Risk Appraisal Guide-Revised, and Psychopathy Checklist-Revised were rated from archival information sources on a sample of 99 adult forensic inpatients from a Canadian psychiatric hospital. Pretreatment and posttreatment ratings were obtained on all dynamic study measures; associations between risk and change ratings with inpatient aggression were examined. Significant pretreatment-posttreatment differences were found on the HCR-20V3, START, and VRS; pretreatment scores on these measures each demonstrated predictive accuracy for inpatient aggression (AUC = .68 to .76) whereas the PCL-R and VRAG-R did not. HCR-20V3, VRS, and START dynamic scores demonstrated incremental predictive validity for inpatient aggression to varying degrees after controlling for static risk factors. Dynamic change scores from these 3 measures also demonstrated incremental concurrent associations with reductions in inpatient aggression after controlling for baseline risk. Several instruments demonstrated predictive validity for inpatient aggression and clinical/dynamic risk and change scores had unique associations with this outcome. The present findings suggest that risk assessments using the HCR-20 V3, START, and VRS may inform the management and reduction of inpatient aggression, as well as assessments of dynamic risk more generally. (PsycINFO Database Record

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-20V3), 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-20V3 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.

This prospective study investigated the predictive validity of five structured risk/forensic instruments for inpatient violence risk in a secure forensic hospital. Episodes of inpatient violence and the following instruments were each coded from hospital files: Historical Clinical Risk Management 20 -Version 3 (HCR-20 V3 ), Psychopathy Checklist Revised (PCL-R), Short-Term Assessment of Risk and Treatability (START), Revised Violence Risk Appraisal Guide (VRAG-R), and Violence Risk Scale (VRS). The dynamic/clinical instruments (HCR-20 V3 , START, and VRS) predicted inpatient violence, even after controlling for the static measures. The results indicated that structured risk instruments may be applied to the assessment of inpatient violence risk.

Existing risk communication procedures are marred by various well-documented problems and inconsistencies. The Council of State Governments' Justice Center (United States) developed a five-level system for risk and needs communication, to standardize these procedures and to provide a common risk language. Introduction of a common language could constitute a dramatic shift in criminal justice processes, with wide-ranging impacts. This article provides a critical review of the system and its suitability for application to various risk assessment functions. Issues discussed include: applicability to specialist and generalist offending behavior, the characteristics of suitable instruments, statistical and conceptual priorities, barriers to precision in language, and conceptual issues related to changes in risk level. A thorough understanding of each of these issues is necessary to apply the system to new contexts and populations, and facilitate straightforward and precise risk communication. Absent further elaboration of the system, many problems with risk communication will persist.

Racial disparities in criminal justice processes and outcomes have garnered considerable attention. Whether and how risk assessment instruments might contribute to such discrepancies are critical questions. However, tools based on the widely applied structured professional judgment (SPJ) model have received little attention in this regard. This study investigated relationships between race and violence risk appraisals derived from two commonly used SPJ tools, the Historical-Clinical-Risk Management 20 (HCR-20 V3 ) and the Spousal Assault Risk Assessment Guide (SARA-V3), using a database of 337 diverse individuals' information. Results were mixed with respect to racial disparity. Race was not clearly associated with summary ratings on the HCR-20 V3 . However, being Indigenous predicted high-risk ratings on the SARA-V3 after controlling for risk factors and criminal history, but not after controlling for actuarial risk scores. While the results were promising in many respects, they nonetheless suggest that associations between race and SPJ risk appraisals warrant further empirical study. Public Significance StatementThis study demonstrates that racial disparities may be observed among risk appraisals derived from structured professional judgment tools, based on a sample of Canadian Indigenous and non-Indigenous persons. The results were mixed and do not identify causes of the disparities, but they provide an impetus and clear directions for further study to further the aim of racial justice in risk assessment.