Accurate predictions of future reconviction, including those for violent crimes, have been shown to be greatly aided by the use of formal risk assessment instruments. However, it is unclear as to whether these instruments would also be predictive in a sample of offenders with intellectual disabilities. In this study, the authors have shown that the Violence Risk Appraisal Guide (V. L. Quinsey, G. T. Harris, M. E. Rice, & C. Cormier, 1998); the Psychopathy Checklist--Screening Version (S. D. Hart, D. N. Cox, & R. D. Hare, 1995); and the History, Clinical, Risk Management--20 (C. D. Webster, K. S. Douglas, D. Eaves, & S. D. Hart, 1997) were all significant predictors of violent and general reconviction in this sample, and in many cases, their efficacy was greater than in a control sample of mentally disordered offenders without an intellectual disability.

Structured professional judgment guides (SPJs) have gained acceptance for the prediction of future violence. We conducted a prospective study of 44 psychiatric inpatients with a variety of mental health problems to test whether the Short-Term Assessment of Risk and Treatability (START; Webster, Martin, Brink, Nicholls, & Middleton, 2004) was able to predict a range of problem behaviors. We obtained outcome behaviors from the nursing record for a period of up to 6 months after the assessment. For all types of behavior tested (violence to others, self-harm, self-neglect, and being victimized), the clinical judgment of risk based on the START was a good predictor. However, the actuarial scores on the Strength and Risk scales of the START were only useful for the prediction of violence. The results provide a strong evidence base for the use of START to predict a range of problem behaviors, and confirms that the START should be used as an adjunct to clinical decision making and not with a blind adherence to the actuarial scores. The difference in efficacy between START used in an actuarial manner and as a SPJ suggests that schemes using other items may prove more effective in guiding the clinician to assess and managing these risks.

The HCR-20 and the VRAG have excellent predictive efficacy in offenders with an ID. A structured clinical judgement based on the HCR-20 was especially predictive.

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The study provides the first independent validation of the COVR and evidence of the usefulness of the COVR in predicting harmful behavior in forensic inpatient settings in the United Kingdom.