Predictive Validity of the HKT-R Risk Assessment Tool: Two and 5-Year Violent Recidivism in a Nationwide Sample of Dutch Forensic Psychiatric Patients

Abstract

This study has examined the predictive validity of the Historical Clinical Future [Historisch Klinisch Toekomst] Revised risk assessment scheme in a cohort of 347 forensic psychiatric patients, which were discharged between 2004 and 2008 from any of 12 highly secure forensic centers in the Netherlands. Predictive validity was measured 2 and 5 years after release. Official reconviction data obtained from the Dutch Ministry of Security and Justice were used as outcome measures. Violent reoffending within 2 and 5 years after discharge was assessed. With regard to violent reoffending, results indicated that the predictive validity of the Historical domain was modest for 2 (area under the curve [AUC] = .75) and 5 (AUC = .74) years. The predictive validity of the Clinical domain was marginal for 2 (admission: AUC = .62; discharge: AUC = .63) and 5 (admission: AUC = .69; discharge: AUC = .62) years after release. The predictive validity of the Future domain was modest (AUC = .71) for 2 years and low for 5 (AUC = .58) years. The total score of the instrument was modest for 2 years (AUC = .78) and marginal for 5 (AUC = .68) years. Finally, the Final Risk Judgment was modest for 2 years (AUC = .78) and marginal for 5 (AUC = .63) years time at risk. It is concluded that this risk assessment instrument appears to be a satisfactory instrument for risk assessment.

Trajectories of Dynamic Risk Factors During Forensic Treatment: Growth Trajectory of Clinical Risk Factors in a Sample of Dutch Forensic Patients

“…At the domain level, excellent interrater reliability was established for both the historical (intraclass correlation [ICC] = .80) and the Clinical domain (ICC = .85). The interrater reliability of the future domain (ICC = .42) was reasonable, which was mainly due to a lack of distribution in the individual T -indicators (restriction of range; Bogaerts et al, 2018 ; Spreen et al, 2013 ).…”

“…Antisocial peers or relatives refer to antisocial network members and substance abuse is measured by the general indicator addiction. School or work performance is related to inadequate job skills ( Bogaerts et al, 2018 ). Finally, psychotic symptoms and a lack of self-reliance were added as indicators of reoffending because psychotic symptoms can evoke antisocial cognitions and attitudes and self-reliance is often a prodromal sign of a psychotic episode ( Skeem et al, 2014 ).…”

“…The use of this technique makes it possible to accurately assess treatment progress for all forensic patients and subsamples of patients related to criminal history, age and duration of stay in a forensic center. Another strength is the use of the HKT-R, as this risk assessment instrument has been validated in multiple studies and in different countries ( Bogaerts et al, 2018 ; Spreen et al, 2013 ). This study provides a unique contribution to the field of forensic psychiatry and provides first insights in changes of severity on risk factors over time during treatment in FPCs, as results showed that the clinical risk factors decrease during treatment, and there appear to be differences between various patient groups.…”

“…In many countries, forensic psychiatric patients are admitted to secure forensic institutions because they have committed a violent crime caused by severe mental disorders. The main goal of staying in low, medium, or high secure services is to receive treatment for offense-related disorders or risk factors, such as impulsivity and hostility, and to allow these patients to reintegrate into society on condition that there has been a change in the severity of risk factors that justify a return to society ( Bogaerts et al, 2018 ). Studies aimed at obtaining longitudinal insights into the changeability of clinical reversible risk factors are very scarce.…”

“…Numerous studies have shown that the presence of risk factors and a lack of protective factors have moderate to strong associations with recidivism ( Beech et al, 2002 ; Bogaerts et al, 2018 ; Mulder et al, 2010 ). However, only a few studies show whether risk factors can actually be reduced and reinforced longitudinally during a stay in high security institutions, such as FPCs ( Van der Veeken et al, 2018 ).…”