Strength-based assessment for future violence risk: a retrospective validation study of the Structured Assessment of PROtective Factors for violence risk (SAPROF) Japanese version in forensic psychiatric inpatients

Abstract

BackgroundThe Structured Assessment of PROtective Factors for violence risk (SAPROF) was recently developed as a strength-based addition to the risk assessment of future violent behavior. We examined the interrater reliability and predictive accuracy of the SAPROF for violence in forensic mental health inpatient units in Japan.MethodsThis retrospective record study provides an initial validation of the SAPROF in a Japanese sample of 95 forensic psychiatric inpatients from a complete 2008–2013 cohort. Violent outcomes were assessed 6 and 12 months after hospitalization.ResultsWe observed moderate-to-good interrater reliability for the SAPROF total score and the internal factors, motivational factors, external factors, and the Final Protection Judgment scores. According to a receiver operating characteristic analysis, the SAPROF total score and all subscale scores predicted violence at both 6 and 12 months after hospitalization with high accuracy. Furthermore, the predictive validity of a combination of the SAPROF with the Historical Clinical Risk Management-20 (HCR-20) outperformed that of the HCR-20 alone.ConclusionsThe results provide evidence of the value of considering protective factors in the assessment of future violence risk among Japanese forensic psychiatric inpatients. The SAPROF might allow for a more balanced assessment of future violence risk in places where the population rates of violent crime are low, such as Japan, but a validation study in a different setting should confirm this. Moreover, future studies should examine the effectiveness of treatment and promoting community re-integration on motivating patients and treatment staff.

Predicting youth reoffending after incarceration: added value of protective factors and heart rate variability

“…In addition, the SAPROF-YV provided incremental predictive validity on top of risk factors for general reoffending. Several studies among adult offenders demonstrated incremental predictive validity for violent reoffending of the SAPROF protective factors (adult version) over well-established risk factors (e.g., those in the HCR-20) for various offender samples (Coupland, 2015;Kashiwagi et al, 2018;De Vries Robbé et al, 2013). Our results support a small but growing body of empirical evidence for the added value of protective factors over risk assessment based on risk factors alone.…”

Protective Factor Assessments: What Are We Measuring?—An Investigation of the Internal Validity of the Structured Assessment of Protective Factors for Violence Risk

“…Although neither of these studies analyzed the SAPROF’s predictive validity, the other four studies did. The Japanese and Irish studies found the SAPROF to have good and incremental predictive validity, whereas the Swiss studies reported only moderate predictive validity (i.e., total score AUC value = .70 for sexual/violent recidivism, total score AUC value = .64 for general recidivism) and no added value compared with other risk assessments (Abbiati et al, 2017, 2019; Abidin et al, 2013; Kashiwagi et al, 2018). To the best of our knowledge, the SAPROF’s internal validity has never been analyzed in detail.…”

Validity of Short-Term Assessment of Risk and Treatability in the Japanese Forensic Probation Service

“…First, the vagueness of some START strength items may originate from the “lack of conceptual certitude around the relationship between protective and risk factors” ( 48 ). This reasoning may be supported by previous findings that assessment tools with separate items and unambiguous definitions for protective factors, such as SAPROF and SAVRY, tend to perform better in demonstrating incremental validity ( 49 – 51 ). Second, strength scores may be more predictive of positive results, such as job attainment and personal recovery, than merely non-negative results such as absence of violence.…”