The HCR-20 and post-discharge outcome in male patients discharged from medium security in the UK

• Published in: Aggressive behavior 2004-11, Vol.30 (6), p.469-483
• Main Authors: Dolan, Mairead, Khawaja, Afshan
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; HCR-20; Medical sciences; post-discharge outcome; Psychology. Psychoanalysis. Psychiatry; Psychometrics. Diagnostic aid systems; Psychopathology. Psychiatry; Techniques and methods; violence
• ISSN: 0096-140X; 1098-2337
• DOI: 10.1002/ab.20044

The Historical Clinical Risk–20 (HCR–20) [Webster et al., 1997a,b] is a structured clinical judgement 20–item risk assessment scale, which was developed for use in Canadian forensic facilities. Data on the HCR–20 in UK samples is limited. We examined the predictive validity of the HCR–20 in relation to post‐discharge outcomes in male medium secure patients who had a history of violent offending. HCR–20 scores (omitting the psychopathy item) at the point of discharge were rated in 70 violent patients released into the community using case file data. Relationships between post‐discharge outcomes (reconviction, readmission, self/collateral reports of violence) over a minimum two‐year follow‐up period were rated blind to the HCR–20 score and examined using a variety of risk prediction statistics. HCR–20 score did not predict reconviction, but was a significant predictor of readmission and self/collateral reports of violence. Subscale analyses indicated that all subscales had predictive validity. High scores on the Historical items were better at predicting who would have poor outcome. High scores on the Clinical and Risk scales were better at predicting how long an individual remained at liberty in the community following discharge. The findings suggest that the HCR–20, without the psychopathy rating, is a reasonably robust predictor of self‐reported violence and readmission in medium secure services. Our finding that it did not predict violent recidivism reflects the utility of this measure in the management of risk in violent patients discharged to the community. Aggr. Behav. 30:469–483, 2004. © 2004 Wiley‐Liss, Inc.