Risk and protective factors in risk assessment: Predicting inpatient aggression in adult males detained in a forensic mental health setting.

Structured clinical risk assessments represent a preferred means of assessing levels of aggression risk at different times and in different individuals. Increasing attention has been given to capturing protective factors, with sound risk assessment critical to high-secure forensic mental health care. The aim was to assess the predictive value of the HCR-20v3 for aggression risk and the long-term care pilot version of the SAPROF (the SAPROF-LC-pilot) in a high-secure forensic mental health inpatient population and to determine the incremental value of protective over risk factors. Participants were adult males detained in a high secure forensic mental health service, with a primary diagnosis of schizophrenia and/or personality disorder. The focus was on examining hospital based aggression (self- and other-directed) at two time points; up to 6 months (T1) and between 7 and 12 months (T2). The HCR-20V3 and SAPROF-LC-pilot demonstrated good predictive validity but with variability across subscales and aggression types/periods. Historical factors of the HCR-20V3 and External factors of the SAPROF-LC-pilot failed to predict, aside from a medium effect at T1 for verbal aggression and self-harm, for Historical factors. There was evidence for protective factors adding to prediction over risk factors alone, with the integration of protective and risk factors into a risk judgement particularly helpful in improving prediction accuracy. Protective factors contributed to risk estimates and particularly if integrated with risk factors. Combining risk and protective factors has clear predictive advantages, ensuring that protective factors are not supplementary but important to the aggression assessment process.

The Structured Assessment of Protective Factors for violence risk (SAPROF): A meta-analysis of its predictive and incremental validity.

Although the inclusion of protective factors in risk assessment is believed to improve prediction, most risk assessment tools emphasize risk factors. In response, the Structured Assessment of Protective Factors for violence risk (SAPROF) has been developed, which focuses exclusively on protective factors and is used in conjunction with a structured risk assessment tool. It has received increasing attention from both researchers and forensic mental health practitioners, and additional versions have been developed for use with adolescents (SAPROF-YV) and sex offenders (SAPROF-SO). To assess their psychometric performance, we conducted a meta-analysis of validation studies. Our final sample included 39 articles with 5,434 subjects from 16 countries. Overall, the SAPROF(-YV/-SO) showed good interrater reliability and moderate-to-good predictive performance for the absence of recidivism and institutional misconduct. All three instruments exhibited incremental validity when used in conjunction with a risk-focused assessment tool. Our meta-analysis additionally showed that changes on the SAPROF are associated with decreased violent and general recidivism after controlling for baseline risk. We also uncovered several shortcomings in current research with the SAPROF(-YV/-SO). Studies did not report calibration indices and most studies were retrospective and limited to male offenders. The present findings provide support for the relevance of protective factors in risk assessment, but future research should focus on their hypothesized role in treatment and risk management. (PsycInfo Database Record (c) 2023 APA, all rights reserved).