Evaluating the HCR-20V3 violence risk assessment measure with mentally disordered offenders and civil psychiatric patients in China.

The current prospective risk assessment study evaluated the application of the Chinese translation of the Historical-Clinical-Risk Management-20 Version 3 (HCR-20V3 ) in a sample of 152 offenders with mental disorders and civil psychiatric patients. The ratings of the presence and relevance of risk factors were compared, as well as summary risk ratings (SRRs), both across offenders and civil psychiatric patients, and across male and female sub-samples. Interrater reliability was consistently "excellent" for the presence and relevance of risk factors and for SRRs. Concurrent validity analyses indicated that HCR-20V3 was strongly correlated with Violence Risk Scale (from r = 0.53 to 0.71). The results of predictive validity analyses provided strong support for the bivariate associations between the main indices of HCR-20V3 and violence within 6 weeks, 7-24 weeks, and 6 months; SRRs added incrementally to both relevance and presence ratings across three follow-up lengths.

Predictive validity of the SAVRY, YLS/CMI, and PCL:YV is poor for intimate partner violence perpetration among adolescent offenders.

OBJECTIVE: Despite advances in developing structured risk assessment instruments, there is currently no instrument to assess and manage the risk of intimate partner violence perpetration among adolescents. Given the empirical link between many forms of antisocial behavior, we tested whether structured tools commonly used by professionals to evaluate adolescents' risk of engaging in general violence and offending could be used to identify adolescents at risk for perpetrating intimate partner violence. HYPOTHESES: Because researchers have not yet examined whether risk assessment tools for general violence and offending predict intimate partner violence perpetration, we did not have a priori hypotheses regarding the predictive validity of these tools for this purpose. METHOD: Research assistants rated 156 adjudicated youth on the Structured Assessment of Violence Risk in Youth (SAVRY), Youth Level of Service/Case Management Inventory (YLS/CMI), and Psychopathy Checklist: Youth Version (PCL:YV) and recorded charges for intimate partner violence perpetration, any violent reoffending, and any reoffending over a 2-year follow-up period. RESULTS: Receiver operating characteristic analysis indicated that total scores and summary risk ratings on the SAVRY and YLS/CMI and total scores on the PCL:YV were significantly predictive of any violent reoffending and any reoffending, with moderate to large effect sizes, but were nonsignificantly associated with intimate partner violence perpetration. Further, penalized logistic regression analysis indicated that the SAVRY, YLS/CMI, and PCL:YV did not significantly add incremental validity to age, gender, race/ethnicity, and prior intimate partner violence perpetration and victimization for predicting future intimate partner violence perpetration. CONCLUSIONS: These findings suggest that the SAVRY, YLS/CMI, and PCL:YV could have limitations for assessing and managing intimate partner violence perpetration among adolescents. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Comparing the lexical similarity of the triarchic model of psychopathy to contemporary models of psychopathy.

OBJECTIVE: The triarchic model of psychopathy (Patrick, Fowles, & Krueger, 2009) posits that psychopathic personality comprises three domains: boldness, meanness, and disinhibition. The present study aimed to clarify conceptual overlap between contemporary definitions of psychopathy, with particular emphasis given to the relevance of boldness (i.e., social dominance, venturesomeness, emotional resiliency)-a topic of recent debate. METHOD: Undergraduate students (N = 439) compared the lexical similarity of triarchic domains with two contemporary models of psychopathy: the Comprehensive Assessment of Psychopathic Personality (CAPP; Cooke, Hart, Logan, & Michie, 2012) and the Five-Factor Model of psychopathy (FFM; Widiger & Lynam, 1998). RESULTS: From a content validity perspective, meanness and disinhibition were lexically similar to both the CAPP and FFM psychopathy, whereas boldness was less strongly associated with these models. Meanness showed the strongest lexical similarity in comparison with past prototypicality ratings of the CAPP and FFM psychopathy. CONCLUSIONS: These findings bear implications for defining and comparing conceptualizations of psychopathy that underpin its assessment.

Concurrent validity of the personality assessment screener in a large sample of offenders.

Mental health problems are disproportionately prevalent in forensic and correctional settings, and there have been numerous attempts to develop screening tools to evaluate individuals in such contexts. This study investigates the clinical utility of the Personality Assessment Screener (PAS; Morey, 1997), a brief self-report measure of risk for emotional and behavioral dysfunction, in a large mixed-gender offender sample (N = 1,658). The PAS is a 22-item measure derived from the Personality Assessment Inventory (PAI; Morey, 1991, 2007), a more comprehensive self-report instrument widely used to assess for psychological disturbances among forensic and correctional populations. We examined the ability of the PAS to concurrently predict clinically significant elevations on the PAI and several other indicators of symptomatology and dysfunction. Collectively, results suggest that PAS total and element (subscale) scores show considerable promise in screening inmates for serious problems with emotional and behavioral functioning, though interpretive ranges used to categorize PAS scores in clinical and community settings may require revision for criminal justice populations. We discuss the applied value of the PAS for detecting specific areas of dysfunction relevant to risk management (e.g., aggression, suicidality) and for concentrating resources on offenders with the most immediate and severe need for psychological services. (PsycINFO Database Record

Are adolescent risk assessment tools sensitive to change? A framework and examination of the SAVRY and the YLS/CMI.

Although many adolescent risk assessment tools include an emphasis on dynamic factors, little research has examined the extent to which these tools are capable of measuring change. In this article, we outline a framework to evaluate a tool's capacity to measure change. This framework includes the following: (a) measurement error and reliable change, and (b) sensitivity (i.e., internal, external, and relative sensitivity). We then used this framework to evaluate the Structured Assessment of Violence Risk in Youth (SAVRY) and Youth Level of Service/Case Management Inventory (YLS/CMI). Research assistants conducted 509 risk assessments with 146 adolescents on probation (101 male, 45 female), who were assessed every 3 months over a 1-year period. Internal sensitivity (i.e., change over time) was partially supported in that a modest proportion of youth showed reliable changes over the 3-, 6-, and 12-month follow-ups. External sensitivity (i.e., the association between change scores and reoffending) was also partially supported. In particular, 22% of the associations between change scores and any and violent reoffending were significant at a 6-month follow-up. However, only 1 change score (i.e., peer associations) remained significant after the Bonferroni correction was applied. Finally, relative sensitivity was not supported, as the SAVRY and YLS/CMI was not more dynamic than the Psychopathy Checklist: Youth Version (PCL:YV). Specifically, the 1-year rank-order stability coefficients for the SAVRY, YLS/CMI, and PCL:YV Total Scores were .78, .75, and .76, respectively. Although the SAVRY and YLS/CMI hold promise, further efforts may help to enhance sensitivity to short-term changes in risk. (PsycINFO Database Record

Influence of the HCR-20, LS/CMI, and PCL-R on decisions about parole suitability among lifers.

Among 5,181 inmates indeterminately sentenced to life in California who were evaluated for parole suitability between January 2009 and November 2010, 11% were granted parole. After administration of the HCR-20, LS/CMI, and PCL-R, psychologists judged most inmates (78%) to be at low or moderate risk for future violence. This overall risk rating (ORR) was significantly associated with parole suitability decisions. Moderate to large associations were observed between the ORR and all risk indices. The HCR-20 Clinical and Risk Management scales demonstrated the strongest associations with parole suitability decisions. Among the LS/CMI scales, Procriminal Attitudes and Leisure/Recreation were most predictive of failure to obtain parole. PCL-R scores had little influence on parole suitability decisions beyond the HCR-20 and LS/CMI. Overall, findings suggest parole board members' decisions were consistent with empirically supported practice, in that individuals assessed to be at relatively low risk were far more likely to be granted parole than those assessed to be at moderate or high risk for future violence.

Remorse, psychopathology, and psychopathy among adolescent offenders.

Remorse has long been important to the juvenile justice system. However, the nature of this construct has not yet been clearly articulated, and little research has examined its relationships with other theoretically and forensically relevant variables. The present study was intended to address these issues by examining relationships among remorse, psychopathology, and psychopathy in a sample of adolescent offenders (N = 97) using the theoretically and empirically established framework of guilt and shame (Tangney & Dearing, 2002). Findings indicated that shame was positively related to behavioral features of psychopathy, whereas guilt was negatively related to psychopathic characteristics more broadly. In addition, shame was positively associated with numerous mental health problems whereas guilt was negatively associated with anger, depression, and anxiety. These results provide empirical support for theory that psychopathy is characterized by lack of remorse (e.g., Hare, 1991), and also underscore shame and guilt as potentially important treatment targets for adolescent offenders.

DSM-5 antisocial personality disorder: predictive validity in a prison sample.

Symptoms of antisocial personality disorder (ASPD), particularly remorselessness, are frequently introduced in legal settings as a risk factor for future violence in prison, despite a paucity of research on the predictive validity of this disorder. We examined whether an ASPD diagnosis or symptom-criteria counts could prospectively predict any form of institutional misconduct, as well as aggressive and violent infractions among newly admitted prisoners. Adult male (n = 298) and female (n = 55) offenders were recruited from 4 prison systems across the United States. At the time of study enrollment, diagnostic information was collected using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; APA, 1994) Axis II Personality Disorders (SCID-II; First, Gibbon, Spitzer, Williams, & Benjamin, 1997) supplemented by a detailed review of official records. Disciplinary records were obtained from inmates' respective prisons covering a 1-year period following study enrollment and misconduct was categorized hierarchically as any (general), aggressive (verbal/physical), or violent (physical). Dichotomous ASPD diagnoses and adult symptom-criteria counts did not significantly predict institutional misconduct across our 3 outcome variables, with effect sizes being close to 0 in magnitude. The symptom of remorselessness in particular showed no relation to future misconduct in prison. Childhood symptom counts of conduct disorder demonstrated modest predictive utility. Our results offer essentially no support for the claim that ASPD diagnoses can predict institutional misconduct in prison, regardless of the number of adult symptoms present. In forensic contexts, testimony that an ASPD diagnosis identifies defendants who will pose a serious threat while incarcerated in prison presently lacks any substantial scientific foundation.

Changes in dynamic risk and protective factors for violence during inpatient forensic psychiatric treatment: predicting reductions in postdischarge community recidivism.

Empirical studies have rarely investigated the association between improvements on dynamic risk and protective factors for violence during forensic psychiatric treatment and reduced recidivism after discharge. The present study aimed to evaluate the effects of treatment progress in risk and protective factors on violent recidivism. For a sample of 108 discharged forensic psychiatric patients pre- and posttreatment assessments of risk (HCR-20) and protective factors (SAPROF) were compared. Changes were related to violent recidivism at different follow-up times after discharge. Improvements on risk and protective factors during treatment showed good predictive validity for abstention from violence for short- (1 year) as well as long-term (11 years) follow-up. This study demonstrates the sensitivity of the HCR-20 and the SAPROF to change and shows improvements on dynamic risk and protective factors are associated with lower violent recidivism long after treatment.

Community violence perpetration and victimization among adults with mental illnesses.

OBJECTIVES: In a large heterogeneous sample of adults with mental illnesses, we examined the 6-month prevalence and nature of community violence perpetration and victimization, as well as associations between these outcomes. METHODS: Baseline data were pooled from 5 studies of adults with mental illnesses from across the United States (n = 4480); the studies took place from 1992 to 2007. The MacArthur Community Violence Screening Instrument was administered to all participants. RESULTS: Prevalence of perpetration ranged from 11.0% to 43.4% across studies, with approximately one quarter (23.9%) of participants reporting violence. Prevalence of victimization was higher overall (30.9%), ranging from 17.0% to 56.6% across studies. Most violence (63.5%) was perpetrated in residential settings. The prevalence of violence-related physical injury was approximately 1 in 10 overall and 1 in 3 for those involved in violent incidents. There were strong associations between perpetration and victimization. CONCLUSIONS: Results provided further evidence that adults with mental illnesses experienced violent outcomes at high rates, and that they were more likely to be victims than perpetrators of community violence. There is a critical need for public health interventions designed to reduce violence in this vulnerable population.

Version 3 of the historical-clinical-risk management-20 (HCR-20V3): relevance to violence risk assessment and management in forensic conditional release contexts.

The conditional release of insanity acquittees requires decisions both about community risk level and the contextual factors that may mitigate or aggravate risk. This article discusses the potential role of the newly revised Historical-Clinical-Risk Management-20 (HCR-20, Version 3) within the conditional release context. A brief review of the structured professional judgment (SPJ) approach to violence risk assessment and management is provided. Version 2 of the HCR-20, which has been broadly adopted and evaluated, is briefly described. New features of Version 3 of the HCR-20 with particular relevance to conditional release decision-making are reviewed, including: item indicators; ratings of the relevance of risk factors to an individual's violence; risk formulation; scenario planning; and risk management planning. Version 3 of the HCR-20 includes a number of features that should assist evaluators and decision-makers to determine risk level, as well as to anticipate and specify community conditions and contexts that may mitigate or aggravate risk. Research on the HCR-20 Version 3 using approximately 800 participants across three settings (forensic psychiatric, civil psychiatric, correctional) and eight countries is reviewed.

Evaluating the psycholegal abilities of young offenders with fetal alcohol spectrum disorder.

Individuals with a diagnosis of fetal alcohol spectrum disorder (FASD) experience a range of physical, cognitive, and behavioral deficits thought to interfere with their ability to competently navigate the arrest, interrogation, and trial process. This study examined the psycholegal abilities of young offenders with FASD, including their understanding and appreciation of Miranda rights, and adjudication capacities (factual knowledge of criminal procedure, appreciation of the nature and object of the proceedings, ability to participate in a defense and communicate with counsel). Two groups of young offenders (50 with FASD and 50 without prenatal alcohol exposure) completed Grisso's Instruments for Assessing Understanding and Appreciation of Miranda rights and the Fitness Interview Test-Revised to assess overall rates of impairment in youth with FASD, as well as differences between the groups. Potentially important predictors of psycholegal abilities were also evaluated. Results indicated the majority of young offenders with FASD (90%) showed impairment in at least one psycholegal ability, and rates of impairment were significantly higher than the comparison group. However, considerable within-group variability was observed. IQ and reading comprehension emerged as robust predictors of participants' psycholegal abilities, while the FASD diagnosis differentiated participants' scores on the FIT-R. These findings underscore the importance of individualized and comprehensive forensic assessments of psycholegal abilities in this population when warranted. Additional system level strains for this population are discussed, including problems in approaching competency remediation, and the potentially growing need for accommodation and forensic assessments in the face of limited financial and professional resources in legal settings.

Procedural justice versus risk factors for offending: predicting recidivism in youth.

Theories of procedural justice suggest that individuals who experience respectful and fair legal decision-making procedures are more likely to believe in the legitimacy of the law and, in turn, are less likely to reoffend. However, few studies have examined these relationships in youth. To begin to fill this gap in the literature, in the current study, the authors studied 92 youth (67 male, 25 female) on probation regarding their perceptions of procedural justice and legitimacy, and then monitored their offending over the subsequent 6 months. Results indicated that perceptions of procedural justice predicted self-reported offending at 3 months but not at 6 months, and that youths' beliefs about the legitimacy of the law did not mediate this relationship. Furthermore, procedural justice continued to account for unique variance in self-reported offending over and above the predictive power of well-established risk factors for offending (i.e., peer delinquency, substance abuse, psychopathy, and age at first contact with the law). Theoretically, the current study provides evidence that models of procedural justice developed for adults are only partially replicated in a sample of youth; practically, this research suggests that by treating adolescents in a fair and just manner, justice professionals may be able to reduce the likelihood that adolescents will reoffend, at least in the short term.

Risk factors of violence during a 4-week period in a psychiatric outpatient population.

The clinical impact of structured risk assessment instruments has been limited by a lack of information regarding a) their short-term accuracy and b) the relationship between change as measured by the instrument and a change in the risk for harm. Data were collected every 4 weeks on a) variables designed to resemble the items of a structured risk assessment instrument, b) substance use, c) social circumstances and mental state, and d) violent behavior. Scores on the variables designed to resemble the items of a risk assessment instrument were associated with violence during the ensuing 4 weeks. However, an increase in a subject's score on these variables was not associated with violence. Instead, increasing cocaine use and increasing social conflict as described by the subject at interview were associated with violence during those weeks.

Construct measurement quality improves predictive accuracy in violence risk assessment: an illustration using the personality assessment inventory.

Much of the risk assessment literature has focused on the predictive validity of risk assessment tools. However, these tools often comprise a list of risk factors that are themselves complex constructs, and focusing on the quality of measurement of individual risk factors may improve the predictive validity of the tools. The present study illustrates this concern using the Antisocial Features and Aggression scales of the Personality Assessment Inventory (Morey, 1991). In a sample of 1,545 prison inmates and offenders undergoing treatment for substance abuse (85% male), we evaluated (a) the factorial validity of the ANT and AGG scales, (b) the utility of original ANT and AGG scales and newly derived ANT and AGG scales for predicting antisocial outcomes (recidivism and institutional infractions), and (c) whether items with a stronger relationship to the underlying constructs (higher factor loadings) were in turn more strongly related to antisocial outcomes. Confirmatory factor analyses (CFAs) indicated that ANT and AGG items were not structured optimally in these data in terms of correspondence to the subscale structure identified in the PAI manual. Exploratory factor analyses were conducted on a random split-half of the sample to derive optimized alternative factor structures, and cross-validated in the second split-half using CFA. Four-factor models emerged for both the ANT and AGG scales, and, as predicted, the size of item factor loadings was associated with the strength with which items were associated with institutional infractions and community recidivism. This suggests that the quality by which a construct is measured is associated with its predictive strength. Implications for risk assessment are discussed.

The safe pilot study: A prospective naturalistic study with repeated measures design to test protective factors against violence in and after discharge from forensic facilities.

Assessing violence risk amongst forensic patients is a vital legal and clinical task. The field of violence risk assessment has developed considerably over the past two decades but remains primarily risk focused. Despite this, growing attention to and work on protective factors or strengths has occurred. In this prospective naturalistic study with repeated observer-rated measures of 27 forensic patients, we tested the role of three potentially important but understudied dynamic protective factors: hope, insight, and resilience, along with a history of criminality, in terms of their impact on violence. Main effects models indicated that higher hopelessness and past criminal convictions were predictive of violence acts; higher resilience was associated with lower violence. In interaction models, hopelessness remained predictive. Importantly, there were significant interactions between resilience and past criminal convictions, with higher levels of resilience leading to lower violence, most amongst those with criminal convictions, and between resilience and hopelessness related emotional distress, in that higher resilience at high levels of patient acknowledged emotional distress due to hopelessness led to lower violence. Findings indicate the importance of focusing on strengths or protective factors in the assessment of risk and treatment planning for forensic patients. Despite the small sample, the repeated measures design was feasible and informative.

Concurrent, Convergent, and Discriminant Validity of the DSM-5 Section III Psychopathy Specifier.

Section III of the fifth iteration of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes an alternative model of personality disorder diagnosis that conceptualizes antisocial personality disorder as an interpersonal, rather than behavioral, construct. However, the diagnostic specifier for psychopathy has been met with recent controversy due to its conceptual and empirical overlap with triarchic boldness, which has been debated as a necessary and sufficient domain of psychopathy. This study examined the concurrent, convergent, and discriminant validity of the specifier using canonical correlation analysis in samples of undergraduate students (N = 224) and community adults with prior criminal involvement (N = 306). Findings highlight the specifier as a multidimensional construct with divergent associations across its three facets. There was limited validity evidence for two of the three facets, raising concerns regarding the clinical utility of the psychopathy specifier.

How much does that cost? Examining the economic costs of crime in North America attributable to people with psychopathic personality disorder.

Cost of illness research has established that mental disorders lead to significant social burden and massive financial costs. A significant gap exists for the economic burden of many personality disorders, including psychopathic personality disorder (PPD). In the current study, we used a top-down prevalence-based cost of illness approach to estimate bounded crime cost estimates of PPD in the United States and Canada. Three key model parameters (PPD prevalence, relative offending rate of individuals with PPD, and national costs of crime for each country) were informed by existing literature. Sensitivity analyses and Monte Carlo simulations were conducted to provide bounded and central tendency estimates of crime costs, respectively. The estimated PPD-related costs of crime ranged from $245.50 billion to $1,591.57 billion (simulated means = $512.83 to $964.23 billion) in the United States and $12.14 billion to $53.00 billion (simulated means = $25.33 to $32.10 billion) in Canada. These results suggest that PPD may be associated with a substantial economic burden as a result of crime in North America. Recommendations are discussed regarding the burden-treatment discrepancy for PPD, as the development of future effective treatment for the disorder may decrease its costly burden on health and justice systems. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Examining the economic costs of crime associated with psychopathic personality disorder: A reply to Verona and Joyner (2022).

In our article, "How much does that cost? Examining the economic costs of crime in North America attributable to people with psychopathic personality disorder" (Gatner et al., 2023, pp. 391-400), we estimated that psychopathic personality disorder (PPD) was associated with substantial crime costs, using a top-down approach of national costs in the United States and Canada. Verona and Joyner (2023) raised several concerns about our findings. Although we think some of their points help to map directions for future research, we disagree with others they raised related to the conceptualization of PPD, the problem of undetected crimes, and their concerns with putative national comparisons. We strongly welcome debate about the societal impacts of PPD in the hope that it spurs increased attention and innovation regarding the treatment and management of PPD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The inconsistency of inconsistency scales: a comparison of two widely used measures.

This study compared the inconsistent responding validity scales of the Personality Assessment Inventory (PAI) and the Psychopathic Personality Inventory (PPI)/PPI-Revised (PPI-R) in two correctional samples to determine the extent to which they overlap in identifying invalid profiles. Results revealed substantial differences in the way the inconsistent responding validity scales of these measures performed. In particular, the PAI identified far fewer participants as having responded inconsistently compared with the PPI/PPI-R. We discuss the implications of our findings for clinical practice, and potential concerns with the use of a single measure to identify inconsistent responding in clinical practice and research.