The HCR-20 is a clinical risk assessment tool born out of the need to maximize the benefits of using the latest research in predicting violence with the experience of forensic practitioners who routinely assess risks in clinical settings. The goal of the instrument was to lay an effective foundation for completing risk assessments while keeping in mind time pressures and pragmatic obstacles faced by clinicians in clinical settings.
The instrument is divided into 3 sections.
- Historical: includes a review of the person's index offense; criminal, psychiatric, family, school, and vocational background; and other relevant historical information.
- Clinical: entails a description of the person's state of mind at the time of the incident or offense, as well as current diagnostic symptoms and other clinical factors that bear on risk.
- Risk management: suggests a treatment plan and gives indication of what services and supports must be available to the individual if risk or violence is to be managed within acceptable bounds.
Violence risk assessment is based on a manageable number of test items rooted in evidence-based knowledge and organized around a few important cross-disciplinary ideas. The items are defined precisely enough for testing but written so as to invite efficient application to a variety of issues and settings that contain a high proportion of persons with histories of violence and a strong suggestion of mental illness or personality disorder (eg, forensic psychology or psychiatry, parole, or correctional environments). The summary stipulates time periods for which the assessment results are intended to hold, how the prediction might vary with altered situational circumstances, and base rates of violence in pertinent samples.
The HCR-20 consists of a checklist of 20 items: 10 historical factors, which are weighted as heavily as the 5 present clinical variables, and 5 future risk management issues (Table 1). Of the individual items, substance abuse and psychopathy are most strongly correlated with violence. Violence includes verbal aggression, self-directed aggression, and aggression toward others and objects.
The HCR-20 checklist items
|H1. Previous violence|
|H2. Young age at first violent incident|
|H3. Relationship instability|
|H4. Employment problems|
|H5. Substance use problems|
|H6. Major mental illness|
|H8. Early maladjustment|
|H9. Personality disorder|
|H10. Prior supervision failure|
|C1. Lack of insight|
|C2. Negative attitudes|
|C3. Active symptoms of major mental illness|
|C5. Unresponsive to treatment|
|Risk management (future)|
|R1. Plans lack feasibility|
|R2. Exposure to destabilizers|
|R3. Lack of personal support|
|R4. Noncompliance with remediation attempts|
HCR-20, Historical Clinical Risk-20.