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Adapting the HCR-20 for Pre-trial Settings
a a a ab
Shannon Toney Smith , Shannon E. Kelley , Allison Rulseh , Karolina Srman & John F.
a
Edens
a
Department of Psychology, Texas A&M University, College Station, Texas, USA
b
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
Published online: 19 May 2014.

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Adapting the HCR-20 for Pre-trial Settings, International Journal of Forensic Mental Health, 13:2, 160-171, DOI:
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 INTERNATIONAL JOURNAL OF FORENSIC MENTAL HEALTH, 13: 160171, 2014
Copyright International Association of Forensic Mental Health Services
ISSN: 1499-9013 print / 1932-9903 online
DOI: 10.1080/14999013.2014.906520

Adapting the HCR-20V3 for Pre-trial Settings

Shannon Toney Smith, Shannon E. Kelley, Allison Rulseh
Department of Psychology, Texas A&M University, College Station, Texas, USA

Karolina S
orman
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of
Downloaded by [Flinders University of South Australia] at 11:43 02 February 2015

Psychology, Texas A&M University, College Station, Texas, USA

John F. Edens
Department of Psychology, Texas A&M University, College Station, Texas, USA

The present study investigated the use of the HCR-20V3 (Douglas, Hart, Webster, &
Belfrage, 2013) among a sample of 84 male inmates in a pre-trial correctional facility.
Overall, results indicated that the newly revised instrument can be adapted for use in a pre-
trial context, although some scoring obstacles (e.g., participants uncertain legal status) were
encountered when attempting to rate certain HCR-20V3 items. Also, some group differences
in risk ratings were found when comparing our sample to HCR-20V3 data collected from
external psychiatric inpatient and post-adjudication samples. Implications for clinical
forensic practice are reviewed, focusing on modifications that may be helpful or necessary
for use in pre-trial settings.

Keywords: HCR 20 V3, pre-trial

Assessing violence risk is essential in several types of
legal proceedings and clinical evaluations, including
sentencing decisions, civil commitment, and clinical
management of individuals potentially at risk for aggres-
sion (Otto & Douglas, 2009). Structured risk assessment
instruments commonly used for this purpose can be
broadly divided into two categories: actuarial methods,
which mathematically derive predictions based on the
statistical or otherwise formulaic combination of risk
factors, and structured professional judgment (SPJ, or
structured clinical judgment), which entails evaluating a
number of scientifically validated risk factors and then
applying clinical knowledge to render risk ratings. In
contrast to actuarial methods, which typically focus on
static factors, the SPJ model conceptualizes risk as a
dynamic process involving continuous re-assessment
(Douglas & Skeem, 2005). Even though dynamic factors
(e.g., anger, psychiatric symptoms, substance abuse) are
suggested to greatly influence violence risk, violence
Address correspondence to Shannon Toney Smith, Department of Psy-
chology, 4235 TAMU, Texas A&M University, College Station, TX
77843. E-mail: stsmith02@neo.tamu.edu
risk reduction treatments specifically focusing on these
factors have been understudied so far (Campbell, French,
& Gendreau, 2009; Douglas & Skeem, 2005).
One SPJ instrument that has demonstrated the ability to
assess dynamic risk with a promising degree of accuracy is
the Historical-Clinical-Risk Management-20 (HCR-20;
Webster, Douglas, Eaves, & Hart, 1997). The HCR-20 is
divided into three scales, encompassing ten historical risk
factors, five risk factors assessing current clinical function-
ing, and five risk factors pertaining to risk management. All
items are coded on a three-point scale (0 Absent, 1
Possibly or Partially Present and 2 Definitely Present).
For clinical purposes however, the instrument developers
do not recommend summing the items to create a total
score, nor are cut scores provided for interpretation.
Instead, the final summary judgment of risk (scored as low/
moderate/high risk) is arrived at based on a clinical evalua-
tion of all relevant information, including medical, psychi-
atric, and legal history.
The HCR-20 demonstrates robust psychometric charac-
teristics including concurrent validity (Douglas & Webster,
1999), as well as acceptable interrater reliability at least for
the historical and clinical items (de Vogel, de Ruiter,

Hildebrand, Bos, & van de Ven, 2004). Meta-analytic
research shows promising predictive validity for the HCR-
20 in predicting violent recidivism, with a median Area
Under the Curve (AUC) of .70 (Singh, Grann, & Fazel,
2011). Notably, the predictive accuracy for structured vio-
lence risk instruments appears optimal for identifying those
at low risk for violence in comparison to those deemed as
high or moderate risk (Fazel, Singh, Doll, & Grann, 2012).
Although in some studies the HCR-20 summary risk rating
has demonstrated incremental predictive validity over the
individual scales (de Vogel et al., 2004; Douglas, Ogloff,
& Hart, 2003; Douglas, Yeomans, & Boer, 2005; Doyle &
Dolan, 2006), each scales unique contribution in predicting
violence is typically explored in published research. In par-
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ticular, the Historical scale has been superior in predicting
community violence among patients discharged from psy-
chiatric units (Doyle & Dolan, 2006). Regarding institu-
tional aggression and violent behavior, however, the
Clinical and Risk Management scales have shown incre-
mental validity beyond the static factors of the Historical
scale (McDermott, Edens, Quanbeck, Busse, & Scott,
2008; see also Campbell et al., 2009).
The Historical-Clinical-Risk Management-20 Version 3
(HCR-20V3)
In the original versions of the HCR-20 and the recently
revised version of this instrument (HCR-20V3; Douglas
et al., 2013), the Historical scale assesses past violent and
antisocial conduct, symptoms of mental illness or substance
abuse, work-related problems, and difficulties with inter-
personal relationships. The Clinical scale captures recent
psychiatric symptoms, indicators of instability, and treat-
ment or supervision noncompliance. The Risk Management
scale reflects potential problems adhering to and benefitting
from future professional interventions, as well as the ability
to manage various social and environmental factors includ-
ing housing and stressors. In contrast with prior versions,
the HCR-20V3 dispenses with numerical item ratings and
instead solely utilizes nominal labels to characterize the
item ratings as N (Not present or Not applicable), P nate psychopathy measures) as long as the instruments
(Possibly or Partially present), or Y (Present) (Douglas
et al., 2013). For the purposes of this article, however, the
numeric values associated with these labels (0, 1, and 2)
will be discussed as researchers utilizing this instrument
will almost certainly investigate these values in their data
analyses.
An additional change to the HCR-20V3 involves the
inclusion of sub-item ratings for many of the risk factors.
The authors stated rationale for this change was to encour-
age evaluators to assess a broad range of issues when rating
the higher order, subsuming risk factor (Douglas et al.,
2013). For example, the risk factor Recent Problems with
Insight (C1) now includes three sub-items that evaluators
ADAPTING THE HCR-20V3 161
are encouraged to rate with reference to insight into: Mental
Disorder, Violence Risk, and Need for Treatment.
Two additional changes included with the instrument
revision are worth highlighting. First, in line with the
importance of assessing intra-individual risk factors for
violence, the HCR-20V3 now encourages the evaluator to
assess not only the presence of each risk factor, but also
how relevant each one is to an individuals propensity for
violence. For example, individuals may have a documented
history of substance addiction, thus warranting a 2 on item
H5 (Substance Use). However, if evidence suggests that an
individual has been in remission from their addiction for
the past 10 years, the relevance of substance abuse to cur-
rent violence risk may be deemed low in relevance or of
moderate relevance. The addition of the Relevance ratings
allows the evaluator to take into account this interaction
between the Presence and Relevance ratings. In research
contexts this may involve calculating scale scores based on
the sum of the interactions between each items Presence
and Relevance rating (K.S. Douglas, personal communica-
tion, March 20, 2013). In clinical contexts, the Relevance
ratings allow the evaluator to visually inspect the degree to
which a defendant exhibits risk factors that are relevant to
his risk, which can then better inform a variety of decisions
(e.g., level of supervision, treatment selection; Douglas
et al., 2013).
A second important change included in the HCR-20V3 is
the scoring content of the Historical item H7 (Personality
Disorder). In version 2 of the HCR-20, this item reflected a
persons degree of psychopathy based on a separate evalua-
tion utilizing the Psychopathy Checklist-Revised (PCL-R;
Hare 2003) or the Psychopathy Checklist Screening Ver-
sion (PCL:SV; Hart, Cox, & Hare, 1995), which to date are
the most extensively used clinical inventories for assessing
this disorder. Additionally, the HCR-20 manual provided
specific scoring guidelines to instruct evaluators on how an
individuals PCL scores should be translated into a rating
on this item. However, in the HCR-20V3 the scoring guide-
lines for this item are considerably broader. Evaluators who
wish to assess a persons degree of personality pathology
might use alternative measures (e.g., DSM criteria, alter-
have adequate empirical support for their use (Douglas
et al., 2013).
Additionally, evaluators are encouraged to consider
personality disorders of the antisocial type (antisocial, psy-
chopathic, and dissocial personality disorders) and all
other personality disorders (Douglas et al., 2013, p. 79).
Not only is a PCL-R assessment no longer required, but
individuals may receive a 2 (Present) on this item for hav-
ing a diagnosis of Antisocial Personality Disorder (ASPD)
or even Borderline Personality Disorder, thus substantially
lowering the threshold for obtaining an elevated rating on
this item. It is widely known that the prevalence of ASPD
in incarcerated samples is estimated to be substantially
 162 SMITH ET AL.
higher (50-80%) than the prevalence of psychopathy (15-
20%), as measured by the PCL-R (Hare, 2003).
Given these considerable changes to the rating guide-
lines for the Personality Disorder item on the HCR-20V3, it
is worth considering how the use of less stringent assess-
ment criteria might impact the conceptualization of this
risk factor in practice. Even though risk assessment is not a
primary aim of the PCL-R, the PCL-based model of psy-
chopathy is one of the most extensively investigated factors
in relation to violence risk (Yang, Wong, & Coid, 2010).
The instruments moderate predictive association with vio-
lence and antisocial conduct is well established, although
its predictive efficacy seems to be almost entirely attribut-
able to the behavioral and antisocial aspects of the instru-
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ment (Kennealy, Skeem, Walters, & Camp, 2010; Yang
et al., 2010) when predicting broadly defined aggression.
However, several studies, including a recent meta-analysis,
indicated that the HCR-20 with item H7 removed provided
incremental validity beyond the PCL in predicting violence
(Guy, Douglas, & Hendry, 2010; see also Campbell et al.,
2009). This raises questions regarding how the conceptuali-
zation of risk on the HCR-20V3 might change with alterna-
tive assessments of item H7.
Challenges in Adapting the HCR-20V3 to Pre-trial
Settings
At the pre-trial stage, risk assessment can provide informa-
tion vital to informing bail decision-making (Summers &
Willis, 2010). In addition to assisting in making pre-trial
release recommendations, risk assessment instruments can
also be used by correctional and probation officers to iden-
tify the level of supervisory conditions required by a given
defendant in a correctional setting or once released into the
community. Within clinical and forensic/correctional set-
tings, the HCR-20V3 is generally intended to evaluate risk
for violence and to facilitate monitoring and decision-mak-
ing concerning facility admission and release, transition in
security or supervision levels, treatment or risk manage-
ment, and case prioritization. As these applications typi-
cally occur following conviction of a crime or admission to
a psychiatric facility, several challenges may arise when
adapting the HCR-20V3 to pre-trial settings.
First, the HCR-20V3 manual stipulates that evaluators
should gather information regarding the examinee from mul-
tiple sources, including criminal justice, health care, educa-
tional, vocational, and social service records. Although
official records of criminal misconduct tend to underesti-
mate the volume of inmate offenses (Steiner & Wooldredge,
in press), institutional files remain necessary and primary
sources of information about risk factors for violent behav-
ior, such as psychological functioning and previous antiso-
cial conduct. In particular, records pertaining to incidents of
violent or aggressive behavior are especially informative in
scoring items on the HCR-20 V3 and reaching Summary
Risk Ratings (SRRs). Research suggests that, much like the
general population, inmates are capable of accurately reveal-
ing personal information and usually do not make inten-
tional attempts to mislead or deceive evaluators, particularly
when participating in confidential research (Thornberry &
Krohn, 2000). When questioned about potentially incrimi-
nating experiences, however, inmates may be unwilling
or unable to respond accurately for a variety of reasons,
including unreliable memories, poor insight, impression
management, or concerns about the legal and institutional
repercussions of their disclosures. File review provides
objective data necessary to supplement and corroborate
information gathered from clinical interview with objective
details, thus hopefully minimizing bias and error. Addition-
ally, different sources of historical information are critical in
identifying unique incidents of violence and significantly
influence the predictive accuracy of violence risk assessment
(Steadman et al., 1998).
Applying the HCR-20V3 to pre-trial settings, however,
may result in several obstacles, as file information for
inmates awaiting trial in correctional facilities may be sub-
stantially lacking in comparison to records of inmates serv-
ing out sentences, particularly when a defendant has had no
prior contact with the criminal justice system. Institutional
records are routinely unavailable, inaccessible, or inade-
quate in providing essential data, thus compromising the
ability of the evaluator to make informed and useful recom-
mendations (Padgett, Webster, & Robb, 2005). For exam-
ple, for inmates awaiting trial, the absence of various types
of records does not necessarily translate to an absence of
problems in corresponding domains. The relevance of an
institutional living situation (R2) to an inmates risk of vio-
lence may be uncertain because a newly admitted inmate
has not been incarcerated long enough to demonstrate a
documented pattern of institutional misconduct (or the lack
thereof). Likewise, an inmate may not be participating in
treatment programs because the institution lacks the resour-
ces necessary to make such programs available, rendering
it difficult to determine expected levels of compliance and
responsiveness (R4).
In situations of limited or unreliable records, evaluators
must carefully consider the credibility and quantity of data
gleaned from the clinical interview and qualify item scores
and summary recommendations accordingly (Douglas
et al., 2013). Information that is inconclusive or uncertain
due to inadequate documentation necessitates a score of
possibly present (1). Consequently, utilizing the HCR-20V3
in pre-trial settings may result in ambiguous and restricted
judgments of violence risk, particularly on specific
domains. For example, the evaluator is ostensibly able
to judge insight (C1) and violent ideation (C2) from evi-
dence provided in the clinical interview. In contrast, deter-
minations of future violence risk for an inmate with
documented violent or aggressive behavior are obfuscated
by the likely unavailability of sufficient treatment while

incarcerated and the tentative nature of future treatment
given the uncertain legal status.
The issue of limited file information in pre-trial settings
is particularly salient to scoring HCR-20V3 items related to
the presence of mental illness, including items H6 (Major
Mental Disorder), C3 (Symptoms of Major Mental Disor-
der), and C4 (Instability). For these items, evaluators assess
the presence or absence of psychotic disorders, mood disor-
ders, or disorders affecting intellectual, executive, or inter-
personal functioning that are associated with dysregulated
cognition, behavior, or affect. Medical documentation of
mental illness can validate information gained from clinical
interview through indications of diagnostic status as well as
clinical descriptions of the inmate. However, medical
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records for inmates awaiting trial are frequently constrained
to intakes containing reiterations of self-reported status, and
inmate disclosures regarding mental health status may devi-
ate from clinical reality for a variety of reasons ranging
from benign (e.g., gaining access to limited mental health
resources) to severe (e.g., avoiding criminal punishment)
(Rogers, 1997). Because of insufficient need or time to
identify and request mental health documentation, records
for pre-trial inmates rarely will contain psychological
reports obtained from previous mental health providers.
Likewise, pre-trial inmates lacking prior contact with the
criminal justice system typically may not yet have under-
gone a diagnostic evaluation as conducted by an institu-
tional mental health provider, raising the difficult question
of how else to confirm self-reported diagnostic status to
facilitate more accurate violence risk assessment. Profes-
sional confirmation is therefore crucial in differentiating
between spurious and veridical claims of previous or current
mental disorder.
A final challenge that arises when utilizing the HCR-
20V3 to evaluate pre-trial inmates violence risk concerns
how best to score the Presence and Relevance for certain
items when the charge against the inmate is not yet a con-
viction. In the United States, for example, inquiries into
guilt by the evaluator or acknowledgement of guilt by the
defendant during a pre-trial forensic evaluation raise con-
cerns regarding the defendants Fifth Amendment right
against self-incrimination and Sixth Amendment right to
assistance of counsel (Estelle v. Smith, 1981). As such,
evaluators in pre-trial settings should be cognizant of the
boundaries of the purpose of the assessment and consider
potential conflicts with a defendants constitutional rights
when writing reports and communicating with the courts.
When pre-trial inmates do not admit guilt to the instant
offense during a clinical interview, accurate assessment
of violence risk is hindered by ambiguity regarding culpa-
bility, particularly when allegations involve severe harm
to another individual and would result in serious legal
or social consequences (e.g., imprisonment, mandatory
treatment).
ADAPTING THE HCR-20V3 163
As an example, an inmate charged with aggravated
assault against a spouse would, if found guilty, exhibit
problems with violence (H1) and relationships (H4). How-
ever, if when evaluated prior to a trial the inmate denies
involvement in the event or refuses to discuss the incident
entirely, uncertainty permeates judgments of violence risk.
In some cases, the inmate has an extensive history of
criminal behavior, such that a conviction is unnecessary
to establish a pattern of violence (or other relevant pat-
terns such as antisocial behavior, substance abuse, or
relationship problems). Nevertheless, there are many
instances in which an inmates sparse or undocumented
criminal history elevates the current charge to a pivotal
position in estimating risk. Ambiguity surrounding the
inmates present culpability not only affects scores for
the presence of historical problems, but it also may pre-
vent the evaluator from conclusively identifying connec-
tions between certain problems and violence risk. For
example, charges of violence toward friends or family
members suggest that relationship problems may be rel-
evant to the risk of violent conduct; however, in the
absence of additional evidence, this association remains
equivocal prior to conviction.
Furthermore, the interpretation of an inmates denial of
involvement in the current charge largely hinges on deter-
minations of guilt. Insistence by the inmate that the charge
is disproportionately severe to the reality of the incident or
absolute denial of the offense may be indicative of prob-
lems with insight into violence risk and need for treatment
(C1) and forecast difficulties in compliance with treatment
and supervision (R4). To further complicate matters,
approximately 90% of U.S. criminal cases are resolved
through plea bargains, and this process often involves
charge bargaining, a mechanism through which prosecu-
tors agree to lessen the charges in exchange for a guilty
plea (Piehl & Bushway, 2007). Conversely, initial charges
may be deliberately enhanced to increase the likelihood of
eliciting guilty pleas to lesser charges (Gutierrez, 2010).
This tactic of charge inflation may result in convictions
for charges that are more representative of the crimes per-
petrated or in innocent defendants pleading guilty to
crimes they did not commit. In either scenario, pre-trial
charges may differ substantially from conviction charges,
and in these examples, the former may ultimately under-
represent the severity of perpetrated crimes whereas the
latter may overestimate actual severity.
Additionally, during pre-trial evaluations the nature
and necessity of violence risk management remain unre-
solved, potentially precluding definitive plans for use of
appropriate professional services (R1) and their rele-
vance to modifying violence risk. Similarly, the rele-
vance of future problems in adhering to and benefitting
from treatment and supervision strategies implemented
to manage violence risk (R4) is difficult to determine
 164 SMITH ET AL.
without knowledge of the mandated interventions or the
type and intensity of violence targeted for management.
Finally, risk management factors are especially tentative
in pre-trial settings as defendants future living situations
(institutional incarceration or community release) depend
on trial outcome. The limited file information and uncertain
culpability inherent in pre-trial settings present several
challenges in utilizing the HCR-20V3 for violence risk
assessment and can result in an abundance of Possibly Pre-
sent scores, as well as tenuous conclusions. Despite these
shortcomings, an accurate violence risk assessment that
acknowledges its limitations is preferable to one based on
unarticulated assumptions (e.g., presumed guilt) and
speculation.
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The Current Study
Given the preceding review, there are a number of issues
concerning the use of the HCR-20V3 in pre-trial settings
that have significant implications for the accuracy and util-
ity of risk ratings and recommendations. Data for the pres-
ent study were obtained as part of a larger project
examining the psychometric properties of several psychop-
athy assessment instruments among inmates incarcerated in
a 600-bed county jail. Inclusion of the HCR-20V3 among
these assessment instruments provides the opportunity to
analyze information concerning the use and performance of
the new measure in a jail setting, which is the focus of the
present study. For comparison purposes, descriptive results
from the present study were contrasted with those from (1)
a Canadian inpatient psychiatric sample and (2) a Canadian
correctional sample. These external samples consisted of
50 Canadian civil psychiatric inpatients, most of whom
were hospitalized involuntarily, and 56 Canadian prison
inmates with sentence lengths on average of less than two
years. Each sample was comprised of approximately 45%
women (Douglas & Strub, 2013, as cited in Douglas et al.,
2013).
We also wanted to investigate the extent to which the
individual risk factors (i.e., the Presence ratings) relate to
the Summary Risk Ratings (SRRs) and whether differences
between the two might be explained at least in part by the
fact that the SRRs represent a combination of both the Pres-
ence and Relevance ratings.
Although the analyses for this research were largely
exploratory, we expected that: (1) Risk Management item
ratings (both in the detention center and in the community)
would be higher in our sample than in the external samples,
given the uncertainty of participants legal status and the
pre-trial detention environment; (2) participants would
obtain higher scores on item H7 (Personality Disorder) uti-
lizing the HCR-20V3 scoring criteria in comparison to older
HCR-20 criteria; and (3) based on prior research supporting
the incremental validity of SRRs over summed HCR-20
scale scores, we explored what incremental contributions
the interaction of the Presence and Relevance ratings might
have in predicting the SRRs beyond the Presence ratings in
isolation.
METHOD
Participants
Participants were 84 incarcerated men who were detained at
a county jail in a small Southwestern United States commu-
nity. All participants were at least 18 years of age at the
time of participation (M 32.02, SD 11.07). Participants
were predominantly European American (34.50%) or His-
panic (34.50%), followed by African American (27.40%),
or another ethnicity (3.60%). The index offense varied
greatly among participants (e.g., failure to pay child sup-
port, possession of a controlled substance), although
23.80% of participants were charged with at least one
violent index offense (e.g., capital murder [N 1], murder
[N 1], assault [N 16]). Participants did not receive
compensation for their involvement in the study.
Measures
Historical-Clinical-Risk Management-20, Version 3
(HCR-20V3; Douglas et al., 2013)
HCR-20V3 scores are based on information from both an
interview and collateral data. Because there is no standard
HCR-20V3 interview, additional questions were appended
to the PCL-R semi-structured interview guide in order to
assess all 20 items of the HCR-20V3. Although summing
the scores from each item to obtain a total score is not rec-
ommended for clinical settings, because the assessments
for the current study were conducted for research purposes,
ratings were quantified on a three-point scale of 0 (Not
Present), 1 (Possibly or Partially Present), or 2 (Pres-
ent). For those items with sub-items, the overall item
score was obtained by utilizing the highest rating from
the associated sub-items (e.g., if the associated sub-item
scores were 0, 0, 1, the overall item score would be 1).
This methodology was employed for both the Presence
and Relevance ratings. (Further information regarding
sub-item ratings can be obtained by contacting the first
author.) Additionally, given the uncertainty regarding
whether each participant would remain incarcerated,
researchers in the current study provided two sets of rat-
ings (one assuming continued incarceration, R-Institu-
tion, and another assuming that participants would be
living in a community setting, R-Community) for Risk
Management items.
To evaluate interrater reliability in the current study,
15 (18%) cases were randomly selected to be indepen-
dently rated by two interviewers. Interrater reliability
was assessed using an absolute agreement, single rater
 ADAPTING THE HCR-20V3 165

intraclass correlation coefficient. ICC(A,1) for each sub- Antisocial Personality Disorder (ASPD)
scale ranged from .92 (Historical) to .67 (Clinical). For
ASPD was assessed for each participant due to the
the Risk Management subscale, ICCs were assessed for
change in scoring criteria for item H7 of the HCR-20V3
both incarcerated (.68) and community (.88) settings.
which, noted above, now allows the use of alternative psy-
ICC(A,1) for Relevance ratings were higher for the His-
chopathy measures and personality diagnoses. Based on the
torical (.85) and Clinical (.77) subscales compared to
DSM-IV TR criteria, a diagnosis of ASPD requires the
the Risk Management scale, both for institutional (.48)
presence of at least three indicators of a pervasive pattern
and community (.67) settings. An inspection of the data
of disregard for and violation of the rights of others occur-
indicated that the poor reliability for the R-Institution
ring since age 15 (e.g., deceitfulness, consistent irresponsi-
scale was primarily due to the items assessing living
bility, remorselessness), evidence of conduct disorder with
environment (R2), response to supervision (R4), and
onset before age 15, and age of at least 18 years (American
problems coping with stressors (R5).
Psychiatric Association, 2000).
Interrater reliability was also assessed for the six cate-
For the current study, the presence or absence of each
gorical SRRs (Future Violence-Institution, Serious Physical
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adult ASPD indicator was coded based on information

Harm-Institution, Imminent Violence-Institution, Future
Violence-Community, Serious Physical Harm-Community,
and Imminent Violence-Community). The overall agree-
ment for the six combined SRRs was moderate (weighted
kappa .66) based on interpretation guidelines proposed
by Shrout (1998), with only one rating across 90 compari-
sons exhibiting a classification discrepancy greater than one
(i.e., Raters 1 and 2 classified a single participant as high or
low risk for imminent violence in the institution, respec-
tively). Interrater reliability for the six individual SRRs
ranged from fair agreement (weighted kappa .43) regard-
ing imminent violence risk in the institution to substantial
agreement (weighted kappa .85) for future violence in
the institution.
We also created a separate set of scale scores by sum-
ming each items Presence rating multiplied by its Rele-
vance rating (e.g., [H1H1 relevance] [H2H2 relevance]
. . .) hereafter referred to as Interaction scale scores (Inter-
action H scale, M 21.13, SD 12.93; Interaction C scale,
M 8.58, SD 5.14; Interaction R Scale-Institutional,
M 5.01, SD 4.53; Interaction R Scale-Community,
M 9.59, SD 5.91).
Psychopathy Checklist-Revised (PCL-R; Hare,
2003)
The PCL-R is a widely used 20-item clinical rating
scale. Each item is scored on a three-point scale of 0 (No),
1 (Maybe/In some respects), and 2 (Yes). Ratings are based
on a semi-structured interview and review of file informa-
tion. Higher scores indicate greater psychopathic tendencies
and are also associated with an increased risk for general
and violent recidivism (e.g., Singh et al., 2011).
High interrater reliability (all ICCA,1) was observed for
total PCL-R scores (ICC .87). Similarly, high reliability
was obtained for Factor 2 (ICC .93; Lifestyle facet ICC
.89; Antisocial facet ICC .92), and acceptable reli-
ability (for research purposes) was observed for Factor 1
(ICC .70; Interpersonal facet ICC .73; Affective facet
ICC .69).
gathered from the structured interview and file review.
High overall agreement was obtained for coding the pres-
ence or absence of at least three ASPD indicators with
93% agreement across raters (kappa .82). Researchers
assessed for evidence of conduct disorder by asking partici-
pants directly if, prior to age 15, they engaged in each of
the indicators of conduct disorder. Conduct disorder was
coded as present if participants endorsed three or more
items or if the researcher found evidence of these items
from the interview or file review.
Given that the HCR-20V3 contains an item rating the
presence of psychopathy, ASPD, or another personality
disorder (H7), a diagnosis of ASPD warranted a score
of 2 (Present) on that item. Meeting all criteria for
ASPD except the conduct disorder specifier, warranted a
score of 1 (sub-threshold; Douglas et al., 2013). All
other cases warranted a score of 0 (Absent), unless a
score of 1 or 2 was achieved based on a diagnosis other
than ASPD (e.g., a high score on the PCL-R or Narcis-
sistic PD).
Procedure
Four graduate-level research assistants (including the first
author) conducted the interviews, file review, and scoring.
The first and last authors attended a two-day training
workshop conducted by two of the HCR-20V3 authors.
Additionally, the first author received training on the
administration and scoring of the PCL-R from multiple
experts who use the PCL-R in applied settings, including
the last author. The first author then provided training on
the scoring and administration of all interview measures
for the other three graduate student research assistants,
two of whom had prior training and experience adminis-
tering PCL measures for research purposes. Prior to data
collection, the interviewers rated three practice cases, dis-
cussed any discrepancies in scoring, and reached consen-
sus ratings. Next, the first three participants were
independently rated by each of the interviewers, and con-
sensus scores were obtained to ensure reliable scoring
 166 SMITH ET AL.
across interviewers. Fifteen additional cases were ran-
domly selected and independently rated by two researchers
to assess reliability.
Inmates incarcerated at the detention center were ran-
domly selected from a pool of volunteers and invited to par-
ticipate. In the majority of cases, participants were recruited
from the orientation housing unit soon after arriving at the
facility, and the modal length of incarceration prior to
enrolling in the study was two days.
A three-part consent process (as recommended by
Stiles, Epstein, Poythress, & Edens, 2011) was utilized
to obtain informed consent from participants. After review-
ing the main consent document, researchers administered a
multiple-choice comprehension quiz to ensure participants
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understood the information described (e.g., purpose of the
study, lack of compensation for participation). After suc-
cessfully completing the comprehension quiz, a voluntari-
ness assessment was administered to confirm that the
inmates were freely and willingly consenting to participate
and did not feel coerced into participation. Participants
were excluded from the study if they could not speak
English fluently, were unable to read and comprehend
English at a fourth-grade reading level, failed the multiple-
choice comprehension quiz (by incorrectly answering two
or more of the five questions), or indicated any coercion in
choosing to participate in the study. Only four inmates
failed the comprehension quiz, and no one indicated that
they had experienced any coercion to participate in the
study.
After conducting the interview and administering
additional self-report questionnaires not relevant to the
current study, researchers reviewed participants deten-
tion center records. These records included demographic
information, current charges, previous criminal history,
and discipline reports for institutional misconduct
obtained at the current facility. Information regarding
discipline reports amassed at other facilities was often
not included in the records. The researchers also
reviewed inmate medical records, which included infor-
mation regarding medication, physical and mental health
diagnoses and treatment, and risk prevention measures
taken at the current facility (e.g., placement in isolation,
restriction of sharp objects). However, the level of
detailed information contained in each file varied
considerably.
Completion of the protocol took approximately three
to four hours, although this period included time neces-
sary to administer several lengthy self-report question-
naires that are not the focus of this article. The time
devoted to the interview and file review necessary to
score the HCR-20V3, PCL-R, and DSM ASPD criteria
was approximately two hours. Approval to complete this
studys protocol was granted by both the university
institutional review board and administrators at the
detention facility.
RESULTS
Table 1 contains descriptive statistics for the HCR-20V3
Presence and Relevance ratings. Inspection of these num-
bers suggests that on average this sample was in a moderate
risk range for each of the scales, although ratings for the R-
Community scale were higher in comparison to the other
Presence scales. Table 2 provides the frequencies of ratings
for the categorical SRRs both within the institution and
upon release into the community over the next 12 months.
The HCR-20V3 allows for three summary risk ratings rated
on a 0 (Low) to 2 (High) scale: Future violence risk (Institu-
tional M 0.44, SD 0.59; Community M 0.96, SD
0.74), Risk for serious physical harm (Institutional M
0.37, SD 0.60; Community M 0.69, SD 0.78), and
Risk for imminent violence (Institutional M 0.40, SD
0.60; Community M 0.58, SD 0.70). As shown in the
table, most participants were rated as Low risk for future
institutional violence, and far fewer participants were rated
as High risk for future violence in the institution than in the
community. Overall, the SRRs were lower when estimated
for the institution than for the community.
One of the major changes to the HCR-20V3 was elimina-
tion of the required use of the PCL-R, so we next investi-
gated how changing this item impacted the score. Prior
HCR-20 scoring criteria for item H7 (Personality Disorder)
specified that PCL-R scores < 20 should be rated 0 on this
item (47 participants in our sample met this criteria),
followed by a score of 1 for scores between 20 and 29
(N 30), and a 2 for scores  30 (N 7). Based on revised
HCR-20V3 scoring guidelines, an examination of the Pres-
ence ratings for H7 reflected that a greater number of partic-
ipants were rated a 2 (Present) on this item (33.30%) in
comparison to the percentage (8.30%) that would have
received a 2 under the previous HCR-20 scoring guidelines
based strictly on PCL-R scores. Further, six participants
deemed low in psychopathy based on prior HCR-20 scoring
guidelines received a 2 on this item in the present study.
According to the same prior scoring guidelines, an addi-
tional 19 participants (22.62%) deemed low in psychopathy
were given ratings of 1 on H7 due to elevated ASPD traits.
Descriptive information and effect size differences from
two external samples have also been included for compari-
son purposes (Table 1). Ratings for the Historical scale
among the present study sample were moderately higher
than for the Canadian civil psychiatric sample, based on
effect size interpretation guidelines provided by Kraemer
and colleagues (2003). Participants in the current study also
evinced slightly greater Clinical scale scores than those
obtained within the Canadian prison sample, but differences
in scores on this scale were negligible in comparison to the
psychiatric sample. R-Community scale scores in the pres-
ent study were greater than both the psychiatric and prison
samples, demonstrating large and small effect sizes,
respectively.
 ADAPTING THE HCR-20V3 167

TABLE 1
Comparison of Present Study HCR-20V3 Item Ratings with Two Samples

Present Sample Present Psychiatric Sample Prison Sample

Presence Sample Presence Effect Size Presence Effect Size
(N 84) Relevance (N 50) Difference (N 56) Difference

HCR-20V3 Item/Scale M (SD) M (SD) M (SD) Cohens d M (SD) Cohens d

Historical Scale 13.92 (4.18) 10.88 (5.28) 10.94 (4.30) 0.70 14.54 (3.59) 0.16
Violence 1.55 (.72) 1.58 (.76) 0.90 (.89) 0.80 1.41 (.78) 0.19
Antisocial Behavior 1.85 (.43) 1.20 (.80) 0.82 (.83) 1.56 1.71 (.59) 0.27
Relationships 1.83 (.43) 1.46 (.74) 1.42 (.73) 0.68 1.66 (.51) 0.36
Employment 1.38 (.81) 0.63 (.74) 1.20 (.78) 0.23 1.80 (.48) 0.63
Substance Use 1.79 (.58) 1.23 (.83) 1.20 (.86) 0.80 1.82 (.47) 0.06
Major Mental Disorder 0.71 (.86) 0.54 (.83) 1.96 (.20) 2.00 1.20 (.90) 0.56
Personality Disorder 1.08 (.76) 1.20 (.90) 0.48 (.68) 0.83 0.68 (.81) 0.51
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Traumatic Experiences 1.18 (.93) 0.81 (.87) 1.52 (.74) 0.40 1.68 (.58) 0.65
Violent Attitudes 1.08 (.87) 1.24 (.93) 0.46 (.68) 0.79 0.98 (.84) 0.12
Tx/Supervision Response 1.46 (.86) 0.99 (.87) 0.98 (.77) 0.59 1.59 (.71) 0.16
Clinical Scale 5.43 (2.23) 4.93 (2.67) 5.40 (1.96) 0.01 4.39 (2.77) 0.41
Insight 1.63 (.67) 1.43 (.77) 0.94 (.84) 0.91 1.11 (.76) 0.73
Violent Ideation 0.51 (.75) 0.68 (.92) 0.52 (.84) 0.01 0.20 (.52) 0.48
Major Mental DO 0.51 (.74) 0.46 (.80) 1.84 (.42) 2.21 0.86 (.92) 0.42
Instability 1.62 (.58) 1.60 (.62) 1.16 (.71) 0.71 1.13 (.85) 0.67
Tx/Supervision Response 1.15 (.94) 0.76 (.86) 0.94 (.82) 0.24 1.11 (.89) 0.04
Risk Management Scale (Institution) 5.64 (1.89) 3.63 (2.73) X X X X
Professional Services 1.77 (.50) 0.51 (.70) X X X X
Living Situation 1.20 (.49) 1.08 (.82) X X X X
Personal Support 0.99 (.70) 0.58 (.66) X X X X
Tx/Supervision Response 0.56 (.73) 0.43 (.66) X X X X
Stress or Coping 1.12 (.65) 1.02 (.82) X X X X
Risk Management Scale (Community) 6.98 (2.32) 5.73 (3.09) 4.06 (2.32) 1.26 6.29 (2.48) 0.29
Professional Services 1.77 (.50) 1.24 (.83) 0.46 (.65) 2.26 0.86 (.77) 1.40
Living Situation 1.08 (.78) 0.94 (.75) 0.48 (.61) 0.86 1.21 (.80) 0.16
Personal Support 1.12 (.74) 1.02 (.78) 0.78 (.79) 0.44 1.45 (.76) 0.44
Tx/Supervision Response 1.58 (.68) 1.26 (.81) 1.06 (.79) 0.71 1.36 (.77) 0.30
Stress or Coping 1.42 (.66) 1.27 (.77) 1.22 (.76) 0.28 1.41 (.65) 0.02

Given that prior research (e.g., Douglas et al., 2005) has with the Interaction scales (created from the interaction
indicated that HCR-20 total scores are not isomorphic with between the item-level Presence and Relevance ratings) as
SRRs and that SRRs evidence incremental validity in pre- predictors. Using the leave one out cross-validation
dicting violence beyond the scale scores, we examined the method (U method), we entered the three Presence scale
extent to which the item Relevance ratings might incremen- scores and the three Interaction scale scores as predictor
tally contribute to the predictive validity of the Presence variables for the SRR: Future Violence (upon release into
ratings in the prediction of the SRRs as criterion variables the community). This resulted in the correct classification
by conducting step-wise discriminant function analyses of 67.90% of the cross-validated cases, x2 (4) 47.38,
p < .001, Wilks .56. Notably, only the Interaction C
and Interaction R-Community scales were retained in the
TABLE 2 DFA, indicating that SRRs are more a function of the inter-
Percentages of Categorical Summary Risk Ratings
action between Presence and Relevance ratings than merely
Summary Risk Rating Low Moderate High the aggregation of the Presence items. Although step-wise
approaches tend to overfit the data, similar results were
Future Violence (In) 60.7 34.5 4.8
obtained in the remaining analyses. DFAs for the remaining
Serious Physical Harm (In) 69.0 25.0 6.0
Imminent Violence (In) 65.5 28.6 6.0 5 SRRs (Future Violence-Institution, Serious Physical
Future Violence (Out) 28.6 46.4 25.0 Harm-Institution, Imminent Violence-Institution, Serious
Serious Physical Harm (Out) 50.0 31.0 19.0 Physical Harm-Community, and Imminent Violence-Com-
Imminent Violence (Out) 53.6 34.5 11.9 munity) indicated that only the interaction scales uniquely
Note. In Risk for violence within the detention center; Out Risk for predicted the SRRs, as the Presence scales in isolation were
violence in the community. not retained in any of the functions.
 168 SMITH ET AL.
DISCUSSION
The present study investigated the HCR-20V3 (Douglas
et al., 2013) among a sample of male inmates in a pre-trial
correctional facility. Our results support the potential use of
this SPJ risk assessment measure in pre-trial settings to
assist with correctional and forensic determinations (e.g.,
correctional facility housing arrangements, bail decisions,
probation pre-trial recommendation reports). However,
more research on this issue is clearly warranted as the
HCR-20V3 entails some scoring challenges as well as
changes from its predecessor that necessitate consideration
prior to adapting it for use with pre-adjudication cases.
Overall, our data indicate that this instrument can be
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reliably scored in a pre-trial setting, despite the scoring
challenges encountered. However, the reliability for the
R-Institution scale was below accepted levels. Perhaps the
unique housing arrangement for participants in the present
study (i.e., large dormitories housing > 60 inmates) con-
tributed to uncertainty regarding the extent to which these
factors would impact participants violence risk in this
setting.
Comparison with Other Settings
In U.S. prison settings, approximately 50% of all inmates
exhibit symptoms indicative of mental health problems
(U.S. Bureau of Justice Statistics, 2006) which many attri-
bute to the shift of mentally ill patients from psychiatric
inpatient settings to correctional settings due to the deinsti-
tutionalization policies of the 1960s (Testa & West, 2010).
Although the average rating on item H6 (Major Mental Dis-
order) in the present study approached 1 (Possibly Present),
the average rating on item C3 (Recent Symptoms of Major
Mental Disorder) was closer to 0 (Not Present). In compari-
son to the Canadian psychiatric and correctional samples
(see Table 1), the lower ratings on these items in the pres-
ent study were even more apparent, demonstrating large
and medium effect sizes (Cohen, 1992), respectively. It is
probable that the lower ratings ascribed in the present study
were caused by several factors. Most importantly, the facil-
ity in which the study was conducted lacked a full-time
mental health staff member, and file information regarding
mental health was severely limited and in most cases was
restricted to self-report intake screenings. Additionally, par-
ticipants may have intentionally withheld information about
mental health symptoms due to social desirability or due to
fears that the information would be deemed cause for
breaching confidentiality and informing staff. Finally, the
present study employed a three-part consent process that
screened participants as ineligible for participation if they
did not pass a comprehension quiz. Two participants were
excluded from the study on this basis due to active symp-
toms of psychosis. Overall, however, the Clinical scale
scores obtained in the present study mimicked those found
in the Canadian psychiatric sample and were slightly
greater than the Canadian prison sample, likely reflecting
the high prevalence of mental health problems in U.S. cor-
rectional samples as well as the paucity of mental health
resources (e.g., treatment availability). Regardless, it is
apparent that in this pre-trial setting, objectively ascertain-
ing participants current and past mental health history
proved difficult.
Similarly, participants in the present study obtained
higher ratings on average for item H7 (Personality Disor-
der) than those in the Canadian psychiatric or correctional
samples, again evidencing large and medium effect sizes,
respectively. Although it is expected that the base rates of
personality disorder, and psychopathy/ASPD in particular,
would be lower in psychiatric settings, it is not readily clear
how to attribute the difference between the present sample
and the Canadian correctional sample. One reason may
stem from the rating criteria. In the present study, this item
was scored based on the HCR-20V3 scoring guidelines that
encourage evaluators to consider any personality disorder
diagnosis. In five cases, participants in the present study
obtained ratings of 1 or 2 on this item due solely to Narcis-
sistic Personality Disorder or subthreshold traits. In the
Canadian correctional sample, participants diagnoses of
ASPD or psychopathy alone were considered for the analy-
ses presented (K. S. Douglas, personal communication,
September 26, 2013). Additionally, approximately half of
the Canadian correctional sample was comprised of
women, and in general, the base rates of ASPD are lower
among incarcerated women than in male offender samples
(Jordan, Schlenger, Fairbank, & Caddell, 1996; Zlotnick
et al., 2008).
Given the broader scoring guidelines for item H7 in the
HCR-20V3, it is worth considering: Is something lost when
the PCL-R is no longer required? Admittedly, changes to a
single item may not drastically impact the overall scale
scores (in research contexts) or risk predictions. However,
to score a PCL-R, evaluators administer a semi-structured
interview that assesses multiple domains including partic-
ipants childhood, family history, antisocial conduct, as
well as self-perceptions about the participants actions and
the legal system. Currently, no specific interview is
required to score the HCR-20V3. If evaluators substitute
ASPD diagnostic status in lieu of conducting a formal
PCL-R interview, the potential exists for variance in the
information gathered across settings, samples, and individ-
ual evaluators. In a similar vein, other psychopathy instru-
ments may be used to score item H7. It is not clear to what
extent this change may impact overall ratings for the entire
HCR-20V3 instrument. Because the present study was con-
ducted under circumstances in which evaluators had access
to the results from a PCL-R semi-structured interview,
ASPD diagnostic information, and other information
gleaned from an additional semi-structured interview, there
is no way to empirically investigate this question with the

present data. Thus, it remains an important topic for future
research.
Pre-trial Setting Item Assessment Difficulties
and Recommendations
Overall, ratings obtained regarding the Risk Manage-
ment Scale-Community scores were greater than those
reported for the Canadian psychiatric and correctional
samples. These results generally conform with expecta-
tions, given the uncertainty regarding the pre-trial par-
ticipants legal status and supervision requirements as
well as the lack of treatment options available in the
present study.
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H1 (Violence) and H2 (Other Antisocial Behavior)
Scoring the Violence and Other Antisocial Behavior
items can prove difficult in pre-trial settings because the
index offenses are charges rather than convictions. In the
present study, the researchers included all official charges,
in addition to any previous charges admitted to by partici-
pants that were not listed in the files, when scoring these
items based on recommendations for this research context
from the HCR-20V3 lead developer (K. S. Douglas, per-
sonal communication, October 1, 2012). An alternate rec-
ommendation provided by the lead developer entailed
scoring these items based solely on prior convictions unless
participants admitted guilt in the instant offense. We opted
not to adopt that strategy in the present context, however.
In clinical settings, evaluators have a more difficult task of
weighing the ethical implications incurred from either low-
ering risk ratings for those who have not been convicted of
the instant offense (and potentially endangering others) or
considering all current charges and raising offenders risk
ratings (and perhaps placing the offender under greater risk
management strategies than are genuinely warranted).
Further, considering the substantial proportion of U.S.
criminal cases that are resolved through plea bargaining, it
would be important for evaluators to be familiar with
informal procedures for charge bargaining in the jurisdic-
tions in which they work to have some sense of what pre-
trial charges may ultimately look like once pled down. For
example, anecdotal evidence suggests that in the authors
jurisdiction, charges of Driving While Intoxicated may be
reduced to the lesser charge Obstruction of a Highway,
which has implications not only for item H2 but also items
H5 (Problems with Substance Abuse) and C1 (Recent Prob-
lems with Insight) as well.
H6 (Major Mental Disorder)
When collateral corroboration was impeded due to a
lack of prior contact with mental health providers (or lack
of records thereof), evaluators attempted to supplement
explicit interview data with direct observation of symptoms
ADAPTING THE HCR-20V3 169
(e.g., irritability, disorganized speech, paranoia) to achieve
more accurate ratings of clinical risk factors. Additionally,
confirmation of diagnostic status was attempted by examin-
ing medical records for currently prescribed medications
indicative of mental health treatment (e.g., antipsychotics,
antidepressants). Alternatively in clinical contexts, evalua-
tors may be able to ascertain the agency where an inmate
previously received psychological services and request
documentation of mental health treatment.
R1 (Professional Services)
The Professional Services item entails assessment of the
extent to which treatment programs designed to reduce a
persons violence risk are available. In a pre-trial setting,
this item proved particularly challenging to score as essen-
tially no treatment options were available to participants at
the time of the research study. Further, because in most
cases participants had not yet been acquitted, convicted, or
sentenced, it was virtually impossible to discern what treat-
ment options (e.g., substance abuse treatment, anger man-
agement) might be available or mandated once participants
left the detention facility. Evaluators in clinical contexts
should avail themselves of information regarding services
that would likely be available to the defendant in all cir-
cumstances (e.g., conviction, acquittal). It may also be ben-
eficial to conduct two sets of ratings for the Risk
Management items (based on the individuals circumstan-
ces if acquitted or convicted).
R2 (Living Situation)
Nearly all participants in this study, with the rare excep-
tions of those recruited from other housing units (e.g., pro-
tective custody, the medical unit), were assessed during
their orientation period soon after entering the facility and
would be transferred to large, dormitory-style housing units
shared with approximately 60 other inmates. These housing
settings often involve stressors including difficulty sleep-
ing, lack of privacy, lack of control over entertainment
options (e.g., disputes over TV), closed-circuit camera
rather than in-person visitation, and the potential for inter-
personal conflict. Therefore, when scoring this item with
respect to the institutional setting, ratings for participants in
the present study nearly always warranted a score of at least
1 (Possibly Present) on this item, given the potential for
increased interpersonal conflict, stressors in the environ-
ment, and negative peer influences. Ratings for this item
will likely vary substantially across pre-trial settings based
on the particular housing situations in which the research or
clinical evaluation takes place.
Relevance Ratings
The Relevance ratings are a new addition to the HCR-
20V3, and it is unclear how these items might be impacted
 170 SMITH ET AL.
by participants setting (e.g., housing, treatment availabil-
ity). Therefore, because of the inherent uncertainty regard-
ing participants legal status in pre-trial settings, we
assessed all risk management items for both a potential
period of institutionalization (In) and one of community
residence (Out).
A specific difficulty encountered with the Relevance rat-
ings included participants whose index offense was Driving
While Intoxicated. None of the present study participants
injured anyone as a result of such an offense. However,
many participants had multiple charges for driving while
under the influence of alcohol, and a substantially greater
portion admitted to driving under the influence of substan-
ces, although they had not been charged. For those partici-
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pants with no prior history of violence, according to the
HCR-20V3 scoring guidelines (Douglas et al., 2013), a
score of 0 (Not Present) on H1 should be assigned. How-
ever, clearly if participants continue to engage in such
risky, substance-impaired driving, that behavior is relevant
to participants risk for committing acts of violence as
defined by the HCR-20 V3 manual. Therefore, in the present
study, participants in these situations received elevated Rel-
evance scores on items H2 (Antisocial Behavior) and often
on C1 (Recent Problems with Insight) as well. Further clar-
ification from the instrument developers regarding scoring
guidelines for this example is important as similar circum-
stances are likely to be frequently encountered, particularly
in pre-trial settings.
Finally, our investigation seemed to indicate that the
combination of the Presence and Relevance ratings seemed
to contribute something incrementally in the prediction of
the SRRs. The inclusion of the Relevance ratings in the
HCR-20V3 may help explicate discrepancies between the
raw scores of the aggregated risk items and the SRRs, in
that the SRRs seem to be a function of both the presence
and perceived relevance of the individual risk factors. In
research and clinical contexts, considering not only the
presence of the risk variables but also how the variable
impacts a particular individuals propensity for violence
increases this instruments idiographic application. Such a
benefit may be well-received in legal realms where having
Relevance ratings may make it clearer to judges and juries
the underlying basis for a persons level of risk, particularly
in cases where the number of present risk factors does not
readily comport with the evaluators global assessment of
risk. The utilization of both the Presence and Relevance rat-
ings to prospectively predict violence remains an important
topic for further investigation.
Summary
Many of the present studys limitations (e.g., inadequate file
information) have been noted previously. However, an
additional area meriting future research would involve cod-
ing evaluators confidence in their ratings. This procedure
advocated by Douglas and Ogloff (2003) was not under-
taken in the current study, and such information may pro-
vide valuable insight into: (1) which items and sub-items
are more difficult to score in pre-trial settings, and (2) the
extent to which the predictive validity of the instrument is
impacted when ratings are made with less confidence.
In conclusion, the present study investigated the use of
the HCR-20V3 in a pre-trial setting. The researchers
encountered some obstacles when attempting to score the
items (e.g., uncertainty regarding participants legal status,
limited file information), and some noteworthy differences
were found in mean item scores when compared to other
recent HCR-20 V3 samples. Overall, however, results indi-
cated that this instrument seems to be adaptable for use in a
pre-trial context. Further, the inclusion of Relevance ratings
in the HCR-20V3 appears to be an advantageous aspect of
the instrument worthy of further study, given that the inter-
action of the Presence and Relevance ratings appears to
incrementally relate to SRRs in our data. Future studies
should investigate the extent to which the Interaction scales
evince similar results in relevant criterion variables (e.g.,
the prospective prediction of violence). We encourage
future research on the predictive validity of the revised
instrument in pre-trial institutional settings as well as in the
community at large.
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