Historical and clinical items of the HCR-20 as predictors of risk within an intellectual disability population
| Published date | 02 March 2015 |
| DOI | https://doi.org/10.1108/AMHID-01-2015-0002 |
| Pages | 62-69 |
| Date | 02 March 2015 |
| Author | Eddie Chaplin,Mo Eyeoyibo,Steve Wright,Kiriakos Xenitidis,Jane McCarthy |
| Subject Matter | Health & social care,Learning & intellectual disabilities,Accounting education |
Historical and clinical items of the HCR-20
as predictors of risk within an intellectual
disability population
Eddie Chaplin, Mo Eyeoyibo, Steve Wright, Kiriakos Xenitidis and Jane McCarthy
Dr Eddie Chaplin is a Research
Lead, based at South London
and Maudsley NHS
Foundation Trust, London, UK.
Dr Mo Eyeoyibo is a Consultant
Psychiatrist, based at Mental
Health of Learning Disability,
Kent and Medway NHS and
Social Care Partnership Trust,
Kent, UK.
Steve Wright is a Research
Associate, based at Institute of
Psychiatry, Psychology and
Neuroscience, King’s College
London, London, UK.
Dr Kiriakos Xenitidis is based at
Institute of Psychiatry,
Psychology and Neuroscience,
King’s College, London, UK.
Dr Jane McCarthy is a
Consultant Psychiatrist, based
at East London NHS
Foundation Trust, London, UK.
Abstract
Purpose – The use of violence risk assessment measures within intellectual disabilities (ID) services is now
the norm and a growing target for research. The purpose of this paper is to examine the clinical utility of the
historical and clinical factors of the HCR-20 in predicting violence.
Design/methodology/approach – The study took place within a national low secure service for adults
with ID examining all completed admissions over a six-year period, (N ¼22). Clinical records covering the
first three months of admission were examined along with historical reports and incident data recorded at
three, six, nine and 12 months admission using the Modified Overt Aggression Scale (MOAS).
Findings – Significant positive relationship between Historical score and total number of incidents was
established. Patients with challenging behaviour less likely to have a previous history of violence, and more
likely to be older at first violent incident than patients without challenging behaviour. Incidents involving
patients with autism were less severe and those with no additional psychiatric diagnosis were significantly
more likely to have substance misuse problems than those with a diagnosis.
Originality/value – The study found the Historical section was predictive of violent incidents and whilst the
study is too small to draw any firm conclusions, the significant positive relationship between the Historical
Score and number of incidents for those without additional diagnosis needs to be investigated further as
well as the potential positive clinical impact of using the HCR-20 in routine clinical practice.
Keywords Mental health, Risk assessment, Intellectual disabilities, Clinical risk, Historical risk,
Violence prediction
Paper type Research paper
Introduction
There is growing evidence of the use of violence risk assessment measures within intellectual
disabilities (ID) services, which has increased awareness of their strengths and limitations within
clinical practice. In recent years there has been an increase in research activity and output
relating to risk assessment in ID populations (Boer et al., 2004; Gray et al., 2007; Lindsay, 2011;
Lindsay et al., 2004, 2006, 2008; Lofthouse et al., 2013, 2014; McGrath et al., 2007; McMillan
et al., 2004, Morrisey et al., 2007; Quinsey, 2004; Quinsey et al., 2004; Tengstro
¨met al., 2006).
The HCR-20 is themost widely used risk assessment measurein forensic services (Lindsayet al.,
2008). Early studies suggest that the HCR-20 (Webster et al., 1997) has good predict ive power
within forensic ID settings, which is consistent with research into other offender populations
(Lindsay, 2011). The predictiveaccuracy of the HCR-20 as only relativelyrecently been a target for
ID researchers(Gray et al., 2007; Lindsay et al.,2008;Tengstro
¨met al.,2006).Grayet al. (2007)
reported the HCR-20 to be a significant predictor of violence in ID, with the historical sub scale
performing particularly well. Whilst Lindsay et al. (2008) reported the HCR-20 had significant
discriminative and predictive validity in high secure, medium secure, low secure and community
ID services.
PAGE 62
j
ADVANCES IN MENTAL HEALTH AND INTELLECTUAL DISABILITIES
j
VOL. 9 NO. 2 2015, pp. 62-69, CEmerald Group Publishing Limited, ISSN 2044-1282 DOI 10.1108/AMHID-01-2015-0002
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