Table of Contents
6.1 THE USE OF THE HCR-20V3 IN DUTCH FORENSIC PSYCHIATRIC PRACTICE....................................3
HCR-20V3...........................................................................................................................................3
RISK-NEED-RESPONSIVITY (RNR) MODEL....................................................................................................3
RISK MANAGEMENT PLAN.........................................................................................................................3
PROTECTIVE FACTORS..............................................................................................................................3
6.2 THE CHARACTERISTICS OF PERSISTENT SEXUAL OFFENDERS........................................................3
RECIDIVISM............................................................................................................................................3
DEVELOPMENT OF SEXUAL OFFENDING........................................................................................................4
RISK FACTORS.........................................................................................................................................4
7.1 UNDERSTANDING ETHNIC DIFFERENCES IN MENTAL HEALTH SERVICE USE.................................5
RESEARCH QUESTION...............................................................................................................................5
PARTICIPANTS........................................................................................................................................5
METHOD...............................................................................................................................................5
RESULTS................................................................................................................................................5
CONCLUSION..........................................................................................................................................5
8.1 THE DIAGNOSTIC PROCESS..........................................................................................................6
STEPS IN THE DIAGNOSTIC PROCESS............................................................................................................6
FIVE BASIC QUESTIONS IN CLINICAL PSYCHODIAGNOSTICS................................................................................6
THE DIAGNOSTIC CYCLE............................................................................................................................6
THE DIAGNOSTIC PROCESS: FROM THE APPLICATION TO THE REPORT.................................................................7
8.2 THE INTERVIEW...........................................................................................................................7
CONTENT OF THE INTAKE INTERVIEW..........................................................................................................7
OBSTACLES DURING THE INTERVIEW...........................................................................................................8
CONSULTATION AND BAD NEWS.................................................................................................................9
REPORTING............................................................................................................................................9
8.3 NEUROPSYCHOLOGICAL QUESTIONS AND METHODS..................................................................9
HISTORY OF NEUROPSYCHOLOGY................................................................................................................9
MISCONCEPTIONS.................................................................................................................................10
TYPE OF QUESTIONS..............................................................................................................................10
MEASURING INSTRUMENTS.....................................................................................................................10
INTERPRETATION PROBLEMS....................................................................................................................11
8.4 ETHICAL ASPECTS AND THE REPORTING OF DIAGNOSTICS.........................................................12
ETHICS................................................................................................................................................12
WRITTEN REPORT..................................................................................................................................12
ORAL REPORT.......................................................................................................................................13
9.1 BEHAVIORAL OBSERVATIONS....................................................................................................14
UNSTANDARDIZED OBSERVATION.............................................................................................................14
STANDARDIZED OBSERVATION..................................................................................................................14
STANDARDIZED OBSERVATION OF SPECIFIC PHENOMENA...............................................................................16
9.2 PSYCHOLOGICAL ASSESSMENT IN CHILD MENTAL HEALTH SETTINGS........................................16
ETHICS................................................................................................................................................17
GENERAL ISSUES IN SELECTING MEASURES..................................................................................................17
ASSESSMENT METHODS..........................................................................................................................17
INFORMANTS.......................................................................................................................................18
INTEGRATING INFORMATION...................................................................................................................18
10.1 INDIVIDUAL DIFFERENCES SCIENCE FOR TREATMENT PLANNING............................................19
, GENES AND ENVIRONMENT.....................................................................................................................19
TRAIT-INFORMED TREATMENT PLANNING...................................................................................................20
10.2 THE PSYCHOTHERAPEUTIC UTILITY OF THE FIVE-FACTOR MODEL............................................21
THE CLINICAL VALUE OF A TAXONOMY OF PERSONALITY................................................................................21
THE FIVE FACTORS IN CLINICAL CONTEXT....................................................................................................21
11.1 THE FEATURES AND QUALITY STANDARDS OF DIAGNOSTIC INSTRUMENTS............................23
THREE TYPES OF DIAGNOSTIC INSTRUMENTS...............................................................................................23
WHAT MAKES A GOOD TEST?..................................................................................................................23
COTAN..............................................................................................................................................24
GOOD INSTRUMENTS NEED GOOD DIAGNOSTICIANS.....................................................................................24
2
, 6.1 The use of the HCR-20V3 in Dutch forensic psychiatric practice
The use of a structured violence risk assessment tool has great importance for society as well as for
patients/offenders. Research demonstrates that the Historical, Clinical, Risk management-20 version
3 (HCR-20V3) is a promising tool with sound psychometric properties and clinical value.
HCR-20V3
Risk assessment tool that is used to predict future violent offenses. It involves 7 steps:
- Case information: Information from clinical and judicial files, and other sources is gathered.
- Presence: The presence of certain risk factors is determined.
o Coding is based on “yes”, “partially”, “no” or “omit” (in case of a lack of information).
- Relevance: The relevance of the risk factors that are present is determined.
o Coding is based on “low”, “moderate” or “high”.
- Risk formulation: Separate risk factors are integrated into a conceptual meaningful
framework that explains a person’s violence.
- Risk scenarios: A prediction about future behavior is made: what might a person do in the
future, and why?
- Management strategies: The results from the first 5 steps are translated into a risk
management plan, using the Risk-Need-Responsivity (RNR) model.
- Conclusory opinions: The final conclusions regarding the risk are stated.
Risk-Need-Responsivity (RNR) model
Risk model according to which the focus of treatment and supervision should be on avoiding
additional damage to society. The well-being and general functioning of the offender is of secondary
importance. The model consists of 3 important principles:
- Risk principle: The high-risk cases should receive high intensity risk management, while the
reverse is true for lower-risk cases.
- Need principle: Management efforts should target dynamic risk factors deemed important
for lowering the risk for a specific patient (these factors are also called criminogenic needs).
- Responsivity principle: Programs should be delivered in a manner that matches the learning
styles (IQ, motivation, psychiatric disorders) of those receiving them.
Risk management plan
A risk management plan based on the HCR-20V3 is described in terms of 4 basic activities:
- Monitoring: The evaluation of changes in risk over time so that risk management strategies
can be revised.
- Treatment: The treatment used to improve deficits in the person’s psychosocial adjustment
or functioning.
- Supervision: The restrictions of the individual’s rights and freedoms.
- Victim safety planning: The security resources for the potential victim.
Protective factors
Factors that can protect an individual from recidivism. It is not only important to diminish risk factors,
but also to reinforce the protective factors. To assess the latter, the ‘Structured Assessment of
Protective Factors for violence risk’ (SAPROF) was developed.
6.2 The characteristics of persistent sexual offenders
Identifying the characteristics of persistent sexual offenders is important for understanding their
behavior, as well as for practical matters involving policies towards sexual offenders.
Recidivism
The tendency of a convicted criminal to reoffend. There are 2 major factors that predict sexual
recidivism:
3
6.1 THE USE OF THE HCR-20V3 IN DUTCH FORENSIC PSYCHIATRIC PRACTICE....................................3
HCR-20V3...........................................................................................................................................3
RISK-NEED-RESPONSIVITY (RNR) MODEL....................................................................................................3
RISK MANAGEMENT PLAN.........................................................................................................................3
PROTECTIVE FACTORS..............................................................................................................................3
6.2 THE CHARACTERISTICS OF PERSISTENT SEXUAL OFFENDERS........................................................3
RECIDIVISM............................................................................................................................................3
DEVELOPMENT OF SEXUAL OFFENDING........................................................................................................4
RISK FACTORS.........................................................................................................................................4
7.1 UNDERSTANDING ETHNIC DIFFERENCES IN MENTAL HEALTH SERVICE USE.................................5
RESEARCH QUESTION...............................................................................................................................5
PARTICIPANTS........................................................................................................................................5
METHOD...............................................................................................................................................5
RESULTS................................................................................................................................................5
CONCLUSION..........................................................................................................................................5
8.1 THE DIAGNOSTIC PROCESS..........................................................................................................6
STEPS IN THE DIAGNOSTIC PROCESS............................................................................................................6
FIVE BASIC QUESTIONS IN CLINICAL PSYCHODIAGNOSTICS................................................................................6
THE DIAGNOSTIC CYCLE............................................................................................................................6
THE DIAGNOSTIC PROCESS: FROM THE APPLICATION TO THE REPORT.................................................................7
8.2 THE INTERVIEW...........................................................................................................................7
CONTENT OF THE INTAKE INTERVIEW..........................................................................................................7
OBSTACLES DURING THE INTERVIEW...........................................................................................................8
CONSULTATION AND BAD NEWS.................................................................................................................9
REPORTING............................................................................................................................................9
8.3 NEUROPSYCHOLOGICAL QUESTIONS AND METHODS..................................................................9
HISTORY OF NEUROPSYCHOLOGY................................................................................................................9
MISCONCEPTIONS.................................................................................................................................10
TYPE OF QUESTIONS..............................................................................................................................10
MEASURING INSTRUMENTS.....................................................................................................................10
INTERPRETATION PROBLEMS....................................................................................................................11
8.4 ETHICAL ASPECTS AND THE REPORTING OF DIAGNOSTICS.........................................................12
ETHICS................................................................................................................................................12
WRITTEN REPORT..................................................................................................................................12
ORAL REPORT.......................................................................................................................................13
9.1 BEHAVIORAL OBSERVATIONS....................................................................................................14
UNSTANDARDIZED OBSERVATION.............................................................................................................14
STANDARDIZED OBSERVATION..................................................................................................................14
STANDARDIZED OBSERVATION OF SPECIFIC PHENOMENA...............................................................................16
9.2 PSYCHOLOGICAL ASSESSMENT IN CHILD MENTAL HEALTH SETTINGS........................................16
ETHICS................................................................................................................................................17
GENERAL ISSUES IN SELECTING MEASURES..................................................................................................17
ASSESSMENT METHODS..........................................................................................................................17
INFORMANTS.......................................................................................................................................18
INTEGRATING INFORMATION...................................................................................................................18
10.1 INDIVIDUAL DIFFERENCES SCIENCE FOR TREATMENT PLANNING............................................19
, GENES AND ENVIRONMENT.....................................................................................................................19
TRAIT-INFORMED TREATMENT PLANNING...................................................................................................20
10.2 THE PSYCHOTHERAPEUTIC UTILITY OF THE FIVE-FACTOR MODEL............................................21
THE CLINICAL VALUE OF A TAXONOMY OF PERSONALITY................................................................................21
THE FIVE FACTORS IN CLINICAL CONTEXT....................................................................................................21
11.1 THE FEATURES AND QUALITY STANDARDS OF DIAGNOSTIC INSTRUMENTS............................23
THREE TYPES OF DIAGNOSTIC INSTRUMENTS...............................................................................................23
WHAT MAKES A GOOD TEST?..................................................................................................................23
COTAN..............................................................................................................................................24
GOOD INSTRUMENTS NEED GOOD DIAGNOSTICIANS.....................................................................................24
2
, 6.1 The use of the HCR-20V3 in Dutch forensic psychiatric practice
The use of a structured violence risk assessment tool has great importance for society as well as for
patients/offenders. Research demonstrates that the Historical, Clinical, Risk management-20 version
3 (HCR-20V3) is a promising tool with sound psychometric properties and clinical value.
HCR-20V3
Risk assessment tool that is used to predict future violent offenses. It involves 7 steps:
- Case information: Information from clinical and judicial files, and other sources is gathered.
- Presence: The presence of certain risk factors is determined.
o Coding is based on “yes”, “partially”, “no” or “omit” (in case of a lack of information).
- Relevance: The relevance of the risk factors that are present is determined.
o Coding is based on “low”, “moderate” or “high”.
- Risk formulation: Separate risk factors are integrated into a conceptual meaningful
framework that explains a person’s violence.
- Risk scenarios: A prediction about future behavior is made: what might a person do in the
future, and why?
- Management strategies: The results from the first 5 steps are translated into a risk
management plan, using the Risk-Need-Responsivity (RNR) model.
- Conclusory opinions: The final conclusions regarding the risk are stated.
Risk-Need-Responsivity (RNR) model
Risk model according to which the focus of treatment and supervision should be on avoiding
additional damage to society. The well-being and general functioning of the offender is of secondary
importance. The model consists of 3 important principles:
- Risk principle: The high-risk cases should receive high intensity risk management, while the
reverse is true for lower-risk cases.
- Need principle: Management efforts should target dynamic risk factors deemed important
for lowering the risk for a specific patient (these factors are also called criminogenic needs).
- Responsivity principle: Programs should be delivered in a manner that matches the learning
styles (IQ, motivation, psychiatric disorders) of those receiving them.
Risk management plan
A risk management plan based on the HCR-20V3 is described in terms of 4 basic activities:
- Monitoring: The evaluation of changes in risk over time so that risk management strategies
can be revised.
- Treatment: The treatment used to improve deficits in the person’s psychosocial adjustment
or functioning.
- Supervision: The restrictions of the individual’s rights and freedoms.
- Victim safety planning: The security resources for the potential victim.
Protective factors
Factors that can protect an individual from recidivism. It is not only important to diminish risk factors,
but also to reinforce the protective factors. To assess the latter, the ‘Structured Assessment of
Protective Factors for violence risk’ (SAPROF) was developed.
6.2 The characteristics of persistent sexual offenders
Identifying the characteristics of persistent sexual offenders is important for understanding their
behavior, as well as for practical matters involving policies towards sexual offenders.
Recidivism
The tendency of a convicted criminal to reoffend. There are 2 major factors that predict sexual
recidivism:
3
