Assessing Violent Recidivism Risk in Forensic Patients

The HKT-R (Spreen et al., 2014 ) is a structured professional tool for assessing the risk of violent recidivism in forensic psychiatric patients. The HKT-R consists of 33 factors spread over three domains: 12 Historical, 14 Clinical, and seven Future factors. All factors are rated on a 5-point scale, ranging from 0 to 4, in which “0” represents no risk and “4” represents a high level of risk. The Historical domain relates to the offender’s personal history up to the moment of the arrest for the current index-offense (e.g., judicial history, employment history, and victim type). The Clinical domain contains 14 factors that are divided into seven risk (e.g., impulsivity and hostility) and seven protective factors (e.g., coping skills and cooperation with treatment). The Clinical domain refers to the offender’s behavior in the last 12 months (e.g., problem insight, psychotic symptoms, and antisocial behavior). In our study, all protective factors were recoded so that higher scores indicated higher protection against reoffending (“0” represents no protection and “4” represents high protection). The Future domain is related to the assessment of potential risks, which could emerge after discharge from the FPC (e.g., stressful circumstances, living arrangements, and work situation).
For patients with a TBS order, a risk assessment of the Clinical items must be performed at least once a year. The annual scores on the 14 Clinical factors indicate whether a reduction in risk factors and/or an improvement in protective factors has occurred, compared with the previous 12 months of stay in the institution. Hence, if changes occur, that could assumingly be ascribed to the given treatment. In this study, only the Clinical dynamic factors were included as Historical factors are static and irreversible, and Future factors are exclusively related to the situation after release. Internal consistency for the Clinical domain was good at both measurement points, with Cronbach’s α being α_T1 = .80 and α_T2 = .83, respectively. Descriptive statistics of the clinical risk and protective factors are presented in Table 1.