Strength-based assessment for future violence risk: a retrospective validation study of the Structured Assessment of PRO
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PRIMARY RESEARCH
Annals of General Psychiatry Open Access
Strength‑based assessment for future violence risk: a retrospective validation study of the Structured Assessment of PROtective Factors for violence risk (SAPROF) Japanese version in forensic psychiatric inpatients Hiroko Kashiwagi1*, Akiko Kikuchi2, Mayuko Koyama1, Daisuke Saito1 and Naotsugu Hirabayashi1
Abstract Background: The Structured Assessment of PROtective Factors for violence risk (SAPROF) was recently developed as a strength-based addition to the risk assessment of future violent behavior. We examined the interrater reliability and predictive accuracy of the SAPROF for violence in forensic mental health inpatient units in Japan. Methods: This retrospective record study provides an initial validation of the SAPROF in a Japanese sample of 95 forensic psychiatric inpatients from a complete 2008–2013 cohort. Violent outcomes were assessed 6 and 12 months after hospitalization. Results: We observed moderate-to-good interrater reliability for the SAPROF total score and the internal factors, motivational factors, external factors, and the Final Protection Judgment scores. According to a receiver operating characteristic analysis, the SAPROF total score and all subscale scores predicted violence at both 6 and 12 months after hospitalization with high accuracy. Furthermore, the predictive validity of a combination of the SAPROF with the Historical Clinical Risk Management-20 (HCR-20) outperformed that of the HCR-20 alone. Conclusions: The results provide evidence of the value of considering protective factors in the assessment of future violence risk among Japanese forensic psychiatric inpatients. The SAPROF might allow for a more balanced assessment of future violence risk in places where the population rates of violent crime are low, such as Japan, but a validation study in a different setting should confirm this. Moreover, future studies should examine the effectiveness of treatment and promoting community re-integration on motivating patients and treatment staff. Keywords: Protective factor, SAPROF, Violence, Risk assessment, Forensic inpatients Background Over the last few decades, our knowledge of violence risk assessment and the risk factors for violence have increased markedly. Risk-focused assessment tools, such as the Historical Clinical Risk Management-20 (HCR-20)
*Correspondence: [email protected] 1 Department of Forensic Psychiatry, National Center Hospital of Neurology and Psychiatry, 4‑1‑1, Ogawahigashicho, Kodaira, Tokyo 187‑8553, Japan Full list of author information is available at the end of the article
[1], are widely used in forensic settings worldwide. However, very little attention has been paid to the factors that might compensate for these risk factors and thereby reduce the risk of violence recidivism, namely protective factors. According to the manual of the Structured Assessment of PROtective Factors for violence risk (SAPROF), protective factors refer to any characteristic of a person, his/her environment, or hi
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