title: Validation of the HCR-20 Scale for Assessing Risk of Violent Behavior in Israeli Psychiatric Inpatients.
abstract: BACKGROUND
  Assessment of risk of violent behavior in forensic psychiatric practice is a complex and responsible clinical task and the use of a valid instrument can make the expert's work more effective. The Historical Clinical and Risk Management scale 20 (HCR-20) is a widely accepted measure of the risk of violence, sexual and criminal behavior. The aim of this study was to validate the HCR-20 in Israeli psychiatric inpatient settings.
  
  
  METHODS
  In a prospective design, data were collected on 150 male patients aged 15-65, diagnosed with ICD-10 schizophrenia, who were hospitalized in three wards: an acute psychiatric ward (n=50), a high security ward (n=50), and an open ward (n=50). The HCR-20, as the predictor measure, and the Positive and Negative Syndrome Scale, as a concurrent measure, werecompleted at baseline, and the Violence Assessment Scale, as the outcome measure, was completed at 6-, 12- and 18-month follow-up points.
  
  
  RESULTS
  Internal consistency reliability was good for the total HCR-20 scale, satisfactory for the H-subscale, but low for the C- and R-subscales. Concurrent validity was good for the C-subscale, and discriminative validity was reasonable for the C- and H-subscales. The total scale as well as the Historical and Clinical subscales predicted the risk of physical as well as physical/sexual violent behavior at both 6- and 18-month follow-up points.
  
  
  CONCLUSIONS
  Appropriate psychometric properties of the HCR-20 suggest that it can serve as a useful measure of the risk of violent behavior in psychiatric settings in Israel. Further research is necessary to confirm norms and cut-off scores, using a larger representative sample.
authors.affiliation: Department of Forensic Psychiatry, Mental Health Services, Ministry of Health, Jerusalem, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Ivgi
authors.affiliation: Department of Forensic Psychiatry, Mental Health Services, Ministry of Health, Jerusalem, Israel.
authors.forename: Arie
authors.initials: A
authors.lastname: Bauer
authors.affiliation: Department of Forensic Psychiatry, Mental Health Services, Ministry of Health, Jerusalem, Israel.
authors.forename: Razek
authors.initials: R
authors.lastname: Khawaled
authors.affiliation: Department for the Treatment of Substance Abuse, Ministry of Health, Jerusalem, Israel.
authors.forename: Paola
authors.initials: P
authors.lastname: Rosca
authors.affiliation: Israel Prison Service, Ashkelon Academic College, Ashkelon, Israel.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Weiss
authors.affiliation: Research Unit, Mental Health Services, Ministry of Health, Jerusalem, Israel.
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Ponizovsky
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D011567:Psychiatric Department, Hospital; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D011594:Psychometrics; D015203:Reproducibility of Results; D018570:Risk Assessment; D012559:Schizophrenia / Q000150:complications / Q000175:diagnosis*; D014754:Violence; D055815:Young Adult