Risk state and purportedly dynamic risk factors: An examination of change in violence risk across multiple assessments

Professionals have increasingly stressed the dynamic nature of violence risk. To be effective at preventing violence, it is essential to reliably and validly measure dynamic risk factors that can alter an individual's risk state. It is imperative to understand the changeability of dynamic risk factors and global ratings of risk state more completely. There is limited, but promising, research to date that has investigated the ability of dynamic factors on structured risk assessment instruments to change over time (internal responsiveness) and even less research has investigated the extent to which this change is associated with violence (external responsiveness). The current study aimed to add to the existing knowledge concerning the responsiveness of dynamic ratings using the HCR-20 and START. With a combined sample of offenders and civil psychiatric patients, participants were assessed approximately monthly for up to six assessments. The first research question addressed internal responsiveness. Although most ratings did not change across assessments, intraindividual change was not uncommon. It was more common for participants to change at least once across all six assessments on nearly all ratings. Aggregate-level change was also observed for most dynamic ratings on both instruments. In contrast to raw score change, reliable change was relatively rare. The second research question addressed external responsiveness. Many of the dynamic ratings were predictive of violence across assessments when controlling for the respective baseline scores, and when controlling for the Historical scale scores. In contrast, when change scores were analyzed, very few items were predictive of violence. Overall, the current study added to the growing body of empirical research supporting the responsiveness of dynamic ratings on the HCR-20 and START. As such, there is accumulating evidence that supports these items as meeting all the criteria for dynamic risk factors. Repeated assessments of dynamic risk factors and risk state aid in identifying targeted management strategies, monitoring the effectiveness of these strategies, and altering the intensity or target of these strategies.