Concurrent validity and clinical utility of the HCR-20V3 compared with the HCR-20 in forensic mental health nursing: similar tools but improved method

Abstract

The main scope of this small-scale investigation was to compare clinical application of the HCR-20V3 with its predecessor, the HCR-20. To explore concurrent validity, two experienced nurses assessed 20 forensic mental health service patients with the tools. Estimates of internal consistency for the HCR-20 and the HCR-20V3 were calculated by Cronbach's alpha for two levels of measurement: the H-, C-, and R-scales and the total sum scores. We found moderate (C-scale) to good (H- and R- scales and aggregate scores) estimates of internal consistency and significant differences for the two versions of the HCR. This finding indicates that the two versions reflect common underlying dimensions and that there still appears to be differences between V2 and V3 ratings for the same patients. A case from forensic mental health was used to illustrate similarities and differences in assessment results between the two HCR-20 versions. The case illustration depicts clinical use of the HCR-20V3 and application of two structured nursing interventions pertaining to the risk management part of the tool. According to our experience, Version 3 is superior to Version 2 concerning: (a) item clarity; (b) the distinction between presence and relevance of risk factors; (c) the integration of risk formulation and risk scenario; and (d) the explicit demand to construct a risk management plan as part of the standard assessment procedure.