HCR-20-C scale effective tool for assessing violent tendencies in patients

A recent study conducted by researchers at the University of California, San Francisco, has procured an interesting array of tools to be used by medical professionals to help evaluate risk for violence amongst patients with mental illnesses.

Spearheaded by psychiatrist Alan Teo, MD, the study revealed that when professionals in training were given information from the “Historical, Clinical, Risk Management-Clinical” (HRC-20-C) scale, their ability to assess violence risk became comparable to their faculty superiors, who had on average 15 years more experience. 

"Similar to a checklist a pilot might use before takeoff, the HRC-20-C has just five items that any trained health professional can use to assess their patients," Teo said in a news release. "To improve the safety for staff and patients in high-risk settings, it is critical to teach budding psychiatrists and other mental health professionals how to use a practical tool such as this one."

"This is the first study to compare the accuracy of risk assessments by senior psychiatrists to those completed by psychiatric residents," added senior author Dale McNiel, PhD, UCSF professor of clinical psychology. "It shows that clinicians with limited training and experience tend to be inaccurate in their risk assessments, and that structured methods such as HCR-20-C hold promise for improving training in risk assessment for violence."

Canadian experts developed the HCR-20-C scale several years ago — the guideline is used now by the U.S.’s northern ally in a number of high-volume settings, such as prisons and hospitals. America is only just beginning to implement the scale in hospital and practice settings. Teo, McNiel and their team hope that results of their experiment will expedite that process.

"The UCSF study was unusual," Teo said, "in applying a shorter version of the tool that could be more easily incorporated into clinical practice."

The findings of the UCSF team were published Aug. 31 in the journal of Psychiatric Services. To access accuracy, the UCSF research team compared doctor risk assessments given when each of the patients was first admitted to the amount of aggression asserted (kicking, biting or hitting of medical staff) after admittance. Patient subjects accessed included 151 who became violent and 150 who did not; patients possessed a number of severe mental illnesses, such as schizophrenia, and were admitted involuntarily.