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 Kashiwagi,Akiko Kikuchi,Naotsugu Hirabayashi,Daisuke Saito,Mayuko Koyama

doi:10.1186/s12991-018-0175-5

Abstract

BackgroundThe 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.MethodsThis 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.ResultsWe 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.ConclusionsThe 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.

Highlights

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
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 his/her situation that reduces the risk of future violent behavior [2, 3]

Summary

Introduction

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. In other words, when these protective factors are not considered, risk assessment becomes unbalanced, thereby leading to inaccurate predictions [5]. This might lead to pessimism among both offenders, who are often stigmatized, and therapists, which might lead to the long-term detention of forensic psychiatric patients. The standardized assessment of protective factors might have a positive and motivating effect on both patients and treatment staff [2, 3] Such a strength-based approach might be effective when integrated into psychosocial treatment, such as that which uses a problem-solving approach and seeks empowerment (e.g., the Good Lives Model) [10, 11]

Results

Discussion

Conclusion