Longitudinal Change of Risk Factors During Treatment in High-Security Forensic Psychiatry in Flanders

• Published date: 01 December 2023
• DOI: http://doi.org/10.1177/0306624X221144293
• Author: Sophie Verschueren,Inge Jeandarme,Ilse Libijn,Stefan Bogaerts
• Date: 01 December 2023
• Subject Matter: Articles

https://doi.org/10.1177/0306624X221144293

International Journal of

Offender Therapy and

Comparative Criminology

2023, Vol. 67(16) 1722 –1740

© The Author(s) 2023

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DOI: 10.1177/0306624X221144293

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Article

Longitudinal Change of Risk

Factors During Treatment

in High-Security Forensic

Psychiatry in Flanders

Sophie Verschueren1,2 , Inge Jeandarme1,

Ilse Libijn3, and Stefan Bogaerts2,4

Abstract

Empirical studies on the longitudinal change of risk factors during treatment of

forensic psychiatric patients are scarce. Therefore, in the current study, changes

in risk factors of 341 high-security forensic psychiatric patients in Flanders were

investigated using latent growth curve analyses. Annual assessments of the Historical

Clinical Future-Revised (HKT-R) at three time points were considered, starting at time

of admission. A significant small improvement was found on the future scale and most

future factors. However, the clinical scale did not change significantly and only one of

the 14 clinical factors (i.e., problem insight) changed significantly over time. Although

the forensic treatment seems to be a slow process, the sensitivity of the HKT-R

to detect clinically relevant change is questioned, underscoring the importance of

determining whether there are instruments capable of detecting small significant

changes over time.

Keywords

forensic psychiatry, risk factors, latent growth curve analysis

Introduction

In the field of forensic psychiatry, a large body of research has studied risk and protec-

tive factors associated with recidivism (Bonta et al., 2014), as risk management is one

1Forensic Psychiatric Centre Antwerp, Belgium

2Tilburg University, The Netherlands

3Forensic Psychiatric Centre Ghent, Belgium

4Fivoor Science and Treatment Innovation, Rotterdam, The Netherlands

Corresponding Author:

Sophie Verschueren, Forensic Psychiatric Centre Antwerp, Beatrijslaan 96, 2050 Antwerpen, Belgium.

Email: sophie.verschueren@fpcantwerpen.be

1144293IJOXXX10.1177/0306624X221144293International Journal of Offender Therapy and Comparative CriminologyVerschueren et al.

research-article2023

Verschueren et al. 1723

of the primary goals of treatment. In this context, dynamic risk factors are especially

important, because of their changeability over time (Douglas & Skeem, 2005). The

degree of change in those dynamic risk factors is included in the examination and

decision-making of practitioners about the risk of recidivism and the further treatment

trajectory of an individual. However, only in the past decade, attention has shifted to

the empirical assessment of longitudinal change of dynamic risk factors during

treatment.

The most influential risk factors for recidivism in offenders were described by

Andrews and Bonta (2010) as “the Central Eight”: four risk factors that are strongly

associated with recidivism (i.e., history of antisocial behavior, an antisocial personal-

ity pattern, antisocial cognitions, and antisocial associations) and four risk factors that

are moderately and indirectly associated with recidivism (i.e., a dysfunctional family

situation, work and school problems, a lack of leisure activities, and substance abuse).

This distinction was confirmed in mentally disordered offenders for violent recidivism

(Bonta et al., 2014).

In recent decades, several risk assessment instruments have been developed to

assess individual changes in empirically supported dynamic risk factors during treat-

ment, for example, the Historical Clinical Risk Management-20 (HCR-20; Webster et

al., 1997), the Violence Risk Scale (VRS; Wong & Gordon, 2006), and the Historical

Clinical Future-Revised (Historische, Klinische, Toekomst-Revised; HKT-R; Bogaerts

et al., 2018; Spreen et al., 2014). Since risk assessment and risk management are

merged in practice, it is necessary to understand the changeable aspects of risk factors

(Andrews & Bonta, 2010; Blanchard, 2013). However, progress can be made in the

empirical assessment of the changeability of dynamic risk factors in inpatient forensic

psychiatric patients since the literature is rather scarce.

Douglas and Belfrage (2001, as cited in Belfrage & Douglas, 2002; see also Webster

et al., 2000) conducted the first study on changes of the HCR-20 over time in a foren-

sic patient population. After approximately 6 months, significant moderate declines in

the clinical and risk management scale were found in high-risk Canadian and Swedish

forensic patients. Over the past two decades, multiple studies have been conducted in

forensic psychiatric patients reporting significant small improvement on clinical scale

scores during treatment (Belfrage & Douglas, 2002; Blanchard, 2013; Chakhssi et al.,

2010; De Jonge et al., 2009; Hogan & Olver, 2016, 2019; Janković et al., 2021; Lewis

et al., 2013; Mastromanno et al., 2018; Morrissey et al., 2014; Olsson et al., 2013;

Olver et al., 2013; O’Shea & Dickens, 2015; Reed et al., 2000; Richter et al., 2018;

Van der Linde et al., 2020; Webster et al., 2009). However, no significant change in

dynamic factors was found in the study of Van der Veeken et al. (2018), using the

Instrument for Forensic Treatment Evaluation (IFTE; Schuringa et al., 2014). The

study was conducted in high security forensic patients at six time points with an inter-

val of 4 to 6 months. Additionally, a Flemish study investigating a sample of patients

residing in three forensic medium-security units found no significant difference in

HCR-20 total scores between admission and discharge (Jeandarme et al., 2017).

Similar non-significant findings were reported in the studies of Longdon et al. (2018)

and Nitschke et al. (2020).