Violence Risk Assessment Two broad approaches actuarial -> score sheet structured professional judgment tools -> more general hard by lawyers limitations bias only be used on population the tool has been made based on can be used alot more broadly HCR-20 REF Risk assessment Formulate risk Manage risk HCR-20 V3 historical clinical future 20 items, 3 summary risk assessment, good psychometric properties have enough support to be safe living situation personal support around them not always true such as families that don't endorse Tx will cause issue with supervision & compliance coping & stress will go back to drinking when stressed likelihood of having the risks history of violence anti-social behaviour e.g. part of gang relationship issues - intimate vs. non-intimate employment issue substance abuse hx of mental illness hx of trauma & child violence violent attitude Tx -> supervision (compliance) & response Clinical insight -> illness, need for Tx, violence risk violent ideation or intent symptoms of illness irritability affective behavioural cognitive issues around supervision & compliance RF & Risk doesn't imply risk for harm -> interns of what likelihood? DRSA -> actuarial -> risk of violence within next 24hrs 7 item tool can be easily used on the ward very intuitive