Protective factors for violence risk in forensic psychiatric patients: A retrospective validation study of the SAPROF

The Structured Assessment of PROtective Factors for violence risk (SAPROF) has recently been developed as a strengths-based addition to the assessment of risk for future violent behavior (de Vogel, de Ruiter, Bouman, & de Vries Robbé, 2009). Following the Structured Professional Judgment (SPJ) model, the positive and predominantly dynamic factors in the SAPROF were designed to counterbalance the assessment of risk as measured by risk assessment instruments, such as the HCR-20. The present retrospective study provides a first validation of the SAPROF in a Dutch sample of 126 forensic psychiatric patients. Analyses showed good interrater reliability, good predictive validity for non-recidivism of violence after clinical treatment for both the SAPROF total score and the SAPROF Final Protection Judgment and good predictive validity for violent recidivism for a combined HCR-20 - SAPROF total score. The predictive validity of the combined HCR-20 - SAPROF measure significantly outperformed the predictive validity of the HCR-20 in this study. Repeated assessments of the same patients over time demonstrated a significant improvement of SAPROF scores during treatment. Overall, the results provide evidence for the relationship between the presence of protective factors and non-recidivism of violence and for the additional value of protective factors in the assessment of risk for future violence. Moreover, the sensitivity of SAPROF scores to change provides support for the usefulness of the instrument in planning and evaluating treatment interventions.