Risk assessments

Here at the hospital, we make every effort to assess risks. Since the introduction of risk assessments at a national level, we have seen a clear decrease in recidivism. We carefully identify the risk factors and protective factors applicable for all of our clients. We use the HCR-20 tool for risk factors and (Structured Assessment of PROtective Factors) for protective factors; SAPROF is a tool that we have developed ourselves. We also develop risk assessments for specific target groups, such as women () and sex offenders (the Static and Stable). In the spring of 2013, the long awaited revision of the HCR-20 will be published: the HCR:V3. We have translated and edited this tool for the Dutch situation in collaboration with researchers from other institutions. The use of risk assessment tools enables us to predict and manage the risks applicable for patients upon their reintegration into society with an ever greater degree of reliability. Repeated risk assessments and continual academic research show the effectiveness of risk assessments too. This makes it even more possible to make well-founded pronouncements about whether or not treatment influences risk factors and whether or not this results in a reduction of the risk of recidivism. All of this contributes to a safer society.


The need for specific treatment for women who commit violent offences has increased in recent years. This is why we have developed the FAM (Female Additional Manual), a risk assessment tool aimed specifically at women in addition to the HCR-20 / HCR:V3.

Some risk factors for violence committed by women are clearly different to those for men. The FAM includes nine specific risk factors for women and additional guidelines have also been formulated for five HCR-20 items. The first research project conducted on the FAM, in relation its reliability and predictive value, is promising. The FAM is now being used broadly at an international level too and a number of studies are being carried out on the tool.

On the website www.violencebywomen.nl more information can be found on violence risk assessment and psychopathy in women and recent research results from a Dutch multicentre study into characteristics in female forensic psychiatric patients.

The FAM can also be used as an addition to the HCR-20V3 (see for more information below).

Read more about FAM:
Coding scheme
HCR - V3 20


The SAPROF (Structured Assessment of PROtective Factors) has emerged from a need expressed by healthcare professionals. They wanted to be able to measure the positive results ensuing from treatment and use these in risk assessments. The structured assessment of violence-related protective factors contributes to a reduction in recidivism. The SAPROF was developed at the Van der Hoeven Kliniek for this purpose; it identifies protective factors. Examples of protective factors are: a stable network, a course or job and a relationship. The tool is now being used broadly both nationally and internationally.

The latest research results prove that the combination of SAPROF with a tool for risk factors makes it easier to predict recidivism; both in the short and long term. Results show that when a patient has a reasonable to large number of protective factors, the likelihood of his reversion to violent behaviour is four times smaller than if there were just a few protective factors. This likelihood is 10 times smaller for the short term. The SAPROF also provides for predictive values during treatment and, as a result, offers points of reference for the formulation of treatment objectives. The tool also makes it possible to measure changes that occur during treatment that are predictive of violence recidivism after treatment. As such, protective factors have been found to reduce the risk of recidivism and, by doing this, contribute to safety.

For more information about SAPROF, see www.saprof.com.

Van der Hoeven Kliniek is onderdeel van De Forensische Zorgspecialisten