Issues regarding the clinical use of the Classification of Violence Risk (COVR) assessment instrument

The MacArthur Study of Mental Disorder and Violence produced an instrument for classifying hospitalized psychiatric patients according to their risk of behaving violently following discharge. The instrument, Classification of Violence Risk (COVR) has been computerized and is now commercially available to clinicians. A validation study performed by the original researchers showed that when the instrument was applied to a new sample of patients, it demonstrated a considerable reduction in positive predictive power. Potential factors affecting the instrument's accuracy in applied settings are reviewed. It is concluded that, until additional research clarifies uncertainty about the instrument, clinicians would do well to be very cautious in utilizing COVR results to make judgments as to violence risk, particularly when the test results suggest a high risk of future violence.