Two main formats are used to promote engagement and discussion. First, participants are provided short vignettes about a fictional patient and a copy of the HCR-20, which includes a few descriptive sentences under each of its 20 checklist items. The manual's descriptions for each item have been simplified to a few clearly written sentences to enhance understanding. In a way that models the treating team's decision making, the group then goes through each item, referring to the item descriptor each time. All attendees, both patients and staff, are asked how they would score each item and their reasons for it. Differences of opinion can often lead to heated discussions among attendees. Once everyone has expressed an opinion, a vote is taken, and the score that receives the most votes is recorded. Once all 20 items have been scored and summarized in a single table, each participant must assess the fictional patient's overall risk (high, medium, or low) and whether or not the person is ready for a short-term leave from the unit, transfer to a lower-security unit, or discharge to the community. It has been observed that the group's decisions conform very closely to the clinical team's decisions based on the same scores.