Why were these risk assessment tools developed?
All children deserve scientifically-informed assessment procedures that will improve their ability to develop and lead happy, healthy and pro-social lives. Based on decades of experience serving young antisocial children, we observed a notable gap between the vast scientific literature on risk factors related to later-life antisocial outcomes and the ability to apply this information during routine clinical practice. The tools were developed to bridge this divide under the rubric of Structured Professional Judgment so that a) at-risk children could benefit from scientifically-informed assessments, b) to increase transparency in the assessment of such children, and c) to advance scientific work in risk factor research.
How were the EARLs developed?
Each of the tools was built on gender-specific reviews of psychological and criminological risk factors and related literatures. The tools were further refined after a series of structured consultations with leading experts and practitioners with extensive experience treating children under the age of 12 with conduct problems. Version 1 of the tool for boys was published in 1998. In 1999, we began the consultation process which resulted in the publication of a Version 2 tool for boys (2001), and a Consultation, Version 1 tool for girls (2001).
Within what settings and for which populations should the EARLs be used?
The tools were originally developed for boys and girls between the ages of 6 and 11 who are thought to be at risk for engaging in future antisocial behavior. Most often, this will include children who will have had police contact resulting from their own misbehaviour (but cannot be charged with a criminal offence) and who have been referred to community-based services for assistance. The tools can be used in a range of settings including the school system, medical settings, child protection, children's mental health, police and youth justice services, private practice, and other community-based organizations. Although conceptually applicable to very young children (i.e., those 0-6 years), for the most part, the EARL-20B has been applied with clinical populations of children aged 6-11. Parallel tools for adolescents (e.g., SAVRY) and adults (e.g., HCR-20) are available for subject populations 12 years of age and over.
Why were separate tools for boys and girls created?
It would be incorrect to assume that risk factors are expressed in the same manner for boys and girls across developmental periods. Similarly, it is possible that a different set of risk factors may play an influential role in the etiology of aggression and antisocial behavior for boys versus girls, and vice versa. While many of the item headings in the EARL-20B and EARL-21G are similar, it is worth noting that each tool was based on a gender-specific review of the child psychopathology literature, and the content of each of the EARL items has been tailored to reflect differences between girls and boys in how risk factors are manifested during middle childhood.
Can the EARLs help with intervention planning as well as with risk management?
Yes. In fact, we argue that persons who use the EARL tools to identify risk have an ethical obligation to do something about it. This is one of the benefits of using a structured clinical risk assessment device. We view each item or risk factor as a starting point from where additional assessment, and ultimately, risk management can begin. The EARLs can greatly assist in the formulation of treatment plans and goal setting with parents. Although it is more common for the tools to be used by a single clinician or clinical team, we have used the tools with parents to compare clinician and parent Item scores for the purpose of reviewing discrepant "perceptions" and addressing areas of clinical concern. This provides families with a participatory role in the clinical process, in addition to gaining a better understanding of risk and risk factors.
What is the format of the EARLs?
Each tool contains 20 or 21 items (for boys and girls, respectively) that are organized under three broad sections: Child, Family, and Responsivity. Each Item is rated on a three-point scale (0-1-2; not present, possibly present, present) where a higher score represents greater risk. All factors are weighted equally to yield a total maximum score of 40 for boys, and 42 for girls. Each manual contains a one-page literature review with accompanying coding instructions for each item. Ratings are organized on a "Summary Sheet" which allows assessors to render numeric (0-1-2) ratings and red flag factors that are particularly concerning through the use of a "Critical Risk" checkbox. The Summary Sheet also provides an "Overall Clinical Judgment" rating that allows assessors to assign a global assessment of risk in addition to a notes section that can be used to justify individual ratings and to outline treatment strategies.
How much time does it take to administer the EARL?
The answer to this question depends on the amount of information one has prior to conducting the assessment. We encourage users of the tool to gather as much information as possible that is relevant to child's antisocial behavior. In addition to other sources, information from case conferences, child and parent interviews, psychological reports, school assessments, standardized clinical measures should be considered. Once this is done, an assessment can be typically performed in about 10 to 20 minutes.
Who is qualified to use the EARLs?
We state up front in each of the EARL manuals that the schemes are to be used only "by clinicians and professionals experienced in working with high-risk boys and/or girls under the age of twelve who have severe antisocial difficulties." With the requisite experience, each manual can be used successfully across a variety of domains and disciplines including children's mental health, child protection, medicine, education, law enforcement, community health, psychiatry, psychology and social work. Although not required, training from the authors is encouraged above and beyond a full reading and understanding of the manuals.
What training is available?
For an overview of training opportunities, please visit the Training page.
How do I order the EARLs?
Click here to purchase the EARLs (link to order page)
"When children come in for treatment, we are seeing the ventral region of their brain lighting up like crazy. There is a lot of activation here. After three months of treatment, we see less activation for the kids who improve with treatment ... Kids are learning to control their impulses and to regulate their emotions."
Professor Marc Lewis, Department of Human Development and Applied Psychology, University of Toronto