-Leena Augimeri, Ph.D. (et. al.)
Published in 2001, 106 pages
Early Assessment Risk List for Boys (EARL-20B) and Girls (EARL-21G)
What is the EARL-20B? The EARL-20B is a structured clinical risk assessment device that provides a comprehensive framework to evaluate 20 risk factors known to influence young children’s propensity to engage in future antisocial behavior. The device is research-based and informed by the clinical expertise of people with extensive experience treating children under the age of 12 with conduct problems.
What is the structure or format of the EARL-20B? The device contains 20 Items that are organized under three broad sections: Child, Family, and Responsivity. Each Item is rated on a 3-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. In addition to the rating column, there is also a “critical risk” column that allows clinicians to red flag factors that are particularly concerning, and an “overall clinical judgment” rating that allows assessors to assign an overall, global rating of risk.
How much time does the EARL-20B take to administer? The answer to this question depends on the amount of information one has prior to conducting an EARL-20B assessment. We encourage users of the device to gather as much information as possible that is relevant to child’s antisocial behavior. 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 15 to 30 minutes.
Are there separate coding forms, protocols, or other materials that I need to purchase to use the EARL-20B? No. We designed the device to be “self contained” so that users need only to read and understand the manual to begin performing EARL-20B assessments. A one-page blank coding form (“summary sheet”) is included in an appendix for unlimited photocopying. While not required, we do encourage users of the device to attend EARL-20B training in addition to joining a registry maintained by the authors. Information about both is contained in the manual.
Are there cutoff scores? No. We warn against the use of cutoff scores in making mechanical decisions about a child’s risk potential or with respect to treatment resource allocation. The inclusion of the “critical risk” column on the summary sheet reflects the notion that a single present factor can represent high risk and for this reason the pattern of risk variables, rather than a total score, should be assessed when making statements about risk potential.
With what population is the EARL-20B to be used? The device was developed for boys, under the age of 12, who are thought to be at risk for future antisocial behavior. The items were developed through an exhaustive search of the child psychopathology literature of children under the age 12, with a specific focus on factors that have been linked to future aggression and antisociality. 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. Devices for adolescents (e.g., SAVRY) and adults (e.g., HCR-20) are available for subject populations 12 years of age and over.
Can the EARL-20B be used with males and females? No. Realizing that the same risk factors may be expressed differently, or that other risk factors my play an important role in the etiology of aggression and antisocial behavior, we developed a separate, but parallel risk assessment device for girls: the Early Assessment Risk List for Girls (EARL-21G). The EARL-21G, while it shares a number of common Item headings with the EARL-20B, includes a specific review of the female child psychopathology literature, and much of the Item content has been tailored to reflect differences between girls and boys in how risk factors are manifested at an early age.
Can the EARL-20B help with intervention planning as well as with risk management? Yes. In fact, we argue that persons who use the EARL-20B 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 such as the EARL-20B. We view each Item or risk factor as a “starting point” from where additional assessment, and ultimately, risk management can begin. The EARL-20B assessment can greatly assist in the formulation of treatment plans and goal setting with parents. Although it is more common for the device to be used by a single clinician or clinical team, we have used the device 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 around risk and risk factors.
Who is qualified to use the EARL-20B? We state up front in the EARL-20B manual that the scheme is to be used only “by clinicians and professionals experienced in working with high-risk boys under the age of twelve who have severe antisocial difficulties.” With the requisite experience, the 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 EARL-20B manual.
Has any research been conducted with the EARL-20B? Yes. To date, four studies have been completed on the EARL-20B, Versions 1 and 2 (for more details, see www.earlscourt.on.ca). Generally speaking, the device has been found to be easy to use, clinically useful, reliable, and valid predictor of future antisocial behavior. For example, the manual describes results from a retrospective file study of 378 boys that compared EARL-20B Version 1 scores at discharge of a children’s mental health program with subsequent youth and adult criminal convictions, on average 7 years later. Children with above-median EARL-20B scores were significantly more likely to be found guilty than their lower-scoring counterparts. Subsequent research on Version 2 of the manual in child psychiatric units across Sweden by Pia Enebrink and colleagues has yielded similarly positive results with respect to the reliability and clinical utility of the device. In addition to our ongoing research on the instrument, additional studies involving the EARL-20 are currently being planned.
What is the cost of the EARL-20B? The EARL-20B manual (the only item currently required to use the instrument) is distributed by Specialized Training Services for $35.00 plus $3.00 to cover shipping and handling.
How do I order the EARL-20B? The quickest way to obtain a copy of the EARL-20B manual is to place an order through Specialized Training Services. You can order online at www.specializedtraining.com or call them at 800-848-1226.
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