The Child and Adolescent Needs and Strengths (CANS) tool is an assessment strategy that is designed to be used for decision support and outcomes management. Its primary purpose is to allow a system to remain focused on the shared vision of serving children and families, by representing children at all levels of the system. In other words, program and system management can function focused on the best interests of the children and families served if care managers have accurate information about the needs and strengths of the children in the system.

Since the Illinois Department of Children and Family Services has made improvement in the awareness and treatment of trauma a priority, the IDCFS version of the CANS includes items from the CANS-Trauma Experiences and Adjustment tool developed in collaboration with sites of the National Child Traumatic Stress Network. Thus, this version of the CANS is also intended to remind everyone in the system about the importance of trauma experiences and their possible effects.

The CANS is a ‘communimetric’ measure, developed from communication theory rather than psychometric theory. Most other measures used for outcomes management purposes were developed from psychometric theories. There are a number of implications of this difference in measurement design; the primary difference is the use of action trumps to correspond to the individual needs and strengths items.

 

For needs:

0 indicates no evidence, no need for action

1 indicates watchful waiting/prevention

2 indicates action

3 indicates immediate/intensive action

 

For strengths

0 indicates a centerpiece strength, something so powerful it can be the focus of a strength-based plan

1 indicates a useful strength

2 indicates that a potential strength has been identified but must be developed

3 indicates no strength has been identified

 

The CANS is also unique in that:

1. It is about the child not about the service. If a child is receiving services that are masking a need, this is factored into the ratings. A hyperactive child on stimulants is still rated a ‘2’ as long as you have to work to control symptoms with medications.

2. You consider culture and development before you establish the action levels. It is in this way that cultural sensitivity is embedded into the CANS and how it can be useful across the developmental trajectory of childhood and adolescence.

3. It is ‘agnostic’ as to etiology. With the exception of two items (traumatic grief and adjustment to trauma), there are no assumptions of cause and effect. The CANS is intended to be descriptive. The occurrence of the behavior, not the reason for it, is all that is considered.

4. It uses a 30-day window unless otherwise specified. Action levels may ‘trump’ this window. If something happened 45 days ago that is relevant to current service planning, this is factored into the ratings.

 

In addition, since the CANS is designed at an item level, it is possible to create a tailored version to any specific purpose. A number of standard versions exist, but several states including Indiana, Tennessee and Virginia have made modifications of the tool to fit their specific information needs and child serving culture.

There is a large body of research demonstrating that the CANS is reliable both in training and field applications. Unlike most of assessments, CANS completed in the field can be audited for accuracy. The audit reliability of the CANS has been reported to be 0.85. In order to be certified in the CANS, you must demonstrate reliability on a case vignette of 0.70 or greater. Case vignettes, due to their inherent brevity and vagueness, have the lowest reliability.

The validity of the CANS has been demonstrated with its correlation with other measures and with its demonstrated ability to identify children and youth who will benefit through placement in different programs and levels of care. The face validity has been demonstrated through its utility in communicating with family members and judges about the needs and strengths of children.

You can use the CANS as an active component of treatment planning. When you initiate a treatment planning process, you can use a recently completed CANS to guide the planning process. Any need items on the CANS which have been rated a ‘2’ or ‘3’ should be addressed in the treatment plan. Strength items rated ‘0’ or ‘1’ can be used for strength-based planning while those rated ‘2’ or ‘3’ should be addressed through strength identification and building activities.

When you are monitoring whether a plan was successful or needs to be adjusted a recently completed CANS will tell you whether needs have been resolved and strengths created. A CANS can be used to celebrate successes with the youth.

Many agencies have embedded the CANS directly into their planning processes. In these applications that needs rated ‘2’ or ‘3’ automatically population the plan document (along with strengths rated ‘0’ or ‘1’). The plan then must address all identified needs and develop strategies to utilize existing strengths.

The CANS is intended to be a communication tool. You can use the CANS to facilitate communication and consensus within your treatment team by sharing the ratings with the team and ensuring that all members are in agreement with the assessment. Discussions about agreement on how the child’s needs and strengths are described provides the foundation for agreement about what approaches to take to address those needs and identify and build strengths. The CANS items will become the language by which these issues are discussed.

The CANS is designed to be used for decision support (e.g. treatment planning, level of care), quality improvement, and outcomes monitoring activities. The Mental Health Services & Policy Program is establishing a ‘Superuser’ program to support both the effective use of the web-based training and to enhance agencies’ potential to utilize CANS data for quality improvement activities. If you are interested in participating in this program, please contact us.

Different versions of the CANS are used in nearly every state, and in nearly every continent. In the U.S., statewide applications exist in Alabama, Florida, Iowa, Massachusetts, Mississippi, New Jersey, New York, and Tennessee, West Virginia, Wisconsin. Virginia Oregon, and Nevada are launching state-wide applications in 2008.

The CANS is an open domain tool that is free to use. The copyright is held by thePraed Foundation in order to maintain its intellectual integrity. A very large number of individuals including professionals, parents, and youth have participated in the creation of the various CANS tools. Training and certification is required for the use of the CANS.

There are a number of books that provide comprehensive description of the history and development of the CANS approach including :

Lyons, JS (2004). Redressing the Emperor: Improving our children’s public mental health services system. Praeger, Westport CT.

Lyons, JS & Weiner, DA (EDS) (2008). Strategies in behavioral healthcare : Total Clinical Outcomes Management. Civic Research Institute, New York

Lyons, JS (2009) Communimetrics: A measurement theory for human service enterprises. New York, Springer.