What is the Child and Adolescent Needs and Strengths (CANS) Assessment
The Child and Adolescent Needs and Strengths (CANS) is a behavioral health evaluation and outcomes measurement tool (see Screeners, Evaluations, Questionnaires, Measures, and Surveys – Oh My! The differences between these five behavioral health assessment tools and when to use them for value-based care). The CANS is used to identify the strengths of children, adolescents, and young adults. It also identifies their needs in order to provide them with the support they need to reach their full potential. This tool is used in schools, social services, and other organizations that work with children and young adults. The CANS is a structured assessment that provides a framework for service planning and decision-making for children and adolescents. It is also used during quality assurance monitoring to support the process of validating that systems are working as planned.
What types of questions are asked on a CANS assessment?
Each question on the CANS asks about the current level of need, development of strength or skill, experience of trauma, or history of behavior for the child and the child’s caregivers. The eight types of questions are listed below. Questions are rated as 0, 1, 2, 3 where ratings of 2 or 3 identify an area to address in care. For strengths and skill, ratings of 0 & 1 indicate an area of strength and skill to recognize and celebrate.
Types of questions on the CANS:
- Child and adolescent areas of need.
- Child and adolescent areas of strength or skill.
- Child an adolescent traumatic experiences.
- Child and adolescent history of past behaviors.
- Caregiver areas of need.
- Caregiver areas of resource (i.e., strengths or skills that could benefit the child).
- Caregiver traumatic experiences.
- Caregiver history of past behaviors.
I heard that the CANS is a Communimetric. What is a communimetric?
The CANS is designed to be collected as a communimetric. A communimetric is method in which the rating of a metric is identified through communication. Each question on the CANS is designed to be answered via a conversation about that area. The conversation could take place as a contextual interview between the professional worker certified to perform the CANS and the family, child and support individuals (e.g., teachers, peer counselors, family advocates, therapists), where appropriate. Not every member need be included in the discussion of every area identified on the CANS.
The method is to perform a contextual interview and cover every topic identified by the CANS. The CANS acts as a checklist of areas that should be included in a contextual interview. The collection of information is conversational, and participants of the conversation talk through the area to come to an agreement on the rating level for that area. Here is an example conversation that might take place as part of a contextual interview to rate a communimetric.
How do you gain consensus through a communimetric? Here is an example:
Clinician: So I would like to talk now about your feelings of anxiety. How would you describe your level of anxiety?
Child: I am fine. I would say my anxiety is a 0.
Father: Remember when you had that math test in school the next day? What happened the night before?
Child: Well, I guess I was worried.
Father: Yes, you were. What happened?
Child: Well, I guess I didn’t eat dinner.
Father: Yes, what else.
Child: I don’t remember.
Father: What did you do to your hand that day?
Child: I guess I cut it.
Clinician: Did you do it accidentally?
Child: I wanted to forget about the test, I guess. It felt better when I did it. Then, I stopped worrying about the test.
Clinician: Do you think that has something to do with the pressure you felt about the test?
Child: I guess so.
Clinician: Anxiety can be like a pressure we feel. It might feel like a pressure to stop thinking about something, to get hyper or to shut down. But when feel so much pressure that we act in ways that hurt ourselves, that can be a concern. When we have a worry that makes us feel hyper or shut down a little, that is a 2. When we feel hyper or shut down a lot, that is a 3.
Child: I guess so.
Father: So what do you think about your anxiety?
Child: I guess I am a 2.
Clinician: I would agree.
Father: Me too.
How does a communimetric differ from capturing multiple opinions ("voices") on the assessment?
Some assessments require a method that is called “triangulation”. This means that the assessment might capture the opinion of the child, the clinician and the caregiver separately without having the conversation described above. Without that communication, the child would have rated themselves a 0 for anxiety, the clinician may have said 1, and the father may have said 3. Often times the average is taken as the final score, which is a 1.33 in that case. The true rating that all the members agreed on after coming to consensus through communication was 2. Building this consensus helps everyone understand the true circumstances and get on the same page. It helps the care team, the child and the caregivers come to an agreement on where to focus in care.
Why is it important to foster communication with families?
The communication that takes place as part of a communimetric measure is important because the relationships are strengthened between people when they interact with each other in ways when shared meaning is formed. Agreeing on the rating creates shared meaning among the participants of the conversation. When a child shares their needs with their caregivers, they feel more confident in communicating what they need, which can lead to better outcomes in their future. A benefits of communicating about a child’s strengths is that it helps them develop self-esteem and feel more confident when they are doing things. The benefits of this type of communication strengthens these relationships around a child and can lead to ongoing increased communication, decreased anxiety, and the potential for increased satisfaction in life for the child.
What are some ways to Share the CANS assessments with the child and family?
Once the contextual interview is complete and all areas of the CANS have been marked or ruled out as an area to be addressed, the results is a completed initial CANS assessment. For each area to be addressed, an intervention can be identified in the care plan. It is helpful to organize a care plan in this way as it breaks up the family work into bite sized pieces that are tied to specific actions and goals, as seen in the family care plan from Opeeka’s P-CIS below (https://www.knechted.digital/opeeka/for-behavioral-social-care-providers/). P-CIS breaks all assessments up into up to four types of family reports, depending on the types of areas covered. the first two reports listed below are described in the subsequent sections. The caregiver reports are formatted in a similar fashion to the child reports.
What are the four types of family reports?
- Child Needs Report
- Child Strength Report
- Caregiver Needs Report
- Caregiver Resources Report
The Child and Adolescent Needs and Strengths (CANS): Child Needs Family Report
The needs report below from P-CIS is a initial child needs family report. The child strengths report is generated separately in P-CIS so that it can be a focal point of a meeting, if desired. The needs report does not contain any reminders of the traumatic areas or past behaviors that may have been discussed. It focuses on only the focal needs that can be addressed during care. It identifies each area where the care team and family agreed that there was a need to address during care, and it identifies the approach to address those needs. It includes white space for the family to capture their own thoughts, notes or drawings. This signifies to the family that their their opinions and voice are valued in care.
The Child and Adolescent Needs and Strengths (CANS): Child Strengths Family Report
The strengths report below from P-CIS (https://www.knechted.digital/opeeka/for-behavioral-social-care-providers/) is a progress report for child strengths. The child needs report is generated separately in P-CIS so that it can be a focal point of a meeting, if desired. The strengths report contains definitions of each of the CANS strengths to help the family understand the concepts of each skill. It identifies strengths to build and celebrates strengths present.
What are reasons to share the CANS assessment results with the family?
Sharing the CANS assessment with the family using the four types of CANS Family Reports can provide several benefits during the care process, as listed below.
- Sharing the CANS Child Needs Report memorialized the agreement that the family achieved for identifying shared concerns. This helps solidify shared meaning and common goals for the family members and the care team, building trust through agreement.
- Sharing the CANS Child Strengths Report reminds the family of the strengths that are already present for the child. This builds self-confidence in the child and helps the caregivers locate child strengths to call upon during times when the child is struggling.
- Sharing the CANS Child Needs Report with Notes helps the family remember the care plan and goals. During times of stress, memory is challenged for caregiver and child alike. Interventions and homework discussed during care may not be easy to recall for families days after an appointment due to the high level of stress families in care are often experiencing.
- Sharing the CANS Child Strengths Report after updates are made through re-assessment helps the family recognize progress on strengths and resilience factors that are building.
- Sharing the CANS Caregiver Report helps caregivers recognize the role they play in the child’s recovery and helps the caregivers recognize where they have strengths that could benefit their child.
What are reasons to share the CANS assessment results with the family?
The Child and Adolescent Needs and Strengths is a communimetric assessment tool that facilitates a shared understanding of areas for focus during care. The tool acts as a checklist to help structure a contextual interview with the child and family so that all commonly important areas are addressed during evaluation and tracked as outcomes during re-assessment over time. In this way, the CANS assessment is multi-faceted instrument offering value to both evaluation and outcomes measurement. Sharing the needs and strengths identified on the CANS can be a valuable way to reinforce collaboration with the family during care. The shared understanding of care plan facilitates efficiency during care. Furthermore, sharing the reports after re-assessment helps the family and care team celebrate progress and reach for goals in care. In alignment with the tenet of “nothing about me without me,” sharing promotes caring and trust in care.