Child and Adolescent Needs and Strengths Assessment

The Child and Adolescent Needs and Strengths assessment is a comprehensive trauma-informed behavioral health evaluation and communication tool. It is intended to prevent duplicate assessments by multiple parties, decrease unnecessary psychological testing, aid in identifying placement and treatment needs, and inform case planning decisions. CANS assessments help decision-making, drive service planning, facilitate quality improvement, and allow for outcomes monitoring.

Background

The required use of an internationally recognized assessment instrument, provides a comprehensive multi-purpose tool developed for mental health services to support decision making, including selection of the level of care, recovery or treatment planning, quality improvement initiatives, and monitoring of service outcomes. The assessment tool is used to communicate the shared vision throughout the system, elevating the individual and family voice along the continuum of care. The uniform assessment serves as the psychosocial assessment, as well as a trauma screening and suicide screening tool, for all people entering community mental health services in Texas. In addition, the uniform assessment is used to determine authorization for community mental health services and the appropriate level of care recommended under Texas Resiliency and Recovery services. An array of evidence-based practices and promising practices can be personalized in each level of care to meet the individual and family needs and build upon the unique strengths of each person. Services and supports provided via the TRR model are expected to result in improved behavioral and emotional functioning.

Six Key Principles of the CANS/Communimetrics Tool

  1. The CANS rating items were chosen because they are each relevant to service planning. An item exists because it might lead down a unique pathway regarding decision-making.
  2. Each item uses a four-level rating system. These levels are designed to translate immediately into action levels. Different action levels exist for needs and strengths. For a description of these action levels, see below.
  3. Rating should describe the youth, not the youth in services. The assessment should identify what is important to the person, and what is important for the person. If the youth receives treatment, the provider should factor the needs of the youth and not how the youth behaves or responds to treatment.
  4. Culture and development should be considered prior to establishing the action levels. Cultural sensitivity involves considering whether cultural factors are influencing the expression of needs and strengths. Ratings should be completed considering the youth's developmental and chronological age depending on the item. In other words, delinquency is not relevant for a young child, but would be for an older youth. Alternatively, school achievement should be considered within the framework of expectations based on the youth's developmental age.
  5. The ratings are generally collaborative. This descriptive tool is completed in a collaborative relationship by incorporating input from the youth and parent or guardian. It's about the 'what' and not the 'why.' It doesn't explain why there might be an underlying cause or reasons.
  6. Specific ratings window (for example, 30 days) can be overridden based on action levels. A 30-day window is used for ratings to ensure assessments stay "fresh" and relevant to the youth's present circumstances. However, if there is good reason, the action levels can be used to override the 30-day rating period. During the initial assessment, the rating is based on the presenting needs that can be outside of the 30-day rating period. Additionally, if the presenting problem or the behavior happened before 30 days and is still a focus of treatment, this behavior would be rated outside of the 30-day window.

Why the CANS?

The assessment is easy to learn and is well liked by recipients, family members, providers, and other partners in the services system because it is easy to understand and is a collaborative tool. The way the CANS works is that each item suggests different pathways for recovery treatment. There are four levels of each item with anchored definitions, however, these definitions are designed to translate into the following action levels and be scored accordingly (separate for needs and strengths).

For needs:

0 = No evidence
1 = Watchful waiting/prevention
2 = Action
3 = Immediate/Intensive Action

For strengths:

0 = Centerpiece strength
1 = Strength that you can use in planning
2 = Identified strength must be built
3 = No strength identified

CANS Documents

CANS Resources