Child and Adolescent Needs and Strengths (CANS) - Allegheny County Assessment Tool
CANS is an assessment tool developed to assist in the management and planning of services to children and adolescents and their families with the primary objectives of permanency, safety, and improved quality in of life. It’s a national tool that has been used to varying degrees in other markets primarily for decision support and service planning, quality improvement and outcomes monitoring.
The CANS is conducted as a conversation and is designed to integrate and communicate information from multiple sources. CANS works to empower persons at every level of the system to collaboratively identify and address the most important needs facing children and families, and to capitalize on their strengths.
The CANS is an “anti-form.” Rather than being a passive instrument for a single person to complete, it is a tool that prompts the CANS assessor to gather and integrate information from multiple sources. Given the diverse and complex nature of the children’s service system, the CANS is a uniform repository of information that allows for input from across different child serving agencies.
Information from the CANS is used to inform the planning process and help to set goals, objectives and strategies to meet needs in a strengths-based manner. Information from the CANS is also used to support decisions about level of care, intensity of services, and placement.
The CANS key principles
- Items in an assessment are selected because they are each relevant to service/treatment planning. An item exists because it might lead down a different pathway in terms of planning actions.
- 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.
- Ratings describe the child, not the child in services. If an intervention is present that is masking a need but must stay in place, then that is factored into the rating (resulting in the rating of “actionable” need, i.e. 2 or 3).
- 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/or chronological age depending on the item.
- The ratings are generally considered “agnostic as to etiology.” In other words, the CANS is a descriptive tool-- It is about the “what” not the “why.”
- A 30-day window is used for ratings in order to make sure assessments stay “fresh” and relevant to the child or youth’s present circumstances. However, the action levels can be used to override the 30-day rating period.
CANS core domains
CANS is comprised of seven core domains. These domains reflect the different aspects that make up one’s life and vision.
- Life Functioning: This domain relates to the activities and relationships that are a part of everyday life including family, school, and health.
- Youth Strengths: This domain relates to a child’s resources and assets. These are the positive things in the child’s life that can be used to promote healthy development and positive outcomes.
- Caregiver Strengths & Needs: This domain refers to areas in which the caregiver may need assistance or support in their caregiving role/responsibilities while simultaneously highlighting the areas in which the caregivers can be a resource for the child.
- Culture: This domain relates to the youth’s adjustment to the primary culture in which they live, including factors such as language barriers or barriers that prevent the practice of their beliefs. Culture is broadly defined to include, but not limited to race, ethnicity, sexual orientation, religion, age, gender, socio-economic status, etc.
- Youth Behavioral/Emotional Needs: This domain refers to the symptoms and/or behaviors that a child may display. This is intended to capture “what” is occurring and not the reasons “why” it is occurring.
- Youth Risk Behaviors/Factors: This domain relates to whether or not the child currently behaves in ways that could prove to be dangerous to him/herself or others.
- Trauma Experiences: This domain focuses on the child’s exposure to potentially traumatic/adverse childhood experiences over their lifetime.
CANS - Allegheny County Forms and Manuals
CANS Comprehensive Long Form - Allegheny County
CANS Comprehensive Short Form - Allegheny County
CANS Comprehensive - Allegheny County manual and user guide
Suggestions for using conversation to complete the CANS
History of the CANS – Allegheny County Assessment Tool
In 2008, as part of the Improving Outcomes for Children and Families in Allegheny County Initiative, staff from the DHS Offices of Behavioral Health; Child, Youth and Families; and Mental Retardation/ Developmental Disabilities (now Intellectual Disability) and the Executive Office partnered with Dr. John Lyons, young adults, caregivers and local staff from the juvenile justice system, to create an Allegheny County version of the CANS Comprehensive.
By November 2009, a working draft of the CANS Comprehensive – Allegheny County was being tested through trainings and simulated use. Feedback from diverse users was considered as the tool was adjusted and further customized for local needs. (See Yes we CANS!, DHS News, November, 2009)
The CANS Comprehensive – Allegheny County and CANS Short Form - Allegheny County were released in October 2010. Its use was promoted first with providers of children’s mental health services.
The CANS and ANSA became part of the DHS Advancing Integration efforts of late 2012 and beyond.
Questions should be addressed to Robin Orlando at Robin.Orlando@AlleghenyCounty.US or Shauna Lucadamo at Shauna.Hines-Lucadamo@AlleghenyCounty.US in the DHS Executive Office.