What is CANS? Child and Adolescent Needs and Strengths Casey Family Programs & Idaho Department of Health and Welfare presents What is CANS? Child and Adolescent Needs and Strengths The Copyright for all versions of the CANS (Child and Adolescent Needs and Strengths) Information Integration Tool are held by the Praed Foundation to ensure that it remains an open domain tool, free for anyone to use. Information on guidelines for use and development can be obtained by contacting the Praed Foundation at praedfoundation@yahoo.com or visit the website at www.praedfoundation.org.

What Will We Discuss Today? Why do we need an assessment for youth being served by Child and Family Services? What is CANS? What is the Casey Family Programs CANS and what is different on the Idaho CANS? Why will we be using CANS? What is youth- and family-centered practice? How can you participate with CANS? Where can you get more information?

Why Do We Need an Assessment? It provides a comprehensive picture of what a youth’s needs and strengths are and informs the service planning process. It helps create a shared vision or common goal of what everyone wants for a youth and family. The information collected and shared provides direction to all members of the team. Planning for a youth requires substantial decision-making, and should be guided by evidence of needs and strengths. A comprehensive assessment tell us what outcomes we should look for over time. In order for multiple professionals, youth and families to work together toward better outcomes there must be a common goal. CANS offers a framework for gathering information about youth and family needs and strengths that inform the planning process. Once a shared vision is reached, there is clear direction of what outcomes are expected and the resources needed to be effective.

1 2 3 Three Types of Assessments Youth and family self-report Provider report Collaborative completion – CANS 2 3 Identify the three different types of assessments that identify youth and family information. CANS is unique in that everyone’s information is captured in one consolidated place.

What is CANS? Child and Adolescent Needs and Strengths Identifies needs and strengths so both are included in a youth’s planning. A functional assessment designed for youth ages 0-26 years old. Functional assessment: Captures current functioning to have an accurate picture of areas of needs and strengths; past behaviors are captured but are not actively addressed in current planning. The CANS can be tailored to best fit the system using it. The Copyright for all versions of the CANS (Child and Adolescent Needs and Strengths) Information Integration Tool are held by the Praed Foundation to ensure that it remains an open domain tool, free for anyone to use. Information on guidelines for use and development can be obtained by contacting the Praed Foundation at praedfoundation@yahoo.com or visit the website at www.praedfoundation.org. Research has shown that increasing a youth’s strengths (regardless of how many needs they have) leads to better outcomes so at Casey we are committed to strengthening children and families so they can have successful lives.

What is the Idaho CANS? Idaho is in the process of customizing our CANS to specifically meet the needs of the children, youth, and families we serve. The Idaho CANS will include robust trauma and parental substance abuse domains. Each item is rated on a simple 4-point scale: 0, 1, 2, and 3 To make sure the CANS is used correctly, providers must be both trained and certified to use the CANS. Refer people to the rating sheet to see all 9 domains and corresponding scales and items. Be prepared to answer specific questions about what the items and/or rating scales mean and how they are used. Bring your own reference guide to read any item that a person has a question about. Be sure to stress that the trauma domain captures information over the course of a child’s lifetime so that information can help as we plan for a child’s care. Please stress that this domain does not say anything about how the trauma experience(s) affects the child today.

What Do the ‘0’ to ‘3’ Ratings Mean? 0 = represents best possible functioning or a significant strength 1 = functioning or strength is okay, but we should keep an eye on it 2 = a moderate degree of functioning impacted or limited strength, and action is needed 3 = a severe degree of functioning impacted or no strength, and immediate and/or intensive action is needed Here is a very global way to think about what each rating communicates about any particular item in the needs or strengths domains. The needs scale and the strength scale are both action-based. The trauma scale indicates frequency and severity but is not action-based – it is a lens for understanding the aspects of intervention and planning. Be sure to note that the scale is used per item and there is not an overall summary score.

EXPOSURE TO POTENTAILLY TRAUMATIC/ ADVERSE CHILDHOOD EXPERIENCES DOMAIN

EXPOSURE TO POTENTAILLY TRAUMATIC/ ADVERSE CHILDHOOD EXPERIENCES DOMAIN

Key Features of the CANS CANS integrates a lot of information and communicates it simply. It is flexible and can be completed in any order. It is not an interview format with questions and answers. Information can be collected from many sources. For most items, it describes how youth and families are doing currently – it looks at the last 30 days. Each item rating translates immediately into an action. There is no complicated scoring needed or overall summary score. Everyone on the team can understand whether something should be done for each item based on how it is rated. It creates a shared language that is easy for anyone to understand – even children – use examples that would resonate with families. Kids get that when you say it is a 0 that means it is great and when you say it is a 3 that means it is really not working/good and we need to take quick action to help. CANS allows for information to be collected over the natural course of engagement rather than as an item inventory. A person can obtain immediate results, (e.g., action or no action) with no need for scoring. Because of all these properties, the tool is easily understood by all the people involved.

Key Features of the CANS It focuses on what is happening and not why. This is important so that everyone keeps a focus on what is happening because we can’t always know why it is happening. Focusing on the why can create feelings of embarrassment or blame for youth and families, which is not helpful to anyone. It always takes into account a youth’s development and his or her culture to provide the most accurate information for planning. Youth and families should see a draft copy of the CANS and inform the ratings before it is finalized.

Using CANS in a Team Can . . . Engage everyone as a full partner. Include everyone’s voices and hopes for the youth. Reduce gossip or past stories that are not currently relevant. Help clarify where people are coming from. Create a meeting agenda focused on the specific needs and strengths of a youth and family. Streamline the process of planning and check-ins. Increase accountability. CANS is useful in keeping the focus on youth and families and thus these are the benefits to the work and team.

Why is Idaho Using CANS? CANS is a youth and family- friendly tool that makes youth and family the center of the work. It is a comprehensive tool that captures a youth’s current needs and strengths with simple, straightforward language. It gives youth and families an opportunity to be full partners in the work.

Why is Idaho Using CANS? It helps social workers put all of the information in one place and allows them to share it easily with youth, family, and other providers to best help the youth and family. It guides the social worker in making decisions about what to focus on, how to prioritize service needs, and the strengths a youth has, as well as which ones to help develop.

Why is Idaho Using CANS? It is purposefully direct and clear. It has simple ratings per item so all important people in the youth’s life can understand and communicate about his or her needs and strengths. It helps youth and families understand the recommendations that providers make for treatment.

Why is Idaho Using CANS? It can be used to track youth and family progress over time. It helps monitor changes over time and whether the treatment is working. The information collected across youth and families will be used to inform and improve services and activities.

What is Family-Centered Practice? Youth and families engaged as full partners in care Parents and youth have greater sense of control in treatment planning Acknowledges and appreciates individual and family differences Shared goal development and planning Parents and youth as experts – immersed in family culture Helps youth and families builds skills and knowledge to anticipate and prepare for future challenges Make a comparison between this approach and when providers are totally in control of making decisions. Sometimes that can create a feeling of mandate for youth and families – If someone makes you do something it can create resentment versus if you are in control.

What Does Research Tell Us? Involving family and youth in the goal-setting positively influences a family’s satisfaction with care and enhances outcomes. Clear goals enhance motivation and lead to more positive outcomes (Locke & Latham, 1990). Specific, functional goals lead to the best outcomes (Ponte-Allan & Giles, 1999). Feedback about performance is necessary – celebrate success! Personal satisfaction comes with successful performance (Theodorakis, et al., 1996).

The CANS Assessment Common Questions

No; the CANS is included as a standard part of care. Can a Family or Youth Refuse the CANS Assessment? No; the CANS is included as a standard part of care. A comprehensive assessment is a requirement for service planning, and monitoring activities. Youth and families should be included in the completion of the CANS and have the right to see all CANS items completed on them.

When is a CANS Required? The recommended practice is to complete an initial CANS within 30 days of a child entering foster care or when a case is open for in-home services to prevent removal. Some jurisdictions have recommended updating CANS every 90 days to keep things current and identify what is working. A CANS should also be updated upon discharge from service or transfer to another level of care. CANS should also be updated if/when there is a significant event in the youth or families life.

What Can Families Do to Participate in CANS? Ask the social worker about CANS and the plan for completing it. Review the items included in the CANS and share details about any past or current concerns they have. Share the youth’s strengths with the social worker and the hopes they have for your youth’s and family’s future. Ask for a copy of the draft CANS to review before it is finalized.

How Can Families Participate with CANS? Ask specific questions about the CANS items, and how and why they were rated for your child. Discuss any items for which they disagree with the rating or want more information. Ask for the CANS summary report. Ask for updates on their child’s progress and the CANS ratings that reflect that progress.

Discussion What questions do you have about the CANS?

Where Can You Get More Info? Miren Unsworth or April Crosby, Idaho Department of Health and Welfare, 334-5700 Mike Scholl, Casey Family Programs (208) 377-1771 http://www.praedfoundation.org/About%20the%20CANS.htmlEmail

Summary of CANS It is required as part of standard care and will guide planning and measuring outcomes. It is comprehensive and integrates a lot of information. It focuses on both needs and strengths. Youth and family are engaged as partners and help complete it. It helps you tell your story, but reduces the need to repeat it again and again. It is an item level tool, so each item has its own rating. The ratings translate immediately into an action. The numbers allows the important people in a youth’s life to easily communicate what his or her needs and strengths are and if action is needed.

Summary of CANS It considers family culture. The focus is on the youth’s needs, not interventions that may mask the true needs. CANS creates a common starting point for case discussions. It helps provide direction for planning. There should be a connection between the ratings on the CANS and the current plan for the child. Social workers should be able to clearly explain why they are providing the kind of treatment or service based on the child’s CANS. It helps support team decisions. CANS monitors the youth’s and family’s progress.