Child and Adolescent Needs and Strengths (CANS) Assessment
Many Rivers... One Ocean...
“Although there are many story tellers in people’s lives there is still just one person, and it is their story. The goal is to represent a commonly understood story that integrates the perspectives of all story tellers. Just as there are many rivers (story tellers) there is ultimately one ocean (the person’s story). The process of integrating many rivers into one ocean – or many perspectives into one story owned by the person who is living it – is person-centered. This integration of stories is, simply, good care.” (Lyons, 2019)
The CANS Tools and Practice Guidelines
CANS Practice Guidelines and Use in Epic (April 2024).pdfStrengths Rating
A strength is a characteristic of a child or youth in the environment that describes a situation that promotes meaning and well-being in his/her/their life.
Needs Rating
A need is a characteristic of a child or youth in the environment that describes a situation in which external assistance could improve his/her/their well-being.
Engaging Child/Youth Clients and Families in the CANS Assessment
This includes recommendations on how to engage child/youth clients in therapeutic assessment using the CANS through integration of Therapuetic Assessment (TA) principles; and expressive arts, story-telling, and narrative therapy.
CANS-SF Case Formulation and Planning Worksheet.pdfThe CANS Priorities for Treatment aims to strengthen the storytelling aspects of helping our clients. It helps inform case formulation and treatment planning based on CANS ratings of needs and strengths.
The Alameda TCOM Collaborative built a site rich with tools that can help you make the most of the TCOM, CANS and ANSA assessment tools. It contains many new tools, tip sheets, and information to help enhance your assessment work.
Mapping it out with CANS-Y-LAND
CANS-Y-LAND is a step by step process of how the CANS is used at the Child Guidance Resource Centers (CGRC). Based on a popular board game, Candyland, CANS-Y-LAND aims to add transparency and help everyone know what is next in their “rainbow road” of care. On the map, you will see stopping points, connection points, road blocks, and maybe even bridge crossings.
Using the CANS and CalAIM Problem List in Care Planning with Clients
CANS-Informed CalAIM Problem List and Care Planning (Rubio, 2023).pdf
Review CANS items and equivalent ICD-10 codes
After completing the CANS Assessment, use the crosswalk document below to check if the CANS items you have rated as actionable (2 or 3) have an equivalent ICD-10 code
Social Determinants of Health (SDOH)-related ICD-10 Z codes range from Z55-Z65. Many CANS items are reflected in these Z codes.
Use the Z-Codes list above to identify SDOH affecting your client that are not captured by the CANS, but later decided to be included in the Problem List.
2. Complete CANS Priorities for Treatment Worksheet
This is a case formulation and care planning tool in Avatar that you can complete to organize and prioritize CANS items for treatment and services.
Priorities for Treatment Needs often include behavioral presentations and impairments in functioning. Many of these CANS items have equivalent ICD-10 F and Z codes (see cross-walk).
Background Needs can include CANS items related to Social Determinants of Health (SDOH): Z codes ranging from Z55-Z65.
In collaboration with your child/youth clients and their families, discuss and decide which Priorities for Treatment Needs and Background Needs will be the focus of interventions.
3. Complete the Problem List
The Problem List reflects the focus of treatment and/or the plan for care/services.
Include in here ICD-10 codes reflective of the CANS Priorities for Treatment Needs and Background Needs (i.e., the SDOH factors), that you have decided, in collaboration with your client, to be the focus of interventions or services.
You can also include ICD-10 codes that were not captured in the CANS assessment (see list).
4. Plan for Care/Services
Include interventions appropriate to address CANS Priorities for Treatment Needs.
Recommend and/or link the client to community resources that can help address Social Determinants of Health (i.e., the CANS Background Needs). This can also involve coordinating care with a case manager.
Document the plan in a progress note; which should provide an accurate picture of the client’s condition, treatment provided, and response to care at the time the service was provided. Ongoing goals are part of the documentation.
The section above includes some San Francisco resources you can use to help clients address some SDOH factors.
Meaningful Use of the CANS Video Training
The Meaningful Use of the CANS Video Training, was developed in conjunction with the CCTASI Regional CANS-Trauma Consortium. The training is broken out into 5 Learning Areas demonstrating how the CANS tool can be meaningfully incorporated into child welfare practice. This training is intended to engage the audience in a discussion about how to make the CANS more meaningful in practice and is meant for use in professional development training to support caseworkers, casework supervisors, and other service providers. You will find below the training slides for each of the 5 learning areas, with embedded video demonstrations or role plays.
Note: Download the modules as PowerPoint slides first so the video recordings will play
Trauma-Informed Practice with the CANS Trauma Module
The Center for Child Trauma Assessment, Services & Interventions (CCTASI) hace created these resources to help service and treatment providers in translating a child's CANS scores into meaningful applications for caregivers, youth, and providers. The resources were designed to highlight information about a child and family's needs and strengths, service planning recommendations and even concrete treatment goals.
Note: Scroll to bottom of website for all presentations and videos
This presentation provides an overview of using the CANS-Trauma in treatment planning and trauma-informed clinical practice.
Includes video demonstrations of how to use the CANS in trauma-informed client engagement, psychoeducation and treatment planning.
Demonstrates the use of CANS Data Reports to assist with client engagement and psychoeducation.
CANS Data Reflection Tools and Guides
We have used story-telling approaches to motivate an effective and meaningful use of CANS data among our clinical and data personnel.
One approach is to ask reflection participants to look at data as a storyboard. When we see data, we tend to approach it by asking questions such as, ‘What do the numbers mean?’ or ‘Where are the statistically significant improvements?’ Using a Storyboard Approach, one can instead ask questions that we customarily use around stories: ‘What’s the story here?’, ‘Who are the protagonists in this story?’, ‘Are there antagonists?’, ‘What are the conflicts in this story?’, ‘What are the resolutions to the conflicts?’, 'What does this story make you feel?' or ‘How does the story end?’
Another approach is to integrate the use of sandtray therapy, in itself an expressive arts story-telling intervention used by many clinicians who work with children and youth. Using a Sandtray Approach, one can look at the data as if it were a sandtray story, and ask sandtray processing questions such as: ‘What is the title of this story?’, ‘What is happening in here?’, ‘Are you, your client, or your program in this scene? Can you show me where?’, ‘Where is the energy here?’ or ‘What has the most power in here?’
We have noticed that using these approaches have augmented the engagement of many of our clinicians around CANS data.
Data Reflection Slide Deck
1. CANS Data Reflection Assist Workshop (DRAW; Rubio, 2023).pdf
Other Resources on the CANS
When used as part of the CFT process, as California is doing, the CANS Assessment can help guide conversations among CFT members about the well-being of children and youth, identify their strengths and needs, inform and support care coordination, aid in case planning activities, and inform decisions about placement.
This website provides information about three tools supported by the Foundation. You will find copies of manuals and answers to frequently asked questions. A video clip from a training website is also provided as an overview. In addition, a powerpoint presentation of the TCOM approach is provided.
Community Data Roundtable uses implementation science to build systems of value in child welfare and behavioral health. We implement Total Clinical Outcomes Management (TCOM) programs, drawing together local stakeholders, families and experts to monitor system performance.
Transformational Collaborative Outcomes Management (TCOM) is an approach grounded in a philosophy of a single shared vision–helping people achieve their health and wellness goals as they navigate healthcare, child welfare, juvenile justice, behavioral health, education, and other complex systems.