THE CHILD AND ADOLESCENT NEEDS AND STRENGTHS (CANS)
WHAT IS CANS?
The CANS is an open domain tool that is free for anyone to use. There is a community of people who use the various versions of the CANS and share experiences and additional items and supplementary tools.
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
The Child and Adolescent Needs and Strengths (CANS) is a multi-purpose tool developed for children’s services to support decision making, including level of care and service planning, to facilitate quality improvement initiatives, and to allow for the monitoring of outcomes of services. Versions of the CANS are currently used in 50 states in child welfare, mental health, juvenile justice, and early intervention applications.
A comprehensive, multi-system version exists as well. The CANS was developed from a communication perspective so as to facilitate the linkage between the assessment process and the design of individualized service plans including the application of evidence-based practices. The CANS is easy to learn and is well liked by parents, providers and other partners in the services system because it is easy to understand and does not necessarily require scoring in order to be meaningful to an individual child and family. The way the CANS works is that each item suggests different pathways for service planning.
There are four levels of each item with anchored definitions; however, these definitions are designed to translate into the following action levels (separate for needs and strengths)
RESEARCH
SIX KEY COMPONENTS OF A COMMUNIMETRIC TOOL
- Items are selected based on relevance to planning.
- Action levels for all items
- Consider culture and development before establishing the action level
- Agnostic as to etiology—descriptive, no cause and effect
- About the child, not about the service. Rate needs when masked by interventions.
- Specific ratings window (e.g. 30 days) can be over-ridden based on action levels
Decision support applications include the development of specific algorithms for levels of care including treatment foster care, residential treatment, intensive community services, and traditional outpatient care. Algorithms can be localized for sensitivity to varying service delivery systems and cultures. The applications of CANS-based decision algorithms have documented dramatic impacts on service system. In Illinois, use of a simple decision model for residential treatment resulted in savings of approximately $80 million per year in residential treatment in the late 1990’s. In Philadelphia, their use of a decision model for Treatment Foster Care reduced lengths of stay dramatically and saved the city $11 million in the first year of use.
In terms of quality improvement activities, a number of settings have utilized a fidelity model approach to look at service/treatment/action planning based on the CANS assessment. A rating of ‘2’ or ‘3’ on a CANS needs suggests that this area must be addressed in the plan. A rating of a ‘0’ or ‘1’ identifies a strength that can be used for strength-based planning and a ‘2’ or ‘3’ a strength that should be the focus on strength-building activities.
Finally, the CANS can be used to monitor outcomes. This can be accomplished in two ways. First, items that are initially rated a ‘2’ or ‘3’ are monitored over time to determine the percent of youth who move to a rating of ‘0’ or ‘1’ (resolved need, built strength). Or, dimension scores can be generated by summing items within each of the dimensions (Problems, Risk Behaviors, Functioning, etc). These scores can be compared over the course of treatment. CANS dimension scores have been shown to be valid outcome measures in residential treatment, intensive community treatment, foster care and treatment foster care, community mental health, and juvenile justice programs.
The CANS has demonstrated reliability and validity. With training, any one with a bachelor’s degree can learn to complete the tool reliably, although some applications require a higher degree. The average reliability of the CANS is 0.75 with vignettes, 0.84 with case records, and can be above 0.90 with live cases. The CANS is auditable and audit reliabilities demonstrate that the CANS is reliable at the item level. Validity is demonstrated with the CANS relationship to level of care decisions and other similar measures of symptoms, risk behaviors, and functioning.