The Adult Needs and Strengths Assessment (ANSA) is a multi-purpose tool developed for adult’s behavioral health 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. The ANSA is currently used in a number of states and Canada in applications hospitals, emergency departments, psychosocial rehabilitation programs, and ACT programs. 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 ANSA 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 original version, the Severity of Psychiatric Illness (SPI), was created in the 1990’s to study decision-making in psychiatric emergency systems. The ANSA expands on the concepts of the SPI to include a broader description of functioning and include strengths with a recovery focus.
The ANSA 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 does not necessarily require scoring in order to be meaningful to an individual and his/her family. The way the ANSA 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)


The ANSA is an open domain tool that is free for anyone to use. There is a community of people who use the ANSA and share experiences and additional items and supplementary tools.



For needs:

a. No evidence
b. Watchful waiting/prevention
c. Action
d. Immediate/Intensive Action

For strengths:

1.Centerpiece strength
2. Strength that you can use in planning
3. Identified-strength-must be built
4. No strength identified


Decision support applications include the development of specific algorithms for levels of care including psychiatric hospitalization and intensive community services, and traditional outpatient care. Algorithms can be localized for sensitivity to varying service delivery systems and cultures.
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 ANSA 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 ANSA 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. ANSA dimension scores have been shown to be valid outcome measures in hospital, partial hospital, psychosocial rehabilitation, and intensive community services.
The ANSA 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 ANSA is 0.75 with vignettes, 0.86 with case records, and can be above 0.90 with live cases. The ANSA is auditable and audit reliabilities demonstrate that the ANSA is reliable at the item level. Validity is demonstrated with the ANSA relationship to level of care decisions and other similar measures of symptoms, risk behaviors, and functioning.




Here you will find the forms and manuals for the different versions of the ANSA tools that are available out there in the us and in the world.
ANSA Placeholder



The Child and Adolescent Needs and Strengths (ANSA) tool is an assessment strategy that is designed to be used for decision support and outcomes management. Its primary purpose is to allow a system to remain focused on the shared vision of serving children and families, by representing children at all levels of the system. In other words, program and system management can function focused on the best interests of the children and families served if care managers have accurate information about the needs and strengths of the children in the system. Since the Illinois Department of Children and Family Services has made improvement in the awareness and treatment of trauma a priority, the IDCFS version of the ANSA includes items from the ANSA-Trauma Experiences and Adjustment tool developed in collaboration with sites of the National Child Traumatic Stress Network. Thus, this version of the ANSA is also intended to remind everyone in the system about the importance of trauma experiences and their possible effects.
The ANSA is a ‘communimetric’ measure, developed from communication theory rather than psychometric theory. Most other measures used for outcomes management purposes were developed from psychometric theories. There are a number of implications of this difference in measurement design; the primary difference is the use of action trumps to correspond to the individual needs and strengths items. For needs: 0 indicates no evidence, no need for action 1 indicates watchful waiting/prevention 2 indicates action 3 indicates immediate/intensive action For strengths 0 indicates a centerpiece strength, something so powerful it can be the focus of a strength-based plan 1 indicates a useful strength 2 indicates that a potential strength has been identified but must be developed 3 indicates no strength has been identified The ANSA is also unique in that: 1. It is about the child not about the service. If a child is receiving services that are masking a need, this is factored into the ratings. A hyperactive child on stimulants is still rated a ‘2’ as long as you have to work to control symptoms with medications. 2. You consider culture and development before you establish the action levels. It is in this way that cultural sensitivity is embedded into the ANSA and how it can be useful across the developmental trajectory of childhood and adolescence. 3. It is ‘agnostic’ as to etiology. With the exception of two items (traumatic grief and adjustment to trauma), there are no assumptions of cause and effect. The ANSA is intended to be descriptive. The occurrence of the behavior, not the reason for it, is all that is considered. 4. It uses a 30-day window unless otherwise specified. Action levels may ‘trump’ this window. If something happened 45 days ago that is relevant to current service planning, this is factored into the ratings. In addition, since the ANSA is designed at an item level, it is possible to create a tailored version to any specific purpose. A number of standard versions exist, but several states including Indiana, Tennessee and Virginia have made modifications of the tool to fit their specific information needs and child serving culture.
There is a large body of research demonstrating that the ANSA is reliable both in training and field applications. Unlike most of assessments, ANSA completed in the field can be audited for accuracy. The audit reliability of the ANSA has been reported to be 0.85. In order to be certified in the ANSA, you must demonstrate reliability on a case vignette of 0.70 or greater. Case vignettes, due to their inherent brevity and vagueness, have the lowest reliability. The validity of the ANSA has been demonstrated with its correlation with other measures and with its demonstrated ability to identify children and youth who will benefit through placement in different programs and levels of care. The face validity has been demonstrated through its utility in communicating with family members and judges about the needs and strengths of children.
You can use the CANS as an active component of treatment planning. When you initiate a treatment planning process, you can use a recently completed CANS to guide the planning process. Any need items on the CANS which have been rated a ‘2’ or ‘3’ should be addressed in the treatment plan. Strength items rated ‘0’ or ‘1’ can be used for strength-based planning while those rated ‘2’ or ‘3’ should be addressed through strength identification and building activities. When you are monitoring whether a plan was successful or needs to be adjusted a recently completed CANS will tell you whether needs have been resolved and strengths created. A CANS can be used to celebrate successes with the youth. Many agencies have embedded the CANS directly into their planning processes. In these applications that needs rated ‘2’ or ‘3’ automatically population the plan document (along with strengths rated ‘0’ or ‘1’). The plan then must address all identified needs and develop strategies to utilize existing strengths.
The CANS is intended to be a communication tool. You can use the CANS to facilitate communication and consensus within your treatment team by sharing the ratings with the team and ensuring that all members are in agreement with the assessment. Discussions about agreement on how the child’s needs and strengths are described provides the foundation for agreement about what approaches to take to address those needs and identify and build strengths. The CANS items will become the language by which these issues are discussed.
The CANS is designed to be used for decision support (e.g. treatment planning, level of care), quality improvement, and outcomes monitoring activities. The Mental Health Services & Policy Program is establishing a ‘Superuser’ program to support both the effective use of the web-based training and to enhance agencies’ potential to utilize CANS data for quality improvement activities. If you are interested in participating in this program, please contact us.
Different versions of the CANS are used in nearly every state, and in nearly every continent. In the U.S., statewide applications exist in Alabama, Florida, Iowa, Massachusetts, Mississippi, New Jersey, New York, and Tennessee, West Virginia, Wisconsin. Virginia Oregon, and Nevada are launching state-wide applications in 2008.
The CANS is an open domain tool that is free to use. The copyright is held by thePraed Foundation in order to maintain its intellectual integrity. A very large number of individuals including professionals, parents, and youth have participated in the creation of the various CANS tools. Training and certification is required for the use of the CANS.
There are a number of books that provide comprehensive description of the history and development of the CANS approach including : Lyons, JS (2004). Redressing the Emperor: Improving our children’s public mental health services system. Praeger, Westport CT. Lyons, JS & Weiner, DA (EDS) (2008). Strategies in behavioral healthcare : Total Clinical Outcomes Management. Civic Research Institute, New York Lyons, JS (2009) Communimetrics: A measurement theory for human service enterprises. New York, Springer.