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Children's Mental Health

CANS FAQ's

What is CANS?

CANS, or Child and Adolescent Needs and Strengths, is a comprehensive functional assessment tool developed by John S. Lyons, PhD.  The CANS is an item level tool that allows for the identification of a child's and family's strengths and needs to inform service planning activities.  The CANS is also an outcome monitoring and measurement tool that can inform various levels of the child and family serving system. 

What is the purpose of CANS?

CANS offers partners across systems an easy-to-use tool with a straightforward, common language to communicate information about child and youth needs and strengths, as well as to inform treatment decisions.  It also provides aggregate data to understand who is being served, how they are being served, their trajectory of care, and which approaches are most effective.  A practice-based implementation of CANS includes collection and sharing of data to inform actionable treatment planning as well as a comprehensive understanding of the children, youth, and families served in the public mental health system.  This will support our integrated system of care for Montana families, youth, and children. 

Is the Montana CANS Comprehensive?

Since CANS is a tool that is valid and reliable at the item level, it allows for customization.  In other words, every item on a version of CANS is included because it has relevancy to service planning.  In May 2012, state officials and key stakeholders participated in a process to customize Montana's version of CANS.  Please click here to access the Montana CANS Reference Guide.

Why is Montana using CANS?

A comprehensive implementation of the CANS tool will support cross- and inter-agency collaboration for those youth and families who are being served by multiple providers in the public system.

Does the Montana CANS support trauma-informed practice?

Yes, the impact of trauma or adverse experiences can have long term effects for individuals, families, and communities.  Research has shown that with proper understanding and targeted care, youth, families, and communities can recover from trauma and reduce its deleterious effects.  The Montana CANS offers providers a standard practice for capturing a youth's experience with trauma and the impact of that trauma.  The trauma experience information captured in CANS should be used as a lens for individualized treatment planning. 

Who is required to have a CANS assessment done?

Currently, a CANS is required for any child who is a Montana Medicaid beneficiary and enrolled in one or more of the following services Current and Proposed Services Requiring Montana CANS Administration The Montana CANS is designed for youth ranging in age from birth to twenty-one years old who are being served in the Montana Medicaid system overseen by the Montana Child Mental Health Bureau. 

When is a CANS required?

Each service has a detailed policy on the timeframes for completing a CANS on a youth.  The recommended practice is to complete an initial CANS upon admission, with updates done every 90 days.  A CANS should also be done upon discharge from service or transfer to another level of care. 

How often is a CANS required?

CANS should be updated every 90 days while a child is enrolled in a service. 

How long should it take to complete a CANS?

CANS should be seen as an information integration tool.  The information needed to complete a CANS can come from a combination of sources (e.g., case summaries, biopsychosocial information, team members, etc).  When first using CANS it can take one to two hours to collect and rate the items.  As you become more familiar with the CANS, it should take less time to use the comprehensive assessment information collected during routine clinical work to rate the items on the CANS. 

How is CANS different from other assessments?

CANS is an item level functional assessment.  When used within a Total Clinical Outcomes Management (TCOM) Framework, CANS is a data-informed decision making framework for individual, agency, and system planning.

What is the scale used in CANS?

CANS uses a 4-point, '0-3' action-oriented scale.  All items are rated based on individual item level definitions to create a common language among providers and key stakeholders, including the youth and family.  A '0' (zero) on each scale indicates best possible functioning with no evidence to support another rating. 

Is there a single summary score for a child on the CANS?

No, there is no summary score for CANS.  CANS is an item level functional assessment.  Each item is included because it impacts service planning.  The meaning of the ratings lie within the items themselves.  The items create a comprehensive picture of a youth's need and strengths, including his/her family.

What is TCOM?

Total Clinical Outcomes Management (TCOM) is a framework that facilitates and supports collaboration and communication of multiple partners serving a youth and family.  TCOM provides transparency and accountability in the shared commitment of serving family despite differences.  Quality data collected at the individual and family level is critical to informing multiple levels of the child and family serving system to ensure effective services and continuous quality improvement.

How can the CANS be used for individual planning, monitoring and outcomes measurement?

CANS is a comprehensive information integration tool comprised of items relevant to children, youth, and families in need of behavioral health services.  The data collected and shared through CANS, paints a comprehensive picture of an individual child and family.  When the CANS assessments of children and families being served are aggregated, it informs the resources, activities, and effectiveness of different levels of the child and family serving system.

Is CANS a strength-focused instrument?

CANS has a domain dedicated to communicating about and using a youth's strengths in planning.  The strengths rating scale allows providers to identify which child strengths can be used in planning and which can be focused on to build.  CANS encourages the practice of discussing strengths with children and families, as well as identifies strengths to be incorporated to encourage strength-based planning for all youth, regardless of how significant their needs may be.

Is CANS a culturally-sensitive instrument?

CANS requires that the person rating each item consider culture, including family culture, as well as activities, values, and beliefs before rating.  In addition, a domain has been included that communicates how culture-specific experience may impact a person's functioning.

Is Montana CANS appropriate for all aged children and youth?

The Montana CANS is designed for youth ranging in age from birth to twenty-one years old who are being served in the Montana Medicaid system overseen by the Montana Child Mental Health Bureau. 

What are the requirements to use CANS?

To use the Montana CANS you must be trained and certified by an approved Children's Mental Health Bureau (CMHB) CANS Trainer.  Training is offered through the Montana CMHB.  Please click here for a list of upcoming trainings.  Once trained, a person must complete a test case vignette and achieve a sufficient level of reliability (.70 or above) in order to become certified.

Can a parent or youth refuse the CANS assessment?

The CANS is included as a standard part of care.  A comprehensive assessment is a requirement for service, and Montana has included the CANS as part of intake and monitoring activities. 

When does a CANS have to be updated?

CANS offers a comprehensive, point-in-time picture that highlight a child's functioning, treatment targets, and projected function outcomes. 

What is CANS certification?

To use the CANS, you must be trained and certified.  Certification is achieved based on demonstration of CANS rating reliability (.70 or above) using evidence provided in a written case vignette.  CANS certification must be renewed annually.  Each year, certified users must complete a test case vignette and achieve a sufficient level of reliability (.70 or above) in order to continue to use the tool.  Recertification annually allows for consistent and periodic checking of reliability, which can help prevent decay of practice reliability.

Who is required to be CANS-certified?

Anyone who is completing a CANS on a child and family must be trained and certified/annually recertified. 

How do you get CANS-certified?

To use the Montana CANS you must be trained and certified by an approved Children's Mental Health Bureau (CMHB) CANS Trainer.  Training is offered through the Montana CMHB.  Please click here for a list of upcoming trainings.  Once trained, a person must complete a test case vignette and achieve a sufficient level of reliability (.70 or above) in order to become certified.

Is there a fee to use the CANS instrument?

The CANS is free to use as long as a person is trained and maintains annual recertification.  Copies of the Montana CANS Reference Guide  and the accompanying ratings sheets can be duplicated as needed.

Can agencies make additional copies of the CANS?

Copies of the Montana CANS Reference Guide and the accompanying ratings sheets can be duplicated as needed.  The CANS is free to use as long as a person is trained and maintains annual recertification.
To access the Montana CANS Reference Guide, Field Rating Sheet and other information on the CANS Program, please click here:  CANS

Who owns the CANS?

Copyrights for all versions of the CANS (Child and Adolescent Needs and Strengths) Information Integration Tool are held by the Praed Foundation to ensure that CANS 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.

Is there a fee to become CANS-certified?

To use the Montana CANS you must be trained and certified by an approved Children's Mental Health Bureau (CMHB) CANS Trainer.  Training is offered through the Montana CMHB.  Please click here for a list of upcoming trainings.  Training Calendar Once trained, a person must complete a test case vignette and achieve a sufficient level of reliability (.70 or above) in order to become certified.  CANS certification is conducted online through the Praed Foundation at www.canstraining.com.  An annual fee of $10 is required to access and use the www.canstraining.com.   Please check with your employer or the CMHB to see if this cost is reimbursable or if a pre-paid coupon code is available. 

Where do I go to get certified?

To use the Montana CANS you must be trained and certified by an approved Children's Mental Health Bureau (CMHB) CANS Trainer.  Training is offered through the Montana CMHB.  Please click here for a list of upcoming trainings. Training Calendar Once trained, a person must complete a test case vignette and achieve a sufficient level of reliability (.70 or above) in order to become certified.  CANS certification is conducted online through the Praed Foundation at www.canstraining.com.

What is the website for taking the electronic CANS certification?

CANS certification is conducted online through the Praed Foundation at www.canstraining.com.  To use the Montana CANS you must be trained and certified by an approved Children's Mental Health Bureau (CMHB) CANS Trainer.  Training is offered through the Montana CMHB.  Please click here for a list of upcoming trainings.  Once trained, a person must complete a test case vignette and achieve a sufficient level of reliability (.70 or above) in order to become certified. 

If I am already CANS-certified, do I need to take the training and certification exam?

To use the Montana CANS you must be trained and certified by an approved Children's Mental Health Bureau (CMHB) CANS Trainer.  Training is offered through the Montana CMHB.  Please click here for a list of upcoming trainings. Training Calendar Once trained, a person must complete a test case vignette and achieve a sufficient level of reliability (.70 or above) in order to become certified.  CANS certification is conducted online through the Praed Foundation at www.canstraining.com.

How often do you have to be recertified in CANS?

CANS certification must be renewed annually.  Each year, certified users must complete a test case vignette and achieve a sufficient level of reliability (.70 or above) in order to continue to use the tool.  Recertification annually allows for consistent and periodic checking of reliability, which can help prevent decay of practice reliability.  To use the CANS, you must be trained and certified.  Certification is achieved based on demonstration of CANS rating reliability (.70 or above) using evidence provided in a written case vignette.

How do I check if I am still certified?

After you create an account at http://www.canstraining.com to become certified, you have full access to the resources on the site.  You can check the date of your last certification on your Profile by clicking 'Test History', followed by 'Certificates'.  The certificate will indicate for which CANS jurisdiction you are certified and the date of certification.  You can print this and keep on file.  You will also be sent a reminder e-mail to the address in your profile before your certification expires.

Is training required to be recertified in CANS?

CANS certification must be renewed annually.  Each year, certified users must complete a test case vignette and achieve a sufficient level of reliability (.70 or above) in order to continue to use the tool.  Recertification annually allows for consistent and periodic checking of reliability, which can help prevent decay of practice reliability.

What happens if I fail the CANS certification exam?

CANS certification is done online at www.canstraining.com.  You have unlimited practice test opportunities and up to three opportunities to achieve the required reliability rating of .70 or above.  If you do not achieve .70 after three attempts the system will prompt you to contact someone for assistance.  A qualified CANS expert will review your previous attempts to identify any patterns.  We will provide you will assistance to become reliable in rating CANS.  After the review, you will be given three more opportunities.

Who can provide CANS training?

To use the Montana CANS, you must be trained and certified by an approved Children's Mental Health Bureau (CMHB) CANS Trainer.  Training is offered through the Montana CMHB. 

Who can be a CANS certification trainer?

To become a Montana CANS Certification trainer, you must achieve at least a .80 reliability score on your CANS certification and complete a training-of-the-trainer program.  There are several requirements, and participation in an ongoing coaching program is required.  You can apply to become a CANS trainer for your agency or the state of Montana.  Please click here for more information and to apply.  http://www.dphhs.mt.gov/mentalhealth/children/documents/TOTRequirements.pdf
http://www.dphhs.mt.gov/mentalhealth/children/documents/TrainerProgramApplication.pdf

Where can I find a CANS training?

To use the Montana CANS you must be trained and certified by an approved Children's Mental Health Bureau (CMHB) CANS Trainer.  Training is offered through the Montana CMHB.  Once trained, a person must complete a test case vignette and achieve a sufficient level of reliability (.70 or above) in order to become certified.  CANS certification is conducted online through the Praed Foundation -- www.canstraining.com.

Why would one become a CANS trainer?

Becoming a Montana CANS certification trainer is an opportunity to train others for certification in CANS, as well as become a CANS resource to support others in your agency who are implementing the CANS.  The demonstrated benefits of CANS indicate that using the CANS tool as a practice framework is beneficial to children and families and to the human services agency and system.

What are the requirements to be a CANS Certification trainer?

To become a Montana CANS Certification trainer, you must achieve at least a .80 reliability score on your CANS certification and complete a training-of-the-trainer program.  There are several requirements, and participation in an ongoing coaching program is required.  You can apply to become a CANS trainer for your agency or the state of Montana.  Please click here for more information and to apply.

How do I apply to be a CANS Certification trainer?

Please click here for more information about becoming a CANS certification trainer and to apply.   You can apply to become a CANS trainer for your agency or the state of Montana.  To become a Montana CANS Certification trainer, you must achieve at least a .80 reliability score on your CANS certification and complete a training-of-the-trainer program.  There are several requirements, and participation in an ongoing coaching program is required.  

How do you become a CANS trainer for your agency?

If you are interested in becoming a CANS trainer, you should discuss the requirements and participation activities with your supervisor to ensure leadership approval and support.  To become a Montana CANS Certification trainer, you must achieve at least a .80 reliability score on your CANS certification and complete a training-of-the-trainer program.  There are several requirements, and participation in an ongoing coaching program is required.  You can apply to become a CANS trainer for your agency or the state of Montana.  Please click here for more information about becoming a CANS certification trainer and to apply. 

Where is CANS data submitted?

CANS data will be entered into the Electric Montana CANS System (MCS).  CANS is intended to be shared to best serve children and families.  

Where is CANS data stored?
Electronic CANS data in the MT CANS System will be stored in secure servers at DPHHS offices in Helena.
Until an electronic MT CANS System is built, where do I send my paper CANS assessments?

Paper CANS assessments should be faxed (not emailed) to CMHB data analyst (Robin Albee) at 406-444-5913.

How do I store the paper CANS ratings sheet for an individual?

After a paper CANS is entered and finalized for a child/youth, CANS rating sheets should be stored in the individual’s secure paper case file, and/or in the Provider Agency’s EMS electronic case file.   After a paper CANS is finalized within the MT CANS system and entered in Provider Agency’s EMS,  it may be destroyed in accordance with Provider Agency’s protocols for disposal of personal health information.

How do I access the state CANS electronic data system?

When the MT CANS System is complete, providers will be able to login to the system via a secure web portal and enter and finalize CANS data for individual children and youth. 

Where CAN I learn more about CANS and its uses?

CANS is used throughout many states and jurisdictions in the U.S. and Canada as well as other places throughout the world.  For more details about the history of CANS and communimetrics, please refer to Lyons, J.S., (2009). Communimetrics:  A theory of measurement for human service enterprises. New York:  Springer.  Also visit, www.praedfoundation.org

Is the CANS a reliable and valid instrument?

There have been multiple studies to support its reliability and validity (Lyons, 2009).  CANS is valid and reliable at the item level and, therefore, allows for it to be tailored for specific jurisdictions and applications.

Who developed CANS?
The CANS family of communimetric instruments was spearheaded by John Lyons.  Over the past decade of CANS use, several individuals have contributed to the development of additional items and versions. 
How can I use CANS in treatment or service planning?

CANS is a comprehensive information integration tool in which the ratings indicate areas of need and priority.  It also indicates useful strengths and areas needing strength building.  The '2' or '3' ratings in the needs items on the CANS translate into something that is actionable and considered in planning.  The ratings of '0', '1', '2', and '3' in the CANS strength items can be used to inform the use of a youth's or family's strengths in care as well as the strength areas that need attention in the plan. 

How do I maximize CANS to promote team work and person-centered planning?

A youth's CANS summary, a list of all needs items with a rating of '2' or '3' and strengths items with any rating, can be shared with all members of the youth's team to ensure that everyone has an opportunity to inform the CANS and use the information for decision-support and person-centered planning. 

How can CANS be used to improve how I work with children, youth, and families?

CANS creates a simple, common language that is accessible to families and youth.  The action-based rating system informs planning and support decision-making. 

How can an agency use CANS to improve their work with children, youth, and families?

Agencies can aggregate their client CANS data to paint a comprehensive picture of who they serve, identify areas of needs and strengths within their client population, and to inform resources and services necessary to meet the needs of the children, youth, and families they serve.

Does the CANS need to be completed if a Wraparound Strengths, Needs and Culture Discovery is conducted?

CANS provides a comprehensive picture of the functioning of a youth with respect to his or her strengths and needs, much like the Wraparound Strengths, Needs and Culture Discovery (SNCD) practice.  All of the information gathered and summarized in a SNCD practice is congruent with the items throughout the CANS.  The CANS should be seen as a capstone or final step of information integration on a target youth after conducting a comprehensive SNCD with a family.  The domains covered in a SNCD overlaps with CANS.  The CANS also allows one to tease apart information into specific needs and strengths.  The ratings on each CANS item inform action-based planning for youth.  Over time, the CANS ratings can be used to communicate, monitor, and measure outcomes. 

Is CANS compatible with Wraparound philosophy and practice?

CANS is a person-centered practice framework.  CANS is a holistic assessment that captures a youth's and family's strengths, needs, and voice.  Research has found that Wraparound can be effective for youth with complex needs covering multiple domains (Bruns & Sutter, 2009).  CANS captures comprehensive information about a youth and family in several domains.  As with any evidence-based practice, the fidelity to the model is vital to the success of the implementation and effectiveness (e.g., McGrew, Bond, Dientzen, & Saylers, 1994).  Within a Wraparound practice model, the CANS can be used to monitor and measure youth and caregiver outcomes. 

Why is the Transition to Adulthood domain for youth 14.5 years or older but Montana statute requires transition to adulthood planning at 16.5 yrs?

CANS uses this age for TAD even when many state laws designate an older age because evidence-based research has indicated that early planning is critical to successful outcomes as youth transition to adulthood or into adult systems. In both child welfare and youth behavioral health, best practice is to start considering youth’s experiences and behaviors earlier than adult transition planning is required to start so that they are receiving the most appropriate services relative to their development and future.  It is a disservice to youth to delay planning, especially past the federally or state-mandated ages.  Part of the reason that the Montana CANS TAD domain includes a specific item about transition to adult services is because several key stakeholders identified this delayed planning as a problem that Montana wants to track and address.  The option of '0' or 'NA' is always available in this domain so that if something is not applicable to a youth, it isn’t included in communication and planning regarding that youth.

Do I have to complete the 0-5 domain if the child is older than 5 years?

If there is relevant information about a youth's development, relationships, or experience between the ages of birth through five years, regardless of his or her current age, that could inform decision-making and planning for a youth, then it should be included in the CANS 0-5 domain. 

Do I have to complete the Transition to Adulthood domain if the child is younger than 14.5 years?

If a youth is experiencing any of the Transition to Adulthood items in this domain, appropriate ratings should be included for those items impacted.  For example, if a 13-year-old youth is pregnant or parenting, this domain must be completed.  There are several other examples of youth who are younger than 14.5 years old whose planning would benefit from the ratings in this domain.

 
Page last updated: 08/01/2013