![](https://sites.northwestern.edu/cans/files/2017/12/pexels-photo-278303-137coqd.jpeg)
These ratings are made based on lifetime exposure of trauma.
For Trauma Experiences, the following categories and action levels are used:
0 | indicates a dimension where there is no evidence of any trauma of this type.
1 | indicates a dimension where a single incident of trauma occurred or suspicion exists of trauma experiences.
2 | indicates a dimension on which the child has experienced multiple traumas or a moderate degree of trauma.
3 | indicates a dimension which describes repeated and severe incidents of trauma with medical and physical consequences.
NU Quick Tip
This domain rates cumulative lifetime trauma experiences and should be rated at the highest level of trauma experienced regardless of when the trauma occurred. Over time, these scores may increase or stay the same but will never decrease.
1. Sexual Abuse
This rating describes the child’s experience of sexual abuse.
0 | There is no evidence that child has experienced sexual abuse.
1 | There is a suspicion that the child has experienced sexual abuse with some degree of evidence. This could include evidence of sexually reactive behavior as well as exposure to a sexualized environment or Internet predation. Children who have experienced secondary sexual abuse (e.g. witnessing sexual abuse, having a sibling sexually abused) also would be rated here.
2 | Child has experienced one or more incidents of sexual abuse but this abuse was not chronic or severe. This might include a child who has experienced molestation without penetration on a single occasion.
3 | Child has experienced severe or chronic sexual abuse with multiple episodes or lasting over an extended period of time. This abuse may have involved penetration or multiple perpetrators.
2. Physical Abuse
This rating describes the child’s experience of physical abuse.
0 | There is no evidence that child has experienced physical abuse.
1 | There is a suspicion that child has experienced physical abuse but no confirming evidence. Spanking without physical harm or threat of harm also qualifies.
2 | Child has experienced a moderate level of physical abuse and/or repeated forms of physical punishment (e.g. hitting, punching).
3 |Child has experienced severe and repeated physical abuse with intent to do harm and that causes sufficient physical harm to necessitate hospital treatment.
3. Emotional Abuse
This rating describes the degree of severity of emotional abuse, including verbal and nonverbal forms.
0 | There is no evidence that child has experienced emotional abuse.
1 | Child has experienced mild emotional abuse. For instance, child may experience some insults or is occasionally referred to in a derogatory manner by caregivers.
2 | Child has experienced moderate degree of emotional abuse. For instance, child may be consistently denied emotional attention from caregivers, insulted or humiliated on an ongoing basis, or intentionally isolated from others
3 | Child has experienced significant emotional abuse over an extended period of time (at least one year). For instance, child is completely ignored by caregivers, or threatened/terrorized by others.
4. Neglect
This rating describes the severity of neglect.
0 | There is no evidence that child has experienced neglect.
1 | Child has experienced minor or occasional neglect. Child may have been left at home alone with no adult supervision or there may be occasional failure to provide adequate supervision of child.
2 | Child has experienced a moderate level of neglect. This may include occasional unintended failure to provide adequate food, shelter, or clothing with corrective action.
3 | Child has experienced a severe level of neglect including prolonged absences by adults, without minimal supervision, and failure to provide basic necessities of life on a regular basis.
**LOOK OUT**
The CANS definition of Neglect only includes lack of basic life necessities. These include food, shelter, clothing, and supervision. If the trauma does not fit into one of these four categories, it should not be scored under Neglect. For example, this item would not be rated because a caregiver is missing the child’s doctor well visits. This differs from the DCFS definition of neglect because it does not cover as many categories.
5. Medical Trauma
This rating describes the severity of medical trauma.
0 | There is no evidence that child has experienced any medical trauma.
1 | Child has experienced mild medical trauma including minor surgery (e.g. stitches, bone setting).
2 | Child has experienced moderate medical trauma including major surgery or injuries requiring hospitalization.
3 | Child has experienced life threatening medical trauma.
6. Witness to Family Violence
This rating describes the severity of exposure to family violence.
0 | There is no evidence that child has witnessed family violence.
1 | Child has witnessed one episode of family violence.
2 | Child has witnessed repeated episodes of family violence but no significant injuries (i.e. requiring emergency medical attention) have been witnessed.
3 | Child has witnessed repeated and severe episodes of family violence or has had to intervene in episodes of family violence. Significant injuries have occurred and have been witnessed by the child as a direct result of the violence.
7. Community Violence
This rating describes the severity of exposure to community violence.
0 | There is no evidence that child has witnessed or experienced violence in the community.
1 | Child has witnessed occasional fighting or other forms of violence in the community. Child has not been directly impacted by the community violence (i.e. violence not directed at self, family, or friends) and exposure has been limited.
2 | Child has witnessed the significant injury of others in his/her community, or has had friends/family members injured as a result of violence or criminal activity in the community, or is the direct victim of violence/criminal activity that was not life threatening, or has witnessed/experienced chronic or ongoing community violence.
3 | Child has witnessed or experienced the death of another person in his/her community as a result of violence, or is the direct victim of violence/criminal activity in the community that was life threatening, or has experienced chronic/ongoing impact as a result of community violence (e.g. family member injured and no longer able to work).
8. School Violence
This rating describes the severity of exposure to school violence.
0 | There is no evidence that child has witnessed violence in the school setting.
1 | Child has witnessed occasional fighting or other forms of violence in the school setting. Child has not been directly impacted by the violence (i. e. violence not directed at self or close friends) and exposure has been limited.
2 | Child has witnessed the significant injury of others in his/her school setting, or has had friends injured as a result of violence or criminal activity in the school setting, or has directly experienced violence in the school setting leading to minor injury, or has witnessed ongoing/chronic violence in the school setting.
3 | Child has witnessed the death of another person in his/her school setting, or has had friends who were seriously injured as a result of violence or criminal activity in the school setting, or has directly experienced violence in the school setting leading to significant injury or lasting impact.
9. Natural or Manmade Disasters
This rating describes the severity of exposure to either natural or man-made disasters.
0 | There is no evidence that child has been exposed to natural or man-made disasters.
1 | Child has been exposed to disasters second-hand (i.e. on television, hearing others discuss disasters). This would include second-hand exposure to natural disasters such as a fire or earthquake or manmade disaster, including car accident, plane crashes, or bombings.
2 | Child has been directly exposed to a disaster or witnessed the impact of a disaster on a family or friend. For instance, a child may observe a caregiver who has been injured in a car accident or fire or watch his neighbor’s house burn down.
3 | Child has been directly exposed to a disaster that caused significant harm or death to a loved one or there is an ongoing impact or life disruption due to the disaster (e.g. house burns down, caregiver loses job).
10. War Affected
This rating describes the severity of exposure to war, political violence, or torture. Violence or trauma related to terrorism is not included here.
0 | There is no evidence that child has been exposed to war, political violence, or torture.
1 | Child did not live in war-affected region or refugee camp, but family was affected by war. Family members directly related to the child may have been exposed to war, political violence, or torture; family may have been forcibly displaced due to the war. This does not include children who have lost one or both parents during the war.
2 | Child has been affected by war or political violence. He or she may have witnessed others being injured in the war, may have family members who were hurt or killed in the war, and may have lived in an area where bombings or fighting took place. Child may have lost one or both parents during the war or one or both parents may be so physically or psychologically disabled from war so that they are not able to provide adequate caretaking of child. Child may have spent extended amount of time in refugee camp.
3 | Child has experienced the direct effects of war. Child may have feared for his/her own life during war due to bombings or shelling very near to him/her. Child may have been directly injured, tortured or kidnapped. Child may have served as soldiers, guerrilla or other combatant in his/her home country.
11. Terrorism Affected
This rating describes the degree to which a child has been affected by terrorism. Terrorism is defined as “the calculated use of violence or the threat of violence to inculcate fear, intended to coerce or to intimidate governments or societies in the pursuit of goals that are generally political, religious, or ideological.” Terrorism includes attacks by individuals acting in isolation (e.g. sniper attacks).
0 | There is no evidence that child has been affected by terrorism or terrorist activities.
1 | Child’s community has experienced an act of terrorism, but the child was not directly impacted by the violence (e.g. child lives close enough to site of terrorism that he/she may have visited before or child recognized the location when seen on TV, but child’s family and neighborhood infrastructure was not directly affected). Exposure has been limited to pictures on television.
2 | Child has been affected by terrorism within his/her community, but did not directly witness the attack. Child may live near the area where attack occurred and be accustomed to visiting regularly in the past, infrastructure of child’s daily life may be disrupted due to attack (e.g. utilities or school), and child may see signs of the attack in neighborhood (e.g. destroyed building). Child may know people who were injured in the attack.
3 | Child has witnessed the death of another person in a terrorist attack, or has had friends or family members seriously injured as a result of terrorism, or has directly been injured by terrorism leading to significant injury or lasting impact.
12. Witness/Victim to Criminal Activity
This rating describes the severity of exposure to criminal activity. Criminal behavior includes any behavior for which an adult could go to prison including drug dealing, prostitution, assault, or battery.
0 | There is no evidence that child has been victimized or witnessed significant criminal activity.
1 | Child is a witness of significant criminal activity.
2 | Child is a direct victim of criminal activity or witnessed the victimization of a family or friend.
3 | Child is a victim of criminal activity that was life threatening or caused significant physical harm or child witnessed the death of a loved one.
**LOOK OUT**
This item includes not only offenses for which someone was arrested, but also offense that someone could be arrested for. For example, a child who was the victim of corporal punishment would be rated here even if the abuser was not arrested. Corporal punishment is battery and is an arrest-able offense.
13. Parental Criminal Behavior
Birth parents & legal guardians only. This item rates the criminal behavior of both biological and stepparents, and other legal guardians, not foster parents.
0 | There is no evidence that youth’s parents have ever engaged in criminal behavior.
1 | One of youth’s parents has a history of criminal behavior but youth has not been in contact with this parent for at least one year.
2 | One of youth’s parents has a history of criminal behavior resulting in a conviction or incarceration and youth has been in contact with this parent in the past year.
3 | Both of youth’s parents have history of criminal behavior resulting in incarceration.