• “The scores from the IA-CANS are different from what I would score for the youth and family.”

Sometimes other professionals get more information about certain items than others.  What do the notes from the other professional reveal about the identified score?  Did you uncover new information that suggests a change in scoring is appropriate?  Did someone’s perspective allow you to score an item differently?

• “I have had multiple conversations with the youth’s therapist and we continue to disagree on certain scores.” 

This is an excellent opportunity to share what information you each possess to form a more complete picture of the youth and the case as a whole. It’s okay to change your item levels when new information becomes available.  Ultimately, you are responsible for choosing the best rating you can with what information you have.

• “The CANS is too long and would require too much time to review with the service providers and family all together.”

It may be helpful to focus the conversations on reviewing only actionable needs (2’s and 3’s) and usable strengths (0’s and 1’s) during the structured meeting.  The actionable needs have interventions tied to them that should be discussed.  The useable strengths should find their way into increasing the well-being of the youth.

• When scoring the CANS, consider any and all sources of information that can provide insight on the youth.
• Don’t forget to consider services the youth received prior to case opening as sources of information. These services could include previous therapists, hospitalizations, mentors, favorite teachers, etc.
• Even if there is no father figure in the child’s life at this time, don’t forget the paternal family as a source of information when scoring the CANS.
• After you receive updates or feedback from service providers on the case, use the new information to reassess item scores and make modifications that reflect the integration of new information.
• For team members who are familiar with the CANS (potentially, this could include therapists, parent coaches, caseworkers), share scores together and discuss actionable needs and usable strengths that you disagree on.
• For team members who are not familiar with the CANS (potentially, this could include family members, youth, mentors, coach, teacher) use the CANS as a starting place for discussion.
• Remember that the CANS is not a judgement of how you or your clients are doing. It is simply meant to provide a snapshot of a youth or family at a point in time. When you are integrating information, including that of the youth or family’s perspective, try to be as objective as possible. At the end of the day no one person is perfect and most of us have evident needs and strengths even when doing our best.

• “It’s difficult to gather all of the information on the youth and families that the CANS covers.”

There is a lot to learn and understand about the families that we work with.  It’s unrealistic to think that you would be able to know every bit of information about the families in one meeting.  The CANS is due within 45 days of case opening.  Use all of the time to engage the family and other professionals involved regarding the information they have gathered as well, before you fill out the CANS.

• It’s impossible to write service plan/treatment plan goals for every need and strength identified on the CANS.”

We agree.  The CANS is able to group needs and strengths for the youth we serve and for the involved adults.  It makes sense to identify what domains have needs for the children and identify services to address those needs.  For example, if there are multiple needs in the risk domain, identify safety mechanisms to ensure everyone will remain safe.  If there are multiple needs in the emotional/behavioral domain, employ supports such as counseling, building a support network, and making meaningful connections.  If there are multiple concerns with traumatic symptoms, identify trauma informed or evidence based therapies.  Each actionable item does not need its own service plan goal.  The adult section of the CANS allows you to identify needs by protective factors.  Use these factors to design your service or treatment plan. Additionally, although the CANS is meant to help inform service planning, it is a separate assessment. You absolutely and always should score based on the current needs and strengths regardless of whether you are addressing the issue with services, or if there are no services available to address that particular item(s).

• “The CANS identifies a lot of needs that other screening tools and assessments already capture.”

In the near future, some of these screening and assessment tools will be reduced or eliminated.  The CANS was instituted after these tools were already in place.  Simply put, the CANS was piled on top of what you were already doing.  Efforts are under way to undue the added burden of having you complete the same information in multiple tools.  You can expect some of the current screening tools to be eliminated and the information from those screening tools will be captured in the CANS.

• Review the SACWIS Risk Assessment. It is derived from 24 CANS items.  These items provide a great deal of information that was gathered by the investigator when there was a crises identified.  This is our “first responders” account of pertinent information.
• Most of the time actionable items should be prioritized when developing the service or treatment plan.
• Strengths can be used to mitigate needs and build resilience. But, sometimes youth like to keep their strengths separate from the trauma they experienced. It can be a place of solace.  Think through how best to use the identified strengths of the youth.
• Don’t forget that children are only returned to stable and capable parents. Creating a service/treatment plan that addresses the needs of the parents in a thoughtful manner, is a priority.

• “How do I explain why CANS scores go up on some items after services have begun?”

The initial CANS is completed within 30-45 days of the case opening.  It can be challenging to build enough trust in the 1^st month or so for the family members to disclose the “true” level of need for all CANS items.  It’s also possible that once services begin the family members address the needs head on.  This can result in CANS scores (needs) going up before they go down (needs resolved).  Finally, some items may go up as the family encounters new challenges they haven’t faced before.  Writing a solid note can give a practical explanation as to why some scores may go up during the course of services.

• “I’m worried that it reflects poorly on me when scores get worse over time.”

It’s natural to feel connected to the families that we serve.  A lot of caseworkers and therapists put everything they have into supporting the families we work with.  It can feel like their success reflects directly on what we do or do not do.  We are only a part of the helping process.  It’s more important to rate the CANS as an accurate reflection of the needs and strengths rather than to own their success or struggles.  Change and healing is not always straight progression up.  Worsening scores is an opportunity to assess and strategize.

• “How can I use CANS scores to inform my recommendations to the court?”

Okay, so the CANS can help me track changes over time and make decisions with the treatment team.  Is it possible, to use my reliable and valid CANS scores outside of the ACR and CFTM?  It is possible.  The CANS tool is becoming more and more recognized throughout the country (all 50 states use some version of the CANS).  In Illinois, the various court districts have differing levels of willingness to use tools as a basis for rulings and judgements.  We are trying to discover the best ways to introduce the CANS within court proceedings to support your training and experience.  The first step is to begin to share the tool with your families so that when it is presented to others, it’s not a complete surprise to them.

• Write clear notes for actionable items and useable strengths that any child welfare professional would be able to utilize if they become involved in the case. Often times, the notes written to support CANS ratings are very helpful to team collaboration and decision making.
• Look at each domain as a separate entity – how are the scores in that domain trending? For example, there are 11 items in the Risk domain.  Did a few of the 11 items get worse this time?  Did some item ratings change into a crises level? Do you need to address the increase in risk behaviors with an intervention or safety mechanism?
• Identify items that show no reduction over time. Consider whether or not the interventions in place are adequate to effect the desired change.
• Do not rely on the CANS as the only source of outcomes management. It is only one piece of a comprehensive outcomes management plan.

• “The tool is too subjective, how can it really support decision making?”

Caseworkers and clinicians often express that they trust most in their training, instincts, and hard earned experiences when it comes to making extremely important decisions for the families they serve. These factors, along with solid supervisory involvement, are undoubtedly important in making good decisions. Yet, no matter how skilled and experienced providers are, the process of deciding what is best for the families they serve has an element of subjectivity. A certified CANS scorer is able to use the CANS as a structure to categorize their professional opinions in a consistent and measurable manner to better support this subjective element. The CANS organizes levels of needs and strengths (ratings) into a format that can be easily shared and accurately understood by others. The CANS transforms the valuable subjective understanding of a case into reliable and valid ratings of the needs and strengths of the family.

• “No one else uses the CANS, how can I use it to support case decisions?”

Unfortunately, the CANS remains relatively unknown to some of the key decision makers within and outside of child welfare.  It is mandated that caseworkers in Illinois utilize the CANS.  It is optional for all other service providers in Illinois.  We need to begin to provide the field with information from the CANS packaged in a way that allows for the CANS to be understood and utilized to support case decisions.  As we move forward, we will be able to support the meaningful use of the CANS – first with you and then branch out to other systems.  This will be a process.

• “All ratings should be a 0 or a 1 when the case closes to justify that decision.”

This is a common misconception that can work against supporting good case decisions.  The historical trauma experiences items (1-13) never go down.  They are rated at the highest level of need so that the history of trauma is captured.  Some items can be rated as actionable at case closing, so long as there is a plan or service in place that is addressing those needs.  For example, Item 50 – Depression could be rated as a 2 upon case closing provided the child was receiving mental health services and was compliant with medications as necessary.  This should be written in the note accompanying the rating.  The CANS ratings tell the story of the family’s needs and strengths when rated accurately.  Not every family is without needs and not every need has to be resolved before the case is closed.

• Review the actionable items and useable strengths in supervision to determine if all pertinent information has been used to make case decisions.
• Identify which domains have multiple actionable items and make sure the case decisions are reflective of those grouping of needs.
• Are the youth ratings supporting increased services, decreased services or a change in service providers?
• Are the parent/caregiver ratings supporting increased services, decreased services or a change in service providers?

• “I’m not sure how to explain some of the more complex items to the family.”

If some CANS items are as not as clear as others, reach out to Northwestern’s support or those around you with CANS experience for assistance.  Put together a list of the more challenging ones and send it to us…we’ll help.

• “I don’t have time to complete the CANS with my families. It is easier to do the CANS later in my office.”

You are certainly correct in trying to manage your time effectively. There is more to do than time allows.  Sometimes during the course of your time with this family, covering the actionable items with the family may be the best you can do.

• “I don’t want to debate the rating I gave on some items with the family member.”

Disagreement can be difficult, but families may ultimately appreciate the chance to discuss with an assessor a rating that reflects observed strengths or concerns.

• “I don’t like upsetting the family when I give 2’s and 3’s on some of the Needs items.”

2’s and 3’s are not the end of the story.  It’s where they are now.  Hopefully, a good conversation will point our families in the best direction for them.

• Show the CANS and other assessment paperwork to the family. Explain in simple terms what it is and when/why you are completing it. Keep your communication honest and accurate, using common and simple language and/or diagrams.
• Use the CANS as a starting place for conversation and an opportunity to demystify the caseworker’s role in service planning and assessment. In other words, talk with the family about CANS as a justification for service recommendations!
• Determine with the family the best way to complete the CANS.
  • The CANS can be completed by the caseworker alone and then receive feedback from the family at the next visit or the CANS can be completed altogether with the family.
• Acknowledge it is difficult to share personal information with someone you don’t know well. It’s okay to let them know that likewise, it’s a little uncomfortable asking about personal items and experiences.
• Take your time… if you feel like engaging the family with the CANS is a good use of your time, the family is more likely to feel the same.