Danielle is an eight-year-old female who lives with her mother and five-year-old brother. ?She fights with her peers and doesnt have any friends. She has a very difficult time
Story:
(rate mother in caregiver domain) Fill in the answers on the form attached. Need within an hour today 7/15/22
Danielle is an eight-year-old female who lives with her mother and five-year-old brother. She fights with her peers and doesn’t have any friends. She has a very difficult time interacting with other children and has displayed significant aggressive and assaultive behaviors at school and home. It has been reported that on a few occasions this behavior has resulted in injury to others. These behaviors prevent her from being able to participate in any recreational activities. She attends a school for youth with emotional and behavioral challenges. She struggles academically and has an individual education plan (IEP) that addresses learning and behavioral needs. She has language delays characterized by limited receptive abilities and she is impulsive. Danielle has been diagnosed with ADHD, ODD, and a language-based learning disorder. The school professionals have offered multiple services to help Danielle function better at school.
Danielle’s mother describes her daughter as a “terror,” with behavior that is verbally and physically aggressive toward her displayed on a regular basis. She says she has a hard time understanding Danielle’s emotions and feelings. She also notes that Danielle’s brother is afraid of her. Frequently, Danielle doesn’t follow her mother’s directions and is defiant. When she is asked to do something, she refuses and her behavior escalates, becoming aggressive and including the throwing of objects. Danielle’s mother has expressed her concerns about being able to keep Danielle safe at home and has asked about alternative placements. She doesn’t understand why Danielle acts like she does and her discipline is not effective.
Her parents are divorced and have a difficult relationship that at times escalates to hostile arguments. When her parents were living together, arguments were constant and there were several incidents of domestic violence during which the police needed to intervene. Prior to the divorce, Danielle’s father was arrested for hitting her mother during an argument in which both children were present. Since then, whenever there are any arguments with lots of yelling, Danielle appears to go into a trance which her mother describes as ‘daydreaming’. During these times, Danielle doesn’t seem to hear or see anything that is happening around her.
Danielle’s mother has a history of alcohol abuse and is in recovery, attending meetings. She has been treated for depression for many years and is currently managing her depression with medication. Given her own struggles with her depression and the stress of dealing with Danielle’s behaviors, she has not advocated for additional services at Danielle’s school. For example, even though she attends all meetings, she never challenges the IEP team even when she believes the services in place are not working.
Both parents are employed and share physical and financial responsible for child care needs. Danielle’s relationship with her father is strong; they appear very connected. At this time, he is not able to care for her full-time because of his job as a long distance truck driver. Danielle’s father reports that when she is with him, Danielle does well. He acknowledges that his daughter is challenging due to her delays, but reports being able to manage her behaviors. He frequently goes to therapy with Danielle but is not always sure how to participate. Her therapist reports that Danielle has offered some ideas for her treatment plan and that her father is supportive but needs support himself. She like spending time with her father because they do various art projects together. She reports that doing art makes her feel better and relaxed. She hopes to be a professional artist when she grows up.
Praed Foundation 1999, 2016 Version 1.0
Date:
M F Child’s Name DOB mm/ dd/ Sex
Assessor (Print Name):
Current Service Type:
0 = Centerpiece 2 = Identified 0 = No evidence of problems 1 = Useful 3 = Not Yet Identified 1 = History, Mild
0 1 2 3 0 1 2 3 Family Strengths Developmental (1) Interpersonal Physical/Medical Natural Supports Sleep Educational Setting Family Functioning Optimism School Achievement Cultural Identity School Behavior Spiritual / Religious School Attendance Talents / Interests Sexual Development Community Life Living Situation Resilience Social Functioning Resourcefulness Decision making
CHILD BEHAVIORAL / EMOTIONAL NEEDS 0 = No evidence of problems 3 = Causing severe/ 1 = History, Watch/Prevent dangerous problems 0 = No evidence of problems 2 = Moderate Needs 2 = Causing problems, consistent with diagnosable d/o 1 = Minimal Needs 3 = Severe Needs
0 1 2 3 0 1 2 3 Psychosis Physical / Medical / Developmental Impulse / Hyper Mental Health/Substance Use Depression Supervision Anxiety Involvement with Care Oppositional Knowledge Conduct Organization Substance Use (3) Social Resources Adjustment to Trauma (2) Residential Stability Anger Control Safety
CHILD RISK BEHAVIORS 0 = No evidence of problems 2 = Recent, Act 0 = No evidence of problems 2 = Moderate Needs 1 = History, Watch/Prevent 3 = Acute, Act Immediately 1 = Minimal Needs 3 = Severe Needs
0 1 2 3 0 1 2 3 Suicide Risk Language Danger to Others (4) Tradition/Rituals Other Self-Harm (recklessness) Cultural Stress Non-Suicidal Self-Injurious Behavior Runaway (5) Sexually Problematic Behavior Delinquent Behavior (6) Modules are on the CANS 2016 Comprehensive Form
CULTURAL FACTORS
3 = Severe
Community Residential Intensive Residential
Caregiver (Planned Permanent): _________________________Relation: __________________________
LIFE DOMAIN FUNCTIONING
CAREGIVER STRENGTHS AND NEEDS (Planned Permanency Family)
CHILD AND ADOLESCENT NEEDS AND STRENGTHS – MAGELLAN CANS 2016 CORE
Please appropriate use: Initial Reassessment Transition/Discharge
yyyy Race/Ethnicity
2 = Moderate CHILD STRENGTHS
- Sheet1
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A Guide for Using the CANS with Clients and Their Families (‘Cheat Sheet’)
This cheat sheet is meant to provide the therapist and/or family members with the following: 1. A short summary of the CANS and simple explanation of CANS scores (0, 1, 2, 3)
2. Some ideas about using the CANS at the beginning of treatment – introducing the CANS and using it
to engage clients and families and keep them involved over time.
3. A client-friendly description of why it’s important to collect CANS information and some ideas on how the CANS can be used in a clinically meaningful way.
4. A one-page summary of the CANS that can be given to families (please see the final page)
Introducing the CANS & using the CANS to engage clients and their families over time:
Therapists are sometimes unsure about when and how to introduce the CANS measure to the family and how to engage family members in the process of completing the measure. Likewise they are unsure how the CANS may be used to discuss their clinical conceptualization of the case and treatment planning with the family. While there is no one way to do these things, the pointers below are meant to give the therapist ideas about how to engage the family in treatment with the use of the CANS.
With regards to timing, therapists are encouraged to introduce the CANS early in the assessment process, shortly after the family presents for treatment. The information all family members provide as part of the initial intake and assessment over time should be reflected in the CANS scores, but this can be done in a number of ways.
For example, sometimes therapists show the CANS scoring sheet and the CANS manual to the family (either with the caregiver alone and/or with the youth). If this is the case, the CANS is completed in the moment, with the family present. While this approach is optional for all therapists, it may be best when used by therapists that have experience and familiarity with the CANS; otherwise, this process could take an excessive amount of time and may be overwhelming for the family. Alternatively, the CANS may be completed by the therapist alone, or with his/her supervisor, after meeting with the family. In this case, the therapist would review the CANS scoring sheet with the family, after the CANS is scored, as a concise way of illustrating the child’s needs and strengths. Sharing the scoring sheet can be an opportunity to get the family’s feedback and to begin a discussion about treatment (e.g., Are any of these scores surprising? What are their ideas, and your ideas, about how the needs on the CANS might fit together?).
Listed on the next page are some of the greatest benefits of the CANS. These are ideas that can be shared with families to help them understand the usefulness of the CANS. Therapists should feel free to use the exact language below, or to adjust it in a way that is more natural for them, in discussing the CANS with their clients.
DECISION MAKING: Some therapists simply use their clinical intuition or their “gut” to assess and make decisions about their client’s needs and which type of treatment or therapy would work best. Therapists also sometimes use their gut to decide whether or not the treatment is helping their clients. In many therapy environments no formal assessment is conducted initially or repeated over time. This makes it difficult to plan appropriately for therapy and monitor progress in therapy in a way that can be shared with the client, families and other professionals in the child’s life.
You can use the CANS to show families how and why you made decisions regarding specific treatment goals and types of treatment interventions and why you chose to work on certain areas initially.
You can also review the CANS scores together with the family over time to see how their child’s emotional and behavioral needs change and improve.
COMMUNICATION & TRANSPARENCY: Remind the family that the CANS is a way of summarizing how the child is doing over all, across a broad range of areas so that we don’t overlook something important or spend time in therapy working on areas where the child has no problems. It also helps us recognize areas where the child is doing particularly well and has strengths – which are important for both children and caregivers to be aware of so they can be emphasized both in therapy, at home and in other settings.
In a nut shell, make sure families understand that the CANS helps you, in your role as a therapist, in the following ways:
Make sure the families you work with understand that you use the CANS because you recognize the importance of being open and transparent with them about what is going on with their child.
To see the ‘big picture,’ of a child and family’s needs – while staying focused on, and prioritizing the child’s most important needs.
To work with the child and the family to come up with ideas about how the different types of needs the child has might be related or might fit together, so that if you focus on one area you might see improvements in other related areas. Also, looking together and highlighting which areas the parents might be able to focus on at home, with guidance from the therapist.
INTEGRATING INFORMATION: The CANS is a place where all of the different information a therapist gets (from the client, the family, other professionals in the child’s life and their own professional opinion) can be integrated in one place.
By combining all of the information about a client in one place the therapist is able to get to most accurate picture of the child and see the child in a holistic way. By completing the CANS with the help of the client and others in the child’s life, the therapist learns that different people in the child’s life may have different information or even different opinions about the child’s needs.
Likewise, by completing the CANS at the beginning of therapy, and again overtime, the therapist along with caregivers will likely learn things about the child that he or she would not otherwise have known or even asked about the child.
On the following page is a simple summary of many of CANS scoring and many points made above.
This next page can be copied and shared with families.
The Child and Adolescent Needs and Strengths measure
A Brief Introduction:
Some of benefits of using the CANS, in a nutshell:
It is COMPREHENSIVE! It includes trauma-specific items and also asks about the strengths a child and family may have, which makes it pretty unique.
It INTEGRATES A LOT OF INFORMATION. It helps clinicians put all of the information they have in one place. This way a lot of information can be considered, and shared (with other professionals or family members) quickly.
It HELPS TO INFORM GOALS AND PLANS FOR TREATMENT. It guides the therapist in making decisions about what to focus on in therapy and where to start, or how to prioritize treatment.
It can be used to TRACK PROGRESS over time. If the CANS is repeatedly scored while a child is in therapy, we have a way of seeing how his or her needs and strengths change over time. A way of seeing how and if the therapy is working!
The CANS keeps things TRANSPARENT! The CANS is purposefully direct and clear. It has simple scoring so that all important people in the child’s life can review and use this measure it as a way to communicate about the child’s case.
CANS Scores – Level of Needs
0 = always stands for the best possible functioning in an area; either it means there is no “need” or
problem in a particular area.
1 = a score of 1 indicates an area that might require a little attention. It represents an area of need that
we want to keep our eye on or we may want to take some preventive measure based on anticipated
need.
2 and 3 = Scores of 2 and 3 always need attention of some type, as both indicate a significant need or a
lack of strength in a particular area. Items scored 2 and 3 should be addressed in the goals for a child’s
treatment. A score of 3 indicates a need for intensive and/or immediate attention.
CANS Scores – Level of Strengths
0 = A zero represents a significant area of strength for a child, it is the best rating a child can get in the
area of strengths.
1 = a score of 1 implies a good strength that can be made even stronger.
2 and 3 = Scores of 2 and 3 indicate a lack of strength in a particular area. A score of 2 means the child
may have some potential for a strength in this area but this strength is not developed. A score of 3
indicates that a child has no identified need in this area.
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