CANS Preschool Windsor

STATE OF MAINE

CHILD AND ADOLESCENT NEEDS AND STRENGTHS:

PRESCHOOL COMPREHENSIVE VERSION

(CANS-PC)

Manual*

Praed Foundation

Copyright 1999 - 2012

John S. Lyons, Ph.D.,

Endowed Chair of Child and Youth Mental Health Research

University of Ottawa

Children’s Hospital of Eastern Ontario

401 Smyth Road, R1118

Ottawa, ON

(613)864-4940

Praed Foundation

550 N. Kingsbury Street, #101

Chicago, Illinois 60654

The CANS PRESCHOOL Ontario Comprehensive version combines items from the Cans Preschool Ontario, the CANS Autism profile and the Wisconsin Department of Children and Families Version 12-7-10. This version was compiled by a working group at Children First, Windsor, Ontario.

Lee Andrews,M.S.W., R.S.W.

Kamal Haffar, M.C.S.P., R.PT.

Kathleen Hofmans, Ph.D., C. Psych

Giavana Jones, M.S., M.A.

For further information about this version, please contact the CANS working group at:

Children First

3295 Quality Way, Suite 102

Windsor, ON N8T 3R9

519-250-1850

*

CANS PRESCHOOL COMPREHENSIVE(CANS-PC) Scoring Form*

GENERAL INFORMATION (Please print clearly):

Child’s Name: ______DOB: ______Gender: □M □ F

CF File # ______Scored form to be attached to which report? □ Intake □ Discharge □IFSP# ____

Date(s) CANS-POC Completed: ______Primary Service Area: □ MH □ Dev □ CCC

Completed by: Staff (Print Name): ______

Completed by: Family/Caregivers: ______ Relationship to child: ______

Who else participated in this CANS-POC: ______ Relationship to child: ______

Was an additional CANS-POC completed? □ Y □ N

If so, with whom? Name: ______Relationship to child: ______

KEY:0 = no evidence or no reason to believe that the rated item requires any action.

1 = a need for watchful waiting, monitoring, or possibly preventive action; mild history.

2 = a need for action. Some strategy is needed to address the problem/need; moderate need.

3 = a need for immediate or intensive action. This level indicates an immediate safety concern

or a priority for intervention; severe need.

A. LIFE DOMAIN FUNCTIONING: / 0 / 1 / 2 / 3 / 0= no need;
1= watchful waiting;
2= need for action;
3= need for immediate action / 0 / 1 / 2 / 3
1. / Family / 8. / Communication
2. / Living Situation / 9. / Medical[1]
3. / Preschool/Childcare/School / 10. / Physical
4. / Social Functioning / 11. / Sleep
5. / Recreation/Play / 12. / Relationship Permanence
6. / Developmental[2] / 13. / Autism Spectrum[3]
7. / Motor
B. CHILD BEHAVIOURAL/EMOTIONAL NEEDS: / 0 / 1 / 2 / 3 / 0= no need;
1= watchful waiting;
2= need for action;
3= need for immediate action / 0 / 1 / 2 / 3
14. / Attachment / 20. / Impulsivity/Hyperactivity
15. / Regulatory / 21. / Oppositional
16. / Failure to Thrive / 22. / Adjustment To Trauma[4]
17. / Depression/Sad / 23. / Aggressive Behaviour
18. / Anxiety/Worry / 24. / Intentional Misbehaviour
19. / Atypical Behaviour[5]
C. REGULATORY FUNCTIONING: / 0 / 1 / 2 / 3 / 0= no need;
1= watchful waiting;
2= need for action;
3= need for immediate action
25. / Eating
26. / Elimination
27. / Sensory Reactivity
D. RISK FACTORS: / 0 / 1 / 2 / 3 / 0= no need;
1= watchful waiting;
2= need for action;
3= need for immediate action / 0 / 1 / 2 / 3
28. / Birth Weight / 33. / Parent/Sibling Problems
29. / Pica / 34. / Maternal Availability
30. / Prenatal Care / 35. / Self-Harm
31. / Labour/Delivery / 36. / Abuse/Neglect
32. / Substance Exposure
E. CAREGIVER NEEDS: / 0 / 1 / 2 / 3 / 0= no need;
1= watchful waiting;
2= need for action;
3= need for immediate action / 0 / 1 / 2 / 3
37. / Physical / 40. / Developmental
38. / Mental Health / 41. / Safety
39. / Substance Use
F. ACCULTURATION: / 0 / 1 / 2 / 3 / 0= no need;
1= watchful waiting;
2= need for action;
3= need for immediate action / 0 / 1 / 2 / 3
42. / Language / 45. / Cultural Stress
43. / Identity / 46. / Cultural Differences[6]
44. / Ritual
G. CAREGIVER STRENGTHS & NEEDS: / 0 / 1 / 2 / 3 / 0=strength;
1=some need;
2=moderate need;
3=severe need / 0 / 1 / 2 / 3
47. / Supervision/Discipline/
Behaviour Support / 55. / Parental Responsiveness
48. / Involvement / 56. / Caregiver Resourcefulness
49. / Empathy for Child / 57. / Understanding of Impact of own Behaviour on Child
50. / Organization / 58. / Knowledge of Rights & Responsibilities
51. / Social Resources / 59. / Knowledge of Service Options
52. / Residential Stability / 60. / Knowledge
53. / Access to Childcare
54. / Family Stress
H. CHILD STRENGTHS: / 0 / 1 / 2 / 3 / 0= centerpiece strength;
1= useful;
2= identified;
3= not identified / 0 / 1 / 2 / 3
61. / Family / 65. / Persistence
62. / Extended Family / 66. / Curiosity
63. / Interpersonal / 67. / Peer Relationships
64. / Adaptability
Are optional modules included withcompletion of this CANS-POC? ( If so, please attach) / ⧠ Y ⧠ N
Is a comment page included with this CANS-POC? ( If so, please attach) / ⧠ Y ⧠ N
OPTIONAL MODULES / CF File #: ______
Child’s Name: / Date CANS-POC Completed:
I. DEVELOPMENTAL MODULE (OPTIONAL) / 0 / 1 / 2 / 3 / 0= no need;
1= watchful waiting;
2= need for action;
3= need for immediate action / 0 / 1 / 2 / 3
68. / Cognitive / 74. / Coordination
69. / Self-Care/Daily Living / 75. / Vision and Hearing
70. / Attention / 76. / Receptive Language
71. / Decision-making / 77. / Expressive Language
72. / Gross Motor / 78. / Speech Sound Production
73. / Fine Motor / 79. / Gestures
J. AUTISM MODULE (OPTIONAL) / 0= no need;
1= watchful waiting;
2= need for action;
3= need for immediate action
Communication: / 0 / 1 / 2 / 3 / Maladaptive Behaviours: / 0 / 1 / 2 / 3
80. / Augmented Communication / 83. / Repetitive Behaviours
81. / Social/Pragmatic Use of Language / 84. / Restricted Interests
82. / Stereotyped Sound Output / 85. / Exploitation
86. / Flight Risk
K. TRAUMA MODULE (OPTIONAL) / 0 / 1 / 2 / 3 / 0= no need;
1= watchful waiting;
2= need for action;
3= need for immediate action / 0 / 1 / 2 / 3
87. / Sexual Abuse / If Sexual Abuse:
88. / Physical Abuse / 97. / Emotional Closeness
89. / Emotional Abuse / 98. / Frequency
90. / Neglect / 99. / Duration
91. / Medical Trauma / 100. / Force
92. / Natural Disaster / 101. / Reaction Disclosure
93. / Witness Family Violence / Adjustment:
94. / Witness Community Violence / 102. / Affect Regulation
95. / Witness/Victim Crime / 103. / Re-experiencing
96. / Traumatic Grief/Separation / 104. / Avoidance
105. / Increased Arousal
106. / Numbing
L. MEDICAL MODULE (OPTIONAL) / 0 / 1 / 2 / 3 / 0= no need;
1= watchful waiting;
2= need for action;
3= need for immediate action / 0 / 1 / 2 / 3
107. / Life Threat / 111. / Impairment in Functioning
108. / Chronicity / 112. / Treatment involvement
109. / Diagnostic Complexity / 113. / Intensity of Treatment
110. / Emotional Response / 114. / Organizational Complexity
M. CULTURAL AWARENESS MODULE (OPTIONAL) / 0 / 1 / 2 / 3 / 0= no need;
1= watchful waiting;
2= need for action;
3= need for immediate action / 0 / 1 / 2 / 3
115. / Knowledge Congruence / 117. / Expression of Distress
116. / Help Seeking Congruence
Child’s Name: / CF File #: /
Date CANS-POC Completed: /

Additional Shared Comments Page (This page to be completed only if helpful):

(Please print clearly)

INTRODUCTION

The CANS is a multiple purpose information integration tool that is designed to be the output of an assessment process. The purpose of the CANS is to accurately represent the shared vision of the child/youth serving system—children, youth and families. As such, completion of the CANS is accomplished in order to allow for the effective communication of this shared vision for use at all levels of the system. Since its primary purpose is communication, the CANS is designed based on communication theory rather than the psychometric theories that have influenced most measurement development. There are six key principles of a communimetric measure that apply to understanding the CANS.

Six Key Principles of the CANS

1. Items were selected because they are each relevant to service/treatment planning. An item exists because it might lead you down a different pathway in terms of planning actions.
2. Each item uses a 4-level rating system. Those levels are designed to translate immediately into action levels. Different action levels exist for needs and strengths. For a description of these action levels please see below.
3. Rating should describe the infant/child, not the infant/child in services. If an intervention is present that is masking a need but must stay in place, this should be factored into the rating consideration and would result in a rating of an “actionable” need (i.e. “2” or “3”).
4. Culture and development should be considered prior to establishing the action levels. Cultural sensitivity involves considering whether cultural factors are influencing the expression of needs and strengths. Ratings should be completed considering the infant/child’s developmental and/or chronological age depending on the item. In other words, anger control is not relevant for a very young infant/child but would be for an older infant/child or infant/child regardless of developmental age. Alternatively, school achievement should be considered within the framework of expectations based on the infant/child’s developmental age.
5. The ratings are generally “agnostic as to etiology”. In other words this is a descriptive tool; it is about the “what” not the “why”. Only one item, Adjustment to Trauma, has any cause-effect judgments.
6. A 30-day window is used for ratings in order to make sure assessments stay “fresh” and relevant to the infant/child’s present circumstances. However, the action levels can be used to over-ride the 30-day rating period.

Action Levels for “Need” Items

0 – No Evidence of Need – This rating indicates that there is no reason to believe that a particular need exists. Based on current assessment information there is no reason to assume this is a need. For example, “does Johnny smoke weed?” He says he doesn’t, his mother says he doesn’t, no one else has expressed any concern – does this mean Johnny is not smoking weed? NO, but we have no reason to believe that he does and we would certainly not refer him to programming for substance related problems.

1 - Watchful Waiting/Prevention – This level of rating indicates that you need to keep an eye on this area or think about putting in place some preventive actions to make sure things do not get worse (e.g. a child/youth who has been suicidal in the past). We know that the best predictor of future behaviour is past behaviour, and that such behaviour may recur under stress, so we would want to keep an eye on it from a preventive point of view.

2 - Action Needed – This level of rating implies that something must be done to address the identified need. The need is sufficiently problematic, that it is interfering in the child/youth’s or family’s life in a notable way.

3 - Immediate/Intensive Action Needed – This level rating indicates a need that requires immediate or intensive effort to address. Dangerous or disabling levels of needs are rated with this level. A child who is not attending school at all or an acutely suicidal youth would be rated with a “3” on the relevant need.

Action Levels of “Strength” Items

0 - Centerpiece Strength. This ratingindicates a domain where strengths exist that can be used as a centerpiece for a strength-based plan. In other words, the strength-based plan can be organized around a specific strength in this area.

1 - Useful Strength. This ratingindicates a domain where strengths exist and can be included in a strength-based plan but not as a centerpiece of the plan.

2 - Identified Strength. This rating indicates a domain where strengths have been identified but that they require significant strength building efforts before they can be effectively utilized in a strength-based plan.

3 - No Strength Identified. This rating indicates a domain in which efforts are needed in order to identify potential strengths for strength building efforts.

Order of CANS Items

The CANS is organized into parts: you can start with any of the sections—Life Domain Functioning or Mental Health, or Risks or Infant/Child Strengths, or Parent/Caregiver Needs and Strengths. This is your judgment call. Sometimes, people need to talk about needs before they can acknowledge strengths. Sometimes, after talking about strengths, then they can better explain the needs. Trust your judgment, and when in doubt, always ask—“we can start by talking about what you feel that you and your infant/child need, or we can start by talking about the things that are going well and that you want to build on. Do you have a preference?”

It is also a good idea to know the CANS. If you are constantly flipping through the pages, or if you read verbatim without shifting your eyes up, it can feel more like an interview than a conversation. A conversation is more likely to give you good information, so have a general idea of the items.

Also, some people may “take off” on a topic. The great thing about the CANS is that you can follow their lead. So, if they are talking about anger control and then shift into something like, “you know, he only gets angry when he is in Mr. S’s classroom”, you can follow that and ask some questions about situational anger. So that you are not searching and flipping through papers, have some idea of what page that item is on.

Making the Best Use of the CANS

To increase family involvement, and understanding, encourage the family to look over the CANS prior to the time you sit down to fit it out. The best time is your decision—you will have a sense of the timing as you work with each family. Families often feel respected as partners when they are prepared for a meeting or a process.

A copy of the completed CANS should be provided to each family. Encourage families to contact you if they wish to change their answers in any area that they feel needs more or less emphasis.

Listening Using the CANS

Listening is the most important skill that you bring to the CANS. Everyone has an individual style of listening. The better you are at listening, the better the information you will receive. Some things to keep in mind that make you a better listener and that will give you the best information:

Use nonverbal and minimal verbal prompts

Head nodding, smiling and brief “yes”, “and”—things that encourage people to continue

Be nonjudgmental and avoid giving personal advice

You may find yourself thinking “if I were this person, I would do X” or “that’s just like my situation, and I did X”. But since you are not that person, what you would do is not particularly relevant. Avoid making judgmental statements or telling them what you would do. It’s not really about you.

Be empathetic

Empathy is being warm and supportive and acknowledging the feelings of another. It is understanding another person from their own point of reference. You demonstrate empathetic listening when you smile, nod, and maintain eye contact. You also demonstrate empathetic listening when you follow the person’s lead and acknowledge when something may be difficult, or when something is great. You demonstrate empathy when you summarize information correctly. All of this demonstrates to the person you are talking to that you are with them.

Be comfortable with silence

Some people need a little time to get their thoughts together. Sometimes, they struggle with finding the right words. Maybe they are deciding how they want to respond to a question. If you are concerned that the silence means something else, you can always ask “does that make sense to you”? “Or do you need me to explain that in another way”?

Paraphrase and clarify—avoid interpreting

Interpretation is when you go beyond the information given and infer something—in a person’s unconscious motivations, personality, etc. The CANS is not a tool to come up with causes. Rather, it identifies things that need to be acted upon. Rather than talk about causation, focus on paraphrasing and clarifying. Paraphrasing is restating a message very clearly in a different form, using different words. A paraphrase helps you to (1) find out if you really have understood an answer; (2) clarify what was said, sometimes making things clearer; (3) demonstrate empathy. For example, you ask the questions about health, and the person you are talking to gives a long description. You paraphrase by saying “Ok, it sounds like X, is that right? Would you say that is something that you feel needs to be watched, or is help needed? “

Redirect the conversation to parents’ own feelings and observations

Often, people will make comments about other people’s observations such as “well, my mother thinks that his behaviour is really obnoxious.” It is important to redirect people to talk about their observations: “so your mother feels that when he does X, that is obnoxious. What do YOU think?” The CANS is a tool to organize all points of observation, but the parent or parent/caregiver’s perspective is the most important at the time when you are doing the CANS. Once you have his/her perspective, you can then work on organizing and coalescing the other points of view. Any statements made by others can be noted in the comments section.

Acknowledge feelings

People will be talking about difficult things and it is important to acknowledge that. Simple acknowledgement such as “I hear you saying that it can be difficult when . . .” demonstrates empathy.

Wrapping It Up

At the end of the CANS, we recommend the use of two open-ended questions. These questions ask if there are any past experiences that people want to share that might be of benefit to planning for their infant/child, and if there is anything that they would like to add. This is a good time to see if there is anything “left over”—feelings or thoughts that they would like to share with you.

Take time to summarize with the family the areas of strengths and of needs. Help them to get a “total picture” of their infant/child and family, and offer them the opportunity to change any ratings as you summarize or give them the “total picture”.

Take a few minutes to talk about what the next steps will be. Now that you have the information organized into a framework, it is time to move into the next stage—planning.

You might close with a statement such as: “OK, now the next step is a “brainstorm” where we take this information that we’ve organized and start writing a plan—it is now much clearer which needs must be met and what can be built. So let’s start . . .”

CODING DEFINITIONS & GUIDELINES

Needs are rated based on the following categories and action levels:

0 indicates a dimension where there is no current need.

1 indicates a dimension that requires monitoring, watchful waiting, or preventive activities.

2 indicates a dimension that requires action to ensure that this identified need or risk behaviour is addressed.

3 indicates a dimension that requires immediate or intensive action.

1. LIFE DOMAIN FUNCTIONING

Check / 01. FAMILYPlease rate the highest level in the past 30 days
0 / No evidence of problems in interaction with family members.
1 / Child is doing adequately in relationships with family members although some problems may exist. For example, some family members may have mild problems in their relationships with child, such as sibling rivalry or under-responsiveness to child needs.
2 / Child is having moderate problems with parents, siblings and/or other family members. Frequent arguing, strained interaction with parent, and poor sibling relationships may be observed.
3 / Child is having severe problems with parents, siblings, and/or other family members. This would include problems of domestic violence, constant arguing, and aggression with siblings.