Child and Adolescent Needs and Strengths (Cans) s1

CHILD/ADULT NEEDS AND STRENGTHS (CANSAT) © / MAINE: CANSAT-DD
Transition Dev. Delay (ages 18-21)
Please Ö appropriate use: / Initial / Reassessment / Date: / M / M / D / D / Y / Y
Transition/Discharge
m / m / d / d / y / y / M / F
Child’s Name / DOB / Gender

November 2013 revised

NEEDS RATING
0 = No evidence of problem - / 1 = History - Watchful
2 = Moderate need / 3 = Severe need -
UNK-Unknown-Need to gather information
**CHILD BEHAVIORAL / EMOTIONAL NEEDS
**CO-EXISTING CONDITIONS
0 / 1 / 2 / 3 / Unk
Psychosis / / / / /
Impulse Control / / / / /
Depression/Anxiety / / / / /
Substance Abuse / / / / /
Anger Control / / / / /
Oppositional Behavior / / / / /
Adj to Trauma / / / / /
Situational consistency to problems / / / / /
Temporal consistency to problems / / / / /
Motivation for psychiatric care / / / / /
RISK BEHAVIORS 0 1 2 3 Unk
Danger to self / / / / /
Danger to others / / / / /
Sexually abusive behavior / / / / /
Social behavior / / / / /
Crime / / / / /
Victimization/Safety / / / / /
**LIFE DOMAIN FUNCTIONING
**FUNCTIONING 0 1 2 3 Unk
Intellectual / / / / /
Knowledge / / / / /
Physical/medical / / / / /
Family / / / / /
School/vocational/ daycare / / / / /
Living Skills (ADL) / / / / /
Residential Stability / / / / /
Motor / / / / /
Sensory / / / / /
Communication / / / / /
Developmental / / / / /
CARE INTENSITY & ORGANIZATION
0 / 1 / 2 / 3 / Unk
Monitoring / / / / /
Treatment / / / / /
Transportation / / / / /
Service Permanence / / / / /
Self-care ADLS / / / / /
Medication Compliance / / / / /
CAREGIVER CAPACITY 0 1 2 3 Unk
Physical / / / / /
Behavioral health / / / / /
Involvement with care / / / / /
Knowledge / / / / /
Resources / / / / /
Organization / / / / /
Home adaptability / / / / /
Residential stability / / / / /
STRENGTHS RATING
0 = Significant strength / 1 = Moderate strength
2 = Mild strength / 3 = Strength not present
UNK-Unknown-Need to gather information
STRENGTHS 0 1 2 3 Unk
Family / / / / /
Interpersonal / / / / /
Relationship Permanence / / / / /
Education/Vocation / / / / /
Well-being / / / / /
Spiritual/religious / / / / /
Talents/Interests / / / / /
Inclusion / / / / /

**Must have at least one score of (2) or higher in each of the two highlighted sections above: “Life Domain Functioning” AND “Child Behavioral / Emotional Needs”.

November 2013 revised