Child and Adolescent Needs and Strengths (CANS)Assessment

0070-548.26 | Revision Date: 10/28/21

Overview

This procedural guide provides information, and guidance, on the implementation and use of the Child and Adolescent Needs and Strengths (CANS) assessment tool.

TABLE OF CONTENTS

Policy

The Child and Adolescent Strengths and Needs (CANS) Assessment Tool

Administration of the CANS Tool

Completing an Initial CANS Assessment

Completing a CANS Update or Reassessment

Integration with Case Planning

Integration with the Child and Family Team (CFT) and CFT Meeting (CFTM)

Confidentiality

CFT Facilitation

Certification/Recertification Requirements

CANS Documentation and Tracking Process

Procedure

Completion of an Initial CANS Assessment for Newly Opened Cases

ER/MART/ERCP CSW Responsibilities

ER/MART/ERCP Supervising CSW (SCSW) Responsibilities

Continuing Services (CS) CSW Responsibilities

CS SCSW Responsibilities

Completion of CANS Reassessments

CS CSW Responsibilities

CS SCSW Responsibilities

When a Referral is Received on an Open Case

ER/MART/ERCP CSW Responsibilities

ER/MART/ERCP SCSW Responsibilities

CS CSW Responsibilites

CS SCSW Responsibilities

Approvals

Helpful Links

Attachments

Forms

Referenced Policy Guides

Statutes

Version Summary

This is a new policy to align with the Continuum of Care Reform (CCR) Act mandates.

POLICY

The Child and Adolescent Needs and Strengths (CANS) Assessment Tool

After the State of California came to a resolution with the Kate A. lawsuit, All County Letter (ACL) 15-11 was issued to remind county child welfare departments that they assume responsibility for ensuring that every child/youth/NMD with an open child welfare case be screened for possible mental health needs at intake and at least annually thereafter. From there, the State introduced the CCR Act.

 

CCR initiated significant reforms in child welfare, including but not limited to, the introduction of Child and Family Teams (CFTs) and, more recently, the use of the CANS assessment. The State selected the CANS assessment for counties’ use to guide staff in Child and Family Team Meetings (CFTMs). Specifically, the CANS assessment aids child welfare agencies in assessing child safety and well-being; identifying a range of social and behavioral healthcare needs; supporting care coordination and collaborative decision-making; and, monitoring outcomes and services.

 

  1. Items are selected based on relevance to planning.
  2. Actions levels for all items
  3. Consider culture and development before establishing the action level .
  4. Agnostic as to etiology - descriptive, no cause and effect
  5. About the child, not about the service - Rate needs when masked by interventions.
  6. Specific ratings window (e.g., 30 days) can be overridden based on action levels.

 

Per ACL 18-09, the CANS assessment must be used to:


The CANS assessment will replace the following:

ck to Policy

Administration of the CANS Tool

Completing an Initial CANS Assessment

 

In addition to the below, staff are encouraged to review and use the CANS toolkit for guidance on use of the CANS assessment tool.

 

For all referrals promoted to a case, an Initial CANS assessment must be completed by the ER/MART/ERCP CSWs no later than thirty (30) days from the date of removal for court and voluntary Family Reunification (FR) cases, or from the date the referral was promoted to a case for all other cases. Exception: ERCP 2PEN cases may be immediately transferred per current policy. For these cases, the CANS assessment is to be completed by the CS CSW.

 

If a child has urgent mental health needs, the CSW can submit a Mental Health Referral (MHR) via the DCFS Referral Portal at any time before and after case promotion.

 

The following table outlines who is responsible for completing the Initial CANS assessment for new cases based on assignment or case-specific circumstances:

 

Specific Situations

Responsible Agency and CSW for completing the Initial CANS Assessment

New cases and child/youth has current DMH involvement prior to case opening

The ER/MART/ERCP CSWs are required to complete the initial CANS assessment unless they are able to obtain a newly completed CANS assessment from (the) DMH-MHP/MAT Assessor within the required time frame.

  • Exception: ERCP 2PEN cases

New cases and child/youth does not have current DMH involvement prior to case opening

The ER/MART/ERCP CSWs are required to complete the initial CANS assessment.

  • Exception: ERCP 2PEN cases

 

Completing a CANS Update or Reassessment

 

CANS Update: This occurs when:

  1. A referral is promoted to a case and the ER/MART/ERCP CSW has completed the Initial CANS, but was unable to fully rate each item/domain. The CS CSW is responsible for updating and finalizing the CANS so that each item in every domain is rated. Or,

 

  1. A CANS is completed (i.e., updated) at any time prior to the CANS reassessment (six (6) month) due date.

CANS Reassessment: This occurs when a case is already open and assigned to the CS CSW. The CS CSW is responsible for completing a CANS reassessment every six (6) months.

 

All children/youth/NMDs under DCFS supervision must have a CANS completed every six (6) months. The CS CSW is responsible for CANS reassessments (unless the child has DMH involvement; in which case, (the) DMH/DMH-MHP/MAT Assessor may complete the CANS reassessment.)

The following outlines who is responsible for completing the CANS Reassessment.

 

Specific Circumstances

Responsible Agency and CSW for completing the CANS Reassessment

Child has DMH involvement

The CS CSWs are required to complete the CANS unless they are able to obtain a newly completed CANS assessment from (the) DMH-MHP/MAT Assessor within the required timeframe.

Open case with no DMH involvement

CS CSW

 

When the child/youth/NMD receives services from DMH/ DMH- MHP, including MAT Assessors, the completion of the CANS assessment is a shared responsibility between DCFS and DMH. DCFS and the DMH/DMH-MHP/MAT Assessor completing the CANS assessment are expected to share the completed CANS assessment for dually-served children.

 

If a current (i.e., completed within six (6) months) CANS assessment has been completed by DMH/DMH-MHP/MAT Assessor, DCFS is not required to complete a new CANS assessment; however, staff should consider if there are any needed updates. If this occurs, the CSW shall complete an updated CANS reflecting the new information. Both Departments must coordinate with each other to share any subsequently obtained information regarding the child/youth/NMD that necessitated the completion of a CANS.

Integration with Case Planning

All case plans must be informed by a CANS assessment; therefore, the CANS assessment must be completed prior to the development of the case plan per current timelines and is required every six (6) months thereafter for subsequent case plan updates. The CANS assessment may be updated sooner if there are significant changes in the child/youth/NMD’s functioning or circumstances.

 

A rating of ‘0’ or ‘1’ on the CANS rating sheet can be used for strengths-based case planning. A rating of ‘2’ identifies an area that should be developed and addressed in the case plan. Any actionable item with a “needs” rating of ‘3’ must be addressed in the case plan and may require immediate attention. As applicable, some items may result in revisions to an existing safety plan.

 

In alignment with the current Coordinated Services Action Team (CSAT) linkage process, if the CSW discovers any actionable item with a “needs” rating of ‘3’ in the Risk Factor or Behavioral Emotional Needs domains, they must ensure that a consultation with the Service Linkage Specialist (SLS) or with DMH co-located staff occurs.

 

During the information-gathering process, if staff learn of a psychiatric emergency, such as the child/youth/NMD posing an immediate danger to self or others, staff must contact ACCESS/Psychiatric Mobile Response Team (PMRT) immediately at 1-800-854-7771. The responding staff shall alert their SCSW of the psychiatric emergency and, if applicable, alert the case-carrying CSW and their SCSW via email.

 

As applicable, staff must follow current mandated reporting and contact documentation responsibilities.

Back to Policy

Integration with the Child and Family Team (CFT) and CFT Meeting (CFTM)

The CANS assessment should be informed by CFT members, and used and completed through the CFT process, when possible. The CANS assessment helps the CFT prioritize actions regarding identified needs and strengths using team-based decision-making.

 

The CFT members must be informed about the CANS prior to a CFTM. CFTMs should have a clear purpose and follow a structured format that includes informing or reviewing the CANS ratings. The entire CANS may be initially completed prior to the CFTM and then reviewed during the CFTM to ensure that the CFT is in agreement with the identified strengths and needs or, the Life Domain Functioning and the Strengths Domain may be completed during the CFTM.

 

CANS is required for all children and youth who have an open case, including those receiving family maintenance (FM) services. While CFTMs are not mandated for FM cases, it is best practice to hold CFTMs and include discussions of the CANS assessment during these meetings.

 

Confidentiality

On occasion, the CANS may be administered and completed outside of CFTMs due to the sensitive nature of some of the items and domains or based on the discretion of the CFT.

 

CWS-CARES database will allow staff to print the CANS assessment/reassessment with redactions by clicking the “discretion needed” button next to those items to be redacted.

 

The CANS assessment should not to be attached to any court report. If the Court orders the release of the CANS assessment, consult with County Counsel.

 

CFT Facilitation

 

Existing policy reflects timelines for the CFTMs and responsible staff for convening and facilitating the CFTMs. The Facilitator must ensure that the CANS informs the discussions and action plan. The CSW shall be informed if there are changes to the draft CANS assessment agreed upon by the CFT during the CFTM, regardless of their attendance.

Certification/Recertification Requirements

Staff are required to complete the initial two (2)-day CANS Certification Training course once when initially becoming certified.

 

CANS re-certification is required annually.

The following staff are required to obtain initial CANS certification (once) and complete annual recertification:

 

Staff must be recertified annually. This may be completed independently through the Praed website. Praed sends all certified staff an email informing them that their certification is about to expire. The emails are sent one (1) week before, the day before, and the day after their certification has expired.

 

Staff may only complete CANS assessments/reassessments if they are currently certified. Staff are to recertify each year prior to their CANS certification expiration date.

CANS Documentation and Tracking Process

The CSW who completes the CANS assessment/reassessment is required to ensure that the completed CANS assessment/reassessment is entered into CWS-CARES. CWS-CARES will eventually replace CWS/CMS, however until then, the application to create a CANS assessment/reassessment resides in CWS CARES. The remainder of the work (e.g., researching the case, documenting its completion, etc.) will need to be completed in CWS/CMS. Designated support staff may also assist with this data-entry. A rating of ‘2’ or ‘3’ on the CANS rating sheet requires a rationale for the rating in the “Comment” section of the respective item.

 

Back to Policy

PROCEDURE

Completion of an Initial CANS Assessment for Newly Opened Cases

The ER/MART/ERCP CSW will complete the CANS except when a case has been identified as an ERCP 2PEN case. ERCP 2PEN cases may be immediately transferred per current policy. For these cases, the CANS is to be completed by the CS CSW.

ER/MART/ERCP CSW Responsibilities

  1. The ER/MART/ERCP CSW shall complete the CANS and ensure that the ratings are entered into CWS-CARES.
  1. Every effort shall be made by the ER/MART/ERCP CSW to enter a rating for each item in every domain.
  2. If unable to determine a rating on any item, proceed as follows: 
  1. Click the "Discretion Needed" box
  2. Rate the items a zero "0"
  3. In the "Comments" box, enter "Unable to rate due to limited information" and document any first impressions.
  4. In the Domain Comment box, indicate the item number and provide a brief narrative as to why the item could not be fully rated.

  1. When the CANS is completed, save it as pdf, then create the Mental Health Referral (MHR) in the DCFS Referral Portal and upload the CANS (pdf format) as an attachment. All CANS assessments/reassessments regardless of ratings will be evaluated by DMH Specialized Foster Care (SFC).

     

    CANS that have a rating of a “3” in the Behavior Emotional Needs domain and/or the Risk Behaviors domain will be flagged for priority review by CSAT and DMH SFC.

    1. Be specific about your concerns and documentation of the immediate dangers to self or others.
    2. Prior to transferring the newly opened case to CS, finish rating the unrated CANS items (using the guidelines above for items unable to fully rate).
  2. If you learn that the child/youth/NMD is an immediate danger to self or others, contact ACCESS (Psychiatric Mobile Response Team) immediately at 1-800-854-7771. The office’s CSAT team is available for consult via telephone or in-person if necessary.
  3. Once all of the items in all of the domains have been assigned a rating the ER/MART/ERCP CSW will notify their SCSW via email or hard copy, that they are ready for the SCSW to review the CANS and supporting documentation, if any.

Note:

  1. Complete the Initial Case Plan prior to transferring to CS, if:

Per current case plan development guidelines, if a CFTM is not convened following the out-of-home care placement, the ER/MART/ERCP CSW must transfer the case no later than ten (10) calendar days from the date of placement to allow the CS CSW time to convene a CFTM and complete the Initial Case Plan within the required forty-five (45) to sixty (60) day timeframe.

  1. File a hard copy of the completed CANS in the purple case folder.

ER/MART/ERCP Supervising CSW (SCSW) Responsibilities

 

  1. Review the completed Initial CANS assessment and, as applicable, the Initial Case Plan to ensure that the CANS assessment aligns with the information obtained during the interview/investigation process and the referral disposition and, as applicable, informs the case plan. The review shall include the following:
  1. Review the CANS for ratings of 2’s & 3’s. Each rating of a 2 or 3 should be accompanied by a comment in the Item Level Comment Box. These comments are to support the context, frequency, and duration of why the rating of ‘2’ or ‘3’ is warranted, and will assist Mental Health and CS with understanding why the rating was applicable.
  2. Approve the Initial CANS assessment in CWS-CARES by updating the Assessment Date within the CANS Assessment form to the current date the SCSW is ‘approving’ the CANS by clicking “complete”, then, as applicable, approve the Initial Case Plan and return to the CSW.

Continuing Services (CS) CSW Responsibilities

  1. Review the newly assigned case to determine if the ER CSW scheduled a CFTM. The ER CSW may have scheduled the CFTM, but the case may have been transferred prior to the CFTM being held.
  1. Contact the family to introduce yourself and schedule the CFTM if one has not been scheduled.
  1. Convene a CFTM if one was not held by the ER CSW.
  1. When facilitating or participating in a CFTM, follow the guidelines of the CFT policy.
  2. Invite the ER/MART/ERCP/DI CSW to the CFTM, if appropriate. If they do not attend the CFTM, they must avail themselves to the CS CSW to prepare for the CFTM and discuss the initial CANS findings prior to the CFTM.
  3. If attendingthe CFTM, consult with the ER/MART/ERCP/DI CSW to determine who is best to take the lead to discuss the CANS findings.
  4. Per current case plan development guidelines, if a CFTM is not convened following the out-of-home care placement, the ER CSW must transfer the case no later than ten (10) calendar days from the date of placement to allow the CS CSW time to convene a CFTM and complete the Initial Case Plan within the required forty-five (45) to sixty (60) day time frame.
  1. If the CFTM results in the necessity to update the CANS, enter the updated CANS into CWS-CARES.
  1. Complete the Initial Case Plan or update the case plan, whichever is applicable.
  2. Once all of the items in all of the domains have been assigned a rating, notify the SCSW via email or hard copy the CANS and supporting documentation, if any, are ready for review.

CS SCSW Responsibilities

  1. Review the completed CANS assessment/reassessment and the new/updated case plan, whichever is applicable, to ensure they align.
  2. Review the CANS assessment for ratings of 2’s & 3’s. Each rating of a 2 or 3 should be accompanied by a comment in the Item Level Comment Box. These comments are to support the context, frequency, and duration of why the rating of ‘2’ or ‘3’ is warranted, and will assist Mental Health and CS with understanding why the rating was applicable.
  3. As applicable, approve the CANS assessment in CWS-CARES by updating the Assessment Date within the CANS Assessment form to the current date the SCSW is ‘approving’ the CANS by clicking “complete”, then, as applicable, approve the Initial or updated Case Plan and return to the CS CSW.
  1. If corrective measures are needed, notify the CS CSW who completed the CANS. Upon receipt and confirmation of the corrective measures, approve the CANS and, as applicable, the Initial or updated Case Plan, and return to the CSW.

Completion of CANS Reassessments

CS CSW Responsibilities

  1. For completion of a CANS reassessment, at least forty-five (45) days prior to the every sixth (6th) month CANS reassessment, or case plan due date, review case records and, as applicable, the most recently completed CANS for any necessary information.
  1. Determine if the child/youth/NMD is currently receiving MH services from DMH/DMH-MHP. If so:
  1. Collaborate with DMH/DMH-MHP to obtain or aid in completing the communimetric CANS.

    If DMH/DMH-MHP completed the CANS reassessment, the CS CSW will have to enter the results into CWS-CARES.

    A designated staff that is registered in CWS-CARES may enter the CANS reassessment results on behalf of the CS CSW.

  2. If DMH/DMH-MHP did not complete the CANS, the CS CSW is required to complete the CANS and enter the results into CWS-CARES.

    The CS CSW is to consult with the DI CSW, if there is one assigned, for any input they may have that would assist in completion of the CANS.
  1. Convene a CFTM.
  1. When facilitating or participatingin a CFTM, follow the guidelines of the CFT policy.
  1. Complete the “Continuing Services (CS) CSW Responsibilities" steps #4 through #9 under the section above titled “Completion of an Initial CANS Assessment for Newly Opened Cases”.
  2. When the CANS (re)assessment is finalized, select “Updated CANS Assessment” on the Special Project tab in the CWS/CMS Client Services Notebook and enter the date that the CANS assessment (re)assessment was completed.

CS SCSW Responsibilities

  1. Complete the "CS SCSW Responsibilities" steps #1 through #3 under the section above titled “Completion of an Initial CANS Assessment for Newly Opened Cases”.

 

When a Referral is Received on an Open Case

 

Note: A CANS reassessment may be completed at any time if it is determined that a reassessment is needed. This is determined by the CS CSW, who, through working with the family, identifies needs, etc. that result in the need for a CANS reassessment. Otherwise:

 

All children/youth/NMDs under DCFS supervision must have a CANS completed every six (6) months. The CS CSW is responsible for CANS reassessments (unless the child has DMH involvement; in which case, the DMH/DMH-MHP may complete the CANS reassessment.)

 

ER/MART/ERCP CSW Responsibilities

  1. During the referral investigation, review the current CANS and discuss with the CS CSW to determine if a CANS reassessment is needed.
  1. If a CANS reassessment is needed, complete the applicable "ER/MART/ERCP CSW Responsibilities" steps #1 through #8 under the section titled “Completion of an Initial CANS Assessment for Newly Opened Cases”.

 

ER/MART/ERCP SCSW Responsibilities

  1. For CANS reassessments, complete the "ER/MART/ERCP SCSW Responsibilities" steps #1 through #3 under the section above titled “Completion of an Initial CANS Assessment for Newly Opened Cases”.

 

CS CSW Responsibilities

  1. Discuss the referral investigation and CANS with the ER/MART/ERCP CSW and determine if a CANS reassessment is needed.
  1. The CS CSW shall complete the applicable "Continuing Services (CS) CSW Responsibilities" steps #1 through #9 under the section title “Completion of an Initial CANS Assessment for Newly Opened Cases”.

 

CS SCSW Responsibilities

  1. For CANS assessments on ERCP 2PEN cases, complete the "CS SCSW Responsibilities" steps #1 through #3 under the section above titled “Completion of an Initial CANS Assessment for Newly Opened Cases”.

 

 

Back to Procedure

APPROVALS

ER/ERCP/MART SCSW Approval

 

CS SCSW Approval

Back to Approvals

HELPFUL LINKS

Attachments

Forms

CWS/CMS

BCIA 8583, Child Abuse or Severe Neglect Indexing Form

SOC 832, Notice of Child Abuse Central Index Listing

SOC 833, Grievance Procedures for Challenging Reference to the Child Abuse Central Index

SOC 834, Request for Grievance Hearing

LA Kids

DCFS 6109, CFT Authorization for Use of Protected Health and Private Information

DCFS 6109 SP, Equipo de Trabajo del Niño y la Familia (CFT) Autorización del uso de su Información de Salud Protegida e Información Privada

 

Referenced Policy Guides

 

0070-548.01, Child and Family Teams

0070-548.24, Structured Decision Making (SDM)

0070-516.15, Screening and Assessing Children for Mental Health Services and Referring to the Coordinated Services Action Team (CSAT)

0080-502.10, Case Plans

0400-503.10, Contact Requirements and Exceptions

 

Statutes

 

ACL 15-11 – States that all children and youth must be screened for indication of mental health needs.

 

ACL 16-84 – Provides information and guidance for the use of child and family teaming to provide child welfare services

 

ACL 18-09 – Provides the requirements for Implementing the Child and Adolescent Needs and Strengths Assessment Tool Within a Child and Family Team.

 

ACL 18-81 – Provides the requirements and guideline for Implementing the Child and Adolescent Needs and Strengths Assessment Tool within Child and Family Team process.

 

ACL 21-27 – Addresses the mandatory entry of the CANS assessment in CWS-CARES and the timeline requirement. It also provides information regarding the CANS support toolkit as well as trainer and trainee requirements.

 

Welfare and Institutions Code (WIC) 706.6. (a) - states that services to minors are best provided in a framework that integrates service planning and delivery among multiple service systems, including the mental health system, using a team-based approach, such as a child and family team.

 

WIC 827 – Addresses release of confidential information, including what information may be shared, under what circumstances, and with whom that information may be shared.

 

 

 

 

 

 

 

 

Back to Helpful Links