Hello!
Finally, I received some answers from a colleague who passed on my questions regarding the use of the CANS (Children Adolescent Needs Strengths) scale to Dr. Jack Simons, Ph.D, Assistant Director, Children's Behavioral Health Interagency Initiatives, from the Massachusetts Executive Office of Health and Human Services. (See the answers highlighted in blue color). My responses are highlighted in brown.
Here are his answers:
What is the CANS?
The CANS forms are available at the CBHI website: www.mass.gov\masshealth\childbehavioralhealth, click on "Information for Providers", click on "CANS Tools". The CANS is designed to provide a standard way of documenting important information from your assessment of the client; at this point the CANS is not being used to produce summary scores or profiles. As we gain experience with the tool, we may be able to use summary scores and statistical prediction rules to help us with service planning, but we are not there yet.
Comments have been made about how the CANS is not a clinical instrument and the category for rating cultural issues are confusing to understand.
Finally, I received some answers from a colleague who passed on my questions regarding the use of the CANS (Children Adolescent Needs Strengths) scale to Dr. Jack Simons, Ph.D, Assistant Director, Children's Behavioral Health Interagency Initiatives, from the Massachusetts Executive Office of Health and Human Services. (See the answers highlighted in blue color). My responses are highlighted in brown.
Here are his answers:
What is the CANS?
The CANS forms are available at the CBHI website: www.mass.gov\masshealth\childbehavioralhealth, click on "Information for Providers", click on "CANS Tools". The CANS is designed to provide a standard way of documenting important information from your assessment of the client; at this point the CANS is not being used to produce summary scores or profiles. As we gain experience with the tool, we may be able to use summary scores and statistical prediction rules to help us with service planning, but we are not there yet.
Comments have been made about how the CANS is not a clinical instrument and the category for rating cultural issues are confusing to understand.
Also, how do I explain to parents what I'm doing and why.
You use the CANS as one way of documenting the info you obtain from the assessment. You don't need to show the CANS form to parents although we hope it will be useful to you in talking with them both during the assessment phase and during the treatment phase. So it is part of your documentation process, and is designed to organize data in a way that will be helpful to you and the parents in planning treatment. It is not a self-report that parents fill out.
Due to the immense information stated for each CANS category, this scale can take more than one hour to explain to parents in which clinicians do not get reimbursed for by insurance companies.
1) What is the threshold scores for determining whether or not a child falls into the Serious Emotional Disturbance category for more intensive services?
The determination of Serious Emotional Disturbance is not based on CANS scores. It is based on a series of questions that appear at the beginning of the CANS form, but are not technically a part of the CANS. (You can see this when you look at the CANS form -- see above on where to find it.)
Clinicians who took the training online or attended a workshop did not learn anything about this Serious Emotional Disturbance(SED) component at the beginning of the CANS form. Where do we find this information on how to determine SED? How can clinicians ethically give this assessment when they were not trained on how to assess for SED?
2) Are parents going to be allowed to sign waivers so providers can score their child's CANS on the virtual gateway?
The Virtual Gateway (VG) CANS application is not required to score the CANS -- that is something the clinician learns to do by taking the CANS training / certification. The CANS is a way of documenting information from the behavioral health assessment. Yes, a parent can decline consent to have the CANS information entered into the VG application. If the parent does not consent to putting the CANS information into the VG application, the clinician documents the CANS on paper and puts it in the record. The clinician uses the CANS either way.
Do we tell parents that the CANS will be used in house instead and put in the client's file?
3) What happens if a parent declines for their child to take the CANS due to the virtual gateway confidentiality issue? -- see previous question. If the parent declines, the clinician will still be expected to enter a limited amount of info (about SED determination) into the VG, but not the CANS itself.
Information posted on the VG can be still accessed by the Departments of Public and Mental Health and Mass Health.
4) How do you score a CANS?
This is covered in the training. Go to https://masscans.ehs.state.ma.us/login.aspx?ReturnUrl=%2fDefault.aspx to register for training.
Some clinicians I spoke with still don't know how to score the CANS including myself? Do we add the points in each category? No scale is given to explain scores.
In summary, there are strengths to the CANS scale but implementation of the this assessment tool is still confusing and more information is still needed. What do you think?
Robbin Miller, LMHC
Citizen-Therapist
Facilitator
Due to the immense information stated for each CANS category, this scale can take more than one hour to explain to parents in which clinicians do not get reimbursed for by insurance companies.
1) What is the threshold scores for determining whether or not a child falls into the Serious Emotional Disturbance category for more intensive services?
The determination of Serious Emotional Disturbance is not based on CANS scores. It is based on a series of questions that appear at the beginning of the CANS form, but are not technically a part of the CANS. (You can see this when you look at the CANS form -- see above on where to find it.)
Clinicians who took the training online or attended a workshop did not learn anything about this Serious Emotional Disturbance(SED) component at the beginning of the CANS form. Where do we find this information on how to determine SED? How can clinicians ethically give this assessment when they were not trained on how to assess for SED?
2) Are parents going to be allowed to sign waivers so providers can score their child's CANS on the virtual gateway?
The Virtual Gateway (VG) CANS application is not required to score the CANS -- that is something the clinician learns to do by taking the CANS training / certification. The CANS is a way of documenting information from the behavioral health assessment. Yes, a parent can decline consent to have the CANS information entered into the VG application. If the parent does not consent to putting the CANS information into the VG application, the clinician documents the CANS on paper and puts it in the record. The clinician uses the CANS either way.
Do we tell parents that the CANS will be used in house instead and put in the client's file?
3) What happens if a parent declines for their child to take the CANS due to the virtual gateway confidentiality issue? -- see previous question. If the parent declines, the clinician will still be expected to enter a limited amount of info (about SED determination) into the VG, but not the CANS itself.
Information posted on the VG can be still accessed by the Departments of Public and Mental Health and Mass Health.
4) How do you score a CANS?
This is covered in the training. Go to https://masscans.ehs.state.ma.us/login.aspx?ReturnUrl=%2fDefault.aspx to register for training.
Some clinicians I spoke with still don't know how to score the CANS including myself? Do we add the points in each category? No scale is given to explain scores.
In summary, there are strengths to the CANS scale but implementation of the this assessment tool is still confusing and more information is still needed. What do you think?
Robbin Miller, LMHC
Citizen-Therapist
Facilitator
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