Transcript Introduction to the Child & Adolescent Needs and Strengths

Introduction to the Child &
Adolescent Needs and Strengths
Assessment
Tim Connor, MS, MA
Mental Health Evaluation Specialist for the
Wisconsin Department of Health Services
Dave Minden, PhD, Clinical Psychologist
Moderated by: Kathy Markeland, WAFCA
7/6/2015
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Webinar Overview
Light Housekeeping
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• I will field questions through the “chat” feature
online and we will address them during the last
half hour of our presentation.
• We are recording this event.
• You will receive a copy of the Power Point
presentation after today’s event.
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Webinar Overview
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What is the context for this conversation?
What is CANS?
Communimetric vs. Psychometric approach
CANS Scoring
DCF Draft Tool
Administration/training/data collection
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Webinar Overview
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Evaluation and Output
Other States
CANS in Wisconsin
What are the deficits/criticisms of CANS?
Validity/Reliability of CANS
LSS Clinical Story – Choosing CANS and
Building CANS Culture
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Why are we talking about CANS?
• 2009-11 Biennial Budget = Wisconsin initiated
a number of changes to the child welfare
system including a commitment to move to a
single statewide standardized child
assessment tool.
• DCF, in consultation with stakeholders, has
selected the Child & Adolescent Needs and
Strengths (CANS) Assessment.
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Why are we talking about CANS?
• DCF is now in the process of "Wisconsinizing"
the tool in preparation for statewide
implementation in January 2011.
• Anticipate that the DCF CANS tool will be
piloted in BMCW as early as July 2010.
Possible that other agencies/counties will be
invited to “pilot” as well.
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Why are we talking about CANS?
• In the Wisconsin child welfare system, CANS
will be a significant part of:
– Determining the “level of care” required for a
specific child.
– Measuring a child’s progress while in care and
making redeterminations about the “level of care”
required.
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Why are we talking about CANS?
• CANS data will also likely contribute to:
– Outcome monitoring of programs and system
wide (including advising performance-based
measures within provider contracts)
– Quality improvement efforts both within
programs and throughout the system.
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What is CANS?
• The CANS is an information integration tool.
• The purpose of the CANS is to accurately
represent the shared vision of the child
serving system, which includes the child,
family and all service providers.
• The CANS is intended to facilitate effective
communication of this shared vision for use at
all levels of the system.
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What is CANS?
• Designed for use at three levels:
– individual child and family
– program
– system of care
• Provides a structured assessment of children
along a set of dimensions relevant to service
planning and decision-making.
• Provides information regarding the child and
family's service needs for use during system
planning and/or quality assurance monitoring.
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What is CANS?
• The CANS originated from the Childhood
Severity of Psychiatric Illness (CSPI) tool, which
assessed the appropriate use of expensive
mental health service interventions.
• CANS ratings are designed to lead directly into
treatment planning. All the CANS items can
be used to determine the appropriate level of
care for a child.
• CANS has an algorithm for determining the
appropriate level of care needed for a child.
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What is CANS?
• 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.
• Following slides compare “communimetric”
and “psychometric” approach to assessment.
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Communimetrics Approach to
Assessment
• Communication value of tool is top priority
– communication from family to provider to service plan
• Content is flexible and must be meaningful to the
service delivery process
• Items selected on clinical rather than statistical
criteria
• “Just enough information” approach to
instrument design
• Trust in the reliability of the responses and
expertise of the rater
• Easy to use and results are actionable
Psychometric Approach to Assessment
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Precise measurement is top priority
Scientific replication of measurement
Focus on reliability and validity
Multiple similar items to test reliability of
responses
• Sophisticated scale scoring
• Interpreting results for service planning not
always straightforward
Inputs and Outputs of Assessment
Six Characteristics of a Communimetric
Tool
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Item-level tool to provide detail for service planning
Item ratings translate immediately into action levels
It is about the child not about the service
Consider culture and development
Primarily a descriptive tool—it is about the ‘what’ not
about the ‘why’
• The 30-day window is to remind us to keep
assessments relevant and ‘fresh’
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Scoring
Needs:
0 - No Need
1 - Watch/Prevent
2 - Act
3 - Act Immediately/Intensively
Strengths:
0 - Centerpiece
1 - Useful
2 - Potential
3 - None identified
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DCF Draft Modules
• Trauma (sexual abuse, adjustment)
• Functioning (school, juvenile justice,
developmental, medical)
• Emotional/Behavioral Needs
• Youth Strengths
• Acculturation
• Risk Behavior (runaway)
• Caregiver strengths and needs
– Permanency plan caregiver
– Current caregiver
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Other Versions of the CANS
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CANS-Juvenile Justice
CANS-Early Childhood (ages 0-3)
CANS-Trauma Exposure and Adaptation
CANS-Developmental Disabilities
CANS-Autism
CANS-Sexual Development
CANS-Mental Health
ANSA (Adult Needs and Strengths Assess.)
FAST (Family Advocacy and Support Tool)
Administering CANS
Method of administration: Instrument is rated by the
child’s provider based on information collected during
the assessment process.
Frequency of administration: The CANS can be
completed as often as needed. After the initial
assessment at the time of enrollment, an updated
assessment is recommended at least every 3 to 6
months.
Burden: It takes 15 minutes to complete 45 items on
the CANS.
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Training Requirements
• Professional knowledge in the field required; at least
a Bachelor’s degree recommended.
– Raters need mental health expertise to rate mental health
items.
• 1 ½ - 2 days of training recommended.
• Must successfully complete test vignette to become
certified.
• Raters maintain the reliability of their ratings by
annually completing vignettes provided by the
author.
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Collecting CANS Data
• The CANS provides guidance on assessment
content and a conceptual approach .
– But does not take the place of provider expertise
• Provider-reliant tool
– Expertise is assumed
– Some interview prompts available………..
– But focus is on organizing assessment info. to
improve communication and gain consensus
CANS Data Systems
• Data system needed if program- and systemlevel uses intended
• At least 3 web-based data systems available
from private groups
– Objective Arts
– Communimetrics Group
– Polaris
• Systems offer a mix of data entry, case
management, system management,
evaluation, and training functions
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Evaluation and Output
• Scoring: Scale/domain scores can be
calculated with a mean of items multiplied by
10.
• Outcome comparisons are best made at the
item level and subscale level (using Total
scores loses too much data).
• CANS has an algorithm for determining the
appropriate level of care needed for a child.
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Changing Practice in Illinois DCFS
• Problem: increasing use of inpatient and
increasing lengths of stay
• Dr. John Lyons hired to evaluate inpatient
placement decisions
• Children’s Severity of Psychiatric Illness (CSPI)
tool developed to verify decisions
– Precursor to the CANS
Changing Practice in Illinois DCFS
• Results:
– Accuracy of hospital placements increased
– Inappropriate placements of African-American
and Hispanic children dropped 15-20%
– Reduction by 1/3 of children and youth placed
in residential treatment in child welfare
Total Clinical Outcomes Management
(TCOM)
Family & Youth
Program
System
Decision
Support
Service Planning
Effective practices
EBP’s
Eligibility
Step-down
Resource
Management
Right-sizing
Outcome
Monitoring
Service Transitions
& Celebrations
Evaluation
Provider Profiles
Performance/
Contracting
Quality
Improvement
Case Management
Integrated Care
Supervision
CQI/QA
Accreditation
Program Redesign
Transformation
Business Model
Design
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Current Status of CANS Training for
ISP/CST’s
• Balancing self-training web modules with inperson training
• Increasing guidance and instructions in
written training materials
• Looking for methods to increase training
capacity
• Integration of “Super Users” into training
Integration of CANS with ISP/CST’s
• Merged instructional manual with interview
prompts
• Incorporated prompts and ratings into
existing assessment paperwork
• Medicaid approved CANS for pre-approval
required for in-home therapy billing
• Integrated ISP/CST CANS paperwork with
CCS & targeted case mgmt. requirements
Current and Future Status of CANS Use
in Wisconsin
• 45 Integrated Service Programs and
Coordinated Service Teams trained
– 230 certified trainers and raters
• Lutheran Social Services implementing
• Department of Child and Family Services
planning for future implementation in foster
care system
• Implications for cross-system applications
Deficits/Criticism?
• Requires consensus and is ‘equalizing’,
meaning no ‘expert’ to solve disagreements
• Training required to use, and recertification
yearly is recommended for accuracy
• Fairly brief, so may miss some level of detail
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CANS Validity
• Validity: Studies have compared the CANS to
results from other instruments and clinical
judgment and found the CANS to be valid. See
manual and literature for details.
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CANS Reliability
• Reliability: Reliability studies have demonstrated
that the CANS is reliable at the item level.
Training and certification is required for the use
of the CANS and the recommended minimum for
certification is a reliability of 0.70 using an
intraclass correlation coefficient on a test
vignette. Average reliability after training is
approximately 0.80. Reliability on case record
reviews has been demonstrated to be 0.85 while
reliability with live interview strategies is above
0.90.
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The LSS Clinical Story:
History and Current Plan
• Pilot training, a few staff attended training
• Utility: achieved LSS’ initial CANS involvement
• Some staff gave CANS impressions, concerns
o Questions: Versions? Administration time
length? (longer than Achenbach, others?)
o Practice time to competent/efficient
administration?
Decision-making on CYF going forward with CANS
Based on:
• Focusing tool to match clients/services
• Fine-tuned program admission/discharge criteria
• Aggregation of data across clients within program,
across programs within service
• Outcome reporting across iii above
• Explore/discover/report/develop programs for
unmet needs of clients/families
• Adaptability of CANS as needs/new questions arise
• Universality: many programs/services within state
and nationally using CANS
• Data/research/algorithms from broad, statewide use
LSS: Next Steps
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Training of September 2009
40 staff from several programs trained
Good: 39 immediately certified
Poor: general feeling that training was
underwhelming
• Homme staff organized around CANS and are using it
well in spite of limited training experience
• Other staff ‘not-yet-organized’ around CANS and
use/understanding is hit or miss
• Dave Minden offering ongoing consultation to try to
obviate not-yet-organized problems
LSS: Future Steps
• Training in April 2010 by Dr. John Lyons, CANS
developer
• 150 Staff in varied CY&F programs to attend
• Creating CANS culture
• Parallel with state
LSS: And Beyond…
Further support
– Trainers day April 2010
– Creating in-house training model
– Ongoing training of new staff
– Clinical support of CANS use
• Conference call monthly
• Staffings organized around CANS
– Software for recording and reporting
Questions?
• Phone lines now open for questions
• If you would like to keep your phone muted
press “*6” (to unmute press “*7”)
• You may continue to send questions in via
chat.
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Additional Resources
• Praed Foundation
www.praedfoundation.org
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Thank You
• Following this webinar, you will be asked to complete
a brief evaluation for continuing education credit
purposes and to help us develop future trainings.
• If you did not log into this webinar, but participated
as part of a group at your agency, a separate
evaluation form will be emailed to you.
• You will receive a copy of today’s Power Point
presentation via email.
• CEUs will follow via email within the next two weeks.
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