| CANS Items | Case Example | Rating | Justification | Resources | Considerations | Further Questions to Ask |
|---|---|---|---|---|---|---|
| Family Functioning | Maryanne is a 14-year-old girl whose parents are in the process of divorcing. While they are civil with each other most of the time, Maryanne has recently witnessed several verbal altercations between them about their parenting decisions. Maryanne reports these arguments make her feel very uncomfortable. | 2 | Because the caretakers are arguing in front of Maryanne about their care, action needs to be taken. | Article on Sibling Relationships and Influences in Childhood and Adolescence |
Consider the severity of family conflict. | How does the youth get along with the family? Are there problems between family members? Has there ever been violence in the home? |
| Social Functioning | Javier is a 15-year-old boy who reports having lots of friends at school and a few close friends he likes to spend time with on the weekends. | 0 | Javier has positive peer relationships and no indication of social difficulties. | Consider the severity of the social problems and the impact of these problems on social relationships. How much is the problem impeding social functioning? | Currently, how well does the youth get along with others? Has there been an increase in peer conflicts? Does he/she have unhealthy friendships? Does he/she tend to change friends frequently? | |
| Medical/Physical | Michael is a 16-year-old boy with exercise-induced asthma. He takes his inhaler before exercise with no problems. | 1 | Michael has a history of medical problems, but no intervention is needed at this time. The current medication seems to be effectively managing his asthma. | Consider the severity of the medical problem and whether this problem is chronic. The clinician could also consider how well managed the problem is. For instance, a poorly managed diabetic client may be rated a 3, while someone with well-managed diabetes might be rated a 1. | Does the youth have any medical problems? Does the youth have a primary care doctor? How often does he/she see the doctor? Does the youth have asthma/diabetes/another chronic illness? | |
| Developmental Delay | Raul is a 6-year-old boy who just moved here from Puerto Rico with his mother. His mother reports that he does not say any words and she asked her pediatrician for a pill to make him talk. | 3 | Raul has indications of a profound developmental delay, and action is needed as soon as possible to help address this need. | Consider the severity of the developmental delay and its impact on independent function. | Has the youth achieved all of the appropriate developmental milestones? Has he/she ever been diagnosed with a developmental delay? Did the youth receive early intervention services? | |
| Learning Disability | Julio is a 13-year-old boy who is in the 8th grade. He recently had testing for learning disabilities and has been put into a handful of special education classes. | 1 | Julio does have a learning disability but is receiving a new intervention. Watchful waiting would be recommended to assess the effectiveness of this intervention before additional action is taken. | Consider the severity of the learning disability and its current impact on the youth's ability to learn. | Does the youth have a diagnosed learning disability? Does the youth have any specific learning needs? How has the youth fared in reading/writing/memory tasks? | |
| Sexual Behavior | Maria is a 17-year-old girl who reports being sexually active with multiple male partners. She is not on birth control and uses condoms irregularly. | 3 | Maria is engaged in unsafe sexual practice and interventions should be initiated. In this instance, a score of 3 might be warranted because her current practice exposes her to significant health risks and should be ameliorated as soon as possible. | Consider the severity of the concern about sexual behavior and the potential risk the behavior may pose to the youth's safety and/or health. | Is the youth sexually active? If so, with how many partners? Is the youth involved or has he/she been involved with exchanging sexual acts for money or goods? Does the youth practice safe sex? | |
| Self Care | Freddy is an 11-year-old boy who shows up to his appointments well-groomed and wearing clean clothes. | 0 | Freddy appears to have no difficulty with self care. | Consider the impact that the self care concern has on daily functioning. For instance, do other youth notice or comment on the youth's hygiene? Does the youth's difficulty with self care cause arguments in the home? | Is the youth able to eat, shower, get dressed, and complete activities of daily living independently at an age-appropriate level? Has anyone expressed concerns about the youth's hygiene? | |
| Community | Brian is a 16-year-old boy who was released from juvenile detention six months ago for getting into trouble for spray painting offensive language on an elementary school wall. He has not gotten into trouble since his release and is engaged in several community activities at the local YMCA. | 1 | Brian has a history of problems in his community, but there is no intervention needed currently. However, given the recentness of his release, it is worth continuing to watch this item. | Consider the possibility that the youth may be removed from the community as a result of their behavior. Is the behavior so severe that they risk residential or other kinds of placement? If so, this would warrant a rating of 3. | How does the youth engage in the community? Has the youth caused any difficulty in any community settings that have resulted in sanctions (such as losing a YMCA membership)? | |
| School Behavior | Julangeles is a 7-year-old girl who frequently misses school due to family car problems; however, her teachers report that she is a joy in classes and causes no problems for them. | 0 | There is no evidence of Julangeles having behavioral problems at school. While she has attendance difficulties, this is rated elsewhere in the CANS. | Journal article on Student−school bonding and adolescent problem behavior |
Consider the severity of any difficult behavior at school, as well as the level of disruption caused by this behavior. The clinician may also consider whether this behavior is likely to result in a serious sanction. | How is the youth's behavior at school? Has the youth ever received a sanction at school due to his/her behavior? Is the youth engaged in his/her classes? Is he/she liked by teachers and peers? |
| School Achievement | Miguel is a 14-year-old boy who is failing all of his classes besides gym. His teachers have just sent a warning letter home saying he is in danger of failing 9th grade and needing to repeat it next year. | 3 | Miguel's school problems are evident, and he needs immediate intervention, as he is in danger of failing a grade and falling behind. | Consider whether the youth has recently failed any of his/her classes and/or is behind in grade level. | How was the youth's last report card? Is school a place where the youth is successful? What kind of grades does the youth receive? What kind of comments do teachers write on progress reports? | |
| School Attendance | Frankie is a 13-year-old boy who is chronically tardy to school. He rarely misses a day, but his teachers have started to contact home because he always comes in late and they are concerned that it will start to impact his school work. | 2 | Frankie has a problem with school attendance that needs to be addressed or it may cause him academic difficulty; however, his tardiness is not a critical problem that needs to be addressed acutely. | Article on school attendance, health and self asteem among adolescents |
Consider both truancy and true absences, and how frequently both occur. You may also consider the total days missed in this, or the prior, year of school. | Has the youth had any difficulty getting to or staying in school? Has the school been in touch about your youth's attendance? Does the child have difficulty getting to school in the morning? |
| CANS Items | Case Example | Rating | Justification | Resources | Considerations | Further Questions to Ask |
|---|---|---|---|---|---|---|
| Psychosis | Julia is a 9-year-old girl who has been seen for the last year. The clinician has not mentioned any concerns about bizarre thoughts or behavior. | 0 | There are no concerns about Julia suffering from psychosis. | Consider whether there is evidence of hallucinations or delusions and if so, whether they are dangerous and may place the youth or others at risk of physical harm. | Has the youth ever talked about hearing, seeing, or feeling something that was not actually there? Has the youth ever done strange or bizarre things that made no sense? Does the youth have a thought disorder or psychotic disorder? | |
| Hyperactivity/Im -pulsivity | Edward is a 9-year-old male who was recently diagnosed with ADHD. He started medications and his teachers report that his behavior has gotten much better and his grades are starting to improve. | 2 | There is a history of hyperactivity, but Edward is getting appropriate intervention and there is no additional intervention needed at this time. | Article on helping teens deal with the challenges of high school |
Consider the degree to which hyperactive and impulsive behavior is present and whether or not this behavior poses any immediate risk. | Is the youth squirmy or restless? Does the youth have difficulty focusing or completing tasks? Does the youth have difficulty listening without interrupting? |
| Depression | Mya is a 16-year-old girl who has been complaining about being sad recently. It has gotten so bad that she's refusing to get out of bed, has stopped going to school, and has quit the basketball team. She also talks frequently about suicide. | 3 | Mya's depression has reacted a critical point and immediate action is required. | Consider the degree to which depressive symptoms interfere with life functioning. | Does the youth seem down, or sad? Does the youth cry easily? Does the youth seem lonely or uninterested in others? Does the youth oversleep/have difficulty sleeping? Has the youth withdrawn from any activities? | |
| Anxiety | Jayden is a 14-year-old male who has struggled on and off with depression. He still attends school, but recently has started to complain that he has "attacks" at school where he feels very worrisome and needs to go to the nurse for a few minutes to calm down. | 2 | Jayden's anxiety is evident and the clinician should take steps to address it. While it is impacting his functioning, Jayden is still able to function for most of the school day, hence the rating of 2, rather than 3. | Consider the degree to which anxiety symptoms interfere with life functioning. | Does the youth have any problems with anxiety or fearfulness? Does the youth seem to have excessive worries? Does the youth have any particular fears or phobias? | |
| Oppositional | Francis is an 11-year-old girl who was referred for therapy because of a recent string of outbursts when the teacher sets a limit where she yells at her teacher and then storms out of the classroom. | 2 | Francis is showing oppositional behavior, which should be addressed by the clinician. | Consider the degree to which oppositional behavior creates a risk to the youth or others. Consider the degree to which this behavior creates difficulty for the youth in major life domains (i.e., school). | Does the youth often argue with adults? Does the youth have difficulty adhering to rules or expectations? | |
| Conduct | Maddox is a 16-year-old boy who is being seen in the clinic for his anxiety. When he was 12 years old, he threw the family cat off of the roof to watch it fall, but he has not had any reported aggressive behavior since that time. | 1 | Maddox has a history of conduct problems, but it does not seem to be a problem currently, and the clinician should watch and wait. | Consider whether the youth's behavior places the youth or community at risk of physical or other types of harm. Consider the degree to which this behavior interferes with the youth's success in school or other life domains. | ||
| Trauma Response | Jeremy is an 8-year-old boy who is being seen in the clinic for concerns about his increasingly aggressive behavior with his father. Neither Jeremy nor his family report any history of emotional, physical, or sexual trauma. | 0 | Jeremy does not have a known history of trauma. | Consider the youth's history of trauma and/or exposure to traumatic events. Consider the degree to which other symptoms you observe (anxiety, depression, etc.) appear to be related to this trauma. Consider the degree to which these symptoms interfere with the youth's functioning. | Has the youth experienced or been exposed to traumatic events? Does the youth have nightmares or flashbacks? | |
| Emotional Control | Heather is a 17-year-old girl who has been in therapy for about a year. Her therapist is impressed by Heather's ability to talk about and reflect on her emotions. | 0 | Heather does not have any problems with emotional control. | Consider the degree to which the youth experiences emotional control difficulties and/or whether these difficulties impact functioning or relationships. | What kind of strategies does the youth use to manage his/her feelings? Does the youth swing between moods quickly or are his/her moods somewhat unpredictable? Do you sometimes feel that the youth overreacts to situations with an emotionally wrought response? | |
| Substance Use | Brianna is a 16-year-old girl who reports that when she was younger, she tried using her friend's ADHD medications a few times to get high, but that she hasn't done that in years and hasn't used any other substances. | 1 | Brianna has a history of substance use, and the clinician should watch and wait. | Consider the frequency and type of substance use as well as how much this use interferes with the youth or family's functioning. You may also consider the degree to which this use is a health risk. | Does the youth use alcohol or any kinds of drugs? If so, what type and how often? | |
| Eating Disturbance | Tanya is an 18-year-old girl who has recently come in to a residential program. She has struggled with anorexia for the last 3 years and has just come out of the hospital, where she was inpatient due to her weight being dangerously low. | 3 | Tanya has a severe eating disturbance which needs immediate intervention. | This article is on Prevalence and Correlates of Eating Disorders in Adolescents |
Consider the degree to which the eating disturbance is life threatening. | How does the youth feel about his/her body? What are the youth's typical eating habits? Has the youth ever been diagnosed with an eating disorder? |
| CANS Items | Case Example | Rating | Justification | Resources | Considerations | Further Questions to Ask |
|---|---|---|---|---|---|---|
| Suicide Risk | Antonio is a 16-year-old boy who is being seen for therapy. He reports that he thinks daily about suicide and what it would be like to die. He doesn't currently have a plan. | 2 | The clinician should address Antonio's suicide risk, but given his absence of an immediate plan, immediate action is not warranted. | Consider the degree to which the youth's suicidality poses an immediate and urgent risk to his/her life or well being. | Does the youth have plans and/or look forward to the future? Has the youth ever talked about a plan or wish to die? Does the youth have any past self-harm or suicidal behavior? | |
| Self-Injurious Behavior | Maleak is a 17-year-old male who reports that he has started to burn himself with a lighter. He does it about once per week and says the pain feels "good." | 2 | The clinician should address this self-injurious behavior, but it has not reached a point of needing immediate intervention. | Consider the degree to which the self-injurious behavior poses a risk to health or well being. | Has the youth ever purposely hurt him/herself? | |
| Recklessness | Christopher is a 16-year-old male who is telling you about how he and his friends have started to play the "pass out game" every day, where they squeeze each other's necks until they pass out. Recently, one of his friends was rushed to the ER because he didn't come to after passing out. | 3 | The clinician needs to immediately address this reckless behavior because the behavior poses an immediate health risk. | Consider the degree to which recklessness or risk-taking places the youth at risk of dire consequences. | Has the youth ever talked about or acted in a way that might be dangerous to him/herself (e.g., riding on top of cars, reckless driving, climbing bridges, etc.)? | |
| Danger to Others | Pedro is a 13-year-old boy who is being seen for therapy. He has never been in a fight and has no history of aggression towards others. | 0 | Pedro has no history of being a danger to others. | Consider the degree to which the youth's behavior places others at significant risk of harm. | Has the youth ever hurt someone intentionally? Does the youth get into physical fights? Has the youth ever threatened to hurt someone? | |
| Sexual Aggression | Logan is a 15-year-old boy who was recently in a residential program because he was sexually abusing his 8-year-old brother. He was recently released from the program and reports to you that he recently had an urge to offend again but that he is working to manage that urge using strategies he learned in therapy. | 2 | Logan's sexual aggression needs to be addressed in an ongoing way, but is not at a critical point. | Consider how recently the act of sexual aggression occurred and whether the youth has engaged in any kind of treatment since the most recent act. You may also consider any urges the youth has disclosed. | ||
| Running Away | Adrienne is a 15-year-old girl who is being seen for depression. She reports that one time about a year ago, she ran away from a foster home and went to a friend's house for a few nights. She has not run away since then and says she is not tempted to again. | 1 | Adrienne has a history of running away, but it is not currently a problem and the clinician can watch and wait. | Consider how frequently running behavior occurs and how recently this behavior occurred. | Has the youth ever run away from home, school, or any other place? If so, how long was he/she gone? How was he/she found? | |
| Delinquent Behavior | Gretta is a 17-year-old girl who is being seen for therapy. She reports never having problems with the law or being arrested. | 0 | Gretta has ho history of delinquent behavior. | Consider how recent acts of delinquency took place and whether they involved the risk of significant loss or injury or placed the youth at risk of significant sanctions. | Has the youth ever broken the law (even if he/she wasn't charged or caught)? Has the youth ever been arrested? | |
| Judgment | Gretchen is a 12-year-old girl who has been seen for the last 6 months for therapy. The therapist has noticed that Gretchen doesn't always seem to understand that there are consequences to her decisions − not doing her homework, skipping basketball practice, etc. When asked to identify the likely result of a choice she makes, she has difficulty assessing the consequences accurately. | 2 | Gretchen is struggling with her judgment, and it is something the therapist should address; however, these lapses in judgement are not causing immediate or acute harm. | Consider whether errors in judgement pose risk to the youth or others' well being. | How is the youth's decision making process? Does the youth typically make good choices for him/herself? Do the youth's choices ever result in problems for the youth or others? | |
| Fire Setting | Anthony is a 17-year-old boy who is struggling with his behavior at home. His father reports that Anthony has started to set fires and is unplugging the smoke detectors. His father feels like he can't go to sleep because he is afraid of what Anthony will do. | 3 | Anthony needs immediate intervention for his dangerous fire-setting behaviors. | Frontiers in Public Health article on fire setting in children and young adolescents |
Consider the severity of any previous fires and how recently the youth engaged in fire setting. | Has the youth ever played with fire or matches? If so, what was the context? |
| Negative Attention Seeking | Paoula is an 8-year-old girl who is being seen for her increasingly disruptive behavior. Teachers report that she is constantly getting up and walking out of class and seems to enjoy that it is disrupting to the class and the attention she gets from teachers running after her. Her teachers have requested an IEP meeting to discuss this concern. | 2 | This is an issue that is making school become problematic and should be addressed by the clinician. Because a meeting has been scheduled, no additional immediate action is required. | Consider the degree to which negative attention-seeking interferes with the youth's functioning in any life domain. | Does the youth intentionally do things to upset adults? | |
| Bullying | Jace is a 13-year-old boy who is being seen for his anger management. Jace reports that he used to be really mean at school. Last year he was known as the class bully and would pick on the smaller youth. Since going to high school, he has stopped picking on other youth, and there have been no concerns raised about his bullying. | 1 | Bullying has been an issue in the past, but is not currently a problem, and the clinician should monitor it for now. | Consider the extent to which the youth has been engaged in bullying and whether this bullying posed a significant risk to the victim. | Have there been any concerns that the youth picks on, makes fun of, or harasses other youth? Does the youth hang out with other young people who are engaged in bullying? | |
| Exploitation | Gracelynne is a 7-year-old girl who is in custody of youth welfare because of concerns about neglect. She is very engaged and attentive with the clinician. She is outgoing and reports that no one is hurting her or making her feel unsafe. | 0 | There is no evidence that Gracelynne is, or is at risk for, being exploited at this time because Gracelynn is in an alternative placement. | Consider how recently the youth was a victim of exploitation and the risk that this exploitation will recur. | Has the youth ever been victimized? Does the youth have a history of exchanging sex for money or goods? Do other people take advantage of the youth? If so, in what ways? |
| CANS Items | Case Example | Rating | Justification | Resources | Considerations | Further Questions to Ask |
|---|---|---|---|---|---|---|
| Communication and Comprehension | Ryann is an 8-year-old boy. His family is Vietnamese and speak no English. They cannot communicate without the use of the language line or an older cousin who can sometimes come to appointments and help translate. | 3 | The family requires a translator for successful intervention. | Consider whether the youth and/or family members require a translator or interpreter to communicate effectively with providers. The youth should never be in a position to translate for other family members. | What language are family members most comfortable speaking? Does anyone in the family have difficulty communicating (either because English is not their native language or they use ASL, Braille, or assistive technology)? | |
| Discrimination/Bias | Haala is a 13-year-old Muslim girl who is receiving services for her anxiety. She reports that when she arrives at the clinic, she notices people seem to ignore her or intentionally not help her, and she attributes this to their discomfort with her wearing a hijab. | 2 | Haala is likely facing discrimination for how she dresses as a young Muslim woman, and the clinician should address this with her and with the clinic staff. | Consider the degree to which discrimination and bias interferes with the youth or family's functioning or acts as a barrier to effective service delivery. | Has the youth or family experienced discrimination? If so, what was the impact of this discrimination on their lives? Do the youth or family report any experience of discrimination or bias? Was it connected to behavioral health services? | |
| Cultural Identities | George is a 15-year-old Greek male. He reports being from a huge Greek family and attending a Greek Orthodox church. He is a volunteer at Greek Week in his community. He sees this identity as a strength and frequently talks about it with pride. | 0 | George shows no evidence of cultural identity needs. | Consider the degree to which the conflict around the youth's cultural identity/ies causes distress to the youth or their family. | What words do the youth and family use to describe themselves? Are the youth and family part of any marginalized groups? Does the youth or family feel pressure to join/leave/hide a particular aspect of their identity? Does the youth ever feel conflicted about aspects of their social identity? | |
| Cultural Differences Within the Family | Matthew is a 15-year-old male who is being seen for his struggles with sexual orientation and gender identity. Initially, his family struggled with his coming out and there was tension in the house; however, over the last year, they have become very supportive and affirming of Matthew. | 1 | Matthew and his family have a history of struggle/conflict regarding cultural differences. However, there is no conflict now, and this should be monitored. | Consider the degree to which any family conflict centers around differences in social identities between family members and how much this conflict interferes with family life. | Do the parents and youth have similar expectations around family responsibilities or social/other behavior that are tied to their culture? Do family members understand/discuss each other's cultural identities? Do the youth and other family members have any conflict that results from different perspectives tied to social identity? | |
| Youth/Family Perspective of Provider/System | Akeem is a 17-year-old male who has been receiving services for 2 years. He and his family have developed a great working relationship with the individual and family therapists. They report being very pleased with their experiences. | 0 | Akeem and his family have no history of need in regards to their view of the provider and system. | Review of high quality practices and associations among families |
Consider the degree to which the family's or other's previous interactions with the service delivery system act as a barrier to successful engagement with the current treatment team. | What has been the youth or family's experience with the behavioral health system? Are there cultural beliefs that impact the youth or family's relationship with providers? Do the youth and/or family prefer a helper from a particular cultural group? |
| Agreement about Strengths and Needs | Zack and his family have been in therapy for the last year. Initially, Zack's father was resistant to coming to family therapy sessions because he did not think their family relationship was something that needed work. However, after meeting with the therapist, he agreed it was helpful and has been engaged in therapy ever since. | 1 | There is a history of disagreement between the family and provider about needs, but this is not currently an issue that needs to be addressed. | Consider the extent of any disagreements between the family and the provider system and whether these disagreements are prohibiting successful engagement. | How would this behavioral health condition/behavior be understood by family or friends? How would others in the community treat or respond to this concern? How do you understand why the youth has these behaviors/symptoms? |
| CANS Items | Case Example | Rating | Justification | Resources | Considerations | Further Questions to Ask |
|---|---|---|---|---|---|---|
| Independent Living Skills | Alimarie is a 17-year-old girl who is 6 months from aging out of the foster care system. Her foster mom reported to the therapist that she is concerned because Ali is unable to do certain things, such as manage money, cook anything besides toast, and schedule appointments. | 2 | This is an issue that needs to be addressed, as Ali is close to aging out of the system; however, there are 6 months to work with, and it has not reached a critical point. | Consider both the level of impairment and its impact on independent living. | Does the young person know how to take care of him/herself? Does the young person know how to cook, clean, etc.? | |
| Transportation | Serenity is a 17-year-old girl with a history of cerebral palsy who was recently placed in a new foster home. She requires a special van for transportation, which her foster mom does not have. She has multiple appointments in the next few weeks and no way to get there. | 3 | Serenity has a critical need for transportation as she would currently miss multiple appointments if this was not addressed ASAP. | Consider how much assistance the youth requires to successfully attend activities/work in the community and whether this transportation requires a special vehicle. | Does the young person have transportation needs that limit his/her participation in treatment or other life activities? Does the young person have a physical disability that requires a special vehicle? Is there a PT1 form for the young person? | |
| Personality Disorder | Samantha is an 18-year-old girl who is moving into independent living. She has been in the foster care system for 4 years due to neglect at home. Her therapist is impressed with her progress over that time and reports that she has a wonderful personality and disposition. | 0 | There are no concerns about Samantha suffering from any sort of personality disorder. | Consider the degree to which any symptoms of a personality disorder interfere with the young person's ability to function independently. | Are there concerns about the young person's personality features? Does the young person have strong and healthy relationships? Has the young person been diagnosed with a personality disorder, and if so, has treatment been helpful? | |
| Parenting Roles | Mia is a 17-year-old girl who has been in foster care for the last few years and is aging out next year. Recently, she found out that she is about 2 months pregnant, and she is not sure that the baby's father will help her at all with the baby. | 2 | Mia has needs regarding assuming a parenting role that need to be addressed. She is only 2 months pregnant, so this has not yet reached a critical point, as there is time to address this need. | Factsheet on helping foster parents with adolescent transition |
Consider the degree to which the youth is able to effectively manage any parenting responsibilities. | Does the young person have any children? If so, who is responsible for those children? Has the young person ever been engaged with the children welfare system in a parenting role? |
| Medication Adherence | Rachelle is a 17-year-old girl with a history of MDD, who has been on an SSRI for the past 3 years. Initially, she struggled to remember to take her medication and would frequently miss days at a time; however, she has had an alarm alert in her phone for the past 2 years and reports that she never misses a dose anymore. | 1 | Rachelle has a history of poor medication adherence; however, she has been doing well for quite some time and can be monitored for now. | Factsheet on helping foster parents with health and well being of adolescent |
Consider whether the young person has ever abused their prescribed medication and/or refused to take the medication and the consequences of such decisions. Consider how recently any difficulties with adhering to prescribed medication regimes occurred. | Is the young person prescribed any medication? If so, does he/she take it as prescribed? How does the young person feel about the prescribed medication? |
| Educational Attainment | Dalton is a 16-year-old male who is receiving services for his aggressive behavior. Although he should be a junior in high school, he is still in the 8th grade and is in danger of failing again. He reports not caring about school and wanting to drop out. | 3 | Dalton has a critical need for intervention for his educational attainment. He is well behind and will likely drop out unless intervention is immediate. | Facsheet on helping foster parents with educational attainment |
Consider the degree to which the young person's educational record or attainment interferes with their ability to function independently and/or earn a living. | Does the young person have a high school diploma or GED? Does the young person plan to attend college? How invested is the young person in his/her educational goals? |
| Financial Resources | Amya is a 17-year-old girl who is aging out of the foster care system next month. She has a minimum wage job, but has no idea how she would pay for college. Recently, she decided to sign herself back in to care so that she would have financial help for school. She feels much more secure now with her finances. | 1 | Lack of financial resources was a problem for Amya, but she has figured out a way to manage it. Paying for college is no longer a concern, but should be monitored. | Factsheet on helping foster parents with financial resources for adolescents |
Consider the level of financial difficulty the youth experiences. If the youth is in poverty, a rating of 3 would be appropriate. | What is the young person's budget? How much income does the young person have each month? |
| CANS Items | Case Example | Rating | Justification | Resources | Considerations | Further Questions to Ask |
|---|---|---|---|---|---|---|
| Family | Shaima is an 11-year-old girl who was removed from her parents' custody due to ongoing drug abuse and neglect. She was adopted by her aunt and uncle, and they have been very loving and supportive during her treatment. | 0 | Although historically, her familial connections have been tenuous, Shaima's adoptive parents are involved and supportive and can be a centerpiece of treatment. | Consider whether the youth has a present and supportive family. | Are there good relationships that the youth has with any family members? Is there a family member that the youth relies on in times of crisis? Is there the potential to further develop any family relationships? | |
| Interpersonal | Sam is a 13-year-old boy who is in treatment for concerns about his depression/anxiety. The therapist reports that he has a friendly and engaged personality, but he does have up lots of guards, which makes it hard to engage at times. | 2 | Sam has some interpersonal strengths that the therapist has noticed. They are not always evident, but there is potential that the therapist can work with him to realize. | Consider how easily/frequently the youth is able to form healthy relationships with others. | Does the youth make friends quickly or easily? Do other people tend to like the youth? Is the youth charming? | |
| Optimism | Jordan is a 17-year-old male who is a few months away from aging out of the foster care system. He reports feeling hopeless about the future. He doesn't think he'll be able to find a job or take care of himself. He reports zero confidence in himself or his future. | 3 | No optimism is identifiable at this time, and the therapist will have to work hard to help identify any strengths in this area. | A Prospective Study of the Effects of Optimism on Adolescent Health Risks |
Consider the degree to which the youth can see his/her positive attributes and/or imagine a positive future for him/herself. | Does the youth generally have a positive outlook on things? Is the youth a glass half-full or half-empty kind of person? What does the youth imagine for his/her future? |
| Educational System | Lucia is a 7-year-old girl who has recently moved here from Puerto Rico. She is being seen for concerns about her behavior in school. The school system does not have any supports in place for her, but has sent her to her pediatrician for an ADHD work-up. | 2 | The school is engaged with Lucia, but has not yet began any interventions. The educational system is a potential strength. | A Harvard Educational Review on Why Literacy Matters in Adolescents |
Consider the degree to which the educational system acts as a partner to help the youth achieve his/her goals and to mitigate obstacles to these goals. | Does the school system respond quickly to identified concerns? Is the school system willing to make adjustments to help meet the needs of the youth? |
| Vocational | William is a 16-year-old boy who has been seen in OP Therapy for about 2 years. He doesn't have a job, but he spends every afternoon in his uncle's autobody shop helping him work on cars. His uncle reports that he is very helpful and is starting to do things more independently. | 1 | His vocational skills are a strength. The therapist can and should use this in the treatment planning. | Paper on Adolescent Work, Vocational Development, and Education |
Consider the degree to which the youth's vocational skills could assist the youth in earning an income that is liveable. | Does the youth know what he/she wants to do for a career? Does he/she have any/all of the skills required for that career? Does the youth have any interests that could be used in a work setting? |
| Talents/Interests | Arianna is a 15-year-old girl who has been seen in OP Therapy for the last year for anxiety. She does OK in school and is a star athlete - lettering in 3 different sports and recently voted Athlete of the Year for her district. She loves being physically active and trying new sports. | 0 | Arianna's involvement and success in sports is a significant strength for her, and the therapist should use it as a centerpiece for treatment planning. | Article from National Resource Center for Gifted and Talented Adolescents |
Consider the degree to which the youth's talents or interests provide the youth with pleasure, self-esteem, or a positive peer group. | What does the youth enjoy doing? Is the youth involved in any organized activities? |
| Spiritual/Religious | Cameron is a 16-year-old boy who is being seen for his struggles with gender identity and sexual orientation. He reports that once he came out, his church rejected him and wouldn't let him be a part of the youth group anymore. He has since severed all religious ties and reports that he hates organized religion. | 3 | Organized religion is clearly not a source of strength for Cameron. The therapist would have to probe more to determine whether other forms of spirituality could be a source of strength. | Consider the degree to which spiritual beliefs or community provide support to the youth, not just whether the youth has spiritual beliefs. | Does the youth have spiritual beliefs? Do these beliefs act as a source of comfort? Is the youth involved in a spiritual community? | |
| Community Connections | Tia is a 16-year-old girl who has been seen for the last 2 years. She just recently came out as a lesbian and is happy that she found a youth group with other teens who identify as LGBT. She also volunteers at the Y and helps with their summer camps. | 0 | Tia is very involved in her community in positive ways. This is a source of strength for her, and the therapist can build off of this as a centerpiece for her treatment. | Consider whether the youth is a member of any identified communities or community activities (e.g., YMCA). | Are the youth or family engaged in any community groups or organizations? | |
| Resiliency | Joquan is a 13-year-old boy. He reports to his therapist that he doesn't think he is good at "much of anything." He is able to say that he might be good at math, as he recently won an award at his school, but he thinks he might just have gotten lucky. | 3 | No evidence of resiliency for Joquan. The therapist will need to check further to see if he shows ways to use his math or other skills in adaptive ways. | Consider the youth's ability to "bounce back" from adversity. | Does the youth seem to recover quickly from tough situations? How does the youth see/use his/her strengths? |
| CANS Items | Case Example | Rating | Justification | Resources | Considerations | Further Questions to Ask |
|---|---|---|---|---|---|---|
| Physical Health | Dallas is a 15-year-old girl who has been seen for her depression. She lives with her two parents and her younger brother. She reports that everyone in her family is healthy and no one takes any medications. | 0 | Dallas's caregivers are all healthy. Neither has any physical need. | Consider the impact of the caregiver's health on his/her ability to parent. | How is the caregiver's health? Does he/she have any health problems that limit his/her ability to parent? | |
| Mental Health | Sage is an 8-year-old boy who recently came into custody. He was removed from the home after his mom was placed inpatient for suicidal attempts after extensive spousal abuse. The timeline for mom to be inpatient is unknown at this time, and dad has been incarcerated. | 3 | Sage's mom has severe mental health needs at this time, which are requiring immediate intervention. | Consider the degree to which a mental health concern impairs the caregiver's ability to parent. | Does the caregiver have any behavioral health concerns? Do symptoms of any behavior health issue make it difficult to parent? If so, how and when? | |
| Substance Use | Owen is a 9-year-old boy who is being seen in the clinic. His parents are both present for his intake. Dad reports that in the past he has really struggled with alcohol, but he attends AA meetings and has been sober for the last 3 years. Mom has no history of substance use. | 1 | Owen's dad has a relevant history of substance use; however, it is not an issue at this time. The therapist should be aware of this history, though no action is needed now. | Consider the degree to which any substance use on the part of the caretaker interferes with his/her ability to parent. | Does the caregiver use/abuse substances? Does this use of substance influence the youth in any way? | |
| Developmental Delay | Isla is a 10-year-old girl who has been seen for the last 2 years. Her parents are both fully employed and engaged in her therapy. They are articulate and self-reflective with the therapist. | 0 | There is no evidence of any developmental delay with either parent. | Consider the degree to which a caregiver's developmental delay impedes his/her ability to parent. | Does the caregiver have a developmental delay that impedes his/her ability to parent? If so, how is this impediment managed? | |
| Family Stress | Myles is a 14-year-old boy who is being seen for his aggressive behavior at school. His mom reports that she is at her wit's end with him. She is a single parent and is in danger of losing her job for missing days to pick up Myles from school. She reports wanting to help Myles, but she finds it difficult to be constructive. | 2 | Myles' mom is stressed with managing his behavior and care. She is in danger of losing her job, so action should be taken to help her. However, she is still engaged, and action need not be immediate. | Consider the degree to which the family system is under stress and the impact this stress has on the caregiver's ability to parent. | Does the caregiver feel stressed? If so, what is the primary source of stress? Does the caregiver show stress? If so, how? | |
| Housing Stability | Layla is a 6-year-old girl who is new to the therapist. She reports that her family recently had to move out of a house because the landlord kicked them out. They lived with an uncle for a few days before they had to leave. Currently, they are moving from house to house and recently spent a night in the park. | 3 | There is a severe problem with housing stability that needs to be addressed immediately, as the family has had to spend nights outside. | Consider how often, if at all, the family has been homeless and/or moved. | How stable is the family's living situation? Are there concerns about their living situation? When was the last time that they moved? | |
| Supervision | Mason is a 6-year-old boy who is being seen in the clinic. When he was 2 years old, his mom left him alone and went to the store. He pulled hot coffee down on himself and needed to be hospitalized for a night. Since then, mom reports she has learned more about how to care for and watch Mason and knows he shouldn't be left alone. | 1 | There is a history of inadequate supervision with Mason. However, his mom has made changes and there haven't been recent concerns. The therapist should watch and wait. | Consider the degree to which the caregiver is able to monitor and/or discipline the youth at a developmentally appropriate level and whether this lack of discipline or monitoring puts the youth at risk in any way. | How do caregivers keep an eye on the youth? What kind of rules does the caregiver have in the house? How are these rules enforced? | |
| Involvement | Netta is a 14-year-old girl who is involved in treatment. Her parents have been asked to do family counseling as well. Her mom attends most of the sessions, but her father is resistant. He has told the therapist he thinks the whole process is stupid and he doesn't need to change anything. | 2 | There is a need for action regarding caregiver involvement. Mom is involved, but dad is very resistant. To make family therapy productive, the father needs to be involved more. | Consider the degree to which the caregiver is actively involved in meeting the youth's needs, whether this be engagement in treatment or active involvement in other activities (e.g., with the school). | How involved are the caretakers? Would the caretakers like to take a more active role in the youth's life? | |
| Organization | Nicole is a 9-year-old girl who is involved in services. She is an only child with a single mother. Her mom works 2 jobs and often struggles to remember appointments. She frequently calls at the last minute to reschedule or forgets to show up entirely. She does return phone calls reliably and would like to be better organized. | 2 | The caregiver has an organizational need; however, it is not critical, as Nicole is still getting to some appointments and mom is trying hard to communicate well with providers. | Consider the degree to which difficulties with organization impede the caregiver's ability to follow treatment plans and/or meet the youth's needs. | Does the caregiver remember/keep appointments? Does the caregiver help the youth get to scheduled activities? Can the caregiver keep the house organized? | |
| Natural Supports | Kaymani is a 7-year-old girl who has been seen for 2 years. She lives with her mother who is involved. She is also brought to appointments by either of her grandparents, who also live at home with family and help provide care when mom is working. She also has an uncle and cousins who live nearby who can help out if needed. | 0 | The family does not appear to need any natural resources. | Consider the degree to which the family has a social network that can help support their needs. | Does the caregiver have anyone he/she can call for help? Who can he/she rely on for help with child care or managing the household? | |
| Financial Resources | Micah is a 14-year-old boy who is involved with DCF. He lives with his mom, and they just moved out on their own. They were struggling financially when mom got laid off, but about a year ago, she got a full-time job with benefits, and money has not been a concern for the family since that time. | 1 | There is a relevant history of need with financial resources; however, there is no current need. The therapist can watch and wait to see how the mom's job goes. | Consider the degree to which poverty impacts the family's life. | Does the family have any financial struggles? |