The CANS-MH provides a comprehensive assessment of the type and severity of clinical and psychosocial factors that may impact treatment decisions and outcomes. It is part of the Child and Adolescent Needs and Strengths (CANS) series of decision support tools, with different versions of the CANS tailored to the needs of specific youth populations (see altered versions).
The CANS-MH is designed to affect clinical decision making with the intensity of treatment indicated by the number and severity of presenting risk factors. The measure also assesses for strengths. The CANS-MH can be used either as a prospective assessment tool during treatment planning or as a retrospective assessment tool to review existing information (e.g., chart reviews) for quality assurance monitoring or system planning.
Overview
CANS-MH
Lyons J.S., Griffin E., Fazio M., & Lyons M.B. (1999). Child and Adolescent Needs and Strengths: An Information Integration Tool for Children and Adolescents With Mental Health Challenges (CANS-MH), Manual. Chicago: Buddin Praed Foundation, 558 Willow Rd., Winnetka, IL 60093.
Melanie Buddin Lyons phone: 847-501-5113 fax: 847-501-5291Mlyons405@aol.com [1]The manual and coding form can be obtained free of charge from the website. However, the manual asks that those who wish to obtain permission to use the measure contact Melanie Buddin Lyons.
Administration
4-point scale. Anchors are given for each point in a scale.
Strengths are rated in the opposite manner so that in all cases a low rating is positive, and a higher rating is indicative of a problem and a need for action.
In general the rating for scales is as follows:
0=no evidence and/or no need for action
1=mild degree and/or need for watchful waiting to see if action is needed
2=moderate degree and/or need for action
3=severe or profound degree and/or need for immediate or intensive action
U=unknown but indicates a need for more information
0 (Indicates a child with no evidence of thought disturbance. Both thought processes and content are within normal range.)
1 (Indicates a child with evidence of mild disruption in thought processes or content. The child may be somewhat tangential in speech or evidence somewhat illogical thinking (age inappropriate). This also includes children with a history of hallucinations but none currently. The category would be used for children who are below the threshold for one of the DSM-IV diagnoses listed above.)
2 (Indicates a child with evidence of moderate disturbance in thought processes or content. The child may be somewhat delusional or have brief, intermittent hallucinations. The child's speech may be at times quite tangential or illogical. This level would be used for children who meet the diagnostic criteria for one of the disorders listed above.)
3 (Indicates a child with a severe psychotic disorder. Symptoms are dangerous to the child or other
| Domains | Scale | Sample Items |
|---|---|---|
Training
none needed
Parallel or Alternate Forms
There are multiple versions of the CANS, which are available from http://www.buddinpraed.org/. The different versions are tailored to the needs of specific populations of youth. The CANS-TEA is a version specific to children who have experienced trauma. It is also reviewed in this database.
1. CHILD & ADOLESCENT NEEDS AND STRENGTHS (CANS-CW): An Information Integration Tool for Children and Adolescents with Child Welfare Involvement
2. CHILD & ADOLESCENT NEEDS AND STRENGTHS (CANS-0 to 4. : An Information Integration Tool for Early Development
3. CHILD & ADOLESCENT NEEDS AND STRENGTHS (CANS-DD): An Information Integration Tool for Children and Adolescents with Developmental Disabilities and Their Families
4. CHILD & ADOLESCENT NEEDS AND STRENGTHS (CANS-JJ): For At-Risk and Delinquent Children and Adolescents
5. CHILD & ADOLESCENT NEEDS AND STRENGTHS (CANS-SD): An Information Integration Tool for Children and Adolescents with Issues of Sexual Development
6. CHILD & ADOLESCENT NEEDS AND STRENGTHS-TRAUMA EXPOSURE AND ADAPTATION VERSION (CANS-TEA): An Information Integration Tool for Children and Adolescents Exposed to Traumatic Events
Psychometrics
| Type: | Rating | Statistics | Min | Max | Avg |
|---|---|---|---|---|---|
| Test-Retest | |||||
| Internal Consistency | |||||
| Inter-rater | acceptable | intraclass correlation | 0.77 | 0.85 | 0.81 |
| Parallel/Alternate Forms |
The CANS/CANS-MH is a unique measure in that items are not intended to be summed or factored together. Each item represents a potential target of clinical intervention. As such, traditional psychometrics including internal consistency and factorial validity may not be applicable. Nevertheless, studies have examined psychometrics of CANS ratings, including interrater reliability.
INTERRATER
The most detailed CANS-MH interrater reliability study, Anderson & Huffine (2003), examined interrater reliability (intraclass correlations) with 60 randomly selected cases (children aged 7 days to 17.5 years). Over half of all coding differences did not affect treatment plan (e.g., were a difference of coding 0 vs. 1, or 2 vs. 3). Reliability was reported as follows:
1. Caseworkers and Researchers: Total Scale (.81), Problem Presentation (.72), Risk Behaviors (.76), Functioning (.85), Care Intensity and Organization (.75), Caregiver Capacity (.75), Strengths (.77).
2. Pairs of Researchers: Total Scale (.85), Problem Presentation (.84), Risk Behaviors (.82), Functioning (.85), Care Intensity and Organization (.77), Caregiver Capacity (.68), Strengths (.84).
3. Reliability between pairs of researchers is what is reported in the table, as these are the numbers that are most comparable with studies involving other measures.
4. The manual reports that for clinical vignettes, the average reliability across studies is .75. For case reviews or current cases, the average reliability is .85. Details are not given regarding the studies or the statistics used to assess reliability.
5. Rawal, Lyons, MacIntyre, & Hunter (2004) reported interrater reliabilities of .67-.87 across all raters in study using residential treatment data from four states.
6. Lyons, Griffin, Quintenz, Jenuwine, & Shasha (2003) reported the reliability of provider rated CANS-MH as .80 using audit reliability measures.
7. Lyons, MacIntyre, Lee, Carpinello, Zuber, & Fazio (2004) reported weighted interrater reliability across all reviewers and all items as .86.
In terms of validity, the CANS correlates with other measures of psychopathology, functioning, and strengths in children. Also, the CANS has been shown to distinguish levels of care and intensity of services. Finally, as a decision support, the CANS has been shown to agree with an expert panel of clinicians 81% of the time. See www.buddinpraed.org.
| Validity Type | Not known | Not found | Nonclincal Samples | Clinical Samples | Diverse Samples |
|---|---|---|---|---|---|
| Convergent/Concurrent | Yes | ||||
| Discriminant | Yes | ||||
| Sensitive to Change | Yes | Yes | Yes | ||
| Intervention Effects | Yes | Yes | |||
| Longitudinal/Maturation Effects | Yes | ||||
| Sensitive to Theoretically Distinct Groups | Yes | Yes | |||
| Factorial Validity | Yes |
| Not Known | Not Found | Nonclinical Samples | Clinical Samples | Diverse Samples | |
|---|---|---|---|---|---|
| Predictive Validity: | Yes | Yes | Yes | ||
| Postdictive Validity: | Yes |
Translations
| Language: | Translated | Back Translated | Reliable | Good Psychometrics | Similar Factor Structure | Norms Available | Measure Developed for this Group |
|---|---|---|---|---|---|---|---|
| 1.Spanish | Yes | ||||||
| 2.Portuguese | Yes |
Population Information
Pros & Cons/References
1. The CANS is a great tool for facilitating the exchange of information about patients because it provides a common language regarding an array of important areas of symptomatology and functioning.
2. Item anchors are relevant to clinical decision-making.
3. Information provided can be closely linked to treatment planning.
4. The item incorporates a solid focus on strengths, consistent with strength-based treatment planning guidelines.
5. The measure makes conceptual sense to clinicians.
1. There are few published articles examining the psychometrics of the CANS-MH. What exists is promising, but more research is needed on the test-retest reliability and validity. It is, however, important to note that the parent measure, the Childhood Severity of Psychiatric Illness, has been used in 12 additional published articles.
2. Although items within dimensions can be combined to create continuous scores that can be used to assess outcomes, if a researcher or clinician is targeting a specific problem area (e.g., Depression/Anxiety), for this purpose, the measure might have restricted statistical power because individual problems are assessed using a 3-point scale. The CANS-MH could be used to screen for a problem in a specific area with a positive screen, followed by administration of an instrument that specifically assesses that area. Nevertheless, the CANS-MH would provide a measure of clinically significant change.
Reference for CANS Manual:
Lyons J.S., Griffin E., Fazio M., & Lyons M.B. (1999). Child and Adolescent Needs and Strengths: An Information Integration Tool for Children and Adolescents With Mental Health Challenges (CANS-MH), Manual. Chicago: Buddin Praed Foundation.
Anderson, R. L., & Huffine, C. (2003). Child & adolescent psychiatry: Use of community-based services by rural adolescents with mental health and substance use disorders. Psychiatric Services, 54(10), 1339-1341.
Anderson, R.L., Lyons, J.S., Giles, D.M., Price, J.A., & Estle, G. (2003). Reliability of the Child and Adolescent Needs and Strengths-Mental Health (CANS-MH) scale. Journal of Child & Family Studies, 12(3), 279-289.
LeBuffe, P.A., & Shapiro, V.B. (2004). Lending "strength" to the assessment of preschool social-emotional health. California School Psychologist, 9, 51-61.
Lyons, J.S., Griffin, G., Quintenz, S., Jenuwine, M., & Shasha, M. (2003). Clinical and forensic outcomes from the Illinois Mental Health Juvenile Justice Initiative. Psychiatric Services, 54(12), 1629-1634.
The author provided feedback, which was integrated into the review.