When completing the vignettes, there is a vignette assumption. That is, when reading assume that a full assessment has been done and no mention means 'no evidence'. This is the standard quality assurance if it is not documented it does not exist assumption. What that means, then if there is no mention of a need, the rating should be a '0'. If there is no mention of a strength, then the rating should be a '3'. So, no mention of any suicidality would result in a rating of '0' on Suicide Risk. No mention of any talents or interests would result in a rating of '3' on Talents/Interests. Another way to think about it is that you start the assessment with all 0 ratings on the Needs and all 3 ratings on the Child/Youth Strength and then you look for evidence to adjust your scores accordingly using the action levels. Caregiver ratings use the Need action levels for the vignettes.

Ordinarily certain items would have an N/A option (for example Job Functioning for an underage child, or Foster Caregiver for a child not in foster care). For the purposes of this test please rate such items as '0' for needs and as '3' for strengths.

Alex

Rate Both Parents as Caregiver

Alex is a 13-year-old male, recently discharged after a thirty-day stay in an in-patient psychiatric hospital. He was hospitalized because he heard voices telling him "terrible things about himself" and telling him to kill himself. He reported this to the school social worker who notified his parents. He was taken from school to the hospital. Alex presents as depressed and withdrawn, but will engage in one-on-one interaction with an adult. Alex has been telling people that he has been hearing voices since he was 5 years old. The parents have expressed their gratitude to the school personnel for believing Alex and responding quickly because when he has said similar things at home, they didn't know what to do. Now they are worried that they might not be able to keep him safe at home.

Alex lives with his mother, father, and two older sisters. It is a loving family with close emotional ties. All of the children are kind, obedient, and care about other people. Both parents have severe mental illness, and both older sisters are being treated for mental illness. Each family member has had multiple psychiatric hospitalizations during the past two years. Alex has no relatives in the area.

Although his family has moved many times over the past few years, Alex has remained enrolled in the same school district. He exhibits no behavioral problems at school but he often responds verbally to his auditory hallucinations. In addition, these hallucinations make it difficult for him to concentrate which has impacted his grades. While he has educational goals appropriate for a tenth-grader, he is currently struggling to complete his requirements. He also often comes to school in the same clothes, which appear unwashed, several days a week. The teacher has expressed concern because he is regularly teased by other children. The teacher and the school social worker have met with Alex's parents who have a hard time understanding the immediate risk that Alex's hallucinations pose for him. Alex has no friends at school but interacts well with all staff. He attends school regularly.

Alex and his family have been seen at the same clinic for the past four years. His mother was recently referred to a Day Treatment Program and is doing well. His father has been in recovery for over eight years and has been successful with his recovery. In an effort to get good housing in a safe neighborhood, the family has moved six times in the past 18 months. The family receives financial assistance through programs such as Section 8 benefits, SSI, and food stamps and is able to provide for the basic needs of their family.

When Alex was six years old, he witnessed the shooting of his uncle in front of their house. His uncle died on the sidewalk. The police questioned Alex a number of times about the incident. He experienced sleeplessness consistently for months after the incident and still does periodically. He will randomly ask his parents if they remember "when Uncle Sammy got killed." Alex never received counseling after his uncle's death.

Section 1:

The ratings in this section identify the behavioral health needs of the child/youth. While the CANS is not a diagnostic

tool, it is designed to be consistent with diagnostic communication. In the DSM, a diagnosis is defined by a set of

symptoms that is associated with either dysfunction or distress. This is consistent with the ratings of '2' or '3' as

described by the action levels below. Behavioral/Emotional Needs

For Child/youth Behavioral or Emotional Needs Domain, use the following categories and action levels:

0 No current need; no need for action or intervention.

1 History or suspicion of problems; requires monitoring, watchful waiting, or preventive activities.

2 Problem is interfering with functioning; requires action or intervention to ensure that the need is

addressed.

3 Problems are dangerous or disabling; requires immediate and/or intensive action.

1. Psychosis

0

1

2

3

2. Impulse/Hyperactivity

0

1

2

3

3. Depression

0

1

2

3

4. Anxiety

0

1

2

3

5. Oppositional

0

1

2

3

6. Conduct

0

1

2

3

7. Substance Use

0

1

2

3

8. Somatization

0

1

2

3

9. Anger Control

0

1

2

3

10. Adjustment to Trauma

0

1

2

3

11. Eating Disturbance

0

1

2

3

12. Attachment Difficulties

0

1

2

3

Section 2: Traumatic/Adverse Childhood Experiences

For the Potentially Traumatic/Adverse Childhood Experiences, the following categories and action levels

are used*:

0 Indicates a dimension where there is no evidence of any trauma of this type.

1 Indicates a dimension where a single event or one incident trauma occurred, or suspicion exists of

trauma experiences.

2 Indicates a dimension on which the child has experienced multiple traumas or multiple incidents.

3 Indicates a dimension which describes repeated, chronic, on-going and/or severe trauma with

medical and physical consequences.

1. Sexual Abuse

0

1

2

3

2. Physical Abuse

0

1

2

3

3. Emotional Abuse

0

1

2

3

4. Neglect

0

1

2

3

5. Medical Trauma

0

1

2

3

6. Witness to Family Violence

0

1

2

3

7. Witness to Community Violence

0

1

2

3

8. Witness to School Violence

0

1

2

3

9. Natural or Manmade Disaster

0

1

2

3

10. Disruption in Caregiving/Attachment Losses

0

1

2

3

11. Parental Criminal Behavior

0

1

2

3

12. War/Terrorism Affected

0

1

2

3

13. Witness/Victim - Criminal Acts

0

1

2

3

Section 3: Traumatic Stress Symptoms

Rate the following items within the last 30 days.

• 0. No evidence of need. No action needed
• 1. Significant history or possible need that is not interfering with functioning. Watchful waiting/prevention/additional assessment
• 2. Need interferes with functioning. Action/intervention required
• 3. Need is dangerous or disabling. Immediate action/intensive action required

1. Emotional and/or Physical Dysregulation
2. 0
3. 1
4. 2
5. 3

2. Intrusions/Re-experiencing

0

1

2

3

3. Hyperarousal

0

1

2

3

4. Traumatic Grief and Separation

0

1

2

3

5. Numbing

0

1

2

3

6. Dissociation

0

1

2

3

7. Avoidance

0

1

2

3

Section 4:

This section focuses on behaviors that can get children and child/youth in trouble or put them in danger of harming

themselves or others. Time frames in this section can change (particularly for ratings '1' and '3') away from the

standard 30-day rating window. Child Risk Behaviors

For Risk Behaviors Domain, use the following categories and action levels:

0 No current need; no need for action or intervention.

1 History or suspicion of problems; requires monitoring, watchful waiting, or preventive activities.

2 Problem is interfering with functioning; requires action or intervention to ensure that the need is

addressed.

3 Problems are dangerous or disabling; requires immediate and/or intensive action.

1. Suicide Risk

0

1

2

3

2. Other Self Harm

0

1

2

3

3. Danger to Others

0

1

2

3

4. Sexual Aggression

0

1

2

3

5. Runaway

0

1

2

3

6. Delinquent Behavior

0

1

2

3

7. Fire Setting

0

1

2

3

8. Non-Suicidal Self-Injurious Behavior

0

1

2

3

9. Intentional Misbehavior

0

1

2

3

Section 5:

Life domains are the different arenas of social interaction found in the lives of children, youth, and their families.

This domain rates how they are functioning in the individual, family, peer, school, and community realms. This

section is rated using the needs scale and therefore will highlight any struggles the child/youth and family are

experiencing. Life Domain Functioning

For Life Functioning Domain, use the following categories and action levels:

0 No current need; no need for action or intervention.

1 History or suspicion of problems; requires monitoring, watchful waiting, or preventive activities.

2 Problem is interfering with functioning; requires action or intervention to ensure that the need is

addressed.

3 Problems are dangerous or disabling; requires immediate and/or intensive action.

1. Family Relationships

0

1

2

3

2. Living Situation

0

1

2

3

3. Recreational

0

1

2

3

4. Developmental/Intellectual

0

1

2

3

5. Legal

0

1

2

3

6. Medical/Physical

0

1

2

3

7. Sexual Development

0

1

2

3

8. School Behavior

0

1

2

3

9. School Achievement

0

1

2

3

10. School Attendance

0

1

2

3

11. Social Functioning

0

1

2

3

12. Decision Making

0

1

2

3

13. Sleep

0

1

2

3

Section 6: Cultural Factors

These items identify linguistic or cultural issues for which service providers need to make accommodations (e.g., provide interpreter, finding therapist who speaks family's primary language, and/or ensure that a child/youth in placement has the opportunity to participate in cultural rituals associated with their cultural identity). Items in the Cultural Factors Domain describe difficulties that children and youth may experience or encounter as a result of their membership in any cultural group, and/or because of the relationship between members of that group and members of the dominant society. It is important to remember when using the CANS that the family should be defined from the individual child/youth's perspective (i.e., who the individual describes as part of their family). The cultural issues in this domain should be considered in relation to the impact they are having on the life of the individual when rating these items and creating a treatment or service plan.

For the Cultural Factors Domain, use the following categories and action levels:

0 No current need; no need for action or intervention.

1 History or suspicion of problems; requires monitoring, watchful waiting, or preventive activities.

2 Problem is interfering with functioning; requires action or intervention to ensure that the need is

3

addressed.

Problems are dangerous or disabling; requires immediate and/or intensive action.

1. Language

0

1

2

3

2. Traditions and Rituals

0

1

2

3

3. Cultural Stress

0

1

2

3

Section 7:

This domain describes the assets of the child/youth that can be used to advance healthy development. It is important to remember that strengths are NOT the opposite of needs. Increasing a child/youth's strengths while also addressing his or her behavioral/emotional needs leads to better functioning, and better outcomes, than does focusing just on the child/youth's needs. Identifying areas where strengths can be built is a significant element of service planning. In these items the 'best' assets and resources available to the child/youth are rated based on how accessible and useful those strengths are. These are the only items that use the Strength Rating Scale with action levels. Child Strengths

For Child/Youth Strengths, the following categories and action levels are used:

0 Well-developed or centerpiece strength; may be used as a protective factor and a

centerpiece of a strength-based plan.

1 Useful strength is evident but requires some effort to maximize the strength. Strength might be used

and built upon in treatment.

2 Strengths have been identified but require significant strength building efforts before they can be

effectively utilized as part of a plan.

3 An area in which no current strength is identified; efforts are needed to identify potential strengths.

1. Family Support

0

1

2

3

2. Interpersonal

0

1

2

3

3. Educational

0

1

2

3

4. Talents/Interests

0

1

2

3

5. Spiritual/Religious

0

1

2

3

5. Spiritual/Religious

0

1

2

3

6. Relationship Permanence

0

1

2

3

7. Cultural Identity

0

1

2

3

8. Community Life

0

1

2

3

9. Natural Supports

0

1

2

3

10. Resilience

0

1

2

3

11. Optimism

0

1

2

3

Section 8:

This section focuses on the strengths and needs of the caregiver. Caregiver ratings should be completed by

household. If multiple households are involved in the planning, then this section should be completed once for each

household under consideration. If the child/youth is in a foster care or out-of-home placement, please rate the

identified parent(s), other relative(s), adoptive parent(s), or caretaker(s) who is planning to assume custody and/or

take responsibility for the care of this child/youth. Caregiver Strengths & Needs

For Caregiver Resources and Needs Domain, use the following categories and action levels:

0 No current need; no need for action or intervention.

1 History or suspicion of problems; requires monitoring, watchful waiting, or preventive activities.

2 Problem is interfering with functioning; requires action or intervention to ensure that the need is

addressed.

3 Problems are dangerous or disabling; requires immediate and/or intensive action.

1. Medical/Physical

0

1

2

3

2. Mental Health

0

1

2

3

3. Substance Use

0

1

2

3

4. Supervision

0

1

2

3

5. Involvement with Care

0

1

2

3

6. Knowledge

0

1

2

3

7. Organization

0

1

2

3

8. Social Resources

0

1

2

3

9. Residential Stability

0

1

2

3

10. Safety

0

1

2

3

11. Marital or Intimate Partner Violence

0

1

2

3

12. Developmental

0

1

2

3