Microsoft Word - NCTSN CANS Comp Manual_formatted
This project was funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), US Department of Health
and Human Services (HHS). The views, policies, and opinions expressed are those of the authors and do not necessarily reflect
those of SAMHSA or HHS.
Child and Adolescent Needs and
Strengths (CANS) Manual
The NCTSN CANS Comprehensive – Trauma Version
A Comprehensive Information Integration Tool for
Children and Adolescents Exposed to Traumatic Events
August 2011
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August 2011
Primary Developers
Cassandra Kisiel, Ph.D.
John S. Lyons, Ph.D.
Margaret Blaustein, Ph.D.
Tracy Fehrenbach, Ph.D.
Gene Griffin, JD, Ph.D
Jamie Germain, Ph.D.
Glenn Saxe, M.D.
Heidi Ellis, Ph.D.
Acknowledgements
A large number of individuals have collaborated in the development of the National Child Traumatic Stress
Network (NCTSN) CANS-Comprehensive. Along with the CANS versions for developmental disabilities,
juvenile justice, and child welfare, this information integration tool is designed to support individual case
planning and the planning and evaluation of service systems. The trauma domains on the CANS were
developed in collaboration with Cassandra Kisiel, Ph.D., Glenn Saxe, M.D., Margaret Blaustein, Ph.D, and
Heidi Ellis, Ph.D. within the National Child Traumatic Stress Network in 2002 and have been incorporated
across several versions of the CANS. The NCTSN CANS- Comprehensive is an open domain tool for use in
service delivery systems that address the mental health of children, adolescents and their families. The
copyright is held by the Praed Foundation to ensure that it remains free to use. For more information
about alternative versions of the CANS to use please contact John Lyons. For more information on the
NCTSN CANS Comprehensive – Trauma tool contact, Cassandra Kisiel.
Please Note: Training and certification is required for the ethical and reliable use of the CANS
Contact for further information:
Cassandra Kisiel, Ph.D.
Center for Child Trauma Assessment and Service Planning
Mental Health Services and Policy Program
Northwestern University Feinberg School of Medicine
Chicago, Illinois 60611
Phone: XXXXXXXXXX
XXXXXXXXXX
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www.NCTSN.org
Recommended Citation
Kisiel, C., Lyons, J.S., Blaustein, M., Fehrenbach, T., Griffin, G., Germain, J., Saxe, G., Ellis,H., Praed
Foundation, & National Child Traumatic Stress Network XXXXXXXXXXChild and adolescent needs and strengths
(CANS) manual: The NCTSN CANS Comprehensive – Trauma Version: A comprehensive information
integration tool for children and adolescents exposed to traumatic events. Chicago, IL: Praed
Foundation/Los Angeles, CA & Durham, NC: National Center for Child Traumatic Stress.
About the National Child Traumatic Stress Network
Established by Congress in 2000, the National Child Traumatic Stress Network (NCTSN)
ings a singular
and comprehensive focus to childhood trauma. NCTSN’s collaboration of frontline providers, researchers,
and families is committed to raising the standard of care while increasing access to services. Combining
knowledge of child development, expertise in the full range of child traumatic experiences, and dedication
to evidence-based practices, the NCTSN changes the course of children’s lives by changing the course of
their care.
About the Praed Foundation
Founded in 1999, the Praed Foundation seeks to support transformational activities in human services,
with a special emphasis on improving the lives of children and families. The Foundation has a variety of
projects that supports its mission including managing flexible funding for youth with mental health needs in
the juvenile justice system. The primary work of the Foundation is in support of a mass collaboration of
individuals who seek to use evidence-based assessments as an approach to working together to maintain
the focus of human service enterprise on the people they serve.
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Table of Contents
Primary CANS Domains:
Exposure to Potentially Traumatic/Adverse
Childhood Experiences
6
Symptoms Related to Traumatic/Adverse
Childhood Experiences
11
Child Strengths 16
Life Domain Functioning 20
Acculturation 26
Child Behavioral/Emotional Needs 28
Child Risk Behaviors 34
Caregiver Needs and Strengths 39
Optional CANS Domains:
If you choose not to rate these optional domains, please leave those sections of the scoring sheet
lank
Ratings of Children Five Years Old and Younger 45
Transition to Adulthood 49
CANS Scoring Sheet
Scoring Sheet for the NCTSN CANS Comprehensive 55
NOTE: For additional details or if you have specific questions on any of the items listed in this manual, please
consult the CANS Comprehensive Glossary for further information.
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www.NCTSN.org
CANS Action Levels
The way the CANS works is that each item suggests different pathways for service or treatment
planning. There are four levels of each item with anchored definitions; however, these definitions
are designed to translate into the following action levels (separate for needs and strengths):
For Potentially Traumatic / Adverse Childhood Experiences Domain:
0- No evidence of any trauma of this type
1- A single incident or trauma occu
ed or suspicion exists of this type of trauma
2- Multiple incidents or a moderate degree of trauma of this type
3- Repeated and severe incidents of trauma of this type.
For Needs Domains – Symptoms Related to Trauma/Adverse Experiences, Life Domain
Functioning, Acculturation, Child Behavioral/Emotional Needs, Child Risk Behavior, Children Five
and Younger, Transition to Adulthood, Caregiver Domain:
0- No evidence of a need /no need for action
1- Watchful waiting /prevention/mild need
2- Action needed/moderate need
3- Immediate -- Intensive action /severe need
For Strength Domain:
0- Centerpiece strength
1- Useful Strength
2- Strength has been identified in this area but it must be built
3- No strength is identified in this area /no information
NOTE: The majority of items on the CANS should be rated in the context of what is normative for a child’s
age/developmental stage.
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Exposure to Potentially Traumatic/Adverse Childhood
Experiences Domain
These ratings are made based on LIFETIME exposure of trauma or adverse childhood
experiences.
For this domain, the following categories and action levels are used:
0 = a dimension where there is no evidence of any trauma of this type.
1 = a dimension where a single incident of trauma occu
ed or suspicion exists of
this trauma type.
2 = a dimension where the child has experienced multiple incidents or moderate
degree of this trauma type.
3 = a dimension which describes repeated and severe incidents of trauma with
medical / physical consequences.
1. SEXUAL ABUSE – This rating describes the child’s experience of sexual abuse.
0 There is no evidence that child has experienced sexual abuse.
1
There is a suspicion that the child has experienced sexual abuse with some degree of evidence or
the child has experienced “mild” sexual abuse including but not limited to direct exposure to sexually
explicit materials. Evidence for suspicion of sexual abuse could include evidence of sexually reactive
ehavior as well as exposure to a sexualized environment or Internet predation. Children who have
experienced secondary sexual abuse (e.g. witnessing sexual abuse, having a sibling sexually abused)
also would be rated here.
2 Child has experienced one or a couple of incidents of sexual abuse that were not chronic or severe.
This might include a child who has experienced molestation without penetration on a single occasion.
3
Child has experienced severe or chronic sexual abuse with multiple episodes or lasting over an
extended period of time. This abuse may have involved penetration, multiple perpetrators, and/or
associated physical injury.
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www.NCTSN.org
2. PHYSICAL ABUSE - This rating describes the child’s experience of physical abuse.
0 There is no evidence that child has experienced physical abuse.
1 There is a suspicion that child has experienced physical abuse but no confirming evidence. Spanking
without physical harm or threat of harm also qualifies.
2 Child has experienced a moderate level of physical abuse and/or repeated forms of physical
punishment (e.g. hitting, punching).
3 Child has experienced severe and repeated physical abuse with intent to do harm and that causes
sufficient physical harm requiring hospital treatment.
3. EMOTIONAL ABUSE - This rating describes the degree of severity of emotional abuse, including
ve
al and nonve
al forms. This item includes both “emotional abuse,” which would include
psychological maltreatment such as insults or humiliation towards a child and “emotional
neglect” defined as the denial of emotional attention and/or support from caregivers.
0 There is no evidence that child has experienced emotional abuse.
1
Child has experienced mild emotional abuse. For instance, child may experience some insults or is
occasionally refe
ed to in a derogatory manner by caregivers.
2
Child has experienced moderate degree of emotional abuse. For instance, child may be consistently
denied emotional attention from caregivers, insulted or humiliated on an ongoing basis, or
intentionally isolated from others.
3
Child has experienced significant or severe emotional abuse over an extended period of time (at least
one year). For instance, child is completely ignored by caregivers, or threatened/te
orized by others.
4. NEGLECT - This rating describes the severity of neglect an individual has experienced. Neglect
can refer to a lack of food, shelter or supervision (physical neglect) or a lack of access to needed
medical care (medical neglect) or failure to receive academic instruction (educational neglect).
0 There is no evidence that child has experienced neglect.
1
Child has experienced minor or occasional neglect. Child may have been left at home alone for a
short period of time with no adult supervision or there may be occasional failure to provide adequate
supervision of child.
2
Child has experienced a moderate level of neglect. Child may have been left home alone overnight or
there may be occasional failure to provide adequate food, shelter, or clothing with co
ective action.
3
Child has experienced a severe level of neglect including multiple and/or prolonged absences by
adults, without minimal supervision, and failure to provide basic necessities of life on a regular basis.
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