FREQUENTLY ASKED QUESTIONS ABOUT THE CANS   How is the CANS used?   Around the country, there are three primary uses for the various CANS tools---decision support, quality improvement/assurance, and outcomes monitoring. Probably the most common application of the CANS is as a decision support tool for level of care and service planning purposes. A number of locales use the CANS to support decisions about the intensity of services or residential placement. The CANS is also used as a quality improvement/assurance tool,. Sometimes the QI is accomplished by parent advocates. In this application, the CANS is used to identify needs and the QI application is to determine what interventions were used (if any) to address identified needs. The CANS item format makes this quite easy as any item rated a '2' or '3' requires some intervention. Finally, the CANS is used to monitor outcomes of services. Given the item structure, these applications use repeated ratings at least three months apart. The CANS is not sensitive to change over shorter time periods.   Is it reliable and valid?   We have completed a large number of studies of the reliability and validity of the CANS in its various applications. In terms of reliability, across more twenty studies involving hundreds of trainees, we have found that the reliability of the CANS assessed through vignettes is about 0.75. Across about 25 reviewers, the reliability of the CANS in chart review is about 0.84. In an audit of the CANS, it was found that even the individual items are reliable above 0.70. Dimension scale scores are even higher than the reliabilities reported here, generally about the 0.90 or higher.   In terms of validity, the CANS is correlated with other measures of psychopathology, functioning, and strengths in directions that would be obviously predicted. Also, the CANS has been shown to distinguish levels of care and intensity of services. In addition, as a decision support, the CANS has been shown to agree with an expert panel of clinicians 81% of the time.   Given these data, we are confident that when used appropriately, the CANS is a reliable and valid tool for assisting in the planning and management of children's services. Given that the tool is only three years old, we are only now beginning to see the first professional publications of findings with the various versions. We will keep the website updated with regard to these publications.   Does it require training?   We recommend formal training and ongoing monitoring to ensure the development and maintenance of good reliability. The formal training takes about four hours and consists of an overview, a review of the anchors and at least two practice vignettes. We have found that most individuals develop reliability above 0.70 with this training format. Different places use different strategies to maintain reliability. For example, since the CANS can be used either prospectively or retrospectively, a chart audit can be used to monitor its reliable use in practice. Others use refresher vignettes annually. Still others use CANS case conference methods to ensure the continued reliable use.   We are implementing a certified trainer approach to ensure that a sufficient numbers of professionals are available to provide good training in the use of these tools. Questions about the certified trainer program can be directed to the Foundation.   How do the different versions vary?   The primary concept of the CANS is to support communication. Since the children's service system is diverse and complex, part of the concept is to support communication across different child serving agencies and approaches. However, each approach has a particular need for more specific information. In order to honor this complexity, the CANS use identical items in each version; however, different versions have more or less expanded items. For instance, the CANS-MH has only one item for developmental disability needs while the CANS-DD expand out its functioning domain to include such items as Sensory, Motor, Communication, etc. The CANS-JJ expands items on criminal and delinquent behavior and substance use relative to other versions of the CANS. The CANS-SD has a variety of additional items on sexual behavior, and so forth.   Home About Buddin Praed Foundation | About the CANS | CANS Form Questions or Comments | News | Links | Make a Donation