The CANS (Child and Adolescent Needs & Strengths) Assessment in Child Services: What it means for Value Based Purchasing (VBP)
The CANS is a valuable assessment tool gaining major traction
THE VBP Blog
Subject Matter Expert Guest Author: Dan Warner Ph.D
Dan Warner Ph.D. is the executive director of Community Data Roundtable, a nonprofit organization dedicated to developing a data-driven human services system. Read Full Bio
Subject Matter Experts in our industry help guide, inform, and provide a solid foundation for growth. Here at the VBP blog, we believe these experts are vital to the community we are building. With that in mind, we have reached out to our network to write guest blogs. We will tap into their expertise on specific topics to help contribute to our reader’s knowledge and still provide an Advocate’s Perspective from the VBP team.
November 17, 2022 – All across America, the Child and Adolescent Needs and Strengths (CANS) assessment is gaining major traction. States ranging from California, to Ohio, Maryland, and Texas all have wide-scale mandates for the tool to be administered regularly to children receiving intensive behavioral health services. As the CANS becomes increasingly popular at a rapid pace, it’s important to reflect upon how its implementation is impacting communities and the prospects it may provide for Value Based Purchasing (VPB). We must also consider the role that CANS data and processes can play in national efforts to make a child serving system built on value.
What is the CANS?
At its most basic, the CANS is a form administered regularly by a certified rater in order to identify treatment needs and track progress. CANS forms require input from the child client, their family, and any other members of the treatment team. Every professional who scores a CANS is trained to pull information from as many relevant sources as possible to score the form in alignment with CANS principals and rules. This entire process is collaborative, establishing family voice and choice as central to the rating process.
How is the CANS relevant to value-based care?
When communities consider “value-based” reimbursement contracts, they must first reexamine their community values. Value-based care is ultimately about a community’s shared vision of a child and family serving system, not dollars and cents. There is a growing demand for child serving systems to become more “person-centered… equitable, integrated, cost-effective, and high quality” (as called for in California’s Medicaid transformation initiative called ‘CalAIM’), thus CANS becomes a natural ally.
The CANS is designed to put children and families first. Certified raters are trained to draw on client voice, and create a comprehensive plan for improvement. CANS certified raters are expected to focus on the needs of the child and family, utilize cultural humility, and employ a trauma informed lens with their work. CANS is an effective tool for clear communication across complex teams and silos. In these ways and more, the CANS matches the values of the emerging child-serving landscape, and this is central to its rapid growth and popularity.
However, true VBP is more significant than any individual’s personal recovery journey; it takes entire populations into account (Whittington & Nolan, 2006). This is where the CANS shines, as it is able to provide aggregate information necessary for efficient and effective mental health planning as well as performance tracking.
CANS’ Strengths
The CANS provides a universal language for children’s mental health. With state-wide implementation, children can move freely within a provider network, and their story can travel with them. And now, with more states using the tool, a universal language for children’s needs and strengths is emerging. All providers are trained on the same tool, enabling them to quickly determine a client’s current needs and strengths and start the appropriate treatment right away. Communities can also review their CANS data in aggregate, which is essential for value-based planning.
For example, it is very common for municipalities to review CANS data for the first time, and discover large holes in their treatment network. Oftentimes communities realize that while they offer many services, there may be no available support to address the needs of a specific population. For instance: people who experience psychosis but are not at immediate risk to themselves or others, also people with transportation deficits but not housing deficits. All sorts of niche populations emerge readily when reviewing aggregate CANS data, with its rich comprehensive assessment of mental health, risk, functioning, and caregiver needs. CANS may involve social determinant of health assessments as well – so communities can plan new programming to address what is lacking.
CANS Brings New Opportunities
Many opportunities for value propositions emerge with CANS data. Communities using CANS can issue RFPs to address newly identified gaps in service, and incorporate CANS-based data to develop program design. CANS data also helps community providers predict the number of patients available for new services, which makes planning appropriate rates and program sizes much easier. And of course, thanks to the CANS ability to track outcomes, program success can be measured, as well as rewarded with incentive payments.
Drawbacks to Consider
The CANS does come with some concerns. It must be administered via a sophisticated cross-entity data system to be effective. Capturing CANS data, sharing it across entities, and producing relevant reports for consumers, clinicians, and administrators alike is not a simple task. The best implementation methods are likely to vary by jurisdiction. The decision to use electronic medical records, independent apps, or a combination of the two depends on community needs and wants. As a result of this, a multitude of CANS data capture and reporting initiatives are flowering across the country. Will new integration problems emerge amongst these entities? That remains an open question.
We must also recognize that CANS data alone is insufficient to direct value-based propositions. Mental health planning requires information on units, encounters, administrative data, and many other types of data to explain what is going on beyond the CANS. Blending information types for insight is essential for good value-based system development. However, accessing such broad data and analyzing it appropriately is sure to be a challenge for any community.
And also, very importantly, the model has to actually be followed. Quality concerns lurk around every corner with CANS: How collaborative any given CANS rating process actually is? Do the users actually understand the nuance of all the items? Are there endemic unexpected system blunders that can belie the whole thing? Diligent attention to quality matters in an implementation becomes vital.
Despite the aforementioned challenges, many advocates understand the benefit of CANS and push for it in their advocacy efforts. For example, The Idaho Federation of Families for Children’s Mental Health (https://www.fyidaho.org/), has utilized CANS data in accelerating Idaho’s EPSDT program; or Young Minds Advocacy, a legal advocacy group that promotes CANS use in the public system (https://www.ymadvocacy.org/). Groups like the Idaho Federation of Families for Children’s Mental Health are enthusiastic about the CANS because it promotes person-centered care.
Advocates Perspective on CANS Value
A proper CANS implementation starts with representatives from advocacy groups, government, managed care, and providers working to identify items for their local implementation. Stakeholder collaboration is the key to moving a CANS initiative forward. CANS data is shared on an ongoing basis, often on public dashboards, which can be reviewed and interpreted by the entire community. The clients and families are also able to communicate directly during the rating process, which ensures their understanding of needs and strengths are the focus of treatment. No other tool integrates multiple voices seamlessly into data, and with the same frequency, that the CANS does. CANS supports successful implementations which are ripe for expansion and growth. From my wealth of experience, the CANS gives ‘value to voice.’ It provides an entryway for collaboration in both the treatment and service planning processes. Harnessing this value has much potential for building an impactful and caring child-serving system.
Note: Special Thanks to Lauren Fein LMFT, Special Projects Director at Santa Cruz County Behavioral Health, and Patrick Gardner of Young Minds Advocacy, who reviewed and provided feedback on various versions of this piece. Also, special thanks to Megan Chellew, M.S., CDR’s in-house copy editor, who provided unrivaled feedback and focus.
Onward!
About the Subject Matter Expert Guest Author
Dan Warner Ph.D. is the executive director of Community Data Roundtable, a nonprofit organization dedicated to developing a data-driven human services system. CDR provides technical consultation to communities implementing outcomes and value-based systems, with a particular expertise in the “TCOM Suite” of tools, which includes the CANS, as well as the Adult Needs and Strengths Assessment (ANSA), and the Family Advocacy and Support Tool (FAST). CDR’s advisory board includes representation of advocacy organizations, and insists on implementing a collaborative, mutually beneficial, outcomes monitoring program for total system beneficence.
Subject Matter Experts in our industry help guide, inform, and provide a solid foundation for growth. Here at the VBP blog, we believe these experts are vital to the community we are building. With that in mind, we have reached out to our network to write guest blogs. We will tap into their expertise on specific topics to help contribute to our reader’s knowledge and still provide an Advocate’s Perspective from the VBP team.
Are you interested in writing a guest blog for the VBP blog? We would love to hear from you! Please reach out to mandy.sahhar@xtraglobex.com to start the conversation.