The Praed Foundation is excited to announce that the 18th Annual TCOM Conference this year will take place on:
Calling all clinical supervisors! Do you actively use CANS/ANSA in your supervision sessions? If not, we're calling on you to make these amazing tools a part of the conversation. You know that the TCOM tools are rooted in collaboration and that no one should do them alone! You're the first and most important collaborator who can help supervisees to think actively about their cases using the CANS/ANSA framework to organize the information! Check out our new tips sheet made for supervisors. We'll give you simple tips on how to integrate the CANS/ANSA into your supervision sessions. Let the tool work for you and your supervisees by using it!
Alameda County Behavioral Health has delayed the launch of the requirement for there to only be one CANS per youth since we are still working to resolve some technical challenges that would inhibit this effort significantly. We understand the importance of moving to one CANS per youth for our clients, families, our mental health providers and partners and we want to make the transition as seamless as possible. We will keep you updated as we get closer to being able to roll this initiative out.
Christine Mukai, MBA, LCSW (she/her)
Critical Care Manager/CANS Coordinator/AB 1299
Child and Young Adult System of Care/Crisis
Alameda County Behavioral Health
Maybe it’s time to take advantage of some free coaching! The Alameda TCOM Collaborative is a group of experts in the usage of CANS and ANSA tools. We love to provide support to Alameda County providers who could benefit from free coaching. Coaching with a collaborative member can help you or your agency or program build skills, get questions answered, build a roadmap to greater success in using the tools. We want to help you and your colleagues to be great at using the CANS or ANSA to engage clients, build treatment plans, and get data that helps you and your clients track the impact treatment is making on their lives. If you are just doing the CANS or ANSA because you have to and you would like it to become more useful, reach out for coaching and we can help you build a new and better relationship with these tools. You’ll be so glad you reached out for support! You can be a Transformational Collaborative Outcomes Management (TCOM) Superstar!
Question 1 (Using CANS in Supervision?):
I’m a fairly new supervisor and I supervise several new clinicians. I’m not sure how to integrate the CANS into my weekly individual or group supervision meetings. Should we be looking at the CANS together and discussing it or do I just review it approve it when I get one and provide any feedback I have afterward? What do you recommend? I want to do a good job at supporting my clinical team to most effectively use the CANS.
Thanks for the question. We think the CANS should definitely be discussed in supervision since it’s a collaborative tool! Clinical staff completing the CANS don’t need to hold everything alone; many voices should be a part of determining CANS ratings and discussing treatment goals and progress. The CANS is a great tool to organize information gathered and a great framework for discussing all aspects of cases. We suggest CANS focused discussions be a frequent part of the supervision meetings including looking at progress being made, strengths being developed, and new needs arising. If you’re not sure you’ve got all the skills needed right now to do so or you want to get even better at integrating CANS into supervision, did you know that the Alameda County TCOM collaborative can come to your agency and provide a “CANS and Supervision” roadshow training for you and your team? Just have your program director/team leader reach out to any of the members of the CANS/ANSA Provider Collaborative and we can schedule a training that works with your schedule!
Question 2 (CANS requirements for short episodes of care?):
For clients whose episode is less than 60 days, what is your policy for doing an initial and closing CANS? We have staff do one CANS but often with cases that are quicker open/close cases, we don't have enough data to accurately represent them on the CANS. I know we can fill in 0 for needs items or a 3 for strengths items if we have not identified those needs or strengths items but I'm also cognizant of the data going to the State and all that entails. Are staff required to do any CANS (either initial or closing or both) for clients who open and close their episode within 60 days?
The short answers is: It depends. Both an initial and discharge CANS is often still required even for short episodes of care but it is completely okay and understandable if there is not much change between the two. If a case closes before an initial assessment has been completed then a CANS is not required at all but if an initial CANS is completed (and this includes when the CANS is integrated into in the assessment for some agencies), a discharge CANS is required regardless of the time frame between the two. Just so you know, if your agency staff enter CANS directly into Objective Arts, you can review the last CANS completed which can give staff a great deal of information that they may not have been able to gather individually with the youth or family. In addition, staff can at times auto-populate ratings from the last CANS into the current CANS and then the staff can just make applicable updates based on what information that they have gathered. Hopefully that will help in these short episodes of care. Also, sometimes it can help to shift the focus away from "How do you rate this?" to "What did you and your client decide were actionable needs?" and that completing the CANS is an opportunity to document the current actionable priorities in their life (regardless of the service provider involved).
Question 3 (Monitoring Semi-annual CANS Completion?):
How can we track and ensure completion of semi-annual CANS or ANSA at the 6-month points between utilization reviews?
For agencies who enter CANS and/or ANSA directly into Objective Arts (OA), a staff or supervisor can easily run a "Tickler Report" to see upcoming due dates for CANS/ANSA and this includes indications when a CANS/ANSA is overdue. For agencies with staff who enter the CANS/ANSA in their own Electronic Health Records (EHRs), some agencies have:
Our Alameda County CANS/ANSA Provider Collaborative has provided countless live "Roadshow" trainings to a number of Alameda County agencies on topics ranging from:
Are you interested in bringing a CANS/ANSA training or coaching to your agency? If so, reach out to one of our provider collaborative members to submit a request or ask any associated questions!
Alameda County Behavioral Health will implement the "One CANS per Youth" initiative later this summer. This effort will ensure that each client will only have one CANS assessment at a time. This approach reduces the burden for clients, families and caregivers who may have to be interviewed for the CANS questions more than one time because there is more than one mental health provider working with the same client.
This will be a shift in the way providers complete CANS assessments and how they follow our CANS timelines when there is more than one provider involved with a client. One CANS per Youth will promote efforts in care collaboration and teaming and will eliminate inefficiencies that occur when multiple providers produce an assessment on the same client. CANS is an assessment tool designed to help clients, families/caregivers and providers understand what the needs and strengths are for the client and caregivers and to help care team members focus on these items collaboratively.
Alameda County Behavioral Health will be coming out with a One CANS per Youth grid as time gets closer to provide direction to our mental health providers and partners in understanding which role would be the primary staff responsible for completing the CANS assessment with the collaboration of the other providers involved.
Please stay tuned!
In the Dear Collaborative column, we answer YOUR questions about TCOM and the TCOM tools, CANS and ANSA.
Have questions and want answers? Submit your questions through the Contact page. Submissions are confidential.
Q1: I did the certification training, but I’m just not comfortable asking the families I work with all these questions. Why do I have to ask so many questions?
A1: We know it can be hard, especially if you’re new to the field, to get good at how to do all the things required including using the CANS! We’re sure you got into the field to support people to have better lives and to heal their pain. This is what the TCOM tools are about; they just take some practice to get used to using them! Don’t think of the CANS/ANSA as a questionnaire but as a framework to fit information you gather and know about your client and their family into. This is so everyone on your care team has a shared understanding of what the client and their family want to work on and change.
First, make sure you are transparent with the families and clients you work with that you want to help them with the things they need help with and want to change, AND that to understand their needs you use this tool called the CANS to map out strengths and needs that you will identify together with them when you talk the first few times. Each of the domains in the CANS or ANSA has a core question that you can use to open up a conversation with new clients and their parents. For example the core question for the “Life Functioning” domain is “How is the individual functioning in individual, family, peer, school, and community realms?” You can put this in your own words and ask some questions like this: “How are things going for Andrew at home with the rest of the family”; “Can you tell me what’s been happening at school for Andrew in the last couple weeks”; “How does Andrew get along with other kids in the neighborhood and at school”. Then you’ll take the info you gather and organize it using the CANS.
We know building rapport can be a challenge. Ask your supervisor for support or to role play, or reach out to experienced team members to learn how they succeed at client engagement using the CANS. The TCOM tools are here to help you do great work with clients, supporting them to transform their lives in the areas THEY want to, so practice, practice, practice your engagement skills and it WILL get easier!
Q2: Is it OK to just do the CANS by myself after I meet with the client and their family? I just don’t think they’d understand or be interested in seeing a clinical tool like this.
A2: You might remember from certification training that the TCOM tools are meant to be collaborative tools. This means that the more people work together, the better the data you input will be and the better your treatment with the client will be. We want the client and family voice to be center stage in our work otherwise we’re working on our agenda and that’s not collaborative or client centered and, in the end, it won’t be as effective as it could be. So, the goal in all cases is to involve the clients and their families in understanding the tools exist and working collaboratively to come up with item ratings together. One method of many could be to introduce the tool in the first meeting, ask the general domain questions to gather the information, organize it into ratings, verify each section’s rating with the client or their caregivers, and adjust as needed based on their feedback. This process looks different for every client, but the more collaboration you have, the better the work will be!
Q3: How can the TCOM tools really help me and why do we need them when we have so much paperwork to do already?
A3: The CANS/ANSA are tools that help you with your treatment roadmap. When you get ready to see a client each week, how do you prep? How do you know what you’re working on with the client? How do you know if what you’re doing makes a difference or if the client is making progress? Check your CANS/ANSA frequently throughout treatment to make sure you know what to focus on and to assess progress. Use the tool to guide your treatment plan and check it frequently to identify focus areas for your sessions. Use the data to identify and celebrate successes with your client and your supervisor. Watch those ratings change as you do good work and support your clients with quality care!
Question 1 (Q1): Should I take the practice exam?
Answer 1 (A1): This is entirely up to you. You are given 2 hours to test and if you pass the practice exam, it will not count towards your certification so this will likely double the amount of testing time which is why many people opt to move directly to the real exam. No one gets penalized for taking the test more than once and there is no limit on the number of times that you can take the test. One benefit to taking the practice exam is that it will show you which answers that were incorrect so that you can figure out where to adjust your thinking or seek consultation to help support your efforts to pass the certification test.
Q2: What do I do if I work in 2 Counties?
A2: Email email@example.com and ask for help registering your account under both Counties.
Q3: Do I have to take multiple certification exams if I serve multiple age groups of people?
A3: No, if you pass the certification exam for any age group (CANS or ANSA), you are certified to complete any of the CANS/ANSA versions.
Q4: How do I know what caregiver to rate in the exam when there are multiple referenced in the test vignette?
A4: The name of the caregiver that you should rate during the test is listed at the top of each vignette but make sure you ONLY rate the caregiver within the caregiver needs domain. The rest of the ratings in the CANS/ANSA should be based on the strengths and needs of the youth/young adult/adult who is officially the identified client/patient.
Blog content is created by the shared effort of the Alameda TCOM Collaborative members. Send feedback through the Contact page.