 Trainings to look forward to in 2020 include:
CANS & ANSA Overview & Certification:
Training for Trainers—Coming this spring – date TBD Agency-specific trainings available in:
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The TCOM tools (CANS and ANSA) are planning tools that express what areas to focus on in treatment with measurable metrics. It shows the level of urgency needed to take action, to provide clinical interventions for specific needs, and what strengths to build on in treatment with clients. The tools are also used for tracking case progress, acting as a roadmap throughout the time we work with clients. The CANS/ANSA help us to identify needs & strengths and treatment plans in an organized and communication-oriented manner that keeps us focused on the uniqueness of each client and what they present.
When you think about clinical supervision, supervisees and their supervisors are surely discussing all of these themes in the room each week. You are bringing client needs and strengths into the supervision hour, discussing assessment and interventions, and sharing progress and changes in the lives of the clients. What would it be like to do this using the CANS/ANSA in the clinical supervision space? Could the tool help you focus and organize the complex information and make the case easier to discuss with purpose and attention to what needs to be addressed? Try it out. Make a commitment. The tools have more impact the more we commit to using them in the way they are intended: to bring multiple voices into the conversation, keep the client front and center, and help us be the best clinicians we can be. Supervisors and supervisees, see what can come from using the tools in your time together! The Alameda TCOM Collaborative has an entire section of Supervision Resources for supervisors and clinicians, including:
 In the Dear Collaborative column, we answer YOUR questions about TCOM and the TCOM tools (CANS, ANSA-T, ANSA).
Have questions and want answers? Submit your questions through the Contact page. Submissions are confidential. Q1: What do I do as a clinician if there are A LOT of action items or needs identified on the CANS and I can’t address all of them in treatment at this time? A1: This is one example of when the collaborative nature of the CANS can be a helpful tool in determining where the highest needs are and who can address them. If you are addressing one set of needs and another provider is addressing another, you can work in collaboration and provide this context in your clinical documentation (e.g., clinical formulation and treatment plan). Additionally, it can be helpful to categorize needs as either background needs (typically more static, underlying needs that may be driving current behaviors, such as “Living Situation”) and target needs (identified with a "2" or "3" and intended to be addressed in treatment, such as “Self-Harm”). For target needs that are believed to share the same root cause, you can cluster them together and select interventions that address the whole cluster. By addressing target needs, you may also impact background needs. Similarly, you can categorize strengths into useful strengths and strengths to build. This is helpful when incorporating strengths into the treatment planning process. The process of clustering needs and strengths in order to focus treatment can not only help you as a clinician, but also the client, family, and treatment team to reach consensus and work toward common goals. Q2: When completing the ANSA, who is considered the caregiver when assessing caregiver needs? A2: For adult services, the “caregiver” is generally any person the recipient identifies as their caregiver. This could be a friend, a family member, or a spouse. When completing the CANS/ANSA certification exam, it will be made explicit who the caregiver is, both in the vignette and at the top where it reads “rate [name] as caregiver.” Q3: There’s a lot to remember regarding the CANS and ANSA tools. Is there a one-pager with key points? A3: Yes! Praed Foundation created the Child and Adolescent Needs and Strengths (CANS) User Tip Sheet and the Adult Needs and Strengths Assessment (ANSA) User Tip Sheet. Both tip sheets include a description of the tool, guiding principles, questions to consider and a quick action rating guide. Both serve as a great snapshot. If you’re interested in digging deeper, check out our Manuals & Scoresheets and Engagement & Planning Tools resources . Each newsletter features top questions submitted to the Alameda TCOM Collaborative. If you have an urgent or critical CANS-related question, you can contact your agency's CANS/TCOM Coordinator or one of the Collaborative Members at any time.  Why do we require that Alameda County providers do their initial CANS/ANSA Certification Training in person rather than simply having folks log in and do it themselves online? It’s a fair question to ask, given that it would seemingly be more efficient to have everyone do it on their own.
We do initial certification training in person because such an environment allows for deeper and broader understanding of these tools, connection-building with other providers, the opportunity for active conversation and questions, and the chance for individualized support from our experienced trainers. It is an all-day training, designed to allow you to briefly set aside your many obligations, immerse yourself in the experience, and not feel rushed. What’s more, most folks pass their certification test on their first try after these trainings, making this in-person setup, well, quite efficient, too. Think about the trainings you have been to throughout your career. Which ones were more effective? Which ones answered your specific questions? From which kind did you retain more information? Here’s to more fantastic training and CANS-certified providers in 2020! Be sure to check out the Alameda TCOM Collaborative Training Calendar for all upcoming in-person training sessions. Our CANS data says YES!  As providers, we know the importance of being strengths-based in our clinical work. This means being aware of our clients' strengths and emerging strengths, and identifying them in our CANS. Data from across Alameda County shows that clients receiving services are building their strengths during their time in treatment. The 14 items in the Strengths Domain show consistent increases in the number of centerpiece and existing strengths (ratings 0 and 1) from midway through treatment to discharge.
The largest gains were seen in the following CANS items:
The data set included almost 16,000 children and youth served by Alameda County providers from July of 2017 to July 2019. The outcome data clearly shows the importance of treatment and how we are making positive differences in the lives of children and youth. Keep up the good work!  Objective Arts (OA) is the system that is used to aggregate all Alameda County CANS/ANSA data and you can learn how to use reports within that system by attending one of the OA Key Reports Data trainings which will be held on:
OA Key Reports Data Training Objectives:
Who Should Attend: Supervisors, managers, and administrators who want to learn how to use the CANS/ANSA data to further support understanding the populations served, clinical decision making, program decisions and care coordination. Please RSVP by September 12, 2019 to Christine.Mukai@acgov.org We also have an OA reports user manual to aid you in your efforts to interpret CANS/ANSA data. We look forward to seeing what all of you can do with a little more training and resources for CANS/ANSA data reporting!
 There are 3 new Alameda County CANS Collaborative members: Bree Desmond (Fred Finch Youth Center), Sara Pollock (WestCoast Children's Clinic), and Dana Wolfenbarger (Seneca Family of Agencies). Bree Desmond is our new Collaborative member from Fred Finch Youth Center. Bree’s current role is the Clinical Supervisor for Alameda County’s new Wraparound program for youth who are ages 8-18 and not involved in the Juvenile Justice or Child Welfare systems but are at risk of involvement in these systems. Bree has been at Fred Finch Youth Center for over a decade and held the role of Quality Manager/Data Analyst for most of her tenure. This gave her a great deal of experience providing training and collaboratively implementing the CANS/ANSA including creating a team and system for internal data aggregation and reporting at the agency and program level. Bree has been working in the social work field for more than 20 years and has been committed to serving the most vulnerable youth and families in variety of clinical roles. She is a Licensed Clinical Social Worker who is a caring, persistent, strong advocate and in her free time she enjoys singing, dancing, hiking, swimming, movies, and gardening.  Sara Pollock is our new Collaborative member from WestCoast Children's Clinic. Sara's current role is the CANS-SSA Coordinator for Alameda County working with Social Services to help implement screenings of foster youth. She has been with WestCoast Children's Clinic since 2014 and has been a long-time user of the TCOM Tools in her roles as a community-based therapist, assessor, and clinical supervisor within our doctoral internship and postdoctoral residency training programs. In her clinical roles, Sara has demonstrated a strong commitment to the children and families she's served and has employed principles of transparency and high integrity. She has also demonstrated a deep sense of collaboration in her work with teammates and clients as well as promoted client-centered care at many levels of the system. At a personal level, Sara has been a political advocate for Public Service Loan Forgiveness, loves riding horses and appreciates spending time outdoors.  Dana Wolfenbarger is our new Collaborative member from Seneca Family of Agencies. Dana's current role is a Clinical Documentation Analyst on Seneca's Quality Improvement Team. She has been with Seneca since 2013 and has held positions in the training department as well as clinician positions in both community based and school based programs. Dana brings a lot of wonderful experience of embedding the TCOM framework in her work as a clinician. She has worked directly with families to engage them in the collaborative assessment process, including coming to a shared understanding of needs and strengths and facilitating transparency around the CANS tool. Dana hopes to bring her experience and excitement about how the CANS can improve treatment outcomes for youth and families to the Collaborative’s meetings and trainings. Dana enjoys photographing bees and making books in her spare time including books chronicling her travels, family recipes, favorite punk band, family relationships.
 Our Provider Collaborative would like to offer training and supports that are most helpful to your learning of the CANS & ANSA tools. Before we do that, we wanted to get your input to guide the development of the supports we will provide. Your input will let us know what topics are most important to you, as well as what you already know and do well.
To best support you, we ask about three things:
The survey will run between April 29th through May 10th, 2019 and it should take about 15 minutes to complete. The survey is completely voluntary and you can withdraw at any time. Survey responses will be analyzed by the training provider, Chapin Hall, and results will be reported as a group, so that your identity and responses remain confidential. Survey data will be used by BHCS & our Provider Collaborative to learn how we can best support you through training, consultation, and policy alignment. Thank you for taking a few moments to help us better understand and support your work!!  Stars Community Services has had outstanding CANS/ANSA completion rates. We interviewed them to highlight this accomplishment and find out directly how they achieve it. Great job Stars team! Hopefully other providers will benefit from learning about your processes. Interviewees:
When asked what Stars staff attributed their stellar CANS completion rates to, they first stated “It’s required” candidly. But there is more to it than that or every agency would have the same level of CANS completion rates. They shared the following strategies that they think supports their outstanding completion rates. They have Opening, 30-day, 6-month, Annual and Discharge document checklists which include the CANS as one of the required documents. These checklists require signatures of the primary clinician and initials of supervisors and administrative staff are also required after they review the packets to help ensure all documents are present and complete for increased accountability. On these they have a prompt to supervisors to print the CANS and scan these into the EHR which keeps the supervisor more engaged in ensuring that the CANS is completed and submitted. Stars staff shared that their assessment and CANS are separate documents and though Stars has their own EHR, their primary clinicians enter their CANS directly into Objective Arts (OA). This has allowed the Research department to extract the CANS data from OA and produce some program level reporting. The clinicians are also utilizing CANS rating decreases to track the improvements of their clients in their treatment.  STARS Leadership Team Training seems to be another key factor that has supported high completion rates for Stars. Veronique Lee stated that they have an all-day CANS Certification Training in their New Employee Orientation including time built in for trainees to take the test and this usually occurs within 2 weeks of hire. There are different tiers of training after New Employee Orientation to train staff on the clinical loop. Agency wide, Stars works to titrate trainings and do refreshers as well as provides program level trainings. Mattie’ Nogaye stated “It’s not a one stop shop”. Stars has 4 Leadership staff that have been certified as CANS Trainers. Having 4 Leaders is intentional to ensure that there is no void of training even when there is turnover or scheduling conflicts. In addition, Esmeralda Gonzalez emails all clinical staff CANS related training opportunities provided through the CANS Collaborative as they arise and she is also readily available as a consultant on an ongoing basis for clinical staff. When asked about any challenges they have had and how they overcame them, Chris shared that when the Praed Foundation switched to Schoox, the Training and QA department created a process map to ensure that CANS certifications were linked to the agency’s OA account. This helped prevent delays in staff being able to enter CANS in Objective Arts and so he stated he wished they had done this sooner.
It is clear that Stars has great systems in place to train and support their staff to not only get their CANS completed consistently when required, but also to hold themselves and each other accountable to a high level of compliance with all requirements which are in place to support their staff and the clients they serve. |
