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.

In the Dear Collaborative column, we answer YOUR questions about TCOM or the TCOM tools (CANS, ANSA-T, ANSA). Have questions and want answers?  Submit your questions through the Contact page and look for the answer in the next edition of Dear Collaborative.

Q1: I find the strengths and needs scoring differences difficult to remember. Can you help?
A1: Absolutely. It can be confusing that the ratings for strengths go in the opposite direction as the ratings for needs. A simple way to remember is that a zero is always the most positive in both areas and go from there. A zero in needs means there is no evidence of a need which is generally positive. A zero in strengths means there is a centerpiece strength which is also positive. So, if you start with a zero in your mind equaling positive you can go from there on any item, be it a need or a strength.

Q2: Asking all these questions to families and clients takes too long and isn’t what I became a therapist for. Why do I have to do this?
A2: Great question! I bet you became a therapist to help people and support them to make their lives better. This is what the TCOM tools were developed for as well. Without tools to organize all the information families and clients share with us, we won’t have a roadmap to know where we’re going. The CANS/ANSA framework helps us make sure that the client, family, and therapist all share an understanding of what treatment is for and what we’re doing together. CANS/ANSA helps us to organize client needs and strengths and track progress throughout our work. Using the tools doesn’t look any one way with clients. Every therapist should think about their own family, client engagement style and strengths and then work with their supervisor to figure out how to share the CANS/ANSA with the clients and their families so they understand the tool and can work with you to identify what their own needs, strengths, and shared goals are for treatment. If you don’t have a roadmap, you’re likely to be lost a lot!
 
Q3: As a supervisor, how can I help my supervisees learn to be really good at using the CANS/ANSA?
 A3: Supervisors are so important in helping the CANS/ANSA be more than just “another form that has to be completed.” You can make sure it’s what it should be: a strategic tool that helps everyone involved in a case communicate and support transformation and change. Learning takes time and has stages. Supervisors can support staff from the first stage of just getting certified through to becoming advanced CANS/ANSA users if you integrate learning into supervision sessions. A few suggestions for early stage users: Ask them to pretend they are explaining to another professional why they use the CANS or ANSA. Make sure you can explain it too! If either you or your supervisor are stuck here, go back to the website materials and videos or sign up for one of our in person trainings like “TCOM in supervision.” Our training calendar is always posted on Schoox.
 

In the Dear Collaborative column, we’ll answer YOUR questions about TCOM or the TCOM tools (CANS, ANSA-T, ANSA).

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.


Have questions and want answers?  Submit your questions through the Contact page and look for the answer in the next edition of Dear Collaborative. Submissions are treated confidentially.


Q1:    Are the CANS/ANSA considered Communimetric tools?  What the heck does that mean?
A1:   According to tool developer John Lyons, Communimetrics is designed to make thinking processes transparent and provide a conceptual organization or framework for the thinkers to be attuned to the relevant factors that must be thought through in any particular circumstance.  In other words, a Communimetric tool (like the CANS/ANSA) attempts to delineate common factors in the lives of participants that are important to address, measure, and/or recognize. What makes it a Communimetric tool rather than just a metric tool, is the agreed upon numeric designations that are designed to be easily communicated and understood by all members of the system, creating an enhanced opportunity for collaborating in a shared vision of treatment.


Q2:    Why is there so much information on TCOM?  What does it mean? Why is it a part of the CANS/ANSA?
A2:    TCOM is an acronym that stands for Transformation Collaborative Outcomes Management.  TCOM is the philosophy/framework developed to ensure greater collaboration between providers and consumers as well as to enhance the efficiency and effectiveness of services provided in a complex, mental health system.  The CANS and ANSA are communimetric (see Q1) assessment tools developed to accomplish the principles of TCOM; it measures transformation change, creates a structure for collaboration, and makes outcomes transparent and quantifiable.  Consequently, it is important to focus on TCOM and its greater philosophy in an effort to foster a more in-depth understanding of the CANS and ANSA tools.


Q3:    Why are there so many versions of the Alameda CANS/ANSA?  How do I know which version to certification test to take?
A3:   The different versions of the Alameda CANS/ANSA were created to be slightly different based on the age of the participants being assessed.  It is important to note that getting certified in any one version enables a clinician to administer any of the various versions of the assessment.  This is helpful for those service providers who work with different age groups.


Here is a breakdown of the currently available tools; each has an available certification test on www.tcomtraining.com:

• Alameda County ANSA 25+ 1.0
  This is an assessment designed to be used with adults who are 25 years of age or older
• Alameda County ANSA-T 1.0
  This is an adult assessment focused on transition age youth, ages 17.5 to 25
• Alameda County CANS 6-17 2.0
  This CANS version is designed to assess participants between the ages of 6 and 17; the 2.0 indicates that this is the second iteration of the assessment, as some items have been changed
• Alameda County CANS 0-5 1.0
  Some clinicians use the nickname “Baby CANS” to refer to this assessment because it focuses on participants who are 5 years old or younger.
• California CANS 50 1.0
  This contains the state mandated core 50 items that are incorporated into the other Alameda County versions.  

All of the Alameda County tools can be found on the Manuals and Scoresheets page. The California CANS 50 is found on the DHCS website. See something that should be added or updated? Send a note to the collaborative for action!

In the Dear Collaborative column, we’ll answer YOUR questions about TCOM or the TCOM tools (CANS, ANSA-T, ANSA).
 
Have questions and want answers?  Submit your questions through the Contact page and look for the answer in the next edition of Dear Collaborative. Submissions are treated confidentially.

Q1: I need to certify or recertify for CANS on Schoox. Do I have to do all the learning modules to do so?
A1: No, even though you see the 68 learning modules that provide helpful videos and quizzes on all domains in the CANS, you can scroll past any and all modules you don’t feel you’d like to review. Scroll all the way down to step 68 if you wish and click directly on the “certification exam” and then click “start vignette” for initial certifications or “retake vignette” for recertifications and you’ll be ready to go!
 
Q2: What is the point of the CANS/ANSA? Why do we do it?
A2: The CANS/ANSA helps us make sure we aren't missing part of the picture and are assessing and capturing all areas of risk and strength in a collaborative process with all stakeholders. The CANS/ANSA tool assists us to organize client needs and strengths and gives us a clear metric to help create shared language in treatment planning and track progress throughout our work. CANS/ANSA help protect against clinician and referral source bias, and protect against the ways systems can over and under diagnose client strengths/challenges based on cultural assumptions and personal bias.  The CANS/ANSA manuals give us clear definitions for each rating item. Using CANS/ANSA provides a framework to see change over time which makes it easier to discuss with the client/family the progress that is being made in treatment.
 
Q3: I can’t get past the “I am not a robot” in the Schoox registration process. I am NOT a robot! What do I do?
A3: This is a browser compatibility problem that is easily fixed. Please use Google Chrome, Firefox, Safari, or Internet Explorer-Edge. If you are having trouble with Internet Explorer, you are most likely using an old outdated version. Please upgrade to the newest version, called Edge, or switch to one of the other compatible browsers listed above. You can always seek assistance from support@TCOMTraining.com as well if needed.

Q4: I can’t pass the exam and I don’t know what to do!
A4: There are a couple things you can do to improve your chances of passing next time:

• Take your time (you have 2 full hours available) and print out the manual and rating form.
• Remember that action overrides anchor definitions always. Don’t get stuck on the “anchors” (aka the descriptions for each action level within a given item) and instead focus on the action levels. Ask yourself if this is something you would check on (rating 1) or something you would definitely intervene on (rating 2) or urgently intervene on (rating 3).
• Attend an in-person certification training: trainings are listed on the Alameda TCOM training calendar  and on the Schoox site with on-line registration available.

 
Each newsletter will feature top questions that are submitted to the Alameda TCOM Collaborative. If you have an urgent or critical CANS/ANSA -related question, you can contact your agency's CANS/TCOM Coordinator or one of the Collaborative Members.

In the Dear Collaborative column, we’ll answer YOUR questions about TCOM or the TCOM tools (CANS, ANSA-T, ANSA).
 
Have questions and want answers?  Submit your questions through the Contact page and look for the answer in the next edition of Dear Collaborative. Submissions are treated confidentially.


Q1: How do I score someone with a substance abuse history who hasn't used in 30 days?
A1: This depends on the reasons for their 30-day abstinence. If the reason for the abstinence is that the client has engaged in voluntary recovery, then you would rate this item as at least a 1, indicating a recent history of substance abuse.  If you and/or the individual feel that the risk of relapse is significant and that more planning is needed to support recovery plans, then this should override the “30‐day window” rule. If the reason for the abstinence is due to a situation in which the individual has no choice but to abstain (e.g. jail, or a locked detox program), then you would rate the item according to the individual’s Substance Abuse needs just prior to entering the program.
 
Q2: I barely know this client at this early stage, but I need to turn in my assessment. What happens if I find out more about their actual treatment needs after I have completed the ANSA?
A2: At any given time, we have incomplete knowledge about the people we work with. When paperwork is due, we capture only what we know about the client at that time and expect to learn more as we move forward together. As we learn more, we update our understanding of their needs, strengths and treatment planning implications. It is always possible to update your CANS or ANSA ratings and this is recommended if there are significant shifts in the client’s life, particularly if your treatment plan is shifting because of the changes. 
 
Q3: What should I put in the strengths domain if I can't identify any strengths?
A3: In the Strengths domain, if there is no evidence of a particular strength, we rate it a score of 3. When planning treatment with the individual, family, and team, it is helpful to explore possible strengths or how the team can engage in strength building activities that suit the individual’s goals and desires.
 
Each newsletter will feature top questions that are submitted to the Alameda TCOM Collaborative. If you have an urgent or critical CANS/ANSA -related question, you can contact your agency's CANS/TCOM Coordinator or one of the Collaborative Members.

In the Dear Collaborative column, we’ll answer YOUR questions about TCOM or the TCOM tools (CANS, ANSA-T, ANSA).

Have questions and want answers?  Submit your questions through the Contact page and look for the answer in the next edition of Dear Collaborative. Submissions are treated confidentially.

Q1: If I have an adult client who is homeless, but doesn’t want to be housed, what do I score the Living Situation item on the ANSA?
A1: Like all items, “Living Situation” is scored based on the actual conditions the client faces. Homelessness would warrant a rating of 3. The individual’s choice of whether or not to seek housing is a separate issue. The client's voice and choice should certainly be respected in the decision of whether this item should be a Treatment Target. In the client’s situation, this item would likely be categorized as a Background Need.

Q2: Should I change the version of the CANS I use now that DHCS and DSS is mandating the CANS?
A2: No. You’re all set. The State has mandated that all counties use “the Core Fifty” items for outcome evaluation purposes. These items are already present in the Alameda County version of the CANS.

Q3: Would a need with a 2 or 3 score that a client wants to change in their life go in the treatment plan if the client doesn’t want your help to make the change?
A3: It would go in the treatment plan, but the important question is, “where?” The 2 or 3 rating indicates that the item is an area in which the individual does hope to see some transformation occur. If they do not want the treatment team’s direct help with making that happen this item would be captured in the Treatment Plan among the “Anticipated Outcomes” or “Background Needs.”

Each newsletter will feature top questions that are 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.