We are excited to announce the upcoming Collaborative Trainings including:
The online training calendar has details for upcoming trainings. In addition, the Collaborative is happy to plan agency specific trainings at your site! Just reach out to your collaborative coach or contact us to submit a request!
One of the important questions that agencies ask about the State-wide CANS implementation is how to use the data collected to support improvement of client care. In order to respond to the need for expanded information on this topic, a comprehensive guide has been developed for administrators and supervisors to help generate data reports for their programs utilizing Objective Arts (OA).
The Objective Arts Key Reports: User Manual for Alameda County details four reports with direct agency usefulness for basic compliance tracking, as well as examining service efficacy. The user manual provides step-by-step instructions with illustrations for each of the four key reports, including the creation of customized report templates, how to run reports, and report interpretation.
The Objective Arts Key Reports: User Manual for Alameda County will be available to download online starting in late Spring.
Have you ever been asked to score something on a number scale? How sure were you that your number rating meant the exact same thing as the person asking for the rating? With communimetrics, the number scale is not subjective because each number is clearly linked to a specific concept but you may still find yourself in need of more support in order to effectively bring the CANS/ANSA into supervision and the treatment planning process across your agency within Alameda County Behavioral Health Care Services
We are here to help with that! There are a variety of NEW tools on our website that are now available for you to print and utilize which can help to guide engagement with your clients and families. Erin Rosenblatt, from Westcoast Children’s Clinic created these new tools with the intention of “enhancing [the] provider’s practice when using the TCOM tools (CANS/ANSA). While many who are new to using the CANS/ANSA focus on proficiency with the tool, these new tools will help providers understand how to integrate the principles and practices into work with clients, families, and in supervision.”
We would “encourage anyone that is looking to know how to further integrate the CANS/ANSA or TCOM into their practice to explore and see what tools resonate” and align most with their current space and processes. The updated documents can be found in the following sections:
“I think people will be surprised about how much they already are doing and how easy it can be to integrate these aspects into their day to day work with clients.”- Erin Rosenblatt
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.
Did you know Alameda Behavioral Health Care Services recently created two positions to support providers in utilizing the CANS and ANSA tools in a more coordinated and effective manner? Meet Christine Mukai, CANS Coordinator, and Michael Castilla, ANSA Coordinator.
Welcome to the team Christine and Michael!
Would you mind telling us a little about your job experience prior to coming into your new position?
Christine: My work experience started back in the late 90’s with SUD in NYC, then day treatment in LA, and outpatient in SF. Then I joined Alameda County in 2002 in outpatient, then to the AB3632 unit, which later became the ERMHS unit. The past 6 years have been with the CEC School based program until switching over to becoming the CANS Coordinator. I have used the CANS since 2014.
Michael: My work history has primarily been in Supported Employment. For eight years I assisted individuals with mental health, dual diagnosis, and with developmental disabilities to find and maintain employment. I’ve worked with adults and Transition Aged Youth populations. I’m currently working as a Social Worker Supervisor with In Home Support Services (IHSS). We serve Minor Children cases and assess their needs in order for them to remain safely in their homes and to avoid premature out of home placement. As a supervisor, I review the assessments provided by the Social Workers in my unit. We assess each individual’s Functional Index Ranking and work to promote independence.
What is the county’s current focus and future hopes for the CANS and ANSA tools?
Christine: The Alameda County Behavior Health (ACBH) is focusing on providing mental health and substance use services to limited income individuals and families. ACBH very recently had a logo and branding update to reduce the stigma and negative connotation towards people who suffer from mental health and substance use. The county is also putting efforts into providing a continuum of care and has recently started an FSP for wrap services under the Children and Young Adult System of Care.
The future for CANS is to have more users understand how it can be a tool that is useful beyond the needs and strengths assessment. CANS can be helpful in treatment planning, engagement, supervision and understanding outcomes.
Michael: I am very eager to get started and will know more as I become immersed in my new role. I am a big proponent of recognizing people’s strengths and what they can do. My career for the last 12 years has been around assisting individuals with maintaining independence and utilizing natural supports. My passion is coaching and supporting others with discovering new goals. My hopes are to assist all program recipients with recognizing their strengths and finding success with meeting their goals and continuing to dream for more.
What CANS or ANSA item do you most identify with?
Christine: The Sleep question is what I identify most with. Good restful sleep is essential in daily functioning and it’s a good indicator to understand the other areas. When I get consistent good sleep, I feel great and feel like I can conquer anything!
Michael: I most identify with Talents and Interests under Individual Strengths. I truly believe that we should continue to be curious with the world around us and to seek to improve our current talents as well as discovering new ones.
What is something that you do for fun?
Christine: Something I like to do for fun is go hiking or to the beach.
What is the last book you read that you enjoyed?
Michael: The last book that I really enjoyed was the “Power of Habit” by Charles Duhigg. I found it to be inspirational and very informative.
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:
Esmeralda Gonzalez is the Training Coordinator for STARS Behavioral Health Group. She was recently welcomed as a new addition to the Alameda County TCOM Collaborative.
She is “loving everything the CANS has to offer” and is excited to learn more about how the CANS can enrich the treatment planning process.
Esmeralda’s own children (3 and 6 years old) inspire her engagement in mental health work with youth. She is proud to support direct service staff through advocacy and the development of critical resources.
Esmeralda's superpower is in event planning, which provides an outlet for her creative tendencies. Her crafting specialties include huge paper flowers, backdrops for dessert tables and decorative photo booths. The Collaborative will definitely benefit from the infusion of fun and enthusiasm that Esmeralda brings. Welcome!
A recent picture of the Collaborative membership is below.
Westcoast Children’s Clinic (WCC) has committed itself to practice-improvement in countless ways that have benefited the entire Alameda County system of care. One recent innovation in their intake process is showing promise for increasing engagement, client voice & choice, and TCOM integration. Like many organizations, WCC has traditionally used an initial intake process that is somewhat divorced from assessment and treatment. In this old model, a clinically trained intake clinician would take calls, check Medi-Cal eligibility, and gather relevant information about the client/family presenting issues and needs. Following this hour-long phone intake, the intake clinicians would make clinical determinations about the general course of treatment and would match the client with a clinician who best suited the client’s needs. When clinically indicated, the intake clinician would refer the client to services elsewhere. Although this process was designed to ensure clinical excellence and is conducted with sensitivity to the client’s experience, there are potential disconnections in having a lengthy intake on the phone prior to starting even lengthier assessment process with another WCC team member.
In the Spring of 2018, WCC formed a pilot group of about eight clinicians. All were TCOM champions interested in helping to improve engagement practices within their organization. Each was selected by a supervisor or director who recognized their ability to embed TCOM principles into their engagement, assessment and treatment activities. The group was involved in the development and implementation of a strategy to infuse these principles more fully into the WCC intake process. The resulting pilot approach is called Collaborative Initial Evaluation and it differs from their traditional intake process in significant ways.
The largest difference is that the initial phone contact with a client is very brief and is used primarily to set up a face to face meeting with a Collaborative Initial Evaluation clinician. This clinician would work with the client for up to 30 days, effectively conducting screening, intake and assessment in an integrated manner as the client’s needs become clarified. In this approach, there is no decision made about the course of treatment without the family’s input. Rather, needs and goals are discussed over the course of the month, allowing the clinician to centralize a relational and deferential stance with the client while also gathering all the information necessary for a complete clinical assessment. To ensure that TCOM and Communimetric principles are at the heart of this process, the clinician and client follow a comprehensive but concise guide. The semi-structured guides lead them through a collaborative conversation about the client’s hopes for transformation in all the potentially relevant life domains covered in Alameda County’s version of the CANS. As this process unfolds, the client’s “top needs” are identified, and only at that point is there a clinical determination of the recommended course of treatment – which could involve ongoing work with the clinician conducting the Collaborative Initial Evaluation or transfer to a better suited clinician.
The shift in practice has not been without challenges, but even the challenges have been constructive. For example: Some clinicians have found it challenging to conduct a 30-day evaluation while knowing they may end up transferring the work to a colleague. The tension between relationship building and time-bound information gathering demanded a more pointed approach to assessment. In reflection, some clinicians shared that they worried this approach would feel “intrusive.” If the assessment and treatment are expected to be done by the same person, this fear of intrusion can result in an “either/or” approach where “relationship building” is emphasized over concrete assessment of needs. Collaborative Initial Evaluation forces a “both and” resolution of this tension - giving clinicians the opportunity to sharpen their clinical assessment skills even more while still maintaining their commitment to respectful, relational work.
Westcoast Children’s Clinic has since introduced the practice across one of their programs – infusing the implementation process with the wisdom gained from the pilot group. All clinicians in this group were trained in performing the initial evaluations and in “taking a handoff” from another clinician. And all received additional training in team-based care. As this new phase unfolds, WCC continues to refine the protocol, discovering new ways to determine early on what course of assessment and treatment is best given the client’s emerging strengths, needs and goals. The hope is that this practice will eventually be introduced agency-wide and that it can be shared with and replicated/improved by other organizations. Any questions about this innovative practice can be directed to Cinthya Chin Herrera, Psy.D, WCC Assistant Director of Training (email@example.com).
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Blog content is created by the shared effort of the Alameda TCOM Collaborative members. Send feedback through the Contact page.