​Our CANS Lotería series is getting an expansion pack!
In honor of Día de los Muertos approaching this fall, we’re taking a look at Coco Loteria and using some of its unique cards to explore the Culture domain of the CANS.

The CANS Cultural Factors Domain asks us to consider 4 areas:

• Language
• Traditions and Rituals
• Cultural Stress
• Cultural Differences within the Family

 
These 4 items remind us that culture isn’t simply about where someone is from. It can influence how families communicate, practice traditions, navigate their environments, and understand one another.

​So let’s deal the cards …

Card #1: La Bisabuela (The Great Grandmother) - Language
At first glance, La Bisabuela might seem like a card about family. But let’s use it to think about how culture and language are passed between generations. Language can be a source of connection. Stories shared with grandparents, songs, sayings, jokes, or conversations that carry meaning within a family. But language can also create barriers when families are trying to access services.

​The Cultural Factors Domain asks us to consider whether a family has difficulty obtaining resources, supports, or accommodations because of written, spoken or signed language needs.
 
CANS Lens:
Are we communicating with the family or simply communicating at
them?
 
A culturally responsive approach means considering whether interpretation, translated materials, ASL, or other communication accommodation is needed for the family to meaningfully participate in treatment.

Card #2: La Flores de Cempasúchil (Marigolds) – Traditions and Rituals
Marigold flowers are part of Día de los Muertos traditions. But here’s where we can go deeper with the CANS:
Does the family have access to participate in the traditions and rituals that are meaningful to them? These traditions extend far beyond Día de los Muertos, encompassing whatever unique practices help a family feel connected and grounded.

The Cultural Factors Domain specifically includes daily activities too. So we’re not only talking about major celebrations. It might be:

• Preparing a traditional meal
• Attending a religious service
• Observing a holiday
• Maintaining a family ritual
• Participating in community or cultural activities
• Having access to culturally meaningful foods, clothing, music, or practices.

​And sometimes the barrier isn’t that the family doesn’t value the tradition. They may simply not have access to participate.
 
CANS Lens:
Is something getting in the way of this child or family participating in the traditions and activities that matter to them?

​Card #3: El Mundo de Los Muertos (The World of the Dead) – Cultural Stress
This card gives us an opportunity to talk about something we don’t always associate with "culture:"
 
The environment.
 
The Cultural Factors Domain asks us to consider whether a child or family experiences hostility or other problems in their environment related to racism, discrimination, or other cultural stressors.
 
So instead of only asking: “What cultural backgrounds does this family have?”
We can also ask: “What is this family experiencing because of their culture, identity, language or differences?”
 
A child may experience discrimination at school. A caregiver may experience racism in their community. A family may avoid certain spaces because they don’t feel welcome or safe. These experiences aren’t simply “cultural background.” They are cultural stressors.
 
CANS Lens:
What is happening around the is happening around the child and family – not just within them?

Card #4: La Abuela (The Grandmother) – Cultural Differences within the Family
Culture doesn’t always mean everyone in the family shares the same values, traditions, or identity. Different generations may have different expectations.
 
A child may feel differently about a tradition than their caregiver. Family members may have different levels of acculturation. Adoptions, mixed-race families, immigration experiences, and generational differences can all contribute to differences in identity and values.
 
The CANS asks us to consider:
Do those cultural differences create disagreements or conflict within the family?
 
And that’s an important distinction. Having different cultural identities isn’t automatically a problem.
 
CANS Lens:
The concern isn’t that the difference exists. The concern is when those differences create conflict or interfere with family functioning.

Bonus card: La Ofrenda (The Offering)
An ofrenda can look very different from family to family. Some families may create one; others may not. Some may observe Día de los Muertos in other ways, while others don’t participate at all. And that’s actually the point.
 
We shouldn’t assume; we should ask.
 
Instead of: “Does this family celebrate Día de los Muertos?”
We can ask: “What traditions or rituals are meaningful to you and your family?”
 
Instead of: “What language does this family speak?”
We can ask: “What communication supports does this family need to have full access to services?”
 
Instead of: “What is this family’s culture?”
We can ask: “Are there cultural experiences, differences, or stressors that are
affecting this child or family?”

We hope this edition inspires new ways to dig deeper into the Cultural Domain—using tools like Lotería and Coco to spark meaningful connections with the families you serve! ​

Collaborate with youth/family and teams. Check your understanding and elevate youth/family voice by engaging youth/family and teams in conversations about where action would be most helpful.

• Introduce the CANS and use it as a tool to increase transparency and invite collaborative documentation. Ex: “I’m going to be gathering team input and completing a document we call the CANS, which is a snapshot of what’s working well (strengths) and where you might need some support (needs). Let’s talk about it.”

​

Get creative with engagement. Use art, play, CANS cards, Lotería cards, and other tools to surface information about actionable needs and strengths to build.

• Follow your flow. Engagement and assessment look different for everyone, and what you learn can be reflected in the CANS.

​

Bring the CANS into natural meeting spaces. Add the CANS as a standing agenda item in meetings such as Child and Family Team Meetings. [See article SF CYF T.I.P.s: “Meaningful Use of the CANS Video Training”]

• Start with CANS items most relevant to the case. Use them to develop shared understanding, identify and prioritize action, and monitor progress over time. Explore and incorporate additional items as helpful. 

​

Utilize CANS narratives to provide context. Increase team communication and understanding by expanding upon action levels as helpful.

• Include brief narrative details that explain actionable items and shifts over time. This is particularly helpful when completing CANS updates or operating off of external assessments.​

Our TCOM partners in San Francisco have shared a number of helpful resources to increase meaningful, collaborative use of the CANS, including in Child and Family Team Meetings. Check out their videos!

Topic highlights:

• Learning Area 1: Introducing and Explaining the CANS to Families
• Learning Area 2: Engaging the Family Using the CANS
• Learning Area 5: Using the CANS in Supervision
• CANS in CFTs Video Roleplays

​[Note: Download the modules as PowerPoint slides first so the video recordings will play]

Q1: Isn’t the CANS just more paperwork?

​A1: Not at all. The CANS is a conversation tool, not a checklist. CANS helps us all understand what we’re doing together and what youth and families need. Families say it helps them feel heard because it focuses on what matters most, and then the supports they receive actually make a difference.
​

Q2: My caseload is high, and I don’t know how CANS can help me.  

​A2: CANS cuts through noise by highlighting the needs that matter most right now. It keeps teams focused and prevents kids from getting lost in the shuffle. It helps you identify the highest needs and prioritize so you can be effective when you only have so many hours in your week.​
​​

Q3: How can I explain to families why they should care about the CANS and how it benefits them?  

​A3: The CANS turns conversations into concrete plans and offers clarity, making it easier for families to see what’s happening and what support is coming next. CANS directly shapes the services a child receives. Higher needs mean more support, and strengths mean more opportunities. It’s a tool that can turn a family’s story into real resources.​​

Grab a coffee and let's go! Check out: 

• ​Live CANS Certification Training ​
• Loteria and the CANS
• New TCOM Training (Schoox) Guides
• Updated National Training Info​​

In this edition of the Lotería and the CANS series, we wanted to focus on the card El Borracho (The Drunkard). In traditional Lotería decks, El Borracho is often portrayed humorously as he stumbles cartoonishly. But beneath the humor, there is something much heavier.
​
For many youth and families we work with, substance use is rarely “just about substances.” It can be about numbing, survival, escaping, or carrying burdens that feel too heavy to hold alone. Alcohol is the most widely used and abused substance among teens. Approximately 1 in 5 high school students report drinking alcohol in the past 30 days. Additionally, 9 out of 10 adults with a substance use disorder began using substances before age 18. So it stands to reason that substance use conversations are important to have with the youth and families we serve. The Lotería cards can support us in having these conversations much more easily.

Within the CANS framework, substance use is not viewed in isolation. It exists within a larger story: trauma exposure, family stress, grief, community violence, cultural disconnection, mental health needs, peer relationships, and coping strategies. El Borracho reminds us to slow down and ask not just “what is the behavior?” but “what is the behavior doing for this youth?” From there, we can determine what their strengths and needs are and what action level is required from us.
​
Youth who use substances are often quickly labeled as defiant, unmotivated, or reckless. But CANS invites us to use a different lens, one that is more curious, contextual and compassionate. For some, alcohol or drug use becomes a way to quiet intrusive memories, manage anxiety, cope with grief, or to feel something or feel nothing at all. For some youth, substances are introduced through family systems or community norms. For others, experimentation becomes a coping tool after trauma or chronic stress. Some youth are trying to survive environments where substance use has become normalized, expected, or even necessary for emotional protection.
​

El Borracho as a Reflective Tool in Practice
El Borracho can challenge us to move away from shame-based responses and toward deeper understanding. Lotería cards can create safety through symbolism. Sometimes, youth are more willing to talk about a character than directly about themselves.
​

Instead of asking:

• “Do you have a substance abuse problem?”
  

​We might better begin with using El Borracho:

• “What comes up for you when you see this character?”
• “What do you think led to this moment on the card?”
• “Do you think people judge him before hearing his story?”
• “What is this character thinking? Doing?”
• “What do you think he is trying to forget?”
• “What is your relationship with alcohol and substances?”
• “When do people stop using substances for fun and start using them to survive?”

​

These kinds of reflective questions can create room for storytelling and honesty without immediately activating shame or defensiveness. These questions allow us as providers to learn about the people we serve, hear their stories, and understand their worldviews. Once we make the space to hear our client’s stories first, then we can move to actions and interventions.
​

El Borracho can also help clinicians reflect on their own biases:

• What assumptions do I make about youth who use substances?
• Which substances are normalized in my culture or family system?
• How do race, class, culture, and systemic inequities shape who gets punished versus supported?
• Am I focusing only on stopping the behavior, or understanding the unmet need underneath it?

​

Substance use conversations matter deeply, especially with adolescents and transition-age youth.

The more I work within CANS and TCOM, the more I appreciate how interconnected everything is. Substance use may connect to:

• Trauma symptoms
• Depression
• Sleep difficulties
• Family conflict
• Peer dynamics
• Cultural stress
• Legal involvement
• Grief and loss
• Or lack of meaningful connection and belonging.

This is why a communimetric approach matters. We are not simply checking boxes or diagnosing problems. We are trying to understand the full picture of the youth’s life and how and when we should offer support.
​

El Borracho reminds us that behaviors tell stories.
Sometimes the story underneath substance use is: “I didn’t know how else to cope.”

Harm Reduction, Hope, and Healing
Working with youth around substance use requires balance. Accountability matters. Safety matters. And relationships matter too.

Young people are more likely to engage when they feel:

• Heard instead of judged,
• Understood instead of labeled,
• And supported instead of shamed.

Healing often begins when someone finally asks: “What happened to you?” instead of “What’s wrong with you?”

El Borracho may appear unsteady, but he also reminds us of something profoundly human: people seek relief when pain feels unbearable.

Our work is not only to reduce harm but to help youth build lives where they no longer need the escape.
​

Looking Ahead
As we continue exploring Lotería and the CANS together, we invite you to sit with El Borracho a bit longer.

What assumptions surface for you? What stories are hidden beneath the behavior? And how might curiosity create more room for connection, healing, and hope?
Behind every behavior is a need and behind every need is a story waiting to be understood.

​Footnote: While many of us may not be Certified Alcohol and Drug Counselors, it is still important that we develop a thoughtful understanding of a youth’s relationship with substances. Within the CANS framework, substance use is part of the larger story of a young person’s functioning, coping, environment, and support system. Our role is not necessarily to provide specialized treatment, but to notice patterns, ask meaningful questions, reduce shame, and recognize when additional support or referrals may be needed. When concerns rise above our level of training or are out of our scope of practice, collaboration and referral to specialized substance use-knowledgeable providers can be an important part of supporting the youth and family holistically.

The CANS made these patterns clear. With that information, the team arranged weekly respite, connected her to a caregiver support group, and provided in‑home coaching to strengthen routines. She said, “I finally felt like people saw what I was carrying and what I was doing right.” These supports reduced her stress and improved consistency at home, which helped her grandson stabilize and engage more fully in treatment. ​

​Adapting Your Approach by Age and Need
Engagement isn't "one size fits all.

​The Heart of Engagement: Support, Not Judgment
Ultimately, engagement is about building a shared vision. The goal of assessment is not to label or judge, but to determine where support is needed. By listening with empathy and being open to different perspectives, we can build the trust necessary for meaningful change.