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 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:
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:
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:
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:
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.  Lotería is more than just a game; it’s a collection of symbols that mirror the many facets of our lives. Just like Loteria can help open up conversations that inform our CANS, Loteria can also help us. Today, we’re using iconic Loteria images to help you tune into the energy you need most right now. How to play: Take a deep breath, clear your mind, and look at the four cards below. Don’t overthink it! Let your intuition guide you to the image that "jumps out" or speaks to your current mood. Your chosen card reveals a personal affirmation designed to root your day in intention and strength. Which one is calling your name?
Affirmations 🌳 El Arbol (The Tree)
Everyone agrees that family is important; this APA article talks a little about it. CANS is a great tool to understand families. Using the CANS Caregiver Domain is vital because a child’s mental health is tied to the stability of their home environment. The domain highlights clear areas such as supervision, stress, mental health, substance use, and access to supports. When these needs are identified early, you can create a plan that strengthens safety and consistency at home. Without this information, services focus only on the child and miss the conditions that shape daily functioning. Other items in the Strengths Domain such as family strength, spiritual/religious, cultural identity, and community life can tell you about the strengths of the family system as well as those of the child/youth.
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.
WestCoast Children’s Clinic recently held a training session that provided valuable insights into how to better engage with children, youth, and families by centering their unique developmental and cultural contexts. Trainer Bethany Blank, LCSW is a TCOM Human Services Program Specialist with the Idaho Department of Health and Welfare and shared both her professional and personal perspectives on navigating services with developmental needs.
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.
This season, I’ve been reflecting on the Loteria card La Rosa (The Rose). At first glance, it represents beauty, love, tenderness, and growth. But we can’t forget that every rose has its thorns. La Rosa (The Rose) feels especially meaningful in our CANS and TCOM work. We are constantly asked to hold complexity. To see strengths and needs at the same time. To notice what is blooming while also tending to what is sharp, guarded, or hurting. In many of the children and families we work with, the “thorns” often show up first. A youth may present with anger, withdrawal, defiance, or hypervigilance. A caregiver may appear disengaged, overwhelmed, or resistant. But if we pause and look more closely, those thorns are rarely random. They are protective. They formed for a reason.
With youth or caregivers, you might ask:
In Supervision, La Rosa (The Rose) can guide reflective conversations:
In team meetings, this metaphor can help reframe difficult behaviors. Instead of asking, “Why are they acting this way?” we might ask, “What has this thorn been protecting?” This shift aligns deeply with the TCOM principles: understanding context, centering the person’s story, and using shared language to drive meaningful care planning. Growth Takes Tending Roses don’t bloom without care. They need water, sunlight, pruning, and protection. Healing works the same way. When we identify actionable needs in the CANS, we’re not labeling a family; we’re identifying where tending is needed. When we identify strengths, we’re naming the blossoms that can be nurtured. La Rosa (The Rose) also reminds us that growth is seasonal. There are times of blooming, and times that feel dormant. That doesn’t mean growth has stopped; it may simply be happening underground. Looking Ahead As we move forward into this next season, I invite you to carry La Rosa (The Rose) into your work. Notice the blossoms. Honor the thorns. Tend to what needs care. And remember that even in the most complex cases, something is always growing. 
Spanish TCOM and CANS Manuals One of the most important features of the site is access to Spanish-language manuals, including Praed Foundation framework materials and tools such as the Child and Adolescent Needs and Strengths (CANS) tool. Having the manual available in Spanish supports:
Language matters, especially when discussing needs, strengths, trauma, and resilience. Metaphors can make TCOM Understandable Another highlight of Hablemos TCOM is its collection of metaphors and explanatory tools designed to make TCOM and CANS concepts easier to discuss with families. TCOM is not “just an assessment.” It’s a communication tool, a shared decision-making framework, and a way to tell a child or family’s story in a structured, collaborative way. Metaphors can shift the narrative from:
These kinds of tools are especially helpful when introducing TCOM in culturally responsive ways, honoring families’ lived experiences, and reducing defensiveness or fear in the early stages of information-gathering. Why This Matters
For Spanish-speaking families navigating complex systems, language access can either be a bridge or a barrier. A site like Hablemos TCOM reinforces a core value of TCOM itself: shared understanding. When we can explain needs and strengths clearly, in someone’s primary language, we increase collaboration, trust, and meaningful engagement. If you supervise bilingual clinicians, work in community-based settings, or partner with Spanish-speaking caregivers, this site is worth bookmarking and sharing. Let’s keep building systems where communication truly connects.  If you have a hankering for more insight into the philosophical underpinnings of the CANS, are curious about the use of the CANS across the US and worldwide, or just want to expand the usefulness of the CANS in your own practice with youth and families there is a resource for you! The TCOM Channel on YouTube is full of short, informative videos and even recordings of presentations from the annual CANS Conferences. This includes some real gems to deepen your understanding about all things CANS, from what really is “masking” (the Masking Principle: https://www.youtube.com/watch?v=pTQiBPz6mUo), to cultural considerations in using the CANS (Culture Conversations https://www.youtube.com/watch?v=1g-PWFhacVM), to integrating the CANS with Motivational Interviewing (Motivational Interviewing with Children & Families https://www.youtube.com/watch?v=Nip2dLsQdOs).  Happy browsing!  Q1: Where can I get the manuals and rating sheets in English and the County’s threshold languages? A1: The Birth-24 manuals and rating sheets have been translated into the county’s threshold languages. (Please visit Manuals & Scoresheets - ALAMEDA TCOM COLLABORATIVE) to access these documents, which are downloadable in MS Word. At this time, the IP-CANS manual is only in English, but the rating sheets have been translated into Spanish. The County is working to get the IP-CANS and rating sheets translated into the county’s threshold languages. Stay tuned. Q2: Why can’t I create an assessment in Objective Arts? A2: There can be multiple reasons you may not be able to create an assessment in OA. For example: Missing/Expired/Invalid Certification. Check to see that your CANS certification is “Valid.” If your certification has expired, please recertify as soon as possible. When a certification expires, that user account is deactivated by the Praed Foundation after 90 days. If you need assistance to reset their password or reactivate the account, they may contact Praed support at [email protected]. Q3: Is there a way to print ONLY the IP-CANS questions? A3: In Objective Arts, you can select a new print option from the drop-down on the lower left corner of the screen. You can select print and “IP-CANS Scoresheet”. Please print “IP-CANS Scoresheet” if a placing Agency (Probation or Child Welfare) requests a copy of the CANS. See the screenshot below:  Q4: Did you miss the new ACBHD memo regarding Indirect Note Updates in Clinician’s Gateway: A4: The Indirect Note template was updated to work the same way as an individual (direct) note template, where a user selects a client first and then a program. In addition, logic was added to allow a user to finalize and transfer an Indirect Note to SmartCare using the AAA/Indirect Client, but retain the actual Client Identification in Clinician’s Gateway for medical record continuity. The memo was sent out via email on March 10, 2026. For questions about this memo, please contact Information Systems Support, [email protected].  This past October, I (Cristal Alvarado, EBAC/ Alameda TCOM Collaborative Member), had the privilege of presenting at the 2025 TCOM Conference held in Chicago. This year’s theme was grounded in “Standing on the Shoulders of Those Who Came Before.” As someone who lives at the intersection of Play Therapy and CANS practice, the theme resonated deeply. Our work is always built on foundations laid long before us, by early play therapy pioneers, by youth and families who’ve trusted us with their stories, and by the evolving framework of TCOM and the CANS itself.
One participant even shared that they played this game for many years as a child, and didn’t realize just “how deep” families could get with the game. It was a moment of inspiration and motivation.
Participants loved the hands-on approach of the session. Many noted how deeply these questions reach, how much we ask young people to reflect on, and how easy it is to forget the emotional lift required. Playing through the experience allowed everyone to feel the depth, not just think about it.
Why Play Matters in CANS Work One of the biggest takeaways (for the participants) was this: if we ask clients to do something, we should try it ourselves. Play-based methods make the experience more accessible, relational, authentic, AND more ethical (meeting the developmental needs of children and youth when assessing and gathering information). When we feel what it’s like to answer difficult questions in a “game,” we become more attuned to how we ask, pace ourselves, and support youth through the process. Standing on the Shoulders…and Reimagining Moving Forward Both sessions felt like a natural blending of my two worlds: Play Therapy and CANS. I left the conference feeling energized by the feedback. People felt motivated to integrate games into their work. They appreciated the blend of clinical depth and cultural responsiveness. And many said it helped them reconnect with the humanity at the heart of assessment. That’s the legacy we stand on: innovation rooted in relationship, safety, culture, and care. Want This Training At Your Agency? If you’re interested in bringing CANS + Games (Jenga, Uno, Lotería, or other playful tools) to your staff or program, we’d love to come teach. Contact us here. Let’s bring play, culture, and connection into your CANS practice. Thank you for growing in this work with us. Here’s to standing strong on shoulders….and building new ones! |
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