Scoring the CANS and ANSA

1. Scoring the CANS and ANSA Some additional information not in the training materials provided by John S. Lyons, PhD and the Praed Foundation

2. Child and Adolescent Needs and Strengths (CANS) and Adult Needs and Strengths Assessment (ANSA) • This is a comprehensive, multisystem assessment. • This tool was designed to be comprehensive in nature. Thus, when going through the training, you will see, hear and read a lot of examples which incorporate developmental disabilities, situations in which people are in group homes or institutions, have multiple diagnosis and have an intense amount of family involvement. • This can “throw a person off” when trying to get certified, as most Coastal Plains staff are mainly mental health services focused and the state of Texas does not “blend” systems of care to include IDD, MH and Substance Abuse services.

3. Things to Remember • In general, the ratings are about the “what” not the “why” of the person and situation. There is no “cause and effect” to the scoring. • Example: Bob has been on Thorazine for 40 years and has difficulty speaking because of Tardive Dyskinesia. His mother, case manager, an old friend and the nurse understand what he says, as they have worked with him a long time. The front desk staff, doctor and community members/friends do not understand him. This results in Bob getting frustrated, raising his voice and wave his arms around which some people think is threatening. • Domains that this part of a scenario will score on what: • Physical/Medical: score = 2 as Tardive Dyskinesia is a chronic medical problem • Social Connectedness: score = 2 his communication barriers are scaring people • Community Connection: score = 2 as his communication barriers are limiting his ability to connect with people in the community. • Natural Supports: score = 1 His mother is a natural support to him • Impulse Control: score = 1 as Bob does sometimes loose control, raise his voice and wave his arms around when upset. • Anger Control: score = 1 as Bob gets frustrated, raises voice and waves arms around • The “why” is the Tardive Dyskinesia, his communication barriers and long-term use of Thorazine. If we scored on the “why” they scores would be higher, as this is a significant barrier for Bob. Very few people understand him. When he becomes frustrated with this, he scares people.

4. Scoring Challenges - NEEDS • The CANS and ANSA utilizes a four (4) point scoring system. • Under NEEDS • 0 = No evidence of a need or no need for action (at the time) • 1 = there is a need present, but…right now you, the person and the team just need to watch the situation and if the need increases, then action may be justified • 2 = A need is present and severe enough that action is justified, but not emergency action • 3 = A need is not only present, but emergency, intensive or immediate attention to address this need is required

5. Scoring Challenges - STRENGTHS • Under STRENGTHS • 0 = there are significant strengths present in this person or the person’s life at the current time • 1 = though there are some strengths notes, they are not overwhelmingly present • 2 = this score indicates that there are minimum strengths present that the person has, either personally or in their life. • 3 = there are no strengths currently found or recognized by the person

6. Scoring, continued… • Remember, scoring is determined over the past 30 days (unless the tool specifies a longer or shorter period of time). • On some questions, there are opportunities to score “N/A”. For example, if a person does not have a “caregiver” then you will score N/A all the way down this scale. During the on-line training exercise, the N/A option does not show up. • There are also some questions in which you will be provided the option “U” for “unknown”. Again, this option does not show up in the on-line training.

7. Areas which may pose confusion • Danger to Self or Others: • This “risk behavior” topic sounded straight forward, but it is not. You are not only addressing “suicidal” & “homicidal” behaviors/tendencies, but also behaviors that could result in danger to self and others. • Examples? • A 13 year old girl having unprotected sex (this is scored a 3) • A man who is actively psychotic and threatens people on the street because he thinks they are talking about him. (score a 3) • A 22 year old who has lost 50 pounds in 2 months, now weighing 79 pounds and believes she is still “fat” and “would rather die than eat” (score a 3 - but if she is still eating, a 2) • A person who drinks daily and does not remember how they get to the grocery store to get more beer. They always have more beer in their refrigerator in the morning and their car is parked in different places every day. (score a 2)

8. Self Injury and Other Self Harm… • Self-Injurious Behavior: • This behavior is intentional and purposeful to self. • It may be anxiety driven, developmentally based, or done to seek a sensation. • It only becomes a “3” or “serious” if it requires medical intervention of some kind (e.g. stiches, a helmet for head banging, constant physical restraints, etc…) For example: A person who cuts on themselves to know that they are still alive: Self-injurious behavior. The cuts are minor, do not require medical attention and cutting has been going on for year, but no cutting in the last week – score a 1, cutting in the past week – 2, cutting requiring stitches or cuts are severely infected score a 3. Choking self for pleasure/high – serious as death can occur. Burning self with cigarette to “feel” something – score similarly to the cutting. • Other Self Harm: • This can be either intentional or unintentional behaviors. • Many people will cut or burn themselves to “feel something or know that that are still alive” and this would be “self-injury”. But if they are doing it on a dare, to see what would happen, prove a point, etc… this is “other self harm” • People who “play chicken” with cars or trains; hold “impromptu races”; “bungee” jump without a certified bungee; drink and drive on occasion; use recreational drugs for the “fun of it”; a girl is in a relationship with a physically abusive, dominant man; a college student is prostituting self to pay bills and not using protection; etc… • The scoring on this would require you to ask: “How risky is this behavior?” “Is this a daily, weekly, monthly occurrence?” “How great is the risk?” “Could serious injury, health problems or death occur?” The more dangerous, serious and recent, the higher the score. For example: Playing chicken with trains/cars recently – score a 3; Burning initials into arm with a cigarette – score a 1 unless the burn is infected; Or, a person pulls out their hair (subconsciously) and eats it, but not a lot – score a 1; has large bald spots with scabs – score 2; is having stomach cramps (probably blockage from “hair balls”) score a 3 as they need an x-ray or other medical attention to remove blockage; Drinking and driving, playing the “mix & try” game of dumping all the pills from the parent’s med cabinets and taking a handful of them = 3.

9. Sexual Aggression