CANS STUDY GUIDE COMPLETE QUESTIONS AND CORRECT DETAILED ANSWERS

CANS STUDY GUIDE COMPLETE QUESTIONS AND CORRECT DETAILED ANSWERS “The purpose of the CANS is to accurately - CORRECT ANSWER represent the shared vision of the child/youth serving system—children, youth, and families." "Since its primary purpose is communication, the CANS is designed based on - CORRECT ANSWER communication theory rather than the psychometric theories that have influenced most measurement development." "The rating of 'N/A' for 'not applicable' is available for a few items under specified circumstances. For those items where the 'N/A' rating is available, it should be used only - CORRECT ANSWER in the rare instances where an item does not apply to that particular youth." "As a strength-based approach, the CANS supports the belief - CORRECT ANSWER that children, youth, and families have unique talents, skills, and life events, in addition to specific unmet needs." "Strength-based approaches to assessment and service or treatment planning focus on collaborating with - CORRECT ANSWER children/youth and their families to discover individual and family functioning and strengths." "Failure to demonstrate a child/youth's skill should first be viewed as an - CORRECT ANSWER opportunity to learn the skill as opposed to the problem. Focusing on the child/youth's strengths instead of weaknesses with their families may result in enhanced motivation and improved performance." "Involving the family and child/youth in the rating process and obtaining information (evidence) from multiple sources is necessary and - CORRECT ANSWER improves the accuracy of the rating." "As a quality improvement activity, a number of settings have utilized a fidelity model approach to look at service/treatment/action planning based on the CANS assessment. A rating of '2' or '3' on a CANS need suggests - CORRECT ANSWER that this area must be addressed in the service or treatment plan" "A rating of a '0' or '1' identifies a strength that can be used for strength-based planning and a '2' or '3' a strength that should be the - CORRECT ANSWER focus of strength-building activities, when appropriate." "It is important to remember that when developing service and treatment plans for healthy children and youth trajectories, balancing the plan to address - CORRECT ANSWER risk behaviors/needs and protective factors/strengths is key. It has been demonstrated in the literature that strategies designed to develop child and youth capabilities are a promising means for development, and play a role in reducing risky behaviors." "Finally, the CANS can be used to monitor outcomes. This can be accomplished in two ways. - CORRECT ANSWER First, CANS items that are initially rated a '2' or '3' are monitored over time to determine the percent of individuals who move to a rating of '0' or '1' (resolved need, built strength). Dimension scores can also be generated by summing items within each of the domains (Behavioral/Emotional Needs, Risk Behaviors, Functioning, etc.). These scores can be compared over the course of treatment. CANS dimension/domain scores have been shown to be valid outcome measures in residential treatment, intensive community treatment, foster care and treatment foster care, community mental health, and juvenile justice programs." "When an item on the CANS is rated a '2' or '3' ('action needed' or 'immediate action needed') we are indicating not only that it is a serious need for our client, but one that we are going to attempt to work on - CORRECT ANSWER during the course of our treatment. As such, when you write your treatment plan, you should do your best to address any needs, impacts on functioning, or risk factors that you rate as a 2 or higher in that document." "The CANS is often completed every 6 months to measure - CORRECT ANSWER change and transformation. We work with children, youth, and families and their needs tend to change over time. Needs may change in response to many factors including quality clinical support provided. One way we determine how our supports are helping to alleviate suffering and restore functioning is by re -assessing needs, adjusting treatment or service plans, and tracking change" "When a client leaves a treatment program, a closing CANS may be completed to define progress, measure ongoing needs and help us make continuity of care decisions. Doing a closing CANS, much like a discharge summary integrated with CANS ratings, provides a - CORRECT ANSWER picture of how much progress has been made, and allows for recommendations for future care which ties to current needs. And finally, it allows for a shared language to talk about our child/youth and creates opportunities for collaboration. It is our hope that this guide will help you to make the most out of the CANS and guide you in filling it out in an accurate way that helps you make good clinical decisions." "he CANS domains can be a good way to think about capturing information. You can start your assessment with any of the sections— - CORRECT ANSWER Life Domain Functioning or Behavioral/Emotional Needs, Risk Behaviors or Child/Youth Strengths, or Caregiver Resources & Needs—this is your judgment call. Sometimes, people need to talk about needs before they can acknowledge strengths. Sometimes, after talking about strengths, then they can better explain the needs. Trust your judgment, and when in doubt, always ask, "We can start by talking about what you feel that you and your child/youth need, or we can start by talking about the things that are going well and that you want to build on. Do you have a preference?"" "LISTENING USING THE CANS - Use nonverbal and minimal verbal prompts. - CORRECT ANSWER Head nodding, smiling and brief "yes," "and"—things that encourage people to continue." "LISTENING USING THE CANS - Be nonjudgmental and avoid giving personal advice. - CORRECT ANSWER You may find yourself thinking "If I were this person, I would do x" or "that's just like my situation, and I did x." But since you are not that person, what you would do is not particularly relevant. Avoid making judgmental statements or telling them what you would do. It's not really about you." "LISTENING USING THE CANS - Be empathic. - CORRECT ANSWER Empathy is being warm and supportive. It is the understanding of another person from their point of reference and acknowledging feelings. You demonstrate empathetic listening when you smile, nod, maintain eye contact. You also demonstrate empathetic listening when you follow the person's lead and acknowledge when something may be difficult, or when something is great. You demonstrate empathy when you summarize information correctly. All of this demonstrates to the child or youth that you are with him/her." "LISTENING USING THE CANS - Be comfortable with silence - CORRECT ANSWER Some people need a little time to get their thoughts together. Sometimes, they struggle with finding the right words. Maybe they are deciding how they want to respond to a question. If you are concerned that the silence means something else, you can always ask "Does that make sense to you?" Or "Do you need me to explain that in another way?"" "LISTENING USING THE CANS - Paraphrase and clarify—avoid interpreting - CORRECT ANSWER Interpretation is when you go beyond the information given and infer something—in a person's unconscious motivations, personality, etc. The CANS is not a tool to come up with causes. Instead, it identifies things that need to be acted upon. Rather than talk about causation, focus on paraphrasing and clarifying. Paraphrasing is restating a message very clearly in a different form, using different words. A paraphrase helps you to (1) find out if you really have understood an answer; (2) clarify what was said, sometimes making things clearer; and (3) demonstrate empathy. For example, you ask the questions about health, and the person you are talking to gives a long description. You paraphrase by saying "Ok, it sounds like . . . is that right? Would you say that is something that you feel needs to be watched, or is help needed?"" "Often, people will make comments about other people's observations such as "Well, my mother thinks that his behavior is really obnoxious." It is important to redirect people to talk about their observations: "So your mother feels that when he does x that is obnoxious. What do YOU think?" The CANS is a - CORRECT ANSWER tool to organize all points of observation, but the parent or caregiver's perspective can be the most critical. Once you have their perspective, you can then work on organizing and coalescing the other points of view." "People will be talking about difficult things and it is important to acknowledge that. Simple acknowledgement such as "I hear you saying that it can be difficult when ..." demonstrates - CORRECT ANSWER Empathy" "At the end of the assessment, we recommend the use of two open-ended questions. These questions ask if there are any past experiences that people want to share that might be of benefit to planning for their young person, and if there is anything that they would like to add. This is a good time to see if there is anything - CORRECT ANSWER "left over"—feelings or thoughts that they would like to share with you." "Systems Involvement: Melanie changes foster placement twice a school year. She has lived in 6 different homes in the last 3 years. - CORRECT ANSWER 3" "Strengths are designed to be.... - CORRECT ANSWER Assets!" "Strength based planning for children is - CORRECT ANSWER taking a strength to address a need" "Strength based planning for youth is - CORRECT ANSWER taking a strength to promote healthy development" "Strengths are NOT the - CORRECT ANSWER opposite of needs. Increasing their strengths while also addressing their behavioral/emotional needs leads to better functioning, and better outcomes, than does focusing just on their needs." "For the Strengths Domain,the following categories and action levels are used: - CORRECT ANSWER - 0 Well-developed or centerpiece strength; may be used as a protective factor and a centerpiece of a strength-based plan. - 1 Useful strength is evident but requires some effort to maximize the strength. Strength might be used and built upon in treatment. - 2 Strengths have been identified but require significant strength building efforts before they can be effectively utilized as part of a plan. - 3 An area in which no current strength is identified; efforts are needed to identify potential strengths." "Family: Bruce is in foster care, but has an uncle with whom he is close. - CORRECT ANSWER 1" "Interpersonal: 5-year-old Mindy is very shy. It takes a lot of prompting for her to play with others. When prompted, she will attempt to play with the other children. - CORRECT ANSWER 2" "Educational Setting: 13-year-old Tracey has an IEP in place and it appears to be effective. - CORRECT ANSWER 1" "Vocational: 16-year-old Anthony says his parents are rich so he is not interested in volunteering or getting a part-time job. - CORRECT ANSWER 3" "Coping Skills: 14-year-old Josh manages stress well and really knows how to have a good time. - CORRECT ANSWER 0" "Living Situation: Nancy has the occasional fight at home with her parents; her parents are concerned about her behavior at home. - CORRECT ANSWER 1" "Social Functioning: 9-year-old Will has no friends and struggles with basic interactions including initiating conversation, entering groups, and connecting with other people. - CORRECT ANSWER 3" "Developmental/Intellectual: A child's intellectual functioning is so poor that it prevents valid testing. - CORRECT ANSWER 3" "Recreation/Recreational: 15-year-old Sarah is active in a variety of sports and church-related activities. - CORRECT ANSWER 0 - The recommended response is 0, because Sarah has no problems with recreational functioning. She has access to sports and church-related activities that she enjoys." "Medical: 9-year-old Paula has leukemia and her doctors say that she might not live for more than one year. - CORRECT ANSWER 3" "Physical: Cailin has asthma. She is able to take part in gym class if she has her puffer. - CORRECT ANSWER 1" "Sleep: Doris has night terrors that wake her up in a panic nearly every night. She has become afraid of falling asleep and tries to stay up all night. - CORRECT ANSWER 3" "Sexualized Behavior/Sexuality/Sexual Development: On occasion, a 13-year-old girl expresses inappropriate sexual language. - CORRECT ANSWER 1 - The recommended response is 1 because on occasion the girl expresses inappropriate sexual language." "Activities of Daily Living: 6-year-old Lily always gets up and puts her clothes on by herself. She also can feed herself the food that her mother has made her. - CORRECT ANSWER 0" "School Behavior: A 12-year-old boy has explosive rages in class where he stands up and swears at his teachers; he is facing an expulsion hearing. - CORRECT ANSWER 3" "School Achievement: A 10-year-old boy is struggling to keep up with the materials in class; he has a C- average. - CORRECT ANSWER 2" "School Attendance: Over the past couple of months, Tremont has missed a day of school every month. - CORRECT ANSWER 2" "Legal Issues: 16-year-old Arthur was recently arrested for possession of marijuana. - CORRECT ANSWER 2 - The recommended response is 2, because the individual is currently involved in the legal system due to his possession of marijuana." "LANGUAGE - Culture Domain - CORRECT ANSWER This item looks at whether the individual and family need help with communication to obtain the necessary resources, supports and accommodations (e.g., interpreter). This item includes spoken, written, and sign language, as well as issues of literacy - 0 No evidence that there is a need or preference for an interpreter and/or the individual and family speak and read the primary language where the individual or family lives. - 1 Individual and/or family speak or read the primary language where the individual or family lives, but potential communication problems exist because of limited vocabulary or comprehension of the nuances of the language. - 2 Individual and/or significant family members do not speak the primary language where the individual or family lives. Translator or family's native language speaker is needed for successful intervention; a qualified individual(s) can be identified within natural supports. - 3 Individual and/or significant family members do not speak the primary language where the individual or family lives. Translator or family's native language speaker is needed for successful intervention; no such individual is available from among natural supports." "IDENTITY - Culture Domain - CORRECT ANSWER refers to the individual's view of self as belonging to a specific cultural group. This cultural group may be defined by a number of factors including race, religion, ethnicity, geography, sexual orientation or gender identity and expression (SOGIE). - 0 Individual has clear and consistent cultural identity and is connected to others who share his/her cultural identity. - 1 Individual is experiencing some confusion or concern regarding his/her cultural identity. - 2 Individual has significant struggles with his/her own cultural identity. Individual may have cultural identity but is not connected with others who share this culture. - 3 Individual has no connection to his/her cultural identity or is experiencing significant problems due to internal conflict regarding his/her cultural identity" "CULTURAL STRESS - Culture Domain - CORRECT ANSWER This item identifies circumstances in which the individual's cultural identity is met with hostility or other problems within the child/ youth's environment due to differences in attitudes, behavior, or beliefs of others (this includes cultural differences that are causing stress between the individual and their family). Racism, negativity toward sexual orientation, gender identity and expression (SOGIE) and otherforms of discrimination would be rated here. - 0 No evidence of stress between the individual's cultural identity and current environment or living situation.1 Some mild or occasional stress resulting from friction between the individual's cultural identity and current environment or living situation. - 2 Individua lis experiencing cultural stress that is causing problems of functioning in at least one life domain. Individual needs support to learn how to manage culture stress. - 3 Individual is experiencing a high level of cultural stress that is making functioning in any life domain difficult under the present circumstances. Individual needs immediate plan to reduce culture stress." "Language: Fatima and her entire family speak only Arabic and require an outside translator in order to communicate about her needs. - CORRECT ANSWER 3 - The recommended response is 3, because there is evidence that the individual and her family do not speak the primary language where they live, and an Arabic language speaker is needed for successful intervention. Action is required to ensure that the individual's needs are addressed." "Cultural Identity: Parents have expressed some concerns that their teenager may be considering joining a gang. - CORRECT ANSWER 1" "Cultural Stress: Zoran is a Serbian youth who is in constant conflict with his parents. They want him to grow up Serbian and he considers himself to be Canadian. His parents are upset with the beliefs and habits he is developing as they experience him as rejecting their culture. This is affecting his functioning at home, but not in other areas of his life. - CORRECT ANSWER 2 - The recommended response is 2, because there is evidence that Zoran is experiencing cultural stress that is causing problems of functioning in his home. He needs support to learn how to manage cultural stress." "EMOTIONAL AND/OR PHYSICAL REGULATION - Behavior/Emotional Needs Domain - CORRECT ANSWER his item describes the individual's difficulties with arousal regulation or expressing emotions and energy states. This item should be rated in the context of what is normative for an individual's age and developmental stage - 0 Individualhas no difficulties regulating emotional or physiological responses. Emotional responses and energy level are appropriate to the situation. - 1 History or evidence of difficulties with affect/physiological regulation. The individual could have some difficulty tolerating intense emotions and become somewhat jumpy or irritable in response to emotionally charged stimuli, or more watchful or hypervigilant in general or have some difficulties with regulating body functions (e.g. sleeping, eating or elimination). The individual may also have some difficulty sustaining involvement in activities for any length of time or have some physical or somatic complaints. - 2 Individual has problems with affect/physiological regulation that are impacting his/her functioning in some life domains, but is able to control affect at times. The individual may be unable to modulate emotional responses or have more persistent difficulties in regulating bodily functions. The individual may exhibit marked shifts in emotional responses (e.g. from sadness to irritability to anxiety) or have contained emotions with a tendency to lose control of emotions at various points (e.g. normally restricted affect punctuated by outbursts of anger or sadness). The individual may also exhibit persistent anxiety, intense fear or helplessness, lethargy/loss of motivation, or affective or physiological over-arousal or reactivity (e.g. silly behavior, loose active limbs) or under arousal (e.g. lack of movement and facial expressions, slowed walking and talking).- - 3 Individualis unable to regulate affect and/or physiological" "PSYCHOSIS (THOUGHT DISORDER) - Behavior and Emotional Needs Domain - CORRECT ANSWER This item rates the symptoms of psychiatric disorders with a known neurological base, including schizophrenia spectrum and other psychotic disorders. The common symptoms of these disorders include hallucinations (i.e. experiencing things others do not experience), delusions (i.e. a false belief or an incorrect inference about reality that is firmly sustained despite the fact that nearly everybody thinks the belief is false or proof exists of its inaccuracy), disorganized thinking, and bizarre/idiosyncratic behavior. - 0 No evidence of psychotic symptoms.Both thought processes and content are within normal range. - 1 Evidence of disruption in thought processes or content. Individual may be somewhat tangential in speech or evidence somewhat illogical thinking (age-inappropriate). This also includes a child/ individual with a history of hallucinations but none currently. Use this category for children/individual who are below the threshold for one of the DSM diagnoses listed above. - 2 Evidence of disturbance in thought process or content that may be impairing the individual's functioning in at least one life domain. Individual may be somewhat delusional or have brief intermittent hallucinations. Speech may be at times quite tangential or illogical. - 3 Clear evidence of dangerous hallucinations, delusions, or bizarre behavior that might be associated with some form of psychotic disorder that places the individual or others at risk of physical harm." "ATTENTION/CONCENTRATION - Behavior/Emotional Needs Domain - CORRECT ANSWER Problems with attention, concentration and task completion would be rated here. These may include symptoms that are part of DSM attention-deficit hyperactivity disorder. Inattention/distractibility not related to opposition would also be rated here. - 0 No evidence of attention or concentration problems. Individual is able to stay on task in an age-appropriate manner. - 1 Individual has evidence of problems with attention or concentration that do not interfere with their functioning. Individual may have some difficulties staying on task for an age-appropriate time period in school or play. - 2 Individual has problems with sustained attention.Individual may become easily distracted or forgetful in daily activities, have trouble following through on activities, and become reluctant to engage in activities that require sustained effort. An individual who meets DSM diagnostic criteria for ADHD would be rated here. - 3 Individual has severe impairment of attention or concentration. An individual with profound symptoms of ADHD or significant attention difficulties related to another diagnosis would be rated here." "IMPULSIVITY - Behavior/Emotional Needs Domain - CORRECT ANSWER Problems with impulse control and impulsive behaviors, including motoric disruptions, are rated here. This includes behavioral symptoms associated with Attention-Deficit Hyperactivity Disorder (ADHD), Impulse-Control Disorders and mania as indicated in the DSM-5. Children/individuals with impulse problems tend to engage in behavior without thinking, regardless of the consequences. This can include compulsions to engage in gambling, violent behavior (e.g., road rage), sexual behavior, fire-starting or stealing - 0 No evidence of symptoms of loss of control of behavior. - 1 There is a history or evidence of mild levels of impulsivity evident in action or thought that place the individual at risk of future functioning difficulties. The individual may exhibit limited impulse control, e.g., individual may yell out answers to questions or may have difficulty waiting one's turn. Some motor difficulties may be present as well, such as pushing or shoving others. - 2 Clear evidence of problems with impulsive, distractible, or hyperactive behavior that interferes with the individual's functioning in at least one life domain. This indicates an individual with impulsive behavior who may represent a significant management problem for adults (e.g., caregivers, teachers, coaches, etc.). An individual who often intrudes on others and often exhibits aggressive impulses would be rated here. - 3 Clear evidence of a dangerous level of hyperactivity and/or impulsive behavior that places the individual at risk of physical harm. This indicates an individual with frequent and significant levels of impulsive behavior that carries considerable safety risk (e.g., running into the street, dangerous driving or bike riding). The individual may be impulsive on a nearly continuous basis. The individual endangers self or others without thinking." "DEPRESSION - Behavior/Emotional Needs Domain - CORRECT ANSWER This item rates symptoms such as irritable or depressed mood, social withdrawal, sleep disturbances, weight/eating disturbances, and loss of motivation, interest or pleasure in daily activities. This item can be used to rate symptoms of the depressive disorders as specified in DSM-5 - 0 No evidence of problems with depression. - 1 History or suspicion of depression or evidence of depression associated with a recent negative life event with minimal impact on life domain functioning. Brief duration of depression, irritability, or impairment of peer, family, or academic functioning that does not lead to pervasive avoidance behavior. - 2 Clear evidence of depression associated with either depressed mood or significant irritability. Depression has interfered significantly in individual's ability to function in at least one life domain. - 3 Clear evidence of disabling level of depression that makes it virtually impossible for the individual to function in any life domain. This rating is given to an individual with a severe level of depression. This would include an individual who stays at home or in bed all day due to depression or one whose emotional symptoms prevent any participation in school, friendship groups, or family life. Disabling forms of depressive diagnoses would be rated here." "ANXIETY - Behavioral/Emotional Needs Domain - CORRECT ANSWER This item rates symptoms associated with DSM-5 Anxiety Disorders characterized by excessive fear and anxiety and related behavioral disturbances (including avoidance behaviors). Panic attacks can be a prominent type of fear response - 0 No evidence of anxiety symptoms. - 1 There is a history, suspicion, or evidence of mild anxiety associated with a recent negative life event. This level is used to rate either a mild phobia or anxiety problem that is not yet causing the individual significant distress or markedly impairing functioning in any important context. - 2 Clear evidence of anxiety associated with either anxious mood or significant fearfulness. Anxiety has interfered in the individual's ability to function in at least one life domain. - 3 Clear evidence of debilitating level of anxiety that makes it virtually impossible for the individual to function in any life domain" "OPPOSITIONAL BEHAVIOR (Compliance with Authority) - Behavioral/Emotional Needs Domain - CORRECT ANSWER This item rates the individual's relationship with authority figures. Generally oppositional behavior is displayed in response to conditions set by a parent, teacher or other authority figure with responsibility for and control over the individual - 0 No evidence of oppositional behaviors. - 1 There is a history or evidence of mild level of defiance towards authority figures that has not yet begun to cause functional impairment. Individual may occasionally talk back to teacher, parent/caregiver; there may be letters or calls from school. - 2 Clear evidence of oppositional and/or defiant behavior towards authority figures that iscurrently interfering with the individual's functioning in at least one life domain. Behavior causes emotional harm to others. An individual whose behavior meets the criteria for Oppositional Defiant Disorder in DSM-5 would be rated here. - 3 Clear evidence of a dangerous level of oppositional behavior involving the threat of physical harm to others. This rating indicates that the individual has severe problems with compliance with rules or adult instruction or authority." "TRIANGULATION/MANIPULATION - Behavior/emotional Needs Domain - CORRECT ANSWER This item describes the degree to which an individual engages in behavior that creates conflict among others or manipulates others in a manner that creates functioning problems - 0 No evidence of triangulation or manipulative behaviors. - 1 Individual may occasionally engage in behavior that pits parents, caregivers, authority figures, or siblings against each other or sometimes does manipulative things that others find concerning but do not create functional impairments. - 2 Individual engages in triangulation or manipulative behaviors that have created functioning problems for themselves or others. Child successfully creates significant conflict among parents, caregivers, authority figures, siblings, or classmates or engages in manipulative behaviors that limit someone's ability to function. - 3 Individual engages in severe triangulation or manipulative behavior that prevents functioning in at least one life domain or the level of triangulation or manipulation creates dangerous situations for the child or others" "CONDUCT - Behavioral/Emotional Needs Domain - CORRECT ANSWER These symptoms include antisocial behaviors like shoplifting, lying, vandalism, cruelty to animals, and assault. This item would include the symptoms of conduct disorder as specified in DSM - 0 No evidence of serious violations of others or laws. - 1 There is a history, suspicion or evidence of some problems associated with conduct problems including but not limited to lying, stealing, manipulation of others, acts of sexual aggression, or violence towards people, property or animals. The individual may have some difficulties in school and home behavior. Problems are recognizable but not notably deviant for age, sex and community. - 2 Clear evidence of problematic conduct behavior including but not limited to lying, stealing, manipulating others, sexual aggression, violence towards people, property, or animals. An individual rated at this level will likely meet criteria for a diagnosis of Conduct Disorder. - 3 Evidence of a severe level of aggressive or antisocial behavior, as described above, that places the individual or community at significant risk of physical harm due to these behaviors. This could include frequent episodes of unprovoked, planned aggressive or other antisocial behavior." "SUBSTANCE USE - Behavior/Emotional Needs Domain - CORRECT ANSWER This item describes problems related to the use of alcohol and illegal drugs, the misuse of prescription medications, and the inhalation of any chemical or synthetic substance by an individual. This rating is consistent with DSM-5 Substance-Related and Addictive Disorders. This item does not apply to the use of tobacco or caffeine. - 0 Individual has no notable substance use difficulties at the present time. - 1 Individual has substance use problems that occasionally interfere with daily life (e.g., intoxication, loss of money, reduced work/school performance, parental concern). History of substance use problems without evidence of current problems related to use is rated here. - 2 Individual has a substance use problem that consistently interferes with the ability to function optimally, but does not completely preclude functioning in an unstructured setting. - 3 Individual has a substance use problem that represents complications to functional issues that may result in danger to self, public safety issues, or the need for detoxification of the individual." "ATTACHMENT DIFFICULTIES - Behavioral/Emotional Needs Domain - CORRECT ANSWER This item rates the level of difficulties the individual has with attachment and their ability to form relationships - 0 No evidence of attachment problems. Caregiver-individual relationship is characterized by mutual satisfaction of needs and individual's development of a sense of security and trust. Caregiver is able to respond to individual cues in a consistent, appropriate manner, and individual seeks age-appropriate contact with caregiver for both nurturing and safety needs. - 1 Some history or evidence of insecurity in the caregiver-individual relationship. Caregiver may have difficulty accurately reading individual's bids for attention and nurturance; may be inconsistent in response; or may be occasionally intrusive. Individual may have some problems with separation (e.g., anxious/clingy behaviors in the absence of obvious cues of danger) or may avoid contact with caregiver in age-inappropriate way. Individual may have minor difficulties with appropriate physical/emotional boundaries with others. - 2 Problems with attachment that interfere with individual's functioning in at least one life domain and require intervention. Caregiver may consistently misinterpret individual cues, act in an overly intrusive way, or ignore/avoid individual bids for attention/nurturance. Individual may have ongoing difficulties with separation, may consistently avoid contact with caregivers, and have ongoing difficulties with physical or emotional boundaries with others. - 3Individual is unable to form attachment relationships with others (e.g., chronic dismissive/ avoidant/detached behavior in care giving relationships) OR individual presents with diffuse emotional/physical boundaries leading to indiscriminate attachment with others. Individual is considered at ongoing risk due to the nature of his/her attachment behaviors. Indi" "EATING DISTURBANCE - Behavioral/Emotional Needs Domain - CORRECT ANSWER This item rates problems with eating, including disturbances in body image, refusal to maintain normal body weight, recurrent episodes of binge eating, and hoarding food. - 0 No evidence of eating disturbances. - 1 There is a history, suspicion or mild level of eating disturbance. This could include some preoccupation with weight, calorie intake, or body size or type when of normal weight or below weight. This could also include some binge eating patterns. - 2 Eating disturbance impairs individual's functioning in at least one life domain. This could include a more intense preoccupation with weight gain or becoming fat when underweight, restrictive eating habits or excessive exercising in order to maintain below normal weight, and/or emaciated body appearance. This level could also include more notable binge eating episodes that are followed by compensatory behaviors in order to prevent weight gain (e.g., vomiting, use of laxatives, excessive exercising). The individual may meet criteria for a DSM-5 Feeding and Eating Disorders (including Anorexia Nervosa, Bulimia Nervosa, Avoidant/Restrictive Food Intake Disorder, etc.). Food hoarding also would be rated here.- - 3 Individual's eating disturbance is dangerous or puts his/her health at risk. This could include significantly low weight where hospitalization is required or excessive binge-purge behaviors (at least once per day)." "BEHAVIORAL REGRESSIONS - Behavioral/Emotional Needs Domain - CORRECT ANSWER This item is used to describe shifts in previously adaptive functioning evidenced in regression in behaviors or physiological functioning. - 0 No evidence of behavioral regression.1Individual has some regressions in age-level of behavior (e.g., thumb sucking, age-inappropriate whining). - 2 Individual has regressions in age-level of behavior, including loss of ability to engage with peers, stopping play or exploration in environment that was previously evident, or occasional bedwetting. The regressive behavior is impacting the individual's functioning or others around them. - 3 Individual has more significant regressions in behaviors in an earlier age, as demonstrated by changes in speech or loss of bowel or bladder control. The regressive behavior puts the individual at significant risk" "SOMATIZATION - Behavioral/Emotional Needs Domain - CORRECT ANSWER Symptoms in this item include the presence of recurrent physical complaints without apparent physical cause or conversion-like phenomena (e.g., pseudoseizures). - 0 No evidence of somatic symptoms.1Individual has a mild level of somatic problems. This could include occasional headaches; stomach problems (e.g., nausea, vomiting); joint, limb, or chest pain without medical cause. - 2 Individual has somatic problems or the presence of conversion symptomsthat interfere with their functioning. This could include more persistent physical symptoms without a medical cause or the presence of several different physical symptoms (e.g., stomach problems, headaches, backaches). Individual may meet criteria for a somatoform disorder. Additionally, the individual could manifest any conversion symptoms here (e.g., pseudoseizures, paralysis). - 3 Individual has somatic symptoms causing significant disturbance in school or social functioning and place the individual risk. This could include significant and varied symptomatic disturbance without medical cause" "ANGER CONTROL - Behavioral/Emotional Needs Assessments - CORRECT ANSWER This item captures the individual's ability to identify and manage their anger when frustrated - 0 No evidence of any anger control problems.1 History, suspicion of, or evidence of some problems with controlling anger. Individual may sometimes become verbally aggressive when frustrated. Peers and family are aware of and may attempt to avoid stimulating angry outbursts. - 2 Individual's difficulties with controlling anger are impacting functioning in at least one life domain. Their temper has resulted in significant trouble with peers, family and/or school. Anger may be associated with physical violence. Others are likely quite aware of anger potential. - 3 Individual's temper or anger control problem is dangerous. Individual frequently gets into fights that are often physical. Others likely fear the child/youth" "MOOD DISTURBANCE - Behavior/Emotional Needs Assessment - CORRECT ANSWER Symptoms included in this item are symptoms of depressed mood, hypomania, or mania. - 0 Individual with no prolonged emotional/mood problems. No evidence of depression, hypomania, or mania. - 1 Individual with prolonged emotional/mood problems. Evidence of depression, irritability, or other issues of mood causing mild problems with peers, family, or school functioning. Mild mood swings with some evidence of hypomania. - 2 Individual with a moderate level of mood disturbance. This would include episodes of mania, depression, social withdrawal, school avoidance, or inability to experience happiness. - 3 Individual with a severe level of mood disturbance. This would include an individual whose emotional symptoms prevent appropriate participation in school, friendship groups, or family life" "TRAUMATIC GRIEF & SEPARATION - Behavioral/Emotional Needs Domain - CORRECT ANSWER This item describes the level of traumatic grief the individual is experiencing due to death or loss/separation from significant caregivers, siblings, or other significant figures. - 0 There is no evidence that the individualis experiencing traumatic grief or separation from the loss of significant caregivers. Either the youth has not experienced a traumatic loss (e.g., death of a loved one) or the individual has adjusted well to separation. - 1 Individualis experiencing traumatic grief due to death or loss/separation from a significant person in a manner that is expected and/or appropriate given the recent nature of loss or separation. History of traumatic grief symptoms would be rated here. - 2 Individualis experiencing traumatic grief or difficulties with separation in a manner that impairs functioning in some but not all areas. This could include withdrawal or isolation from others or other problems with day-to-day functioning. - 3 Individualis experiencing dangerous or debilitating traumatic grief reactions that impair their functioning across several areas (e.g. interpersonal relationships, school) for a significant period of time following the loss or separation. Symptoms require immediate or intensive intervention." "Adjustment to Trauma: A 16-year-old girl is a sexual abuse survivor who has flashbacks and night terrors. Her parents report that she is acting out sexually. - CORRECT ANSWER 3" "Emotional and/or Physical Regulation: Maria's mother reports Maria feeling out of control of her emotions. She experiences rapid mood shifts and has an explosive temper. In times of stress, Maria will emotionally "explode" without being able to control herself. - CORRECT ANSWER 3 - The recommended response is 3 because the individual has rapid mood shifts and explosive temper they can not control themselves. These self-regulation problems place the individual at risk." "Fire Setting: 12-year-old Austin is a self-described pyromaniac. He states that he loves fire and the bigger the better. He has twice been caught trying to set fires in a nearby park where all of the neighborhood kids play. - CORRECT ANSWER 3 - Feedback: The recommended response is 3 because intensive and/or immediate action is required to address the his acute risk behavior to himself and others. He has shown a commitment and want to set fires." "Intentional Misbehavior/Social Behavior: 16-year-old Lauren is always threatening to commit suicide so that she can be hospitalized and see her favorite therapist who works there. The therapist at the hospital knows that Lauren is not serious and Lauren is at risk of being banned from that hospital. - CORRECT ANSWER 3" "Sexually Reactive Behavior: Tara was sexually abused by her stepfather, but does not show any evidence of sexually reactive behavior. - CORRECT ANSWER 0" "Bullying: Daryl is a 14-year-old who was recently disciplined for taking the lunch money of a 12-year-old. - CORRECT ANSWER 2 - Feedback: The recommended response is 2 because Daryl was recently caught and disciplined for bullying another child at school." "Exploitation: Jude was raped by a stranger on her visit to the city last month. - CORRECT ANSWER 2 - Feedback: The recommended response is 2 because Jude has been recently raped, but is not in acute risk of re-exploitation" "Bullied by Others: Jordan loves to play soccer but has avoided the team because certain girls on the team bully her. - CORRECT ANSWER 2 - Feedback: The recommended response is 2 because although Jordan loves playing soccer she has been avoiding playing due to girls on the team bullying her." "Cruelty to Animals: Caton was caught with a group of boys who had thrown rocks at several neighborhood dogs. They were having a contest regarding who could hit the dog with the biggest rock from the longest distance. - CORRECT ANSWER 2" "INDEPENDENT LIVING SKILLS - Transition to Adulthood Domain - CORRECT ANSWER This item focuses on the presence or absence of skills and impairments in independent living abilities or the readiness to take on those responsibilities - 0 No evidence of any deficits or barriers in demonstrating developmentally appropriate responsibility or anything that could impede the development of skills to maintain one's own home. This level indicates a person who is fully capable of independent living. - 1 This level indicates a person with impairment of independent living skills. Some problems exist with maintaining reasonable cleanliness, diet and so forth. Problems with money management may occur at this level. Problems are generally addressable with training or supervision. - 2 This level indicates a person with impairment of independent living skills that impact functioning. Notable problems completing tasks necessary for independent living and/or managing him/herself when unsupervised would be common at this level. Problems are generally addressable with in-home services and supports. - 3 This level indicates a person with impairment of independent living skills that place the individual at risk. This individual would be expected to be unable to live independently given current status. Problems require a structured living environment. - N/A Not applicable." "TRANSPORTATION - Transition to Adulthood Domain - CORRECT ANSWER This item is used to rate the level of transportation required to insure the individual can effectively participate in his/her own treatment - 0 Individual has no unmet transportation needs. - 1 Individual has occasional unmet transportation needs (e.g., appointments). These needs would be no more than weekly and not require a special vehicle. The needs can be met with minimal support, for example, assistance with bus routes to facilitate independent navigation, or provision of a bus card. - 2 Individual has occasional transportation needs that require a special vehicle or frequent transportation needs (e.g., daily to work or therapy) that do not require a special vehicle. Individual can self-transport with a med-van service. - 3 Individual requires frequent (e.g., daily to work or therapy) transportation in a special vehicle. He/she is completely reliant on others for transportation and cannot self-transport. - N/A Not applicable" "PARENTING ROLES - Transition to Adulthood Domain - CORRECT ANSWER This item is intended to rate the individual in any caregiver roles. For example, an individual with a son or daughter or an individual responsible for an elderly parent or grandparent would be rated here. Include pregnancy as a parenting role. - 0 Individual has a parenting role and he/she is functioning appropriately in that role.1Individual has responsibilities as a parent but occasionally experiences difficulties with this role. - 2 Individual has responsibilities as a parent and either the individual is struggling with these responsibilities or these issues are currently interfering with the individual's functioning in other life domains. - 3 Individual has responsibilities as a parent and is currently unable to meet these responsibilities: the dependent is at risk, or these responsibilities are making it impossible for the individual to function in other life domains. Individual has the potential of abuse or neglect in their parenting. - N/ANot applicable, as individual is not a parent" "INTIMATE RELATIONSHIPS - Transition to Adulthood Domains - CORRECT ANSWER This item is used to rate the individual's current status in terms of romantic/intimate relationships. - 0 Individual has a strong, positive, adaptive partner relationship with another; or he/she has maintained a positive partner relationship in the past but is not currently in an intimate relationship. -1 Individual has a generally positive partner relationship with another person. He or she may have had a problematic partner relationship in the past. - 2 Individual's partner relationship interferes with their functioning. - 3 Individual is currently involved in a negative or unhealthy relationship with another person. This relationship is either dangerous or disabling to the individual. -N/A Not applicable." "MEDICATION COMPLIANCE - Transition to Adulthood Domain - CORRECT ANSWER This item focuses on the individual's willingness or ability to participate in taking prescribed medication. - 0 Individual self-administers any prescribed medications as prescribed and without reminders or is not currently on any medication. -1 Individual will take prescribed medications routinely, but sometimes needs reminders to maintain compliance. Also, a history of medication non-compliance but no current problems would be rated here. - 2 Individual is sporadically non-compliant. This person maybe resistant to taking prescribed medications or may tend to overuse his/her medications. He/she might comply with prescription plans for periods of time (1-2 weeks) but generally does not sustain taking medication in prescribed dose or protocol. This would include individuals who are sporadically non-compliant with medications for physical health that may place them at medical risk. - 3 Individual has refused to take prescribed medications during the past 30-day period or has abused his/her medications to a significant degree (e.g., overdosing or overusing medications to a dangerous degree). - N/A Notapplicable" "TREATMENT INVOLVEMENT - Transition to Adulthood Domain - CORRECT ANSWER Treatment involvement describes the individual's involvement in their own treatment. - 0 Individual fully involved in his/her own treatment. Family supports treatment as well. - 1 Individual or family involved in treatment, but not both. Individual mat be somewhat involved in treatment, while family members are active or youth may be very involved in treatment while family members are unsupportive. - 2 Individual and family are ambivalent about treatment involvement. Individual and/or family may be skeptical about treatment effectiveness or suspicious about clinician intentions. - 3 Individual and family are uninterested in treatment involvement. An individual with treatment needs who is not currently in treatment would be rated here. - N/A Not applicable." "EDUCATIONAL ATTAINMENT - Transition to Adulthood Domain - CORRECT ANSWER This item rates the degree to which the individual has completed his/her planned education. - 0 Individual has achieved all educational goals, OR has no educational goals and educational attainment has no impact on lifetime vocational functioning. - 1 Individual has set educational goals and is currently making progress towards achieving them. - 2 Individual has set educational goals but is currently not making progress towards achieving them. - 3 Individual has no educational goals and lack of educational attainment is interfering with individual's lifetime vocational functioning. - N/A Not applicable" "JOB FUNCTIONING - Transition to Adulthood Domain - CORRECT ANSWER If the individual is working, this item describes his/her functioning in a job setting. - 0 No evidence of any problems in work environment. Individual is excelling in a job environment.1Individualhas some mild problems at work (e.g., tardiness, conflict). He/she is functioning adequately in a job environment. - 2 Individual has moderate problems at work. He/she has problems with his/her development of vocational or prevocational skills. - 3 Individual has severe problems at work in terms of attendance, performance or relationships. Individual may have recently lost a job. - N/A Individual is not currently working, or individual is younger than 16 years old." "TRANSITION TO ADULT SERVICE SYSTEM - Transition to Adulthood Domain - CORRECT ANSWER Successful transition to an adult services system requires cooperation between the individual and those professionals representing them. This item rates the individual's readiness for transition, including paperwork/referrals, scheduled appointments, and intakes - 0 No evidence that there are any barriers to successful transition. - 1 Individual and professional are progressing towards successful transition but require significant support/monitoring to meet timeframes/requirements. - 2 Individual and professional are waiting for paperwork/referral, etc. There is some concern that timeframes will not be met. - 3 Transition at this time is not likely, as the appropriate steps have not been completed or will not be completed in time. - N/A Client is not transitioning to adult services system." "ACCESSIBILITY TO CHILD CARE AND/OR RESPITE - Transition to Adulthood Domain - CORRECT ANSWER This item refers to the individual's access to appropriate childcare and/or respite for young children or older adults with developmental delays. - 0 Individual has access to sufficient/affordable child care resources and/or respite. - 1 Individual has limited access to sufficient/affordable child care resources and/or respite. Needs are met minimally by existing, available resources. - 2 Individual has limited access to sufficient/affordable child care resources and/or respite. Current resources do not meet the individual's needs. - 3 Individual has no access to child care resources and/or respite. - N/A Individual is not a parent." "FINANCIAL RESOURCES - Transition to Adulthood Domain - CORRECT ANSWER This item rates the financial resources that the individual can bring to bear in addressing the multiple needs of the individual and family. -0 Individual has sufficient financial resources to meet his/her current needs. - 1 Individual has some financial resources that meet the majority of his or her current needs. - 2 Individual has limited financial resources and needs substantial assistance to meet his/her needs. - 3 Individual has no financial resources and is unable to meet his/her needs. - N/A Not applicable." "RESIDENTIAL STABILITY - Transition to Adulthood Domain - CORRECT ANSWER This item rates the current and likely future housing circumstances for the individual. If the individual lives independently, his/her history of residential stability can be rated - 0There is no evidence of residential instability. Individual has stable housing for the foreseeable future. - 1 Individual has relatively stable housing but has either moved in the past three months or there are indications that housing problems could arise at some point within the next three months. Also, some residential instability if living independently, characterized by the potential loss of housing due to the person's difficulty with self-care, disruptive behavior, financial situation, or other psychosocial stressor. A recent move for any reason that the individual found stressful is rated here. - 2 Individual has moved multiple times in the past year. This level also includes a moderate degree of residential instability if the person is living independently, characterized by recent and temporary lack of permanent housing. - 3 Individual has experienced periods of homelessness in the past six months. Also, significant degree of residential instability if living independently, characterized by homelessness for at least 30 days as defined by living on the streets, in shelters, or other transitional housing. - N/A Not applicable." "Independent Living Skills: Freddie sometimes does not manage his money properly. His parents are going to get him some money management training to teach him how to budget. - CORRECT ANSWER 1" "Transportation: A 17-year-old girl requires transportation daily to visit her doctors to monitor her health condition. She requires a special vehicle and cannot self-transport. - CORRECT ANSWER 3" "Parenting Roles: Mia has a daughter who she often leaves home alone without a babysitter. - CORRECT ANSWER 3" "Intimate Relationships: David's girlfriend is physically and emotionally abusive towards him. He does not feel worthy of anyone else. - CORRECT ANSWER 3" "Medication Involvement / Medication Compliance: Jeremy refuses to take his antipsychotic medications. - CORRECT ANSWER 3" "Treatment Involvement: 13-year-old Steven acknowledges his need for self-care, but is not willing to change to improve his self-care issues. - CORRECT ANSWER 2" "Educational Attainment / Job Attainment: Clyde has no educational goals. - CORRECT ANSWER 3 - Feedback: The recommended response is 3 because Clyde has not educational goals. This may limit his life functioning." "Job Functioning: 16-year-old Tommy was recently fired from his fast food job for missing work and being insubordinate to the manager. - CORRECT ANSWER 3" "Transition To Adult Services System: Rebecca is looking to transfer her services but her referral has still not arrived and she is starting to get a bit worried. - CORRECT ANSWER 2" "Accessibility to Child Care and/or Respite: Delilah has no one to watch over her Daughter when she is busy. - CORRECT ANSWER 3 - Feedback: The recommended response is 3 because the Mother has no identified childcare for her Daughter when she is busy." "Financial Resources: Ralph lives paycheck to paycheck. Sometimes he runs out of money at the end of the pay period and has to cut back on things. - CORRECT ANSWER 3" "Residential Stability: Johnny has lost his housing and is homeless. - CORRECT ANSWER 3" "PHYSICAL HEALTH - Caregiver Resources and Needs Domain - CORRECT ANSWER This item refers to medical and/or physical problems that the caregiver(s) may be experiencing that prevent or limit their ability to parent the individual. This item does not rate depression or other mental health issues - 0 No evidence of medical or physical health problems. Caregiver is generally healthy. - 1 There is a history or suspicion of, and/or caregiver is in recovery from medical/physical problems. - 2 Caregiver has medical/physical problems that interfere with their capacity to parent the individual. - 3 Caregiver has medical/physical problems that make parenting the individual impossible at this time." "MENTAL HEALTH - Caregiver Resources and Needs Domain - CORRECT ANSWER This item refers to any serious mental health issues (not including substance abuse) among caregivers that might limit their capacity for parenting/caregiving to individual - 0 No evidence of caregiver mental health difficulties. - 1 There is a history or suspicion of mental health difficulties, and/or caregiver is in recovery from mental health difficulties. - 2 Caregiver's mental health difficulties interfere with their capacity to parent. - 3 Caregiver has mental health difficulties that make it impossible to parent the individual at this time." "SUBSTANCE USE - Caregiver Resources and Needs Domain - CORRECT ANSWER This item rates the impact of any notable substance use by caregivers that might limit their capacity to provide care for the individual. - 0 No evidence of caregiver substance use issues. - 1 There is a history of, suspicion or mild use of substances and/or caregiver is in recovery from substance use difficulties where there is no interference in their ability to parent. - 2 Caregiver has some substance abuse difficulties that interfere with their capacity to parent. - 3 Caregiver has substance abuse difficulties that make it impossible to parent the individual at this time" "DEVELOPMENTAL - Caregiver Resources and Needs Domain - CORRECT ANSWER This item describes the presence of limited cognitive capacity or developmental disabilities that challenges the caregiver's ability to parent - 0 No evidence of caregiver developmental disabilities or challenges. Caregiver has no developmental needs.1Caregiver has developmental challenges. The developmental challenges do not currently interfere with parenting. - 2 Caregiver has developmental challenges that interfere with the capacity to parent the individual. - 3 Caregiver has severe developmental challenges that make it impossible to parent the individual at this time." "SUPERVISION - Caregiver Resources and Needs Domain - CORRECT ANSWER This item rates the caregiver's capacity to provide the level of monitoring and discipline needed by the individual. Discipline is defined in the broadest sense, and includes all of the things that parents/caregivers can do to promote positive behavior with their individual - 0 No evidence caregiver needs help or assistance in monitoring or disciplining the individual, and/or caregiver has good monitoring and discipline skills. - 1 Caregiver generally provides adequate supervision, but is inconsistent. Caregiver may need occasional help or assistance. - 2 Caregiver supervision and monitoring are very inconsistent and frequently absent. Caregiver needs assistance to improve supervision skills. - 3 Caregiver is unable to monitor or discipline the individual. Caregiver requires immediate and continuing assistance. Individual is at risk of harm due to absence of supervision or monitoring" "INVOLVEMENT WITH CARE - Caregiver Resources and Needs Domain - CORRECT ANSWER This item should be based on the level of involvement the caregiver has in the planning and provision of services - 0 Caregiver is actively involved in the planning and/or implementation of services and is able to be an effective advocate on behalf of the individual. - 1 Caregiver is consistently involved in the planning and/or implementation of services for the individual but is not an active advocate on behalf of the individual. - 2 Caregiver is minimally involved in the care of the individual. Caregiver may visit individual when in out-of-home placement, but does not become involved in service planning and implementation. - 3 Caregiver is uninvolved with the care of the individual. Caregiver may want individual out of home or fails to visit individual when in residential placement or individual has no known caregiver" "CULTURE CONGRUENCE - Caregiver Resources and Needs Domain - CORRECT ANSWER Culture congruence describes whether or not the caregiver has cultural differences in child rearing practices, child development, and early intervention with the majority culture - 0 The family does not have cultural differences related to child rearing practices, child development, and early intervention that are considered by the majority culture as problematic for the child. - 1 The family has some cultural differences related to child rearing practices, child development, and early intervention that are generally accepted but not considered to put the child at risk. - 2 The family has cultural differences related to child rearing practices, child development, and early intervention that are considered to put the child at risk. - 3 The family has cultural differences related to child rearing practices, child development, and early intervention that is considered abusive or neglectful and may result in intervention." "KNOWLEDGE - Caregiver Resources and Needs Domain - CORRECT ANSWER This item should be based on caregiver's knowledge of the specific strengths, needs, development, legal rights, and supports of the individual in his/her care, as well as the caregiver's ability to understand the rationale for the treatment or management of needs. The caregiver's understanding of his/her child's needs should include an understanding of the intersection between normative development and the impact of trauma. - 0 Present caregiver is fully knowledgeable about the individual's psychological strengths, needs, developmental capacity, and functioning. - 1 Present caregiver, while being generally knowledgeable about the individual, has some mild deficits in knowledge or understanding of the individual's needs or developmental capacity and functioning. Caregivers and providers are able to work together to negotiate disagreements. - 2 Significant deficits exist in the caregiver's ability to understand the individual's strengths, needs, and developmental capacity. There is disagreement between the caregivers and/or providers regarding the indiv