By Ellen Moran
A young girl is described as bright, but having few friends. She is frequently late for school and has been absent four times in five weeks. Does she need behavioral health services? Behavioral health providers taking a new training and certification exam through the Eunice Kennedy Shriver Center’s Child and Adolescent Needs and Strengths (CANS) training program learn how to evaluate her situation and others.
“We’ve made a lot of changes to the training and a lot of changes to the exam,” said Philip Chase, PhD, a professor of psychiatry at UMass Medical School who led the creation of the new training and exam while director of the CANS program. “The goal of the new training is to instruct providers on how to use CANS in daily practice.”
The CANS training program, developed in conjunction with the Children’s Behavioral Health Initiative (CBHI), a program of the Center for Behavioral Health of the Massachusetts Executive Office of Health and Human Services, is an online training and certification program established in 2008. John Lyons, PhD, of the University of Chicago, who developed the CANS, helped CBHI create the version used in Massachusetts.
“CANS is a tool developed to support communication and collaboration in children’s services,” said Sarah Rulnick, MPH, CANS program director. “We work with behavioral health providers to ensure youth in Massachusetts get the services they need.”
The initial training and certification focused on the basic characteristics of CANS as an assessment tool. The new training instructs behavioral health providers for MassHealth, the Massachusetts Medicaid program, on how CANS can be integrated into their day-to-day practice to assist care planning and strength-based, family-focused treatment for youth under age 21.
The new certification exam includes one comprehensive vignette, 30 mini-vignettes and 10 multiple-choice questions about CANS and CANS in practice. The CANS categories are the child or adolescent’s behavioral/emotional needs; risk behaviors; cultural considerations; transition to adulthood; strengths; and caregiver needs. Providers must be certified every two years.
Since the new exam was launched on May 22, more than 2,000 providers have been certified or recertified. There have been nearly 40,000 CANS certifications in Massachusetts since 2008.
Behavioral health providers include social workers, nurses, family counselors, educators and psychologists. The children needing services range from very young children with severe autism to emerging adults who are getting their General Educational Development (GED) certificates, Chase said. Behavioral problems include difficulty getting along with family members, school absenteeism or such risk behaviors as substance abuse, attempted suicide, running away, sexual aggression and fire setting.
The biggest changes in the training and exam are the inclusion of information on CBHI’s system of care and how CANS is incorporated into that care, Chase said.
“CBHI’s system of care starts with its values: services should be child-centered and family-driven, strength-based, culturally responsive, collaborative and integrative, and continuously improving,” he said.
“We provide videos, narrations, examples and exercises to help illustrate these values. I am particularly proud of the videos and discussions on cultural responsiveness as they move beyond typical descriptions of race and ethnicity to subtle and equally important areas of cultural identity. CANS in Practice focuses on how CANS can be used to help achieve CBHI’s system of care,” Chase said.
The program provides extensive training on how the CANS ratings can be used to assist treatment or care planning, to evaluate the effectiveness of treatment, to integrate services by a hub provider, and to inform transition planning.
“One of the critical discussions of CANS in Practice to busy providers are tips on how to use CANS efficiently. The more that CANS is integrated into the whole system of care therapists provide, the more efficient and effective it is as a tool,” he said.
Chase has worked with the CANS training program for four years. He was tasked with evaluating the training and certification exam and began compiling recommended changes with feedback from MassHealth and other departments serving children and youths, parents, providers, managed care specialists, and training experts. From this evaluation, the new training and exam was created.
The developers of the training and certification exam were careful to make sure the online site was accessible to as many providers as possible, including those who might have difficulty with hearing, vision, or hand-eye coordination, Chase said. Working with INDEX, another program of the Shriver Center, the CANS training program was built around best practices in online accessibility.