Cans

Praed Foundation 1999, 2016 Version 1.0

Date:

 M  F Child’s Name DOB mm/ dd/ Sex

Assessor (Print Name):

Current Service Type:

0 = Centerpiece 2 = Identified 0 = No evidence of problems 1 = Useful 3 = Not Yet Identified 1 = History, Mild

0 1 2 3 0 1 2 3 Family Strengths     Developmental (1)     Interpersonal     Physical/Medical     Natural Supports     Sleep     Educational Setting     Family Functioning     Optimism     School Achievement     Cultural Identity     School Behavior     Spiritual / Religious     School Attendance     Talents / Interests     Sexual Development     Community Life     Living Situation     Resilience     Social Functioning     Resourcefulness     Decision making    

CHILD BEHAVIORAL / EMOTIONAL NEEDS 0 = No evidence of problems 3 = Causing severe/ 1 = History, Watch/Prevent dangerous problems 0 = No evidence of problems 2 = Moderate Needs 2 = Causing problems, consistent with diagnosable d/o 1 = Minimal Needs 3 = Severe Needs

0 1 2 3 0 1 2 3 Psychosis     Physical / Medical / Developmental     Impulse / Hyper     Mental Health/Substance Use     Depression     Supervision     Anxiety     Involvement with Care     Oppositional     Knowledge     Conduct     Organization     Substance Use (3)     Social Resources     Adjustment to Trauma (2)     Residential Stability     Anger Control     Safety    

CHILD RISK BEHAVIORS 0 = No evidence of problems 2 = Recent, Act 0 = No evidence of problems 2 = Moderate Needs 1 = History, Watch/Prevent 3 = Acute, Act Immediately 1 = Minimal Needs 3 = Severe Needs

0 1 2 3 0 1 2 3 Suicide Risk     Language     Danger to Others (4)     Tradition/Rituals     Other Self-Harm (recklessness)     Cultural Stress     Non-Suicidal Self-Injurious Behavior     Runaway (5)     Sexually Problematic Behavior     Delinquent Behavior (6)     Modules are on the CANS 2016 Comprehensive Form

CULTURAL FACTORS

3 = Severe

 Community  Residential  Intensive Residential

Caregiver (Planned Permanent): _________________________Relation: __________________________

LIFE DOMAIN FUNCTIONING

CAREGIVER STRENGTHS AND NEEDS (Planned Permanency Family)

CHILD AND ADOLESCENT NEEDS AND STRENGTHS - MAGELLAN CANS 2016 CORE

Please  appropriate use:  Initial  Reassessment  Transition/Discharge

yyyy Race/Ethnicity

2 = Moderate CHILD STRENGTHS