CHILD AND ADOLESCENT NEEDS AND STRENGTHS (CANS) 5 - 21 Name Child/Youth DOB Court File Number – Effective Date Age at Time of Assessment Assessment Type Current Caregiver TRAUMA 0 1 2 3 SCHOOL 0 1 2 3 Sexual Abuse Attendance         a. Emotional Closeness to Perpetrator Behavior         b. Frequency of Abuse Achievement         c. Duration Relation with Teachers         d. Force     e. Reaction to Disclosure     f. Victim of Sex Trafficking     Physical Abuse CHILD/YOUTH & FAMILY ACCULTURATION 0 1 2 3     Neglect Language         Emotional Abuse Identity         Medical Trauma Ritual         Natural Disaster Cultural Stress         Witness to Family Violence Knowledge Congruence         Witness to Community Violence Help seeking Congruence         Witness/Victim - Criminal Acts Expression of Distress         Adjustment to Trauma 0 1 2 3 Adjustment to Trauma     Traumatic Grief/Separation     Intrusions CHILD/YOUTH BEHAVIORAL/EMOTIONAL NEEDS 0 1 2 3     Attachment Psychosis         Dissociation Impulse/Hyperactivity         Depression     Anxiety     Oppositional     LIFE FUNCTIONING 0 1 2 3 Conduct     Family Nuclear Anger Control –         Family Extended Substance Use –         Living Situation Somatization         Developmental Behavioral Regression         a. Cognitive Affect Dysregulation         b. Autism Spectrum     c. Communication     d. Self Care/Daily Living     Medical CHILD/YOUTH RISK BEHAVIORS 0 1 2 3     a. Life Threat Suicide Risk         b. Chronicity Self Injurious Behavior         c. Diagnostic Complexity Other Self Harm         d. Emotional Response Exploited         e. Impairment in Functioning Danger to Others         f. Treatment Involvement Sexual Aggression         g. Intensity of Treatment Delinquent Behavior         h. Organizational Complexity Runaway         Physical a. Frequency of Running         Dental b. Consistency of Destination         Daily Functioning d. Safety of Destination         Social Functioning Adult e. Involvement in Illegal Acts –         Social Functioning - Peers f. Likelihood of Return on Own     Legal g. Involvement of Others         a. Seriousness h. Realistic Expectations         b. History Intentional Misbehavior         c. Arrests Fire Setting         d. Planning Bullying         e. Community Safety     f. Legal Compliance     g. Peer Influences     h. Parental Criminal Behavior (Influences)     i. Environmental Influences     Eating Disturbance     Sleep     Sexual Development     Life Skills     Expectant Parent/Parenting    
CHILD AND ADOLESCENT NEEDS AND STRENGTHS (CANS) 5 - 21 Name – Child/Youth DOB Court File Number Effective Date Age at Time of Assessment Assessment Type Current Caregiver TRAUMA 0 1 2 3 SCHOOL 0 1 2 3 Sexual Abuse     Attendance     a. Emotional Closeness to Perpetrator     Behavior     b. Frequency of Abuse     Achievement     c. Duration     Relation with Teachers     d. Force     e. Reaction to Disclosure     f. Victim of Sex Trafficking     Physical Abuse     CHILD/YOUTH & FAMILY ACCULTURATION 0 1 2 3 Neglect     Language     Emotional Abuse     Identity     Medical Trauma     Ritual     Natural Disaster     Cultural Stress     Witness to Family Violence     Knowledge Congruence     Witness to Community Violence     Help seeking Congruence     Witness/Victim - Criminal Acts     Expression of Distress     Adjustment to Trauma 0 1 2 3 Adjustment to Trauma     Traumatic Grief/Separation     Intrusions     CHILD/YOUTH BEHAVIORAL/EMOTIONAL NEEDS 0 1 2 3 Attachment     Psychosis     Dissociation     Impulse/Hyperactivity     Depression     Anxiety     Oppositional     LIFE FUNCTIONING 0 1 2 3 Conduct     Family – Nuclear     Anger Control     Family – Extended     Substance Use     Living Situation     Somatization     Developmental     Behavioral Regression     a. Cognitive     Affect Dysregulation     b. Autism Spectrum     c. Communication     d. Self Care/Daily Living     Medical     CHILD/YOUTH RISK BEHAVIORS 0 1 2 3 a. Life Threat     Suicide Risk     b. Chronicity     Self Injurious Behavior     c. Diagnostic Complexity     Other Self Harm     d. Emotional Response     Exploited     e. Impairment in Functioning     Danger to Others     f. Treatment Involvement     Sexual Aggression     g. Intensity of Treatment     Delinquent Behavior     h. Organizational Complexity     Runaway     Physical     a. Frequency of Running     Dental     b. Consistency of Destination     Daily Functioning     d. Safety of Destination     Social Functioning – Adult     e. Involvement in Illegal Acts     Social Functioning - Peers f. Likelihood of Return on Own     Legal     g. Involvement of Others     a. Seriousness     h. Realistic Expectations     b. History     Intentional Misbehavior     c. Arrests     Fire Setting     d. Planning     Bullying     e. Community Safety     f. Legal Compliance     g. Peer Influences     h. Parental Criminal Behavior (Influences)     i. Environmental Influences     Eating Disturbance     Sleep     Sexual Development     Life Skills     Expectant Parent/Parenting    
2016-03-Adoption-Assistance-Algorithm.docx