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Commissioner Michael F. Hogan, PhD
Governor Andrew M. Cuomo

Home and Community Based Services Waiver
Guidance Document
Division of Children and Families

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Child and Adolescent Needs and Strengths (CANS – MH)
Use with manual dated 1/20/03

"0" indicates no need for action,
"1" indicates a need for watchful waiting to see whether action is warranted,
"2" indicates a need for action,
"3" indicates need for immediate/intensive action.
The rating of "U" indicates unknown at the time.

ID#
Date of Assessment
Race/Ethnicity
Age
Gender
Name of Service
Psychiatric Diagnosis
Address/Zip Code
Caseworker Name
Caregiver
Problem Presentation 0 1 2 3 U N/A
1. Psychosis   circle circle circle circle circle  
2. Attention Deficit/Impulse   circle circle circle circle circle  
3. Depression/Anxiety   circle circle circle circle circle  
4. Oppositional Behavior   circle circle circle circle circle  
5. Antisocial Behavior   circle circle circle circle circle  
6. Substance Abuse   circle circle circle circle circle  
7. Adjustment to Trauma   circle circle circle circle circle  
8. Attachment   circle circle circle circle circle  
9. Situational Consistency circle circle circle circle circle  
10. Temporal Consistency circle circle circle circle circle  
Risk Behaviors 0 1 2 3 U N/A
11. Danger to Self   circle circle circle circle circle  
12. Danger to Others   circle circle circle circle circle  
13. Elopement   circle circle circle circle circle  
14. Sexually Abusive Behavior   circle circle circle circle circle  
15. Social Behavior   circle circle circle circle circle  
16. Crime/Delinquency   circle circle circle circle circle  
Functioning 0 1 2 3 U N/A
17. Intellectual/Developmental   circle circle circle circle circle  
18. Physical/Medical   circle circle circle circle circle  
19. Family   circle circle circle circle circle circle
20. School Achievement   circle circle circle circle circle  
21. School Behavior   circle circle circle circle circle  
22. School Attendance   circle circle circle circle circle  
23. Sexual Development   circle circle circle circle circle  
Care Intensity & Organization 0 1 2 3 U N/A
24. Monitoring   circle circle circle circle circle  
25. Treatment   circle circle circle circle circle  
26. Transportation   circle circle circle circle circle  
27. Service Permanence   circle circle circle circle circle  
Caregiver Needs & Strengths 0 1 2 3 U N/A
28. Physical/Behavioral Health   circle circle circle circle circle circle
29. Supervision   circle circle circle circle circle circle
30. Involvement   circle circle circle circle circle circle
31. Knowledge   circle circle circle circle circle circle
32. Organization   circle circle circle circle circle circle
33. Resources   circle circle circle circle circle circle
34. Residential Stability   circle circle circle circle circle circle
35. Safety   circle circle circle circle circle circle
Strengths 0 1 2 3 U N/A
36. Family   circle circle circle circle circle circle
37. Interpersonal   circle circle circle circle circle  
38. Relationship Permanence   circle circle circle circle circle  
39. Educational   circle circle circle circle circle  
40. Vocational   circle circle circle circle circle circle
41. Well being   circle circle circle circle circle  
42. Optimism   circle circle circle circle circle  
43. Spiritual/Religious   circle circle circle circle circle  
44. Talents/Interests   circle circle circle circle circle  
45. Inclusion   circle circle circle circle circle  

Comments or questions about the information on this page can be directed to the Home and Community Based Waiver Program.