Louisiana CSoC Outcomes:
CANS Analysis
Wendy Bowlin, LPC, MBA
Director of Quality and Outcomes, Magellan of Louisiana
December 6, 2016
Agenda
1. CANS
• Overview
• Scoring
• Psychometric Properties
• Outcomes Monitoring
2. Member Characteristics
3. Outcomes
4. Modules
5. Next Steps
6. Questions/Feedback
2
Provider All-Call: CANS
The Louisiana Child and Adolescent
Needs and Strengths (CANS)
CANS
• The CANS Comprehensive Multisystem Assessment is completed based on a
face-to-face interview with the child (and guardian(s) when possible) and
additional supporting information.
• The CANS is a multi-purpose tool developed for children’s services to support
decision making, including:
‒ Eligibility and service planning,
‒ Facilitating quality improvement initiatives, and
‒ Monitoring of outcomes of services.
• Versions of the CANS are currently used in 50 states in child welfare, mental
health, juvenile justice, and early intervention applications.
‒ The Louisiana CANS was developed with Dr. John Lyons to meet the unique
needs of the state at the initiation of the CSoC program.
• The CANS links the assessment process and the design of individualized service
plans, including the application of evidence-based practices.
http://praedfoundation.org/tools/the-child-and-adolescent-needs-and-strengths-cans/
4
Provider All-Call: CANS
Using the CANS
• The CANS assesses the child in the following areas: Problem behavioral/emotional
needs, child risk behaviors, life domain functioning, caregiver strengths & needs, youth
strengths, and acculturation.
• The CANS measures Needs and Strengths using a 4 point scale to rate the highest level
from the past 30 days:
For needs:
0. No evidence
1. Watchful waiting/prevention
2. Action
3. Immediate/Intensive Action
For strengths:
0. Centerpiece strength
1. Strength that you can use in planning
2. Identified-strength-must be built
3. No strength identified
• A rating of ‘2’ or ‘3’ on a CANS needs suggests that this area must be addressed
in the 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 focus on strength-building
activities.
http://praedfoundation.org/tools/the-child-and-adolescent-needs-and-strengths-cans/
5
Provider All-Call: CANS
Reliable and Valid Tool
• The CANS has demonstrated reliability (tool produces similar results under
consistent conditions) and validity (tool measures what it is purported to
measure)
‒ The average reliability of the CANS is 0.75 with vignettes, 0.84 with case
records, and can be above 0.90 with live cases.
‒ To further support reliability and validity, Magellan performed input
validation (e.g., identifying and investigating outlier scores, duplicates,
etc.) to ensure integrity of data.
• Statistical significance means the outcome is the result of a relationship
between specific factors versus merely the result of chance.
‒ Measured using a p-value
‒ Anything equal or less than 0.05 is considered statistically significant
‒ The lower the number the more likely outcome is not due to chance
6
Provider All-Call: CANS
Outcomes Monitoring
• Outcomes Monitoring can be accomplished in two ways:
‒ Items that are initially rated a ‘2’ or ‘3’ are monitored over
time to determine the percent of youth who move to a
rating of ‘0’ or ‘1’ (resolved need, built strength).
‒ The Global Score (sum of all items that measure outcomes)
and Domain Scores can be generated by summing items
within each of the dimensions (Problems, Risk Behaviors,
Functioning, etc). These scores can be compared over the
course of treatment.
7
Provider All-Call: CANS
Outcomes Analysis
• The following Outcomes Analysis includes:
• All Population (n= 1278)
• Most Severe or Top 25% (n=332)
• Date Parameters: The date range of the report is from
3/1/2012 to 10/16/2016.
• Only electronic CANS submitted on or after 11/20/2014 are
included. (Note: the actual assessment date may have
occurred prior to this date.)
8
Provider All-Call: CANS
Member Characteristics
Initial Assessments
Life Domain Functioning
16.8
13.0
30
22.5
18.6
Child Strengths
Acculturation
30
0.2
0.1
9
Caregiver Strengths & Needs
14.4
10.5
Child Behavioral/Emotional Needs
14.1
10.5
Child Risk Behaviors
7.7
5.1
36
36
30
15
10.1
7.8
School Behavior
Global Score
57.8
0.0
Max Points Possible
10
Provider All-Call: CANS
171
75.7
50.0
Severe: Initial Assessment (Average Sum)
100.0
150.0
200.0
All: Initial Assessment (Average Sum)
Diagnostic Characteristics of Members
36.1%
36.5%
Attention-deficit and NOS disorders
27.7%
31.2%
Conduct, Oppositional, and Impulse Control
12.7%
10.5%
Depressive and NOS Mood
8.4%
9.6%
Adjustment, Anxiety and PTSD
5.7%
4.9%
Bipolar
Developmental and Disorders usually
diagnosed in childhood
4.8%
4.0%
Thought disorders
2.1%
1.4%
Other
1.8%
1.3%
Alcohol and Substance Use
0.6%
0.5%
0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0%
11
Provider All-Call: CANS
% Severe
% All
Average Length of Stay
Months
Mean LOS
12
12
11
10
9
8
7
6
5
4
3
2
1
0
Provider All-Call: CANS
11.2
11.1
All
Severe
Outcomes
Global Scores
80.0
75.7
Represents a 24.1
point decrease or
a 31.8% decline.
70.0
60.0
57.8
51.6
50.0
41.5
All
40.0
Severe
30.0
Represents a 16.3
point decrease or
a 28.2% decline.
20.0
10.0
0.0
Initial
Discharge
*All changes represent statistically significant improvement (p≤.001).
14
Provider All-Call: CANS
Domain Scores: All Population
20
18.6
18
Child Strengths
16
Life Domain Functioning
14
13.8
13.0
Acculturation
12
10.5
10
8
7.8
Caregiver Strengths & Needs
9.0
8.2
7.3
6
5.1
4
4.6
3.1
2
0.1
0
Initial Assessment
Child Behavioral/Emotional
Needs
Child Risk Behaviors
School Behavior
0.1
Transition DC
*All changes represent statistically significant improvement (p≤.001) except Acculturation Domain.
15
Provider All-Call: CANS
Domain Scores: Most Severe Population
25
22.5
Child Strengths
20
Life Domain Functioning
16.8
15
16.0
Acculturation
14.4
14.1
11.4
10.1
10
10.1
9.4
7.7
6.3
5
Caregiver Strengths & Needs
Child Behavioral/Emotional
Needs
Child Risk Behaviors
4.5
School Behavior
0.2
0
Initial Assessment
0.1
Transition DC
*All changes represent statistically significant improvement (p≤.001) except Acculturation Domain.
16
Provider All-Call: CANS
Problem Presentation: All Population
2.5
Somatization
2.0
Beh Regression
Psychosis
Impulse/Hyper
1.5
Depression
Anxiety
Oppositional
1.0
Conduct
Adj to Trauma
Anger Control
0.5
Substance Use
Eating Disturbance
0.0
Initial Assessment
Transition DC
*All changes represent statistically significant improvement (p≤.001).
17
Provider All-Call: CANS
Problem Presentation: Most Severe Population
3.0
Somatization
2.5
Beh Regression
Psychosis
2.0
Impulse/Hyper
Depression
Anxiety
1.5
Oppositional
Conduct
1.0
Adj to Trauma
Anger Control
0.5
Substance Use
Eating Disturbance
0.0
Initial Assessment
Transition DC
*All changes represent statistically significant improvement (p≤.001).
18
Provider All-Call: CANS
Other Notable Scores
16.0
14.0
13.4
12.0
10.0
Juv Justice Avg Sum (n=386)
8.0
Violence Avg Sum (n=608)
6.1
6.0
4.0
6.0
Trauma Avg Sum (n=594)
3.9
3.1
2.0
1.9
0.0
Initial Assessment
Transition DC
*Includes all outcomes elements associated with the module. Average total scores at
initial and discharge are reflected in the graph.
**All changes represent statistically significant improvement (p≤.001).
19
Provider All-Call: CANS
% of Youth Triggering Modules
Sexually Abusive Experience
27.2%
Fire Setting
10.5%
Juvenile Justice
29.7%
Runaway
17.4%
Sexually Abusive Behavior
4.5%
Violence
56.5%
Substance Use
13.8%
Trauma
46.5%
Family/Caregiver
16.3%
Developmental Disability
25.7%
School
92.3%
0%
20
Provider All-Call: CANS
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Next Steps
National Benchmarking
• Magellan, with the approval of LDH, is sharing data with
University of Washington to assist them with a study on using
CANS data for benchmarking and outcomes monitoring in
state-wide Wraparound initiatives.
‒ UW recently presented an analysis of three states, including de-
identified Louisiana data.
‒ Louisiana CANS scores were close to the mean/average on
intensity of needs.
‒ Study identified significant differences between states.
• UW is currently conducting an 8 state analysis to further
explore similarities and differences.
22
Provider All-Call: CANS
Regional Differences
• Present data to Wraparound agencies, providers, and
stakeholders to explore:
‒ Regional differences in percent of youth triggering modules:
o Population differences?
o Referral sources (e.g., court system, community,
providers, state agencies, etc.)?
‒ Regional differences impacting outcomes.
23
Provider All-Call: CANS
Cross Tabulation Study
• Magellan is in the process of conducting an in-depth statistical analysis to look at
other factors that could be influencing why some members are more likely to:
‒ Discharge successfully from CSoC
‒ Have statistically significant improvement on the CANS
• Magellan will compare groups against factors, such as:
‒ Member's DCFS/OJJ involvement
‒ Involved in Office of Citizens with Developmental Disabilities
‒ Number of out of home placements prior to CSoC
‒ Parent and/or Youth Support on Plan of Care
‒ At least one natural/informal support on Child and Family Team
‒ Number of placements in Alternative School Settings
‒ Youth has an Individualized Education Plan (IEP)
• If relationships are identified, we will be able to better target interventions to
certain populations or factors to improve chances of positive outcomes.
• Results expected by the end of 2016.
24
Provider All-Call: CANS
Feedback/Questions
Confidentiality Statement
By receipt of this presentation, each recipient agrees that the information contained herein will be kept
confidential and that the information will not be photocopied, reproduced, or distributed to or disclosed to others
at any time without the prior written consent of Magellan Health, Inc.
The information contained in this presentation is intended for educational purposes only and is not intended to
define a standard of care or exclusive course of treatment, nor be a substitute for treatment.
26
Provider All-Call: CANS
Thanks