What is the Care and Needs Scale (CANS)?
The Care and Needs Scale (CANS) is a validated clinician-rated instrument designed to assess the type and intensity of care and support needs for older adolescents and adults with an acquired brain injury (ABI). Developed by Robyn L. Tate in 2003, its purpose is to provide a systematic and objective way to document support requirements based on an individual's functional abilities rather than their impairments. By doing so, it helps health professionals, caregivers, and individuals create effective care plans and secure appropriate funding for services.
The two key components of CANS
The CANS is composed of two primary sections that work together to provide a holistic picture of a person's support requirements:
- Needs Checklist: A 28-item checklist that documents the types of activities affected by the brain injury. The items are organized into five groups (A-E), ranging from very basic needs (e.g., eating and tracheostomy management) to higher-level social participation activities.
- Support Levels: An eight-category, hierarchically arranged rating scale that documents the extent of support required, indexed by the amount of time the person can be left alone. The levels range from 0 (does not need contact) to 7 (cannot be left alone).
How CANS is administered and scored
Administering the CANS typically takes around 15 minutes and should be performed by a trained health professional with experience working with individuals with brain injuries. The assessor gathers information from various sources, including direct observation, interviews with the individual, family members, and caregivers, and review of documentation.
The scoring process involves the following steps:
- Needs Identification: The assessor goes through the 28-item needs checklist, marking a 'yes' for any item where the individual requires support.
- Group Determination: The assessor determines the highest group (A-E) in which the individual has a 'yes' response.
- Support Level Assignment: Based on the highest needs group and the assessor's evaluation of the individual's independence level, a final CANS level from 0 to 7 is assigned. The support level documents the frequency and intensity of care needed, such as whether it's intermittent, daily, or 24-hour supervision.
Comparison of different needs assessment scales
To understand the uniqueness of the CANS, it's helpful to compare it with other assessment tools used for similar purposes. While the CANS focuses specifically on measuring the intensity and type of support needs, other scales might concentrate on different aspects of a person's functioning.
| Feature | Care and Needs Scale (CANS) | Supervision Rating Scale (SRS) | Functional Independence Measure (FIM) |
|---|---|---|---|
| Primary Focus | Measures specific care and support needs after a TBI, linking needs to intensity. | Assesses the level of supervision required, particularly after brain injury. | Measures an individual's level of functional ability in performing activities of daily living (ADLs). |
| Scoring | A dual-component score: a needs checklist and a 0-7 support level. | A single score reflecting the level of supervision required. | A 7-level scale for each item, measuring degree of independence. |
| Perspective | Clinician-rated, based on information from multiple sources. | Clinician-rated or self-report. | Assesses what the patient actually does, not what they could do. |
| Best For | Documenting the full spectrum of support needs for funding and planning purposes. | Quick assessment of supervision needs, especially in the long-term. | Evaluating the burden of care and quantifying independence over time. |
The benefits and limitations of using CANS
Like any clinical tool, the CANS offers distinct advantages while also having specific limitations that need to be considered.
Benefits
- Comprehensive Assessment: The dual-component structure ensures that both the type and extent of support are documented, providing a detailed picture of the individual's needs.
- Clear Communication: The hierarchical scoring provides a clear, universally understood metric for communicating the intensity of support required among healthcare providers, family members, and funding bodies.
- Treatment Planning: By identifying specific areas of need, the CANS helps guide the development of tailored and effective care plans.
- Sensitivity to Change: The scale's structure allows it to detect subtle changes in an individual's needs over time, which is valuable for monitoring progress and adjusting care.
Limitations
- Specific Application: The CANS was primarily developed for adults with acquired brain injuries, and while it has been adapted for other populations, it may not be suitable for all general health assessments.
- Training Required: Accurate administration requires a trained professional with experience in ABI care, which means it cannot be used by untrained caregivers.
- Focus on Function: The scale focuses on functional activities and support needs rather than the underlying impairments, which may not capture the full clinical picture in all cases.
Practical application of the CANS in care planning
The information gathered from a CANS assessment is not just a numerical score but a rich data set that drives practical care planning. Care managers and clinicians use the report to formulate person-centered care plans that address both the specific functional needs and the overarching supervision requirements.
Documenting and planning care
- Needs Prioritization: By identifying the highest needs group, the care team can prioritize interventions. For example, a person with needs in Group A (very basic) requires immediate and intensive support compared to someone with needs only in Group D (social participation).
- Resource Allocation: The support level score (0-7) directly informs resource allocation, helping to justify the need for more frequent services, personal care attendants, or supervised living arrangements. A higher CANS score typically correlates with a greater need for funding.
- Monitoring Progress: Regular reassessments using the CANS allow the care team to track changes. An improving CANS score can indicate the success of rehabilitation efforts, while a declining score can signal a need for reassessment of the care plan or a potential significant change in condition.
- Caregiver Support: The CANS also provides insights into the caregiver's needs and the burden of care, enabling the provision of additional support or respite services to prevent burnout.
For additional information on the development and validation of the CANS, authoritative resources can be found through the American Psychological Association (APA) database. This source provides access to the original citation and abstract for the scale, which is essential for researchers and professionals seeking foundational information.
Conclusion
The Care and Needs Scale (CANS) is an invaluable, clinically-rated tool that objectively measures the care and support required by individuals with acquired brain injuries. Its two-part structure—a detailed needs checklist and a hierarchical support level scale—provides a comprehensive and systematic approach to assessment. The CANS facilitates clear communication among healthcare providers and helps justify funding and guide person-centered care planning. While primarily designed for TBI and ABI, its use in determining functional support needs underscores its importance in the broader rehabilitation landscape. By providing a reliable metric for needs assessment, the CANS empowers clinicians to deliver more effective and appropriately resourced care, ultimately improving the quality of life for individuals with complex support requirements.
