Conversations with the TCOM trainers:
The Importance of Identifying a Caregiver on the tools
By Cassandra Cooper and Lynn Steiner
Cassandra Cooper (she/her), MA, LCPC and Lynn Steiner ( she/her), MSW, IL-MD, are Senior Policy Analysts at the Center for Innovation in Population Health at the University of Kentucky.
The items and domains in the TCOM tools help us capture an individual’s areas of strengths and needs so that we can figure out where intervention or support may be needed. In the case of the Caregiver Resources & Needs Domain, our goal is to identify the capacity of the person – or people – functioning in a caregiver role in order to be able to support the individual in their care.
While identifying a caregiver may seem straightforward, our work and caregiving circumstances can be complex. Depending on the system (e.g., child welfare or behavioral health), state policy, agency requirements, and the variety and complexity of family structures, it may be challenging at times to determine which adult functions in a caregiving role when multiple adults live in the individual’s home or are involved in their life.
Now, it is important that when you have questions about whom to rate in a specific case, you should first speak to your supervisor and/or seek guidance from your agency policy. But for general guidance, here are a few questions we’ve received in our coaching desk to consider, followed by our responses:
I work with children involved with child welfare. They often have foster parents, and their biological parents are involved when the permanency goal is to return home. Who do I rate in the caregiver domain on the CANS?
We hear many variations on this question. Sometimes it’s about biological parents, substitute caregivers, or divorced parents with significant others or new spouses. The basic question here is, when multiple adults are involved in the child’s life, whom do we rate on the CANS?
And the short answer is: any adult with caregiving responsibilities for the child will be rated as a caregiver. The most important factor is the determination of involvement in caregiving functions. A parent who is in prison but talks on the phone weekly to their child and asks them about their homework is involved in caregiving (even if their capacity to do so is limited). A grandmother who lives with her daughter and watches the children after school and helps get them ready for bed is involved in caregiving. A father in a two-parent family who could be involved but leaves all of the parenting work to his spouse is considered a caregiver with one or many needs in the caregiver domain. In a family where the parents are divorced, and the child spends some time in each parent’s home, both parents are considered caregivers. A grandfather who lives in the home but does not provide any care would not be rated as a caregiver. When in doubt, ask: Do you have any responsibility for providing care to the child?
Note that in child welfare, the permanency goal is usually your guide. This means that you may not be rating foster parents in the caregiver domain when the goal is to return home; only the person or people fulfilling the permanency goal will be rated. Suppose there is no identified person that the child will be returning to. In that case, you may not be rating anyone in the caregiver domain since there is no caregiver who will be supporting the child, and therefore knowledge of caregiver resources and needs is not relevant in this child’s situation.
Once I’ve identified all of the caregivers, I struggle with how to document assessing them. I’ve heard that you rate each individually, but then I’ve also heard that you rate them together as a unit. Which one is right?
They both are. Whether you rate each adult separately or as a unit depends on the tool (for example, the FAST requires you to rate caregivers individually while the CAT requires that caregivers be rated together), your field of focus (e.g., child welfare), and your agency requirements (some states or agencies require you to rate caregivers separately and some together). From an assessment perspective, the key point here is to identify caregiver needs, regardless of which caregiver it is related to. For purposes of planning or treatment, you will want to know which caregiver has the need and in which area so that you can target your interventions or support to that caregiver. When in doubt, refer to your supervisor and agency policy.
I mostly work with adults in behavioral health. If someone is married, would I rate their spouse as a caregiver?
Although sometimes only one partner makes dinner and pick up the other partner’s socks, partners aren’t caregivers! The exception is if the adult is dependent on their spouse for assistance with daily life tasks due to serious mental health or cognitive challenges or medical needs. If the spouse is responsible for providing care to a dependent adult, they will be rated in the caregiver domain. Also, if you find yourself in the other end of this caregiver role (between partners), please put your dirty clothes in the laundry bin.
In reference guides, we note that a caregiver’s perspective is valuable to the information-gathering process. In families, the caregiver has needs and resources that impact themselves as well as the needs of their family; being able to identify needs and address them, and identify resources and leverage them, is one result of good assessment. To do this, we must identify the relevant caregiver or caregivers and engage them to support the family’s and individual’s well-being.
Did you find this article useful in helping you to determine who is a caregiver and why assessing them is helpful? If so, please tell us in the comments! What else would you like to know?
Cassandra Cooper (she/her), MA, LCPC, is a Senior Policy Analyst at the Center for Innovation in Population Health at the University of Kentucky. She works with Illinois and other states and jurisdictions providing training and facilitating Learning Collaboratives to systems implementing the Child and Adolescent Needs and Strengths (CANS) and Transformational Collaborative Outcomes Management (TCOM). Prior to joining the TCOM team, Ms. Cooper was a Field Implementation Support Specialist, Trauma Informed Practice Specialist and Learning Collaborative Facilitator at the Illinois Department of Children and Family Services, where she served as a primary facilitator on the implementation of a family- centered, trauma- informed and strength-based model of practice. Ms. Cooper utilizes her experience as a licensed clinical professional counselor, an educator and her knowledge of TCOM in coaching and supporting individuals and jurisdictions on the practice applications of the CANS, ANSA and other TCOM tools.
Lynn Steiner (she/her), MSW, IL-MD, is a Senior Policy Analyst at the Center for Innovation in Population Health at the University of Kentucky. In this role, she is mainly responsible for providing coaching and training to people who are certifying on the TCOM tools (e.g., the CANS, CAT, ANSA, FAST). Ms. Steiner has over 15 years of experience with the TCOM philosophy and tools. She believes that providing resources and practice go a long way towards providing a quality assessment. She was involved in similar work previously at Chapin Hall at the University of Chicago and at Northwestern University’s Mental Health Services and Policy Program. Ms. Steiner has a master’s in social work degree from the Jane Addams College of Social Work at the University of Illinois.