By Kate Cordell, PhD, MPH, Managing Director at Mental Health Data Alliance, LLC
What if we could utilize the CANS and ANSA to identify which items, if resolved, were associated with success in our program? What if we could look at that by race/ethnicity, gender and age? If we could, we could get a lot closer to identifying what works for whom.
The CANS and ANSA are ideally suited for determining what works for whom. These assessments help build a comprehensive picture of a person’s story as it relates to well-being. I find it helpful to visualize a story as a tapestry – each unique and beautiful.
Every story is different. Yet stories are woven with some common thread. The CANS and ANSA help us visualize this tapestry and then track transformational changes in these patterns over time. The CANS and ANSA can track progressive stages toward resilience and recovery – personal to each individual – but with common themes.
Looking at changes over time, the CANS and ANSA ascertain needs which were addressed and strengths which were built, all informed through underlying trauma identified. When an individual transforms his story toward well-being, there are often some natural changes, such as increases in optimism and decreases in frustration. An individual might experience increases in functioning such as more time spent on talents and interests and less time spent exhausted due to sleep deprivation. The changes associated with successful outcomes are likely common among groups of individuals who share some common threads in their stories.
The definition of success is as individual as the story. And therefore, we need to be flexible in how we define success. For one individual, it may be starting a romantic relationship and for another individual it may be starting or advancing a career. However, success in these terms is supported by building common underlying strengths, such as interpersonal skills and addressing common underlying needs, such as anxiety. The CANS and ANSA can identify the proportion of identified needs addressed and the number of strengths built as part of a definition of success.
In thinking through these considerations, I decided to build a tool to help identify items, if resolved, which were associated with success among subgroups of individuals. This dashboard allows agencies and jurisdictions to define success in their own terms – on the fly. Perhaps for one adult program success is defined as addressing 33% of needs and building two strengths and meeting the primary personal goal (e.g., starting a career).
Next, we might look at a children’s out of home placement program and reset the definition of success to addressing 50% of child needs, addressing 30% of caregiver needs, building 2 strengths and maintaining a family placement for 1 year. I decided to build a dashboard which would feed the user’s definition of success into an analysis – as a form of mass customization.
Once a definition of success is established, the dashboard identifies all individuals who met the definition of success and those who did not. In the example of a children’s program, 32% met the definition of success.
Next the dashboard further prioritizes which items are more often associated with meeting that definition of success. In the example, family functioning followed by optimism and living situation are highly prioritized for success. The top 10 priorities are displayed.
The dashboard then creates a decision tree to mark any subgroup differences in probability of success by items addressed. In the example, when family functioning is identified and resolved there is a 76% probability of success versus a 27% probability of success when it is unresolved or not indicated. When family functioning is not indicated or is unaddressed, building a strength of optimism improved the probability of success to 70%. The tree identifies further combinations for success.