Transitions: How does managed care use the Child and Adolescent Needs and Strengths (CANS) tool?

By: Barbara Ann Dunn, ACSW, LCSW, Director, Program Innovation and Outcomes, Magellan Healthcare

Transitions

Using Child and Adolescent Needs and Strengths (CANS) algorithms for access and transition decision support is particularly helpful when celebrating successes. It’s not always appropriate to use the algorithms to screen people for discharge from programs. Screening divides those who get certain services and those who don’t; however, it may not be appropriate for use in the same way for discharging. The CANS needs items get a youth into a program, while strength-building creates lasting progress. It is possible for a youth to be ready for discharge when they still have needs. If youth and their families have built coping skills and a supportive environment, they may be ready to leave formal services. We should celebrate that success.

At one point in our Louisiana program, half the youth discharging from wraparound still met the criteria for wraparound eligibility. This was not a failure to make progress; youth were making progress, and CANS scores were better at discharge, particularly in the area of increased linkage to natural supports. We took this as evidence of families and youth transitioning out of formal wraparound and having confidence in their own skills and natural supports, and needing less intensive professional supports.

The other side of the coin are youth in a program having a reassessment CANS and not meeting the criteria to continue in the program. Managed care makes a difference during this assessment, because care managers can include clinical information in the scoring and advocate for planned transitions.

A care manager in our Louisiana program compares the CANS to other material in the request for wraparound, such as the Independent Behavioral Health Assessment and other information in our clinical system. At times as the managed care organization, we have information in patient repositories the provider does not, such as data on a hospitalization, a crisis call, medications or even a complicating physical health claim.

Advocating for planned transitions throughout work with families and youth prepares them for the coming day. The best way to achieve this preparation is to build self-efficacy through intentional building of strengths. When the time for transition comes, whether to a lower level of care or less-intensive service, or to no formal services at all, family and youth confidence in their strengths is what will win the day. From our experience, if we use the greatest change in strengths as the most impactful for transition, we will focus on building the following for a successful planned transition:

• Natural supports
• Resilience
• Resourcefulness
• Optimism
• Family strengths

A final note on transitions — in behavioral healthcare, a discharge from a program can be seen as a success. That may be purely based on utilization and length of stay and not on actual success. The CANS is a functional outcomes measure, i.e., it measures how a youth and family is functioning in real life. As value-based programming expands, the CANS will be used for evidence of discharge success. Let’s all embrace this. Managed care organizations value the work you do fully, and we cannot do it without measurement of functional outcomes.

We come to the end of this blog series. I hope you have a better understanding of how managed care should work in the behavioral healthcare system. I am not a spokesperson for all of managed care; I can only speak to what Magellan Healthcare has done and plans to do with the CANS. We all have functions in the behavioral health system, and we work best when we understand the reasons behind those functions, because at the end of the day, we have common goals and work better together.

Looking forward to seeing you at the TCOM Gathering in the Clouds Nov 11-13, 2020!

Barbara Ann Dunn, ACSW, LCSW

TCOM Conference Program Chair 2020