CANS certification tests do not simulate real-world CANS assessments.

Chapin Hall is the new owners of CANS, according to two Chapin Hall employees and the developer of CANS. “Last year, Praed granted Chapin Hall (also a 501.c.3) with exclusive licensing rights” (Lyons & Israel, 2017).

Chapin Hall is explicit about how CANS is to be completed. “The CANS is a multi-dimensional measure designed to be completed collaboratively by caregivers, youth, and the clinician” (Israel, Accomazzo, Romney & Zlatevski, 2015, p. 241).

Which is harder? We think we’ve rank-ordered them for you:

1. VIGNETTE: Looking at a one-page, Cliff’s-note vignette where virtually every sentence gives you the answer to a CANS question.
2. CHART AUDIT: Retrospectively, looking at the medical record or chart of the client and ensuring there is evidence to support the clinician’s CANS ratings.
3. INTERVIEW: Spending a few hours with the family interviewing everyone and using your clinical judgment to arrive at CANS answers.Remember a cornerstone of completing CANS is that “one must consider culture and development prior to establishing the action levels” (Obeid & Lyons, 2011, p. 73). Yet, Chapin Hall boasts that “anyone with a bachelor’s degree can learn to complete the tool reliably.” It would be great to see the scientific study behind that.
4. PRE-MEASUREMENT TRIANGULATION: That’s John Lyons term for completing the tool collaboratively and arriving at consensus for each CANS item.“It is always possible that someone who completes the measure fails to actually involve others in its production.… It is also possible that users with different perspectives cannot come to an agreement… when disagreements are not resolvable, the “1” rating (indicating watchful waiting/prevention) is recommended, so that the parties can monitor the need and see over time who has the more accurate perspective.” (Obeid & Lyons, 2011, p. 76-77)

Training certification simulates #1, the easiest version. In some testing software you are even given feedback on what you got wrong so that you can change your answers and get your certificate. Without any training at all, one might assume that eighth-graders could take the “training test” and get a certificate. That would be a simple study to conduct.

The only published reliability study on CANS used #2, the chart audit approach. Notwithstanding the developers’ misleading conclusions, only a handful of CANS items met his standard of reliability. No one has studied #3, but a handful of cases are readably available in most every state system for analysis. It’s not methodologically possible to study the hardest, but required, #4.

If CANS developers and owners wanted to show some integrity and honor with the millions they are making on CANS (e.g., $5M for just New York), they would get permission from a family to videotape Lyons interviewing the youth, parents, foster parents, clinicians, residential staff, etc., and arriving at that consensus that he says is easy, happening 99% of the time. He claims it can happen in fifteen minutes.