Non-blind follow-up administrations are encouraged. The University of Chicago’s Chapin Hall has created a video to assist CANS raters in completing repeated CANS measures over time:

The CANS is updated by first having the previous CANS being placed in the new form. The items that need to be revised can be easily changed without having to complete the entire tool, or go through another full discovery process. (Fernando, 2018).

This unethical process ensures that rater bias is exaggerated. As Lyons wrote almost two decades ago: “the desire to look good in the face of accountability” will cause outcome assessments to be invalid ([R], p. 76). Instead of taken steps to minimize these biases, CANS researchers go out of their way to augment them. Through this “re-testing” process behavioral health providers and caseworkers have all the data at their fingertips to ensure that their clients are showing steady improvement. Cheat-sheets are prepared to assist in the process. Massachusetts’ sheet, for example, states:

 In general, items rated 3 due to intensity of need should be converted to 2 relatively promptly, if the acuity of the need is addressed… When treatment is effective, items rated 2 will resolve to 1 (or occasionally 0) if they are a focus of treatment. (Children’s Behavioral Health Initiative, 2013 [G])

Providers that want to “look good” are spoon-fed all the information they need to game the system and allow state systems to look good in the process.