The Child and Adolescent Needs and Strengths (CANS) assessment is a multi-purpose tool developed for children’s services to support decision making, including level of care and service planning, to facilitate quality improvement initiatives, and to allow for the monitoring of outcomes of services. It is one of the tools in the Transformational Collaborative Outcomes Management (TCOM) framework, developed by Dr. John S. Lyons, consisting of a set of Guiding Values and Core Principles, all centered on how to provide the best and most support to all those in need.

I am often asked “How does managed care use the CANS?” Managed care organizations, like Magellan, are increasingly using clinical decision support tools and implementing value-based programs; the CANS offers a common language to look at resource needs and make the balancing of resources more transparent.

John Lyons frames the use of the CANS as part of “Five Key Decisions”: access, engagement, appropriateness, effectiveness and transitions. This framework on CANS use may be helpful for understanding how managed care uses decision support tools, and the CANS in particular, as the CANS has bonus options beyond the usual clinical decision support tools.

In this post, I provide an overview of each of the Five Key Decisions to shed light on how managed care uses the CANS. I invite you to explore the topics below and follow the links to learn more in my series on the TCOM Conversations blog.

Access

Access refers to screening for a target population, such as using CANS algorithms for matching needs to services. This identifies youth who will benefit from a certain level of care or service, as well as those who will not.

MCOs, with their advanced analytics capabilities, can provide valuable insights to state and local agencies to inform ongoing adjustments to algorithms to ensure that youth have access to the appropriate level of care.

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Engagement

Key Decision 2, Engagement, is about bringing people from access — opening the door — to becoming equal partners in the helping system. Engagement is built on respect and understanding that youth and family are experts in their own lives and need to captain their own ships. Engagement uses a fully person-centered discovery and planning process.

MCOs are tasked with operationalizing engagement, often taking the form of a checklist with time-frames and standards for everything from forms, consents, plans, child and family meetings, authorization, and even how often helpers and family are required to meet.

Proper operationalizing of engagement allows for family and youth to participate as fully as possible in using the CANS for reflection, self-advocacy and self-direction.

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Appropriateness and Effectiveness

An appropriate service should be effective. These two Key Decisions are inextricably linked and are often the basis of medical necessity. Evidence-based practices assign a defined appropriate population and a set of measures demonstrating effectiveness and provide a good example of how the community at large and managed care can agree.

Standardized assessment is an established best practice for measuring appropriateness and effectiveness. The CANS in practice excels at both. When the practice is done well, youth and families flourish and successfully complete their programs.

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Transitions

Using CANS algorithms for access and transition decision support is particularly helpful when celebrating successes. In behavioral healthcare, a discharge from a program can be seen as a success, but “success” may only be based on utilization or length of stay, and not on quality outcomes for the youth and family. 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.

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Barbara Dunn, LCSW, ACSW, is director of program innovation and outcomes for Magellan Healthcare. She is the Conference Program Chair for the 16th annual TCOM Conference, A TCOM Cloud Gathering. Meeting Each Other Where We Are: Collaboration in a COVID-19 World. Learn more about the event here.

Coronavirus (COVID-19) concerns are growing, and school closures are happening in most states. While grown-ups are anxiously figuring out how to handle the impacts of these decisions, kids are observing everything and may feel just as scared and confused as adults.

Talking with children about COVID-19

Children look to parents, guardians, caregivers and other trusted adults to help them make sense of what is happening in the world. COVID-19 is the topic of conversations everywhere on social media, web news outlets and TV. Everyone is being exposed to the fear and uncertainty of this global pandemic.

Children might find it difficult to understand what they are seeing or hearing about COVID-19, so they can be particularly vulnerable to feelings of anxiety, stress and sadness. As an adult, it’s important to make yourself available to listen to children’s thoughts and communicate in an age-appropriate way that addresses children’s questions without stoking anxiety. Children react, in part, on what they see from the adults around them. When parents and caregivers deal with a stressful situation calmly and confidently, they can provide the best support for their children.

The Substance Abuse and Mental Health Services Administration provides Tips for Caregivers, Parents and Teachers During Infectious Disease Outbreaks that includes information on possible reactions and tips for talking with children and youth of different age groups.

Tips for staying at home with children during the outbreak

• Focus on the uniqueness of the moment. This situation has never happened before. How can you make the best of it? Yes, it is stressful on many levels, but for your children, it is a time they will never forget and there is an opportunity in forced togetherness to reinforce your family bonds.
• Plan for different age groups. Younger children will love being home. Young teenagers may not be as thrilled by not being able to hang out with their friends on a daily basis. High schoolers can handle themselves and may be able to help with the younger kids if you have to work.
• Bend with the wind. Meaning: be flexible with the schedule. Let children play, do a fun project together (make cookies or do a craft), eat breakfast for lunch and make room for downtime to read and hang out. Your kids may have quite a bit of time at home, so try to maintain your patience and perspective.

To learn more about what Magellan Healthcare is doing to support clients during the  COVID-19 pandemic, visit  MagellanHealthcare.com/COVID-19.

To learn more about Magellan Health’s corporate response to the COVID-19 pandemic and to view Magellan’s available resources click here: https://www.magellanhealth.com/news/covid-19/

Adapted from: Stockwell, A. (2020, March 13). What to do with your kids when schools are canceled. Retrieved from https://www.vox.com/the-highlight/2020/3/13/21178234/coronavirus-covid-19-school-closures-kids-home

Humans are social beings, and the social distancing that is necessary to flatten the coronavirus curve is hard on everyone. The forced change in social behavior and the resulting isolation can affect people’s mental health in many ways. Whether you are home alone, with a sick family member or with kids out of school, isolation can increase stress and anxiety.

Depending on your situation, isolation can impact you in different ways. From loneliness to feeling cramped, dealing with these feelings on top of worrying about the COVID-19 outbreak can be overwhelming.

General tips
• Keep in touch with your social support groups virtually through social media, FaceTime, Skype, online games and other digital platforms.
• If the weather is nice, go outside and get some fresh air. Maintain a 6-foot distance from others.
• Stay busy. Read, play games or work on a project.
• Decrease the time you spend watching or listening to upsetting media coverage.
• Draw on skills that you have used during difficult times in the past to manage your emotions. That may include deep breathing, meditation, positive self-talk, etc.
• Maintain a healthy lifestyle. Stay hydrated, eat nutritious meals, exercise and get enough sleep.
• Avoid using tobacco, alcohol or other drugs to cope with your emotions.
• Access information that can help you cope with stress, worry and confusion during the pandemic. Visit Magellan Healthcare’s COVID-19 response website for information and links to self-assessments, videos and other resources.
• Get the facts about your risk and how to take precautions. Use trusted national and international resources including the World Health Organization, Centers for Disease Control & Prevention and State Departments of Health.

For people living with children
• Remember that during times of stress, it is common for children to seek more attachment and be more demanding on parents.
• Be honest when discussing COVID-19, but do so in an age-appropriate way. If your children have concerns, help them ease their anxiety.
• Make sure you model good behavior. Children will observe adults for cues on how to manage their own emotions during difficult times.
• Help children find positive ways to express their fears about the situation. Every child has their own way to express emotions. Sometimes engaging in a creative activity such as drawing can help this process.
• Maintain a safe and supportive environment and practice familiar routines in daily life as much as possible, especially if children are confined to home.
• Provide children with engaging activities

For caretakers of older adults
• Provide practical and emotional support by sharing simple facts about what is going on.
• Give clear information about how to reduce risk of infection in words older people with/without cognitive impairment can understand. Repeat the information whenever necessary.
• Engage their family and other support networks in providing information and helping them practice prevention measures (handwashing, proper sneezing and coughing techniques, etc.).
• Be aware that older adults in isolation and/or those with cognitive decline/dementia may become more anxious, angry, stressed, agitated or withdrawn during this time.
• Encourage older adults with experience and special skills to help others by providing virtual peer support, reading to children over the phone, and the like.

To learn more about what Magellan Healthcare is doing to support clients during the  COVID-19 pandemic, visit  MagellanHealthcare.com/COVID-19.

To learn more about Magellan Health’s corporate response to the COVID-19 pandemic and to view Magellan’s available resources click here: https://www.magellanhealth.com/news/covid-19/

Adapted from Miller, H. (2020, March 10). WHO gives advice on handling mental health toll from the coronavirus. Retrieved from https://www.cnbc.com/2020/03/10/who-gives-advice-on-handling-mental-health-toll-caused-by-coronavirus.html. March 13, 2020.

The following is an excerpt from the 2018 Magellan Community Impact Report.

Care is core to every service we deliver and everything we do. For Magellan, success is about so much more than profit or prestige. It’s about doing well by doing good. We’re always caring, listening, learning and using our collective insight to make a difference. When we care together, we turn hope into reality.

Caring and sharing our lived experiences

Wyoming’s High Fidelity Wraparound program is just one of many examples where Magellan team members, who have lived through similar experiences, are returning the care and concern they personally received.

High Fidelity Wraparound is a voluntary planning and care coordination process for children and youth (ages 4-20) with complex behavioral health conditions. High Fidelity Wraparound’s community based solutions and planning process bring people together from different areas of a family’s life to form a team. The team creates steps to help youth stay in their homes, schools and communities.

Through our partnership with the Wyoming Department of Health, Division of Healthcare Financing (Medicaid), Magellan serves as the Care Management Entity for the High Fidelity Wraparound program, setting the rules and providing training for everyone involved in the process.

The  Wiederspahn  family

When Magellan Care Worker Chassity Wiederspahn’s son began  to struggle behaviorally, mentally  and emotionally in first grade, she knew she needed assistance but was at a loss.  Through High Fidelity Wraparound, she was  able to build a team around her family to guide  them in their search for help. The High Fidelity  Wraparound program allowed them to build a strong  support system and learn the resources available in their  community. It gave them confidence that they could handle  the challenges that might lie ahead. As a graduate of High Fidelity Wraparound, Chassity shares her story with the families and providers  she speaks to on a daily basis.

Many of our Magellan team members have lived these  experiences. which enables them to bring a valuable  set of life skills to their daily jobs each and every day.  As employees, the job is more than just the tasks at hand, we  truly care and offer ourselves as role models of hope and success.

The Campbell family

Magellan’s Kathryn (Kat) Campbell, family support specialist, is the proud mother of four beautiful children, two of whom are adopted from Wyoming’s foster care system. Blending a family was an overwhelming process despite the research and preparation of a therapist team. The crash course in secondary trauma left Kat and her partner reeling.

The family was referred by the local crisis center to High Fidelity Wraparound. The process created a safe space for Kat’s entire family to focus on caring for themselves, and they started to feel the support of those around them who were waiting to help. High Fidelity Wraparound’s empowerment and team building strategy gave the family the skills to run their own team for the high needs their children had, long after the family graduated from the process. Kat now trains and mentors providers who work directly  with families like her own.

Children with attention deficit hyperactivity disorder (ADHD) may have difficulty in school, because their symptoms—inattention, impulsiveness, and hyperactivity—get in the way of learning.

Success in school is important for the development of healthy self-esteem and confidence.

You can help your child succeed in school by:

• Working with teachers and other school personnel.
• Educating yourself about ADHD.
• Helping your child control his or her symptoms.

How can you help your child be successful in school?

You can help your child have the greatest chance of success in school by educating yourself, building relationships, maintaining open communication, working with your child, and keeping good records. Preschool or kindergarten is the best time to start using these techniques. But it is never too late to help a child improve his or her school performance.

Education                                                          

Learning as much as you can about ADHD and your child’s education rights will help you work with the school system more effectively.

• Learn about ADHD. Use the Internet to locate national organizations, ask your doctor, or visit your local library or bookstore for information about ADHD.
• Know your child’s symptoms and treatment plan. Talk with your doctor about your child’s behaviors that may interfere with learning and about ways to control those behaviors. Develop a record of your child’s treatment plan.
• Learn about your child’s education rights. Laws exist ensuring education rights for children who have conditions that interfere with learning. These laws also stipulate that parents have a right to be informed about and participate in educational decisions concerning their child. Contact your state and local education departments for information about ADHD in the schools and your rights to educational accommodations.
• Talk with other parents of children with ADHD. Join a support group for ADHD families. Find out how others have effectively worked with school systems.

 Build relationships

A positive relationship with teachers and other school personnel will improve your child’s chances of being successful in school.

• Start early. Before a school year begins, get to know the principal and other appropriate school personnel. Find out as much as you can about the school policies and rules, especially how behavior problems are handled. Find out if there are other children with ADHD in the school and how their behavior is being handled in the classroom.
• Share what you have learned. Find out if the teachers and other personnel need information about ADHD. Look for ways to help them get that information, such as suggesting books, pamphlets, or any local educational programs.
• Get to know your child’s teacher. Before the school year begins, talk with your child’s teacher about his or her style of teaching and discipline in the classroom. Find out whether the teacher has experience teaching children who have ADHD. Share with the teacher information about your child’s symptoms and what behaviors may interfere with his or her ability to learn. You may want to share your child’s treatment plan with the teacher.
• Make a school plan. Work with the teacher to design a plan to help your child perform to his or her potential. Address how to minimize misbehavior and how to react to it. Your plan will change as your child grows and develops. You may need to work with the school to develop an individual education plan (IEP) for your child. An IEP is a tool for classroom and homework adaptations for a child with a disability. For children with milder symptoms, the school may suggest a plan that is used for medical conditions that do not meet the IEP standards (called a 504 plan).
• Ask school personnel for help when needed. Tutoring or services that help with study or organizational skills are sometimes provided through the school. If not, school personnel often have a list of local resources that can help your child.

Keep communication open

Open communication with your child’s teacher can help resolve problems that may occur throughout the school year. The following are suggestions for working and communicating with your child’s teacher:

• Understand the demands upon your child’s teacher. Most children with ADHD can be taught in a regular classroom, although adjustments are sometimes needed. Not all teachers are trained to do this. Also, teachers are stretched to their limits by large numbers of children in the classroom, making it difficult to give each child personal attention. Ask the teacher what he or she needs from you to help assimilate your child.
• Keep the teacher informed. Share with the teacher any relevant changes in your child’s treatment plan. Help facilitate the sharing of information among you, your child’s teacher, and your child’s doctor.
• Visit the classroom. If possible, volunteer for school activities and parties. This will let the teacher know that you are interested in your child’s education and willing to help.
• Request progress reports. Children with ADHD often lose or forget their assignments. Ask the teacher to complete regular progress reports of your child’s performance and behavior.
• Have a final conference. Meet with the teacher at the end of the school year to discuss your child’s overall progress and the teacher’s suggestions for the next year. Ask him or her about possible teachers for the next year and how to help your child get the best chance for success in school.

Work with your child

• Use treatment methods as recommended by your child’s doctor. This may include medicine and/or behavior management techniques. This will help your child control symptoms of ADHD at home and school.
• Keep your child involved. Let your child know that you support his or her teacher. Clearly outline your expectations and the consequences of misbehavior. Talk with your child about how the teacher will let him or her know that a behavior is becoming inappropriate.
• Link school and home. Use the same signals (such as hand signals) that the teacher uses at school to indicate when a behavior is becoming inappropriate. Also, you can reward your child with privileges for remembering to bring home school progress reports. You can further reward him or her if the report is positive. If your child fails to bring a progress report home, you may treat it as if he or she had an unsatisfactory report and withhold a privilege.
• Help your child organize. Even young children can learn to use lists, daily planners, or calendars to keep up with homework assignments, tests, and activities. A young child may need a teacher’s help in writing down assignments.
• Use learning aids, such as tape recorders or computers. Teach your child how to take notes and to underline important information. If your child seems to learn best visually, ask about books that have helpful pictures and diagrams or workbooks.
• Have short sessions. Keep homework sessions to no more than 20 minutes without a break.

Keep good records

Health and school records can help monitor your child’s academic and behavioral progress as well as help identify when treatment adjustments are needed. You should keep and update the following records:

• ADHD evaluations. Collect copies of any records that are used to evaluate your child for ADHD. These records often identify the type of ADHD that your child has, which helps with treatment.
• Evaluations for any other conditions with similar symptoms.
• History of medicines. Record all medicines that your child has taken or is taking to treat ADHD.
• School progress records. Keep copies of any school plans, daily school progress reports, and formal progress reports throughout the year. Also, keep your child’s final grades and any achievement test results. You may find them helpful as you develop school plans for the following year.
• Individual education plan. If your school developed an individual education plan (IEP) for your child, ask for a copy. You may need to share that information with the health professionals working with your child.

©1997–2019, Healthwise, Incorporated

Read the full article here: https://www.healthwise.net/magellanhealth/Content/StdDocument.aspx?DOCHWID=tk1496

This document is for your information only. It is not meant to give medical advice. It should not be used to replace a visit with a provider. Magellan Health does not endorse other resources that may be mentioned here.

Children who are socially withdrawn, shy, and appear to lack self-esteem are more likely than other children to be targets for bullying. Children who appear confident and strong are better able to discourage children from harassing them.

Parents and other important adults in a child’s life can use these suggestions to help boost a child’s self-esteem:

• Encourage your child to participate in extracurricular activities such as sports or drama, which can raise a child’s confidence and sense of mastery. Sports, in particular, also help build strength, which can level the imbalance of physical power between children. Some children may prefer individual sports (such as karate, gymnastics, and swimming) over group sports (such as soccer or baseball). Drama classes can help children project strength and confidence, even if they don’t feel it at first.
• Help children become involved socially with other children through school, church, or community activities. This way, children will build social skills and learn to be at ease with others. Children who have friends and “hang out” with them at school are less likely to be targets for bullying than lonely children who have no social support.
• Role-play with children to show them how to appear confident and how to handle encounters with children who harass them. Help children learn to look people in the eye and to speak with a strong voice—but not shout—when talking to would-be bullies.

©1997–2019, Healthwise, Incorporated

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Childhood isn’t all fun and games. Even young children can feel worried and stressed.

Stress can come from outside sources, such as family, friends, and school. It can also come from children themselves. Just like adults, children may expect too much of themselves and then feel stressed when they feel that they have failed.

How can you help your child with stress?

Adults can help children and teens with stress in many ways. Three important things you can do are to:

• Try to reduce the amount of stress in your lives.
• Help them build positive coping skills.
• Teach them to let stress out.

Reduce the amount of stress in your lives

• Acknowledge your child’s feelings. When children seem sad or scared, for example, tell them you notice they are sad or scared. If appropriate, reassure them that you can understand why they would feel sad or scared.
• Develop trust, and let your child know that mistakes are learning experiences.
• Be supportive, and listen to your child’s concerns. Allow your child to try to solve his or her own problems, if appropriate. But offer to help and be available to your child when he or she needs you.
• Show love, warmth, and care. Hug your child often.
• Have clear expectations without being too strict. Let your child know that cooperation is more important than competition.
• Don’t over-schedule your child with too many activities.
• Be aware of what your child wants (not just what you want).

Build positive coping skills

It is important to help children learn positive coping skills. These skills are often carried into adult life.

• Provide a good example. Keep calm, and express your anger in appropriate ways. Think through plans to reduce stress, and share them with your family.
• Teach them about consequences. Children need to learn about the consequences—good and bad—of their actions. For example, if they do all of their chores on time, they will get their allowance. If they break another child’s toy, they must find a way to replace it.
• Encourage rational thinking. Help your children understand what is fantasy and what is reality. For example, help them see that their behavior did not cause a divorce, or that they are not failures because they were not picked first for something.
• Provide them with some control. Allow your children to make choices within your family framework. For example, allow them to arrange their rooms, choose family activities, and help make family decisions.
• Encourage them to eat healthy foods, and emphasize the importance of a healthy lifestyle.

Get the stress out

Finding ways to get stress out of their systems will help children feel better. The best ways to relieve stress are different for each person. Try some of these ideas to see which ones work for your child:

• Exercise. Regular exercise is one of the best ways to manage stress. For children, this means activities like walking, bike-riding, outdoor play, and individual and group sports.
• Write or draw. Older children often find it helpful to write about the things that are bothering them. Younger children may be helped by drawing about those things.
• Let feelings out. Invite your child to talk, laugh, cry, and express anger when he or she needs to.
• Do something fun. A hobby can help your child relax. Volunteer work or work that helps others can be a great stress reliever for older children.
• Learn ways to relax. This can include breathing exercises, muscle relaxation exercises, massage, aromatherapy, meditating, praying, yoga, or relaxing exercises like tai chi and qi gong.
  • Stress Management: Relaxing Your Mind and Body
• Laugh. Laughter really can be the best medicine. You can be a good role model in this area by looking for the humor in life. Your child can learn this valuable skill by watching you.

©1997–2019, Healthwise, Incorporated

Read the full article here: https://www.healthwise.net/magellanhealth/Content/StdDocument.aspx?DOCHWID=aba5971#aba5972

This document is for your information only. It is not meant to give medical advice. It should not be used to replace a visit with a provider. Magellan Health does not endorse other resources that may be mentioned here.

The holidays are a fun and joyous time but also a very busy one, and holiday stress and anxiety in children can and does happen. During the holidays, there are lots of fun activities and events going on, both at home and at school. And while that can be a good thing, the constant hustle and bustle can be just as overwhelming and nerve-wracking for children as it is for adults.

Recognize the signs that your child is stressed out. These signs may include:

• increased irritability or anger
• clinginess
• more crying, whining, or complaining
• sleep troubles (or sleeping too much)
• physical symptoms like headaches and stomachaches
• more or less eating
• isolation and/or refusal to participate in activities
• regressive behavior such as bedwetting or thumb- sucking

Try these tips to help alleviate your child’s stress and make the holiday season a merrier time for everyone:

Set a Calm Example

The most important way parents can help ease anxiety in children during the holidays is by trying to keep things relaxed as much as possible. As with so many situations, the way parents handle an issue can set the tone for how their kids will behave. If you let holiday stress get to you, your kids will definitely pick up on it, and child anxiety is more likely to be a problem in your house. To minimize anxiety in children during the holidays, take steps to handle your own stress and anxiety.

Set Up Conditions for Good Behavior

Avoid taking your child to places such as the mall or holiday gatherings when he is hungry or tired. It’s hard even for grown-ups to deal with noise and lots of stimulation when they’re not feeling their best; kids get hungry more often and become tired more easily, and may understandably have a tough time being on their best behavior and are more likely to experience holiday stress when they’re exhausted or hungry.

Remember the Importance of Routines

The holidays can throw a big wrench into household routines, and that can play a role in anxiety in children.  To minimize holiday stress in your kids, try to get routines back on track once an event or party is over. For instance, if a school holiday concert or a church gathering goes past your child’s bedtime, try to stick to quiet, calm activities the next day and get your child to bed on time the next night.

Watch What They Are Eating

Another thing that can fall by the wayside amidst the holiday hubbub is healthy eating. Between all the extra sugary holiday snacks and the lack of time to sit down  to regular meals, it can be all too easy for kids to eat less healthy foods, which can contribute to holiday stress and anxiety in children. Try packing healthy snacks when you have to go shopping or run other holiday errands and try to minimize the number of sweet treats at home. Whenever possible, offer healthy snacks, such as air-popped popcorn or apple slices with cheese and crackers and limit cookies and candy to after-snack treats.

Get Your Child Moving

Fresh air and exercise are essential for boosting mood and re-setting the spirit, which can alleviate holiday stress and anxiety in children. Make sure you schedule some time to get your child outside to run around and play.

Avoid Overscheduling

As tempting as it may be to accept every invitation from friends and family, try to limit your holiday parties and activities so that you and your child are not overwhelmed. A couple of events a week may be fine, but having an obligation every day can lead to holiday stress and anxiety in children.

Have Your Grade-Schooler Help You

Big kids love to help mom and dad, especially if they get lots of praise for being responsible and helpful. If you have to shop, ask your child to help you look for an item at the store (fun stocking stuffers for cousins, for example). Giving your child a task will not only boost her self-esteem, it’ll distract her and help prevent any holiday stress and anxiety.

Schedule Some Quiet Time

Having some peace and quiet with your child is more important than ever during the busy holiday season. Find a quiet corner and read a book with your child or create holiday pictures for grandma and grandpa. Take a walk outside in nature, away from noise and crowds and obligations.

Remind Your Child and Yourself What the Holidays Are Really All About

A great antidote for holiday stress and the bloated commercialism of the season is helping others, whether it’s by shoveling an elderly neighbor’s sidewalk or by wrapping presents for needy kids at your local church. Helping your grade-schooler become a charitable child will help alleviate her holiday stress and anxiety.

Help is available. For additional information, visit MagellanHealth.com/MYMH