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Illinois-Medicaid:
Comprehensive Assessment
of Needs & Strengths
Learner Workbook
© 2022 Provider Assistance & Training Hub
Table of Contents
Virtual Learning Quick Start .............................................................................................................................................4
Prepare Before You Attend ...........................................................................................................................................4
During the Session ........................................................................................................................................................4
Guidelines for Virtual Class Discussions .........................................................................................................................5
IM+CANS Overview ..........................................................................................................................................................6
Introduction ..................................................................................................................................................................6
Sponsorship ..................................................................................................................................................................6
Learning Objectives.......................................................................................................................................................6
Unit 1 | Transformational Collaborative Outcomes Management ...................................................................................7
Video #1........................................................................................................................................................................7
A Philosophy from which Change can Grow ..................................................................................................................7
What is the IM+CANS? ..................................................................................................................................................8
Video #2:.......................................................................................................................................................................8
TCOM: Phases of Care ...................................................................................................................................................9
Guiding Decisions: Individual & Family Needs & Strengths ..........................................................................................10
Managing Tensions in Our Work .................................................................................................................................10
Unit 2 | Communimetrics & The Six Key Principles ........................................................................................................11
Video #3......................................................................................................................................................................11
The Six Key Principles ..................................................................................................................................................11
Action Levels: Needs ...................................................................................................................................................12
Example: Identifying Needs .........................................................................................................................................12
Shawn Vignette .......................................................................................................................................................12
Action Levels: Strengths ..............................................................................................................................................13
Example: Identifying Strengths....................................................................................................................................13
Kim Vignette ...........................................................................................................................................................13
Action Levels: Status & Impact ....................................................................................................................................14
The Six Key Principles ..................................................................................................................................................14
Example: Johnny .........................................................................................................................................................15
The Developmental Balancing Act ...............................................................................................................................15
Example: Jorge ............................................................................................................................................................16
Holding the Cultural Context .......................................................................................................................................16
Example: Ken ..............................................................................................................................................................17
Unit 3 | IM+CANS Domains ............................................................................................................................................17
Traumatic Exposures Domain ......................................................................................................................................18
Learner Workbook (V1 – Last Revised: 2022.05.13) Illinois-Medicaid: Comprehensive Assessment of Needs & Strengths | 2
Behavioral/Emotional Needs.......................................................................................................................................18 Life Functioning...........................................................................................................................................................19 Risk Behaviors .............................................................................................................................................................19 Strengths ....................................................................................................................................................................20 Cultural Factors...........................................................................................................................................................20 Caregiver Resources & Needs Addendum....................................................................................................................21 DCFS Addenda ............................................................................................................................................................22 Tips for Rating IM+CANS Items....................................................................................................................................23 Unit 4 | Practice Vignette ...............................................................................................................................................23 Tips for Rating a Vignette ............................................................................................................................................23 Why Practice Vignettes? .............................................................................................................................................23 Mike Vignette .............................................................................................................................................................24 IM+CANS Training Rating Sheet...................................................................................................................................25 Tips for Rating IM+CANS Items in Practice...................................................................................................................26 Collaborative Treatment Planning..................................................................................................................................27 How to Register for Treatment Planning .....................................................................................................................27 Online Certification ........................................................................................................................................................27 TCOM Training: New User Registration .......................................................................................................................27 TCOM Training: Returning User ...................................................................................................................................27 Closing............................................................................................................................................................................28 Commitment & Action Plan.........................................................................................................................................28 Additional Information................................................................................................................................................29 References ..................................................................................................................................................................29 Appendix A: IM+CANS Box 14 Reference Sheet..............................................................................................................30 Learner Workbook (V1 – Last Revised: 2022.05.13) Illinois-Medicaid: Comprehensive Assessment of Needs & Strengths | 3
Virtual Learning Quick Start
The online learning environment is designed to be engaging, interesting, informative and above all,
interactive. Because we want your experience to be great, we have created this Learner Workbook for you to
more easily follow the content and provide your own notes and written answers to exercises throughout. We
encourage you to keep this Learner Workbook following the session so that it may become a reference when
you are conducting this work in the field.
Prepare Before You Attend
Think about what might impact your success before it becomes an obstacle to your learning. Ask, “What
barriers can I remove now so that I will be able to focus during my online session?”
Be aware of personal change. We all handle change differently. Do you like “trying on” new methods,
technology, or the social aspects of learning? Are you willing to share experiences with virtual
participants? Spend some time on self-reflection.
Protect your online learning session time on your calendar. To head off interruptions, inform others
that you will be unavailable during this time. Make sure work commitments are taken care of now so
that during the session you’re dedicated to learning.
Download (and print if you would like) your learner workbook ahead of time and have it available
during the course. Follow along with the instructors to complete written exercises and jot down notes
during the course.
Keep the web address for your virtual classroom handy (found on your Welcome email).
Arrive in plenty of time. Check in at least 15 minutes early to your session to make sure that you are
properly connected through your computer and the audio bridge.
During the Session
Here, success is all about interaction. Participate actively using all of the methods available to you. Remember
that others are depending on your efforts to keep the session running smoothly, generating the most take
away. A major benefit from these sessions, according to participants, is the information that is exchanged
among the group. We encourage and value your contributions.
Remove distraction from background noise. Locate yourself away from other conversations,
television, music, pets, children, and coworkers. Your parakeet might be cute when it chirps, but it
interferes with the session’s flow and distracts others.
Go to a private room or cubicle for the duration of your session.
Use a noise reducing headset and microphone.
Have fun and engage other colleagues.
Learner Workbook (V1 – Last Revised: 2022.05.13) Illinois-Medicaid: Comprehensive Assessment of Needs & Strengths | 4
Guidelines for Virtual Class Discussions
In this session, there will be many opportunities for you to participate in discussions. So, let’s review some
guidelines around the discussions we will be having.
1. Participate: This is a shared learning environment. We encourage everyone to contribute.
2. Be Patient: Read everything in the chat/on the whiteboard before replying. This will help you avoid
repeating something someone else has already said.
3. Be Brief: You should be clear and direct.
4. Emoticons, Acronyms and Abbreviations: Social networking and text messaging has spawned a body
of linguistic shortcuts that are not familiar to all. The learners in this course perform many different
roles and may not be as familiar with some aspects of your job specific language. Please make sure
your response can be easily understood by all.
5. Respect Diversity: It’s a diverse, multi-cultural world in which we live. Use no language that is, or that
could be construed to be, offensive toward others. This session is designed to talk about the complex
issues involved in culture, because of this the session should be a safe space for this discussion to
occur, however if at any time you feel offended, please use the private chat feature to let the co-
facilitator know.
6. Courtesy: Avoid using bold upper-case letters in the chat, it is difficult to read. It can also be
interpreted as yelling or being hostile
7. Be helpful. Criticism must be constructive, and well-meaning.
Learner Workbook (V1 – Last Revised: 2022.05.13) Illinois-Medicaid: Comprehensive Assessment of Needs & Strengths | 5
IM+CANS Overview
Introduction
Instructor: _________________________________
Co-Instructor: _________________________________
Sponsorship
Today’s training is sponsored by the Illinois Department of Healthcare and Family Services and is administered
by the Provider Assistance and Training Hub.
All materials related to TCOM (e.g., CANS) are provided in collaboration with the Praed Foundation at the
University of Kentucky.
Learning Objectives
1. Understand the TCOM philosophy.
2. Utilize the IM+CANS Lifespan Tool as the standardized integrated assessment instrument in the State
of Illinois.
3. Build the skills needed for online testing and certification of the IM+CANS.
Learner Workbook (V1 – Last Revised: 2022.05.13) Illinois-Medicaid: Comprehensive Assessment of Needs & Strengths | 6Unit 1 | Transformational Collaborative Outcomes Management
Video #1
Video Notes
A Philosophy from which Change can Grow
TRANSFORMATIONAL: OUTCOMES:
COLLABORATIVE: MANAGEMENT:
How can we move towards transformational management?
Learner Workbook (V1 – Last Revised: 2022.05.13) Illinois-Medicaid: Comprehensive Assessment of Needs & Strengths | 7What is the IM+CANS?
You can access the IM+CANS and References guide at the PATH webpage.
Video #2:
Video Notes
Learner Workbook (V1 – Last Revised: 2022.05.13) Illinois-Medicaid: Comprehensive Assessment of Needs & Strengths | 8TCOM: Phases of Care
Notes
Learner Workbook (V1 – Last Revised: 2022.05.13) Illinois-Medicaid: Comprehensive Assessment of Needs & Strengths | 9Guiding Decisions: Individual & Family Needs & Strengths
Managing Tensions in Our Work
Philosophy
Strategy
Tactics
Learner Workbook (V1 – Last Revised: 2022.05.13) Illinois-Medicaid: Comprehensive Assessment of Needs & Strengths | 10Unit 2 | Communimetrics & The Six Key Principles
Video #3
Video Notes
The Six Key Principles
Information Science Principles
Relevant
Timely
Actionable
Learner Workbook (V1 – Last Revised: 2022.05.13) Illinois-Medicaid: Comprehensive Assessment of Needs & Strengths | 11Action Levels: Needs
Need is dangerous or disabling .
Immediate/intensive ac�on required. 3
Need interferes with func�oning.
Ac�on/interven�on required. 2
Significan t history of need, or possible need
that is not interfering with func�oning. 1
Watchful wai�ng, addi�onal assessment.
No evidence of need.
No need for ac�on. 0
Example: Identifying Needs
Shawn Vignette
Shawn's parents worry that he is not getting enough sleep at night because of playing videogames with his
friends. Shawn agrees.
Shawn reports that he is very tired at school, and that his grades are slipping in one course because it is
scheduled for early morning, when he is the most tired.
Shawn says he catches up on sleep every weekend, and that other schoolwork and activities are going well.
Is there Is the need Is the need What Action
evidence of a interfering with dangerous or Level applies?
need in sleep? functioning? disabling?
• • • •
Learner Workbook (V1 – Last Revised: 2022.05.13) Illinois-Medicaid: Comprehensive Assessment of Needs & Strengths | 12Action Levels: Strengths
No strength iden�fied.
3 Considerable effort or building tocreate and
develop strength.
Strength iden�fied.
2 Requires building in order to be useful for
individual or planning.
Useful strength.
1 Evident and can be accessed by
individual; useful for planning.
Well developed centerpiece strength.
0 Easily accessible by individual;
essen�al for planning.
Example: Identifying Strengths
Kim Vignette
Kim and her mom have lived in the same neighborhood since she was two. They know all the neighbors well.
When mom is at work, the neighbors help by getting Kim off the bus, feeding her a snack, and helping her with
her schoolwork.
Kim’s mom has become particularly close to an elderly woman next door. She and Kim call her “Grandma,”
and they are invited to dinner at her house most Sundays.
Do Kim and her mom If Kim’s mom is What Action Level
have the Natural struggling with the applies?
Supports in their stress of being a single
neighborhood that parent, can you build a
support Kim’s healthy care plan around the
development and well- natural supports that
being? they have?
• • •
Learner Workbook (V1 – Last Revised: 2022.05.13) Illinois-Medicaid: Comprehensive Assessment of Needs & Strengths | 13Action Levels: Status & Impact
Need is dangerous or disabling . No strength iden�fied.
Immediate/intensive ac�on required. 3 Considerable effort or building tocreate and
develop strength.
Need interferes with func�oning. Strength iden�fied.
Ac�on/interven�on required. 2 Requires building in order to be useful for
individual or planning.
Significan t history of need, or possible need Useful strength.
that is not interfering with func�oning. 1 Evident and can be accessed by
Watchful wai�ng, addi�onal assessment. individual; useful for planning.
Well developed centerpiece strength.
No evidence of need.
No need for ac�on. 0 Easily accessible by individual;
essen�al for planning.
The Six Key Principles
Shared Vision Prinicples
Individual
Focus
The ‘What’
Culture &
Development
Learner Workbook (V1 – Last Revised: 2022.05.24) Illinois-Medicaid: Comprehensive Assessment of Needs & Strengths | 14Example: Johnny
Johnny is a 16-year-old who regularly uses alcohol and heroin and frequently runs away from home. He has
stolen money from his friends and family in the past and tried to sell his dad's car for drugs. Johnny was placed
in a locked rehab facility by his parents five months ago where he has been a model individual.
Prior to entering rehab, he was placed in the hospital for a heroin overdose. Johnny is going to be discharged
from the rehab program next week due to his parents' belief that his being clean and sober for the last five
months indicates that he is fine.
What are some needs you can identify here?
Which Key Principle is illustrated here?
The Developmental Balancing Act
Cognitive
• Mental ability and intelligence.
• Preventative tool for meeting special needs.
Social
• Having the skills to make friends and navigate relationships.
Adaptive Living Skills
• Skills that help individuals function independently.
Physical
• the context that sets parameters for individual development.
Learner Workbook (V1 – Last Revised: 2022.05.13) Illinois-Medicaid: Comprehensive Assessment of Needs & Strengths | 15Example: Jorge
14-year-old Jorge and his family are referred for wraparound services. Jorge has a diagnosis of Autism
Spectrum Disorder and functions more like a 7-year-old (e.g., prefers much younger activities, plays with
younger kids).
Jorge has been recently reunified with his parents after being in foster care for a year. While the parents
successfully completed all the child welfare requirements to get Jorge back, they are still concerned about not
really understanding what Jorge needs and how to parent him. They are worried that he may be removed
again if he doesn’t improve while under their care.
What are some needs you can identify here?
Which Key Principle is illustrated here?
Holding the Cultural Context
Cultural Humility
Cultural Responsiveness
Learner Workbook (V1 – Last Revised: 2022.05.13) Illinois-Medicaid: Comprehensive Assessment of Needs & Strengths | 16Example: Ken
Ken is a 9-year-old boy whose family immigrated from Korea two years ago. He is struggling with a mood
disorder (depressed mood, low energy, he does not find pleasure in any activities he used to enjoy, he no
longer spends time with his friends). Ken was referred by the school counselor and the family has brought
along a cousin who the family has asked to act as a translator for the intake session.
Before the meeting, the translator informs you that the family is uncomfortable with receiving services and
believes that their son’s problems are not related to mental health, but that he is not trying hard enough to do
well in school and make friends. He asks that you do not ask any mental health questions or use any mental
health terminology during the intake. Additionally, he passes on a request from the family that you write a
letter to the school letting them know that their son does not have any mental health problems/diagnosis.
What are some needs you can identify here?
What might be one of the things we do when we start working with Ken and his family?
Unit 3 | IM+CANS Domains
REMEMBER!
• The IM+CANS is never
scored as a checklist.
• We must create a
conversa�on that
includes moving
through the relevant
topics. That starts with
engagement.
Learner Workbook (V1 – Last Revised: 2022.05.13) Illinois-Medicaid: Comprehensive Assessment of Needs & Strengths | 17Traumatic Exposures Domain
The traumatic experiences items are static indicators and identify if an individual experienced a particular
trauma. This domain captures trauma experience in childhood and/or adulthood.
2. TRAUMA EXPOSURE
No = No evidence of any trauma of this type.
Yes = Client has, or is suspected of having, at least one incident, multiple incidents, or chronic, ongoing experience of this type of trauma.
POTENTIALLY TRAUMATIC/ADVERSE CHILDHOOD EXPERIENCES (ACEs)
Item No Yes Item No Yes Item No Yes
Sexual Abuse ☐ ☐ Medical Trauma ☐ ☐ Victim/Witness to Criminal Activity ☐ ☐
Physical Abuse ☐ ☐ Natural or Manmade Disaster ☐ ☐ War/Terrorism Affected ☐ ☐
Neglect ☐ ☐ Witness to Family Violence ☐ ☐ Disruptions in Caregiving/Attachment Losses ☐ ☐
Emotional Abuse ☐ ☐ Witness to Community/School Violence ☐ ☐ Parental Criminal Behavior ☐ ☐
Notes
Behavioral/Emotional Needs
This domain identifies the mental health needs of the individual. While the CANS is not a diagnostic tool, it is
designed to be consistent with diagnostic communication.
3a. Presenting Situation and Presenting Symptoms
BEHAVIORAL/EMOTIONAL NEEDS n/a 0 1 2 3 n/a 0 1 2 3
Depression ☐ ☐ ☐ ☐ 3+: Impulsivity/Hyperactivity ☐ ☐ ☐ ☐ ☐
Anxiety ☐ ☐ ☐ ☐ 3+: Anger Control/Frustration Tolerance ☐ ☐ ☐ ☐ ☐
Eating Disturbance ☐ ☐ ☐ ☐ 6+: Substance Use [L – see p. 5] ☐ ☐ ☐ ☐ ☐
Adjustment to Trauma [A – below] ☐ ☐ ☐ ☐ 6+: Psychosis (thought Disorder) ☐ ☐ ☐ ☐ ☐
0-6: Regulatory ☐ ☐ ☐ ☐ ☐ 6+: Conduct/Antisocial Behavior ☐ ☐ ☐ ☐ ☐
0-6: Failure to Thrive ☐ ☐ ☐ ☐ ☐ 16+: Interpersonal Problems ☐ ☐ ☐ ☐ ☐
0-6: Atypical/Repetitive Behaviors [B – p.3] ☐ ☐ ☐ ☐ ☐ 21+: Mania ☐ ☐ ☐ ☐ ☐
3-18: Oppositional (Non-compl. w/ auth.) ☐ ☐ ☐ ☐ ☐ 21+: Somatization ☐ ☐ ☐ ☐ ☐
Notes
Learner Workbook (V1 – Last Revised: 2022.05.13) Illinois-Medicaid: Comprehensive Assessment of Needs & Strengths | 18Life Functioning
This domain describes how individuals and families are functioning in the family, peer, school, work, and
community realms.
LIFE FUNCTIONING n/a 0 1 2 3 n/a 0 1 2 3
Family Functioning ☐ ☐ ☐ ☐ 0-6: Elimination ☐ ☐ ☐ ☐ ☐
Living Situation ☐ ☐ ☐ ☐ 0-21: School/Preschool/Daycare [C – p. 3] ☐ ☐ ☐ ☐ ☐
Residential Stability ☐ ☐ ☐ ☐ 3+: Decision Making ☐ ☐ ☐ ☐ ☐
Social Functioning ☐ ☐ ☐ ☐ 6+: Legal [K – see p. 4] ☐ ☐ ☐ ☐ ☐
Recreation/Play ☐ ☐ ☐ ☐ 6+: Sexual Development ☐ ☐ ☐ ☐ ☐
Developmental/Intellectual [B – p. 3] ☐ ☐ ☐ ☐ ☐ 16+: Job Functioning/Employment [D – p. 3] ☐ ☐ ☐ ☐ ☐
Communication ☐ ☐ ☐ ☐ 16+: Parental/Caregiving Role [E – p. 3] ☐ ☐ ☐ ☐ ☐
Medical/Physical ☐ ☐ ☐ ☐ 16+: Independent Living Skills [F – p. 3] ☐ ☐ ☐ ☐ ☐
Medication Compliance ☐ ☐ ☐ ☐ 16+: Intimate Relationships ☐ ☐ ☐ ☐ ☐
Transportation ☐ ☐ ☐ ☐ 21+: Basic Activities of Daily Living ☐ ☐ ☐ ☐ ☐
1+: Sleep ☐ ☐ ☐ ☐ 21+: Routines ☐ ☐ ☐ ☐ ☐
0-6: Motor ☐ ☐ ☐ ☐ ☐ 21+: Functional Communication ☐ ☐ ☐ ☐ ☐
0-6: Sensory ☐ ☐ ☐ ☐ ☐ 21+: Loneliness ☐ ☐ ☐ ☐ ☐
0-6: Persistence/Curiosity/Adaptability ☐ ☐ ☐ ☐ ☐
Notes
Risk Behaviors
Risk behaviors are actions that can get individuals in trouble or put them in danger of harming themselves or
others.
4a. Risk Behaviors
RISK BEHAVIORS n/a 0 1 2 3 n/a 0 1 2 3
Victimization ☐ ☐ ☐ ☐ 6+: Delinquent/Criminal Behavior [K – p. 4] ☐ ☐ ☐ ☐ ☐
0-6: Self-Harm ☐ ☐ ☐ ☐ ☐ 6+: Non-Suicidal Self-Inj. Beh. (Self-Mutilation) ☐ ☐ ☐ ☐ ☐
3-6: Flight Risk ☐ ☐ ☐ ☐ ☐ 6+: Other Self-Harm (Recklessness) ☐ ☐ ☐ ☐ ☐
3+: Suicide Risk ☐ ☐ ☐ ☐ ☐ 6+: Danger to Others [I – p. 4] ☐ ☐ ☐ ☐ ☐
3+: Intentional Misbehavior ☐ ☐ ☐ ☐ ☐ 6+: Fire Setting [J – p. 4] ☐ ☐ ☐ ☐ ☐
6-21: Runaway [G – p. 4] ☐ ☐ ☐ ☐ ☐ 21+: Grave Disability ☐ ☐ ☐ ☐ ☐
6+: Sexually Prob. Behavior [H – p. 4] ☐ ☐ ☐ ☐ ☐ 21+: Hoarding ☐ ☐ ☐ ☐ ☐
6+: Bullying Others ☐ ☐ ☐ ☐ ☐
Notes
Learner Workbook (V1 – Last Revised: 2022.05.13) Illinois-Medicaid: Comprehensive Assessment of Needs & Strengths | 19Strengths
This domain describes the assets of the individual that can be used to advance healthy development.
Strengths can either be internal or external.
8. CLIENT STRENGTHS 0 = Centerpiece Strength 1 = Useful Strengths 2 = Identified Strengths 3 = Not Yet Identified Strength
CLIENT STRENGTHS n/a 0 1 2 3 n/a 0 1 2 3
Family Strengths/Support ☐ ☐ ☐ ☐ 6+: Talents and Interests ☐ ☐ ☐ ☐ ☐
Interpersonal/Social Connectedness ☐ ☐ ☐ ☐ 6+: Cultural Identity ☐ ☐ ☐ ☐ ☐
Natural Supports ☐ ☐ ☐ ☐ 6+: Community Connection ☐ ☐ ☐ ☐ ☐
Spiritual/Religious ☐ ☐ ☐ ☐ 6+: Involvement with Care ☐ ☐ ☐ ☐ ☐
Educational Setting ☐ ☐ ☐ ☐ ☐ 16+: Vocational ☐ ☐ ☐ ☐ ☐
0-21: Relationship Permanence ☐ ☐ ☐ ☐ ☐ 16+: Job History/Volunteering ☐ ☐ ☐ ☐ ☐
2+: Resiliency ☐ ☐ ☐ ☐ ☐ 21+: Self-Care ☐ ☐ ☐ ☐ ☐
6+: Optimism ☐ ☐ ☐ ☐ ☐
Notes
Cultural Factors
These items describe difficulties that the individual may experience or encounter as a result of their
membership in any cultural group and/or because of the relationship between members of that group and
members of the dominant society. For children ages 0-6, rate this section for the family.
9b. Cultural Considerations
CULTURAL FACTORS 0 1 2 3 0 1 2 3
Language ☐ ☐ ☐ ☐ Cultural Stress ☐ ☐ ☐ ☐
Traditions and Rituals ☐ ☐ ☐ ☐
Notes
Learner Workbook (V1 – Last Revised: 2022.05.13) Illinois-Medicaid: Comprehensive Assessment of Needs & Strengths | 20Caregiver Resources & Needs Addendum
These items represent potential areas of need for caregivers while simultaneously highlighting the areas in
which the caregivers can be a resource for the individual.
23a. CAREGIVER RESOURCES & NEEDS
Caregiver Name: _______ Caregiver Relationship to Client: _______
Additional Primary Caregivers: _______
CAREGIVER RESOURCES & NEEDS 0 1 2 3 n/a 0 1 2 3
Supervision ☐ ☐ ☐ ☐ Safety ☐ ☐ ☐ ☐
Involvement with Care ☐ ☐ ☐ ☐ Family Stress ☐ ☐ ☐ ☐
Knowledge ☐ ☐ ☐ ☐ Marital/Partner Violence in the Home ☐ ☐ ☐ ☐
Social Resources ☐ ☐ ☐ ☐ Military Transitions ☐ ☐ ☐ ☐
Financial Resources ☐ ☐ ☐ ☐ Self-Care/Daily Living Skills ☐ ☐ ☐ ☐
Residential Stability ☐ ☐ ☐ ☐ Employment/Educational Functioning ☐ ☐ ☐ ☐
Medical/Physical ☐ ☐ ☐ ☐ Legal Involvement ☐ ☐ ☐ ☐
Mental Health ☐ ☐ ☐ ☐ 0-21: Family Relationship to the System ☐ ☐ ☐ ☐ ☐
Substance Use ☐ ☐ ☐ ☐ 0-21: Accessibility to Child Care ☐ ☐ ☐ ☐ ☐
Developmental ☐ ☐ ☐ ☐ 0-21: Empathy with Children ☐ ☐ ☐ ☐ ☐
Organization ☐ ☐ ☐ ☐
Notes
Learner Workbook (V1 – Last Revised: 2022.05.13) Illinois-Medicaid: Comprehensive Assessment of Needs & Strengths | 21DCFS Addenda
26. PARENT/GUARDIAN SAFETY CONCERNS
Item n/a 0 1 2 3 Item 0 1 2 3
Discipline ☐ ☐ ☐ ☐ Frustration Tolerance ☐ ☐ ☐ ☐
Condition of the Home ☐ ☐ ☐ ☐ ☐ History of Maltreatment of Children ☐ ☐ ☐ ☐
27. PARENT/GUARDIAN WELLBEING CONCERNS
Item 0 1 2 3 Item 0 1 2 3
Parent/Guardian Traumatic Reactions ☐ ☐ ☐ ☐ Independent Living Skills ☐ ☐ ☐ ☐
Parent/Guardian Understanding of Impact of ☐ ☐ ☐ ☐ Relationship/Contact with Caseworker ☐ ☐ ☐ ☐
Own Behavior on Children Responsibility in Maltreatment ☐ ☐ ☐ ☐
Effective Parenting Approaches ☐ ☐ ☐ ☐ Relationship with Abuser(s) ☐ ☐ ☐ ☐
28. PARENT/GUARDIAN PERMANENCE CONCERNS
Item 0 1 2 3 Item n/a 0 1 2 3
Social and Family Connections ☐ ☐ ☐ ☐ Parent/Guardian Participation in Visitation ☐ ☐ ☐ ☐ ☐
Involvement in Personal Treatment ☐ ☐ ☐ ☐ Commitment to Reunification ☐ ☐ ☐ ☐ ☐
29. SUBSTITUTE CAREGIVER COMMITMENT TO PERMANANCE ☐ N/A – youth does not have a substitute caregiver
Item 0 1 2 3 Item 0 1 2 3
Collaboration with Other Parents/Caregivers ☐ ☐ ☐ ☐ Inclusion of the Youth in the Foster Family ☐ ☐ ☐ ☐
Subst. Caregiver Support for Perm. Plan Goal ☐ ☐ ☐ ☐
30. INTACT FAMILY SERVICES MODULE ☐ N/A – youth is not enrolled in Intact Family Services
Item n/a 0 1 2 3 Item 0 1 2 3
Parental/Secondary Caregiver Collaboration ☐ ☐ ☐ ☐ ☐ Family Role Appropriateness ☐ ☐ ☐ ☐
Family Conflict ☐ ☐ ☐ ☐ Home Maintenance ☐ ☐ ☐ ☐
Family Communication ☐ ☐ ☐ ☐
31. INTENSIVE PLACEMENT STABILIZATION SERVICES (IPS) MODULE ☐ N/A – youth is not enrolled in IPS
Item n/a 0 1 2 3 Item 0 1 2 3
Years in Care ☐ ☐ ☐ ☐ Knowledge of Youth’s Development and Needs ☐ ☐ ☐ ☐
Placement History ☐ ☐ ☐ ☐ ☐ Discipline ☐ ☐ ☐ ☐
Substitute Caregiver Management of Emotions ☐ ☐ ☐ ☐
Notes
Learner Workbook (V1 – Last Revised: 2022.05.13) Illinois-Medicaid: Comprehensive Assessment of Needs & Strengths | 22Tips for Rating IM+CANS Items
When you are having trouble rating items:
• Read the description of the item to make sure you understand it.
• Get more information – talk to the individual, caregiver or other providers; review records and charts.
• While most items are rated in the last 30 days, some are not. Make sure you know what period of time
you are rating the item.
• Determine the impact on function of the need and the intensity of action that you need to take to
address the need.
• Use the rating level anchors for each item, if they are helpful (remember – the anchors are not going to
describe every possible situation).
• Rate the items collaboratively with individuals, families and the treatment team.
Unit 4 | Practice Vignette
Tips for Rating a Vignette
Completing a practice or test vignette can be very frustrating.
• If there is no information in the vignette related to a particular item:
o rate a NEED as 0 (no need)
o rate a STRENGTH as 3 (no strength)
• Take the vignette literally—don’t overthink, make any assumptions, or add extra information (from
your knowledge base or experience) into the vignette.
• Review the Needs & Strengths tip sheet.
Why Practice Vignettes?
Vignettes provide an opportunity for a deep dive into understand the communimetric principle of the
actionable items.
• Discussions on vignette and ratings:
o help us understand how our assumptions on a case impacts how we see a youth’s needs and
strengths.
o provide use with an opportunity to practice surfacing disagreements about our perspectives on
a youth’s needs or strengths (pre-rating triangulation).
• Practice vignettes help us understand that establishing reliability is not separate from our process of
relating to, and working with, our children, youth, adult, and family individuals.
Learner Workbook (V1 – Last Revised: 2022.05.13) Illinois-Medicaid: Comprehensive Assessment of Needs & Strengths | 23Mike Vignette Mike is a 15-year-old boy who is currently living with his grandparents. He is not in contact with his mother who has a serious substance dependence disorder. The identity of his father is not known. His last contact with his mother was more than five years ago. Over the past three months, Mike has grown increasingly argumentative and disruptive at home and school. He was suspended for one day two weeks ago for fighting. This occurred after heated arguing and swearing at several other youth. In one fight, he was seen pushing the youth with whom he was arguing. Teachers report that his grades have slipped considerably. He went from being a B/C student to mostly failing his courses this school year. Mike is not in special education – his IQ was recently tested to be 96. At home, his grandmother reports that he starts arguments with her, ignores curfew, and sometimes stays out with friends until 2 or 3 in the morning. There is no evidence that he has engaged in any criminal behavior. Mike’s problems appear to have started after his grandfather had a stroke. His grandfather is better but experienced partial paralysis that forced him to retire early. His grandmother works at an area grocery store. No other children or adults live in the house, although Mike’s aunt, who has five children, lives in the neighborhood. Mike is reportedly close to his cousins and spends a lot of time at their house. Mike has expressed interest in moving in with his aunt, but she is unwilling to take on the added responsibility. His grandparents currently feel like they are no longer able to handle Mike’s behavior and are asking about foster care or residential treatment options. His grandparents report that they do not understand why Mike is so ungrateful to them for taking him in. Mike expresses worries about his grandfather’s health and resentment about all the restrictions they have tried to place on his behavior. Mike has lived with his grandparents since he was an infant. At that time, child welfare had taken him from his mother due to allegations of neglect. She would leave him alone for long periods of time and fail to address his basic needs. As an infant, he was significantly underweight. He now is healthy and active. His grandparents are not active in a church and neither they nor Mike has ever attended religious services. Mike reports that he has a girlfriend but has never been sexually active. Mike reports that they have been dating for about 8 weeks. He has a number of male friends at school. His friends have been supportive of him when he has had problems. At the assessment, Mike seemed to be a generally sullen and non-responsive. He was dressed in a baggy shirt and jeans, had his headphones on, and was listening to music until the assessor asked him to turn it off. He answered questions but did not elaborate even when pressed. He reports no suicidal or homicidal ideation. When the conversation turned to talking about Mike’s girlfriend, his mood brightened notably, he smiled, and talked openly about her, how she makes him feel happy and hopeful that things in his life could change for the better. Learner Workbook (V1 – Last Revised: 2022.05.13) Illinois-Medicaid: Comprehensive Assessment of Needs & Strengths | 24
IM+CANS Training Rating Sheet 2. TRAUMA EXPOSURE No = No evidence of any trauma of this type. Yes = Client has, or is suspected of having, at least one incident, multiple incidents, or chronic, ongoing experience of this type of trauma. POTENTIALLY TRAUMATIC/ADVERSE CHILDHOOD EXPERIENCES (ACEs) Item No Yes Item No Yes Item No Yes Sexual Abuse ☐ ☐ Medical Trauma ☐ ☐ Victim/Witness to Criminal Activity ☐ ☐ Physical Abuse ☐ ☐ Natural or Manmade Disaster ☐ ☐ War/Terrorism Affected ☐ ☐ Neglect ☐ ☐ Witness to Family Violence ☐ ☐ Disruptions in Caregiving/Attachment Losses ☐ ☐ Emotional Abuse ☐ ☐ Witness to Community/School Violence ☐ ☐ Parental Criminal Behavior ☐ ☐ 3. PRESENTING PROBLEM AND IMPACT ON FUNCTIOING 3a. Presenting Situation and Presenting Symptoms BEHAVIORAL/EMOTIONAL NEEDS n/a 0 1 2 3 n/a 0 1 2 3 Depression ☐ ☐ ☐ ☐ 3+: Impulsivity/Hyperactivity ☐ ☐ ☐ ☐ ☐ Anxiety ☐ ☐ ☐ ☐ 3+: Anger Control/Frustration Tolerance ☐ ☐ ☐ ☐ ☐ Eating Disturbance ☐ ☐ ☐ ☐ 6+: Substance Use [L – see p. 5] ☐ ☐ ☐ ☐ ☐ Adjustment to Trauma [A – below] ☐ ☐ ☐ ☐ 6+: Psychosis (thought Disorder) ☐ ☐ ☐ ☐ ☐ 0-6: Regulatory ☐ ☐ ☐ ☐ ☐ 6+: Conduct/Antisocial Behavior ☐ ☐ ☐ ☐ ☐ 0-6: Failure to Thrive ☐ ☐ ☐ ☐ ☐ 16+: Interpersonal Problems ☐ ☐ ☐ ☐ ☐ 0-6: Atypical/Repetitive Behaviors [B – p.3] ☐ ☐ ☐ ☐ ☐ 21+: Mania ☐ ☐ ☐ ☐ ☐ 3-18: Oppositional (Non-compl. w/ auth.) ☐ ☐ ☐ ☐ ☐ 21+: Somatization ☐ ☐ ☐ ☐ ☐ 3b. Impact of Problems on Client’s Functioning LIFE FUNCTIONING n/a 0 1 2 3 n/a 0 1 2 3 Family Functioning ☐ ☐ ☐ ☐ 0-6: Elimination ☐ ☐ ☐ ☐ ☐ Living Situation ☐ ☐ ☐ ☐ 0-21: School/Preschool/Daycare [C – p. 3] ☐ ☐ ☐ ☐ ☐ Residential Stability ☐ ☐ ☐ ☐ 3+: Decision Making ☐ ☐ ☐ ☐ ☐ Social Functioning ☐ ☐ ☐ ☐ 6+: Legal [K – see p. 4] ☐ ☐ ☐ ☐ ☐ Recreation/Play ☐ ☐ ☐ ☐ 6+: Sexual Development ☐ ☐ ☐ ☐ ☐ Developmental/Intellectual [B – p. 3] ☐ ☐ ☐ ☐ ☐ 16+: Job Functioning/Employment [D – p. 3] ☐ ☐ ☐ ☐ ☐ Communication ☐ ☐ ☐ ☐ 16+: Parental/Caregiving Role [E – p. 3] ☐ ☐ ☐ ☐ ☐ Medical/Physical ☐ ☐ ☐ ☐ 16+: Independent Living Skills [F – p. 3] ☐ ☐ ☐ ☐ ☐ Medication Compliance ☐ ☐ ☐ ☐ 16+: Intimate Relationships ☐ ☐ ☐ ☐ ☐ Transportation ☐ ☐ ☐ ☐ 21+: Basic Activities of Daily Living ☐ ☐ ☐ ☐ ☐ 1+: Sleep ☐ ☐ ☐ ☐ 21+: Routines ☐ ☐ ☐ ☐ ☐ 0-6: Motor ☐ ☐ ☐ ☐ ☐ 21+: Functional Communication ☐ ☐ ☐ ☐ ☐ 0-6: Sensory ☐ ☐ ☐ ☐ ☐ 21+: Loneliness ☐ ☐ ☐ ☐ ☐ 0-6: Persistence/Curiosity/Adaptability ☐ ☐ ☐ ☐ ☐ 4. SAFETY 4a. Risk Behaviors RISK BEHAVIORS n/a 0 1 2 3 n/a 0 1 2 3 Victimization ☐ ☐ ☐ ☐ 6+: Delinquent/Criminal Behavior [K – p. 4] ☐ ☐ ☐ ☐ ☐ 0-6: Self-Harm ☐ ☐ ☐ ☐ ☐ 6+: Non-Suicidal Self-Inj. Beh. (Self-Mutilation) ☐ ☐ ☐ ☐ ☐ 3-6: Flight Risk ☐ ☐ ☐ ☐ ☐ 6+: Other Self-Harm (Recklessness) ☐ ☐ ☐ ☐ ☐ 3+: Suicide Risk ☐ ☐ ☐ ☐ ☐ 6+: Danger to Others [I – p. 4] ☐ ☐ ☐ ☐ ☐ 3+: Intentional Misbehavior ☐ ☐ ☐ ☐ ☐ 6+: Fire Setting [J – p. 4] ☐ ☐ ☐ ☐ ☐ 6-21: Runaway [G – p. 4] ☐ ☐ ☐ ☐ ☐ 21+: Grave Disability ☐ ☐ ☐ ☐ ☐ 6+: Sexually Prob. Behavior [H – p. 4] ☐ ☐ ☐ ☐ ☐ 21+: Hoarding ☐ ☐ ☐ ☐ ☐ 6+: Bullying Others ☐ ☐ ☐ ☐ ☐ 8. CLIENT STRENGTHS 0 = Centerpiece Strength 1 = Useful Strengths 2 = Identified Strengths 3 = Not Yet Identified Strength CLIENT STRENGTHS n/a 0 1 2 3 n/a 0 1 2 3 Family Strengths/Support ☐ ☐ ☐ ☐ 6+: Talents and Interests ☐ ☐ ☐ ☐ ☐ Interpersonal/Social Connectedness ☐ ☐ ☐ ☐ 6+: Cultural Identity ☐ ☐ ☐ ☐ ☐ Natural Supports ☐ ☐ ☐ ☐ 6+: Community Connection ☐ ☐ ☐ ☐ ☐ Spiritual/Religious ☐ ☐ ☐ ☐ 6+: Involvement with Care ☐ ☐ ☐ ☐ ☐ Educational Setting ☐ ☐ ☐ ☐ ☐ 16+: Vocational ☐ ☐ ☐ ☐ ☐ 0-21: Relationship Permanence ☐ ☐ ☐ ☐ ☐ 16+: Job History/Volunteering ☐ ☐ ☐ ☐ ☐ 2+: Resiliency ☐ ☐ ☐ ☐ ☐ 21+: Self-Care ☐ ☐ ☐ ☐ ☐ 6+: Optimism ☐ ☐ ☐ ☐ ☐ 9b. Cultural Considerations CULTURAL FACTORS 0 1 2 3 0 1 2 3 Language ☐ ☐ ☐ ☐ Cultural Stress ☐ ☐ ☐ ☐ Traditions and Rituals ☐ ☐ ☐ ☐ Learner Workbook (V1 – Last Revised: 2022.05.13) Illinois-Medicaid: Comprehensive Assessment of Needs & Strengths | 25
23a. CAREGIVER RESOURCES & NEEDS
Caregiver Name: _______ Caregiver Relationship to Client: _______
Additional Primary Caregivers: _______
CAREGIVER RESOURCES & NEEDS 0 1 2 3 n/a 0 1 2 3
Supervision ☐ ☐ ☐ ☐ Safety ☐ ☐ ☐ ☐
Involvement with Care ☐ ☐ ☐ ☐ Family Stress ☐ ☐ ☐ ☐
Knowledge ☐ ☐ ☐ ☐ Marital/Partner Violence in the Home ☐ ☐ ☐ ☐
Social Resources ☐ ☐ ☐ ☐ Military Transitions ☐ ☐ ☐ ☐
Financial Resources ☐ ☐ ☐ ☐ Self-Care/Daily Living Skills ☐ ☐ ☐ ☐
Residential Stability ☐ ☐ ☐ ☐ Employment/Educational Functioning ☐ ☐ ☐ ☐
Medical/Physical ☐ ☐ ☐ ☐ Legal Involvement ☐ ☐ ☐ ☐
Mental Health ☐ ☐ ☐ ☐ 0-21: Family Relationship to the System ☐ ☐ ☐ ☐ ☐
Substance Use ☐ ☐ ☐ ☐ 0-21: Accessibility to Child Care ☐ ☐ ☐ ☐ ☐
Developmental ☐ ☐ ☐ ☐ 0-21: Empathy with Children ☐ ☐ ☐ ☐ ☐
Organization ☐ ☐ ☐ ☐
Tips for Rating IM+CANS Items in Practice
The IM+CANS must minimally have sufficient documentation to establish medical necessity
for recommended services.
The initial IM+CANS will not provide as complete of a clinical picture of a customer as
subsequent IM+CANS will, as new information and history will be discovered as the
therapeutic relationship between customer and clinician develops.
If there is no evidence of a need/strengths, the core domain items and the items in any
modules that been triggered for the customer must be scored a ‘0’ for needs or a ‘3’ for
strengths rather than left blank
What must be documented on the IM+CANS for it to be considered
complete?
• An IM+CANS is considered complete once the authorizing LPHA has reviewed,
approved, and signed the IM+CANS.
• The completed IM+CANS should minimally document medical necessity for the
recommended services.
What is required for an “Update” of the IM+CANS?
• An “update” is any change made to the IM+CANS that occurs during the 180-day
period between assessment/reassessment.
• Updates should be used to capture additional information relevant to the
customer’s behavioral health needs and circumstances.
Learner Workbook (V1 – Last Revised: 2022.05.13) Illinois-Medicaid: Comprehensive Assessment of Needs & Strengths | 26Collaborative Treatment Planning
How to Register for Treatment Planning
Go to the PATH webpage.
Click on “Access Training and Materials”.
Click on “See Schedule”.
Iden�fy desired Treatment Planning date.
Click “Register”.
Click “Register Now”.
Online Certification
TCOM Training: New User Registration
1. Enter https://tcomtraining.com into your web browser.
2. Click the “Sign Up” link above the log-in field.
3. Input the *required* information.
4. Complete the “I’m not a robot” verification and click “Sign Up Now”.
TCOM Training: Returning User
1. Enter https://tcomtraining.com into your browser.
2. Enter your email address and password.
3. Once you complete steps 1 & 2, you’ll be prompted to reset your password.
4. Select your agency using the filters.
o If your agency is not listed, contact support@tcomtraining.com to add it as an option.
5. Your account is now reactivated, and your password reset to that of your choosing.
Learner Workbook (V1 – Last Revised: 2022.05.13) Illinois-Medicaid: Comprehensive Assessment of Needs & Strengths | 27Closing
How do you plan to bring the TCOM Philosophy and Communimetrics to your agency?
Commitment & Action Plan
What are the most useful take-aways from the session?
What specific actions will I take? When?
Learner Workbook (V1 – Last Revised: 2022.05.13) Illinois-Medicaid: Comprehensive Assessment of Needs & Strengths | 28Additional Information
• For copies of IM+CANS forms, go to the PATH Training Website.
• For online training and certification, download the “Schoox How To” document with instructions on
creating and accessing an account on https://schoox.com.
• For additional information about the IATP and clarification on policies, visit the HFS website.
• For general questions about the IM+CANS implementation, email hfs.cbh@illinois.gov
References
Illinois Department of Healthcare and Family Services (2018). Frequently Asked Questions: Integrated
Assessment and Treatment Planning (IATP). Retrieved from
https://www2.illinois.gov/hfs/SiteCollectionDocuments/IATPWebinarFAQfinal8218.pdf
Illinois Department of Healthcare and Family Services (2022). Frequently Asked Questions: Community-Based
Behavioral Services (CBS) Retrieved from
https://www2.illinois.gov/hfs/SiteCollectionDocuments/CBSServiceFAQ09162021.pdf
Illinois Department of Healthcare and Family Services (2022). Community-Based Behavioral Services (CBS)
Provider Handbook. Retrieved from
https://www2.illinois.gov/hfs/SiteCollectionDocuments/04282022CommunityBasedBehavioralServices
HandbookFor05012022Final.pdf
Illinois Department of Healthcare and Family Services. (n.d.). Integrated Assessment and Treatment Planning
(IATP). Retrieved from
https://www2.illinois.gov/hfs/MedicalProviders/behavioral/CommunityMentalHealthCenter/Pages/IA
TP.aspx
Provider Assistance and Training Hub (n.d.). Access Trainings and Materials. Retrieved from
https://socialwork.illinois.edu/community-partnerships/agency-based-partnerships/provider-
assistance-and-training-hub/path-training-materials/
Transformational Collaborative Outcomes Management (n.d.). TCOM Conversations. Retrieved from
https://www.tcomconversations.org
Learner Workbook (V1 – Last Revised: 2022.05.13) Illinois-Medicaid: Comprehensive Assessment of Needs & Strengths | 29Appendix A: IM+CANS Box 14 Reference Sheet Learner Workbook (V1 – Last Revised: 2022.05.13) Illinois-Medicaid: Comprehensive Assessment of Needs & Strengths | 30
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