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We have used a uniform methodological approach to develop assessment tools to guide service delivery for children with mental health needs, developmental disabilities, issues of sexual development, juvenile justice involvement and child welfare involvement. In addition, there is a tool that can be used to assess children in the early developmental stages. The basic approach allows for a series of locally constructed decision support tools that we commonly refer to as the Child & Adolescent Needs and Strengths (CANS).
 
The background of the CANS comes from our prior work in modeling decision-making for psychiatric services. In order to assess appropriate use of psychiatric hospital and residential treatment services, we developed the Childhood Severity of Psychiatric Illness (CSPI). This measure was developed to assess those dimensions crucial to good clinical decision-making for expensive mental health service interventions. We have demonstrated its utility in reforming decision making for residential treatment (Lyons, Mintzer, Kisiel, & Shallcross, 1998) and for quality improvement in crisis assessment services (Lyons, Kisiel, Dulcan, Chesler & Cohen, 1997; Leon, Uziel-Miller, Lyons, Tracy, 1998). The strength of the mesaurement approach has been that it is face valid and easy-to-use, yet provides comprehensive information regarding the clinical status of the child or youth.
 
The CANS builds on the methodological approach for the CSPI but expands the assessment to include a broader conceptualization of needs and the addition of an assessment of strengths. It is a tool developed to assist in the management and planning of services to children and adolescents and their families with the primary objectives of permanency, safety, and improved quality in of life. The CANS is designed to be used either as a prospective assessment tool for decision support during the process of planning services or as a retrospective assessment tool based on the review of existing information for use in the design of high quality systems of services. This flexibility allows for a variety of innovative applications. The CANS can be used for retrospective file reviews for planning purposes. Retrospective review of prospectively completed CANS allows for a form of measurement audit to facilitate the reliability and accuracy of information (Lyons, Yeh, Leon, Uziel-Miller & Tracy, 1999).
 
The CANS is designed for use at two levels-for the individual child and family and for the system of care. The CANS provides a structured assessment of children along a set of dimensions relevant to service planning and decision making. Also, the CANS provides information regarding the child and family's service needs for use during system planning and/or quality assurance monitoring. Due to its modular design the tool can be adapted for local applications without jeopardizing its psychometric properties
 
The dimensions and objective anchors used in the CANS are developed by focus groups with a variety of participants including families, representatives of the provider community, case managers, and staff. The goal of the measurement design is to ensure participation of representatives of all partners to begin building a common assessment language. The CANS measure is then seen predominantly as a communication strategy. Testing of the reliability of the CANS in its applications for developmental disabilities and mental health indicate that this measurement approach can be used reliably by trained professionals and family advocates.
 
As an example, the following are a summary of the dimensions of the CANS-MH. Unless otherwise specified, each rating is based on the last 30 days. Each of the dimensions is rated on a 4-point scale after routine service contact or following review of case files. The basic design is that '0' reflects no evidence, a rating of '1' reflects a mild degree of the dimension, a rating of '2' reflects a moderate degree and a rating of '3' reflects a severe or profound degree of the dimension. Another way to conceptualize these ratings is that a '0' indicates no need for action, a '1' indicates a need for preventive services or watchful waiting to see whether action is warranted in the future, a '2' indicates a need for action, and a '3' indicates the need for either immediate or intensive action. In order to maximize the ease of use and interpretation, please note that the last two clusters of dimensions, Caregiver Capacity and Strengths, are rated in the opposite manner to maintain consistency across the measure.