Change in Child and Adolescent Needs and Strengths (CANS) Scores over Time Among Youth in out-of-Home Care: A Latent Growth Curve Analysis

Background and Purpose: Placement into out-of-home care (OOHC) is an adverse childhood experience, and youth in OOHC have experienced other forms of adversity, such as maltreatment. This complex exposure to adversity places youth in OOHC at increased risk for mental/behavioral health problems. The Child and Adolescent Needs and Strengths (CANS) is a decision-support tool used by child welfare and mental/behavioral health systems to identify needs and track progress. However, few studies have examined longitudinal change of youths’ CANS scores (Sokol et al., 2020). The purpose of the current study was to explore how CANS scores of youth in OOHC change over time.

Methods: Through partnership with a state’s child welfare and mental/behavioral health agencies, we used data from 6,104 youth who entered OOHC between 2016-2022. Total scores for each of the six CANS domains (Risk Behaviors, Strengths, Life Functioning, Behavioral/Emotional Needs, Cultural Factors, Caregiver Needs and Resources) were computed for all youth at five timepoints (T1-T5; initial assessment, then approximately every 3 months). Higher scores indicated worse functioning in each of the domains. To explore the trajectory of CANS scores over time, we used latent growth curve models and fit a series of increasingly complex models to identify the best fitting functional form.

Results: Across all six CANS domains, the piecewise linear model fit best. The “change-point” of the piecewise trajectory was at T3. The average initial level (i.e., the intercept) of all six domains significantly varied across youth. Between T1 and T3 (i.e., initial to 6 months), on average, youth experienced a significant linear rate of change in all six domains, such that scores decreased over time. Between T3 and T5 (i.e., 6 months to 12 months), on average the trajectories of CANS scores for all domains except for Caregiver Needs remained relatively stable. The average trajectory for Caregiver Needs decreased linearly from T3 to T5. There was significant between-youth variation in both the rate of change from T1 to T3 and from T3 to T5 across all six domains. The significant covariances across all six domains indicate that on average, youth with higher initial levels tended to decrease faster from T1-T3 and from T3-T5, while youth who decreased faster from T1-T3 tended to have slower rates of change from T3-T5.

Conclusions and Implications: This study contributes to our knowledge of how youths’ needs change over time within the context of OOHC. The findings indicate that on average youths’ scores improve over time and youth with higher initial levels of needs tended to improve faster, at least within the first six months. Understanding whether service receipt after the identification of higher initial needs contributes to the faster rate of improvement for youth is an important area of future research. Additionally, identifying factors that may account for between-youth variability in initial levels and rate of change within CANS domains is important to identify groups of youth who may be more (or less) at risk and to inform potential areas for intervention within child welfare and mental/behavioral health practice.