Using the adult Camberwell Assessment of Need (CAN) in clinical practice
Using CAN clinically
The adult CAN is used by mental health and social care professionals to help them fully understand the difficulties experienced by a service user and then plan appropriate care and support. It supports comprehensive person-centred care planning by recognising the subjective nature of need – allowing information to be gathered from both the professional and the individual they are supporting, and providing a tool to support negotiation about priority needs to target in the care plan.
How does the adult CAN help in clinical practice?
The completed assessment can be used for several purposes:
- to identify the appropriate level of care to offer (people with more severe and wide-ranging mental health problems should be seen by specialist mental health services);
- as a focus for care planning – negotiating the actual help and treatment to be offered;
- as a review mechanism, to record the service user’s needs at a particular point in time and to verify whether Unmet needs are becoming Met needs;
- (in aggregated form) to inform service developments, by identifying domains which are common needs amongst people using the service, but which the service does not currently address.
What client groups can I use the CAN with?
The CAN was initially developed and tested with adults who had a clinical diagnosis of a major psychotic disorder and were receiving help from mental health services either in hospital or the community. Since then, it has been used with many populations, including other types of mental health diagnosis, in a range of service models (assertive outreach, early psychosis, etc.) and with people living with neurological and other long-term conditions. Other versions of the CAN are available for people with learning disabilities (CANDID), older adults (CANE), pregnant women and mothers (CAN-M), forensic (CANFOR) and emergency relief situations (HESPER).
Is the adult CAN a full clinical assessment?
No. The adult CAN is intended to give a comprehensive assessment of the needs of the service user, but for each domain in which needs are identified, a fuller assessment may be necessary. The full assessment information (the service user’s ‘story’) should be recorded in the clinical case notes as normal. The adult CAN measures are designed to be used as summary recording sheets.
What’s the best adult CAN version to use clinically?
For most clinical uses, CANSAS or CANSAS-P will be the best assessment to use.
Is the adult CAN suitable for use with the people who use my service?
The adult CAN is suitable for use as a comprehensive assessment with working age adults who use a range of mental health services. It was developed and tested for use by adult mental health services, in community and hospital settings. It has also been used in assertive outreach teams, early psychosis teams, women-only services, drug and alcohol teams, and acute in-patient surveys. Variants for other groups also exist – see the main Camberwell Assessment of Need page.
Do mental health professionals need special training to use the adult CAN?
The adult CAN is designed to be used by all mental health professionals without any formal training. However, it may sometimes be a good idea to train staff. The CAN 2nd edition book contains detailed information about training, as well as the theory base and empirical evidence for using CAN. It is recommended that the adult CAN 2nd edition book be obtained as a resource when using the CAN clinically.
How is the service user CAN-C assessment completed?
An assessment meeting with a service user can be structured using the 22 domains, but this does not necessarily mean having a copy of the CAN on show during the assessment. There are several ways of obtaining the service user assessment. Often the best approach – consistent with the principle that the focus should be on the conversation not the rating – is to use the 22 CAN domains as a mental checklist of areas to cover in the assessment, with the actual form filled in after the meeting. Many domains will be covered in the course of the assessment, and the remaining domains can then be assessed by starting with a statement such as: ‘To help me get a fuller picture, can I also ask you about…?’. A second approach is to show the service user how to complete CANSAS-P, and give it to them for self-rating before or during the assessment meeting. A third approach is for the staff to ask questions about each domain, and then fill in the service user assessment on the basis of their responses.
Does every domain need to be assessed?
No. Some domains may feel embarrassing or be counter-therapeutic to assess. However, although domains such as intimate relationships and sexual expression can be awkward to introduce, if discussed skilfully this does give an opportunity for people to talk about areas they might find too embarrassing to bring up themselves. It is worth remembering that sexual dysfunction as a side effect of anti-psychotic medication is often not reported, unless specifically asked about. Similarly, risk of violence and suicide should be assessed with sensitivity, using questions such as: ‘Do you ever have problems with your temper?’ and ‘Do you ever feel you can’t cope with all your problems?’. For every domain, the service user can choose not to answer, and this should be made clear. The need rating for that domain is then recorded as ? (Not known).
Do I rate the domain if our clinical team would not offer an intervention for that particular problem?
The 22 domains were widely agreed to be relevant domains of need, although any particular team might only address some of these. Irrespective of whether the team would address this problem, the problem should be rated if it exists. For some domains, one type of help that might be offered is a referral to a more appropriate agency.
How is the staff CAN-C assessment completed?
The staff assessment is recorded separately from the service user assessment. For the staff rating, it is good practice to use the full range of information available. Possible sources of information include an interview with the service user, clinical notes, an interview with the referrer and other staff or agencies involved in the service user’s care.
Clinically, what use can I make of differences between the staff and service user ratings?
It is helpful to acknowledge disagreement, since negotiating care goals leads to a better working alliance, and makes it more likely the service user will adhere to the treatment plan. Not acknowledging differences often results in a care plan which over-emphasises the staff perspective, and for which the service user is less motivated. Where possible, it is important to agree which area(s) to focus treatment on, and what type of help to provide. This negotiation is best done through an explicit discussion leading to agreement with the service user. The discussion may be facilitated by comparing the CAN assessments, to identify those domains which are seen by both staff and the service user as a need, and those about which there is disagreement. The aim is for the discussion to be characterised by respect (so make clear that the service user perspective has been listened to and recorded) and curiosity about the differences. Possible reasons might include:
- differing values, e.g. the service user places a high priority on being independent and so rejects help being offered as they perceive it to be dependency-inducing
- awareness of the full picture, e.g. staff are often not aware of all support the person is getting from informal sources
- differences in expectations, e.g. the service user may have high anticipated discrimination in relation to employment so feel there is no point trying to get a job
Understanding these differences will increase therapeutic alliance and improve recovery support.
Is there an electronic version of the adult CAN for clinical use?
No, though many services internationally have incorporated the adult CAN into their local electronic record systems. If you would like permission to put the adult CAN onto your local system, please send details of what is proposed to firstname.lastname@example.org