Patterns and priorities of service need identified through the Child and Adolescent Needs and Strengths (CANS) assessment

Using recursive partitioning on thousands of enrollment Child and Adolescent Needs and Strengths (CANS) assessments, we identified characteristics of the most troubled children/youth requiring comprehensive interventions reflected by a count of total actionable items (TAI) from 129 possible CANS actionable treatment planning items. Samples included 2557 and 6982 children/youth from two separate large, multi-program, California-based mental health treatment agencies administering CANS routinely upon enrollment. In two separate random forest analyses, 20 top predictors were identified which indicated very high levels of clinical severity needing comprehensive, urgent intervention at each agency, with 13 out of the 20 predictors common to both agencies' populations. Agency-specific decision trees were constructed with the top 20 predictors to examine relationships between predictors, which further identified four predictors of need highly prioritized at both agencies: child's frustration management problems, recreation and leisure time activity challenges, poor response to consequences for aggressive behavior, and lack of optimism. Within these service populations, children with actionable need for intervention in these four areas had four to five times more TAI as compared to children without these areas identified. A handful of the CANS items assessed can indicate very high severity ratings for a service population, and localized use of recursive partitioning analysis based on TAI can identify these core problems for specific programs or across agencies, helping clinicians to understand patterns and priorities within populations served.