Change in Child and Adolescent Needs and Strengths (CANS) scores over time among children and youth in out-of-home care: A latent growth curve analysis

Background

Children and youth in out-of-home care (OOHC) have significant behavioral health needs and may not receive relevant treatment. While the literature has urged implementation of standardized assessment of behavioral health needs, and specifically mental, emotional and social wellbeing, for these children and youth, little is known about the extent to which these needs improve over time.

Objective

The study purpose was to examine whether improvement in functioning was detected over time based on Child and Adolescent Needs and Strengths (CANS) scores, and how scores improved over time.

Participants and setting

The study examined scores for 6104 children and youth in OOHC between 2016 and 2022 in one state.

Methods

Total scores for six CANS domains (behavioral/emotional needs, risk behaviors, strengths, cultural factors, life functioning, caregiver resources and needs) were computed for children and youth at five timepoints at baseline and approximately every three months. To explore the trajectory of scores over time we used latent growth curve models and fit a series of increasingly complex models to identify the best fitting form.

Results

While initial levels of CANS domain scores each varied significantly across children and youth, on average CANS domain scores significantly decreased over time between T1 and T3, demonstrating overall improvement. Children and youth with higher initial levels experienced a faster rate of change T1–T3, which tended to slow from T3–T5.

Conclusions

Understanding whether behavioral health services after the identification of higher initial behavioral health needs contribute to the faster rate of improvement for these youth is an important area of future research. Identifying factors that account for between-youth variability in initial levels and rate of change is important to identify groups of youth who may be more (or less) at risk and to inform intervention.