Phases and Activities of the Wraparound Process - Los Angeles ...

L. A County DCFS Resource Utilization
EXHIBIT A-8
Child and Adolescent Needs and Strengths-Child Welfare (CANS-CW)
revised 02/01/07
Child’s Name:
State ID and Regional Office
Date of Birth
Age:
Assessor:
Assessment Date:
Child’s Current Placement
Child’s Date of admission to current
placement
Child’s ending placement
Service Component:( FM, FR, PP)
No of prior group home placements
No of prior foster home placements
No. of Prior Psychiatric Hospitalizations
Child receiving Wrap, TBS or Systems of
Care
CANS based on TDM or Teleconference
or RPRT
Scoring:
“0” indicates no need for action
“1” indicates a need for watchful waiting to see whether action is warranted
“2” indicates a need for action
“3” indicates the need for immediate or intensive action
Functional Status
1. Motor
2. Sensory
3. Intellectual
4. Communication
5. Developmental
6. Self Care/ Daily Living
0 1 2 3 U