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Care and Needs Scale

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Purpose

The care and needs scale is an 8-level categorical scale that is designed to measure the level of support needs of older adolescents and adults with traumatic brain injury.

Link to Instrument

Acronym CANS

Area of Assessment

Activities & Participation
Cognition
Executive Functioning
Mental Functions
General Health & Development
Bodily Functions

Assessment Type

Observer

Administration Mode

Paper & Pencil

Cost

Free

CDE Status

Not a CDE--last searched 1/27/2026

Populations

Brain Injury
Non-Patient

Key Descriptions

  • 28 item needs checklist covers type of care and support needs
  • Needs checklist items are classified into a hierarchy of five groups (A to E) representing decreasing levels of support needs
  • Extent of support needs is classified into a hierarchical, 8 level support form
  • Once the needs checklist is complete, length of time left alone is determined based on responses
  • The Pediatric Care and Needs Scale (PCANS) was developed to assess support needs following childhood acquired brain injury (ABI) for children ages 5-18 years (Soo et al., 2008). A 25-item checklist was created after examination of the CANS, with three items deemed not appropriate for the pediatric population eliminated and the item employment/school separated into two distinct items for the PCANS. The items were also expanded to a final comprehensive list of 130 activities nested within the 25-item checklist, which was classified into four domains: Special Needs, ADL, IADL, and Psychosocial. The list of activities was grouped according to four age ranges, with separate forms created for each: Form A: 5-7 years, Form B: 8-11 years, Form C: 12-14 years, and Form D: 15-18 years. For each age range, three levels of skill were identified for each activity: independence expected for age, emerging independence, and independence not expected for age. Each of the forms has the same number of activities, but the number of activities where independence is expected is higher in the forms for older children.

Number of Items

28

Equipment Required

  • CANS Checklist

Time to Administer

10-15 minutes

Required Training

Reading an Article/Manual

Required Training Description

Should be performed by a trained clinician. It is intended to be administered by health professionals with experience working in a rehabilitation setting with people with brain injury.

Age Ranges

Adult

18 - 64

years

Older Adult

65 +

years

Instrument Reviewers

Reviewed in January 2026 by occupational therapy students Grace Arndt, Ashley Burk, Isabelle Kadlubowski, Elizabeth Klopp, Grace McNabb, and Kylie Van De Loo under the supervision of Jessica Schmidt OTD, MS-OTR/L, Concordia University Wisconsin.

ICF Domain

Participation
Activity

Measurement Domain

Participation & Activities
Cognition
Emotion
General Health

Professional Association Recommendation

None found--last searched 1/27/2027

Considerations

  • Due consideration must be given for each of the 24 specific items
  • If items in Group A are endorsed, it is likely that items in Groups B, C and D may also require care and support
  • For children and adolescents aged 5-18 years, the Pediatric Care and Needs Assessment is available (see Key Descriptions and data for the Brain Injury population)

Brain Injury

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Test/Retest Reliability

Brain Injury: (Soo et al., 2007; Sample 1: n = 30 w/TBI, mean age = 31.4 years, male = 73%, median time post trauma = 42.3 months (range = 5.4-209.4 months; Sample 2: n = 40 w/brain injury, mean age = 40.3 years, male = 62%, median time post trauma = 31.1 months (range = 5.6-356.2 months); overall age range = 16-70 years; test-retest interval = one week)

  • Excellent test-retest reliability: (ICC = 0.98)

 

Interrater/Intrarater Reliability

Brain Injury: (Soo et al., 2007)

  • Excellent interrater reliability (ICC = 0.93-0.96 between two OTs and a case manager/ICC = 0.95 between two OTs)

 

 

Criterion Validity (Predictive/Concurrent)

Concurrent Validity

Brain injury: (Tate, 2004; n = 67; mean age at injury = 24 years; male = 76%; Time Post Traumatic Brain Injury = 20-26 years)

  • Adequate to Excellent correlations between scores on the CANS and those for the Craig Handicap Assessment and Reporting Technique (CHART) and the Sydney Psychosocial Reintegration Scale (SPRS) (r = -0.46 to -0.85)
  • Excellent correlation between scores on the CANS and the Supervision Rating Scale (SRS) (r = 0.75)

Brain Injury: (Soo et al., 2010; n = 68)

  • Adequate to Excellent correlations between CANS level of support need SRS (r = 0.68), Functional Independence Measure (FIM) (r = -0.54 to -0.59), SPRS (r = -0.43 to -0.54), and Disability Rating Scale (DRS) (r = 0.64)

Brain injury: (Soo et al., 2007)

  • Moderate to high concurrent validity between the CANS and the Supervision Rating Scale (r = 0.75) and measures of community participation with the CHART and SPRS (r=-0.46 to –0.8 and r= - 0.61--0.85, respectively)

Pediatric Brain Injury: (Soo et al., 2008; n = 32 parents of children w/ABI aged 5 – 18 years, Australian sample, PCANS)

  • Excellent correlations between the PCANS support extent and intensity scores and the Vineland Adaptive Behavior Scales (VABS) (r = -0.63 to -0.77)
  • Adequate to Excellent correlations between PCANS support extent and intensity scores and the Functional Independence Measure for Children (Wee-FIM) (r = -0.46 to -0.69), and King’s Outcome Scale for Childhood Head Injury (KOSCHI) (r = -0.57 to -0.63)

Predictive Validity

Brain injury: (Soo et al., 2010)

  • Adequate predictive validity between CANS at inpatient rehabilitation discharge and scores on measures of functioning at 6-month follow up: SRS (r = 0.43), Functional Independence Measure (FIM) (r = -0.38 to -0.41), SPRS (r = -0.42 to -0.47), and Disability Rating Scale (DRS) (r = 0.42)

Construct Validity

Convergent validity:

Brain Injury: (Soo et al., 2010)

  • Adequate correlations between CANS level of support scores and MMSE Orientation (r = 0.46) and Total (r = 0.38) scores.

Pediatric Brain Injury: (Soo et al., 2008)

  • Excellent correlations (p < 0.01) between:
    • VABS daily living skills and PCANS ADL items (r = -0.71)
    • VABS socialization and PCANS psychosocial items (r = -0.64)
    • Wee-FIM self-care and PCANS ADL items (r = -0.64)
    • Wee-FIM mobility and PCANS ADL items (r  = -0.63) 
  • Adequate correlations (p < 0.05) between:
    • VABS daily living and PCANS IADL items (r = -0.43)
    • VABS communication and PCANS psychosocial items (r = -0.48)

 

Discriminate validity:

Brain Injury: (Soo et al., 2007)

  • Significant ability of CANS to discriminate between client and relative ratings of level of support (z = -3.42, p < 0.01), with median scores indicating that client ratings of support needs were lower than relative ratings with scores of 1 (can be left alone, with intermittent contact) and 3 (can be left alone a few days a week), respectively.

Brain Injury: (Soo et al., 2010)

  • Excellent correlations between CANS level of support scores and Shipley Institute of Living Scale (SILS) – Vocabulary (r = -0.26) and NEO-Five Factor Inventory (NEO-FFI) (r = -0.07 to 0.16)
  • Significant ability of the CANS level of support scores to discriminate between dichotomized posttraumatic amnesia (PTA), FIM, and DRS scores, with participants having longer PTA or lower functioning scores on the FIM or DRS having a significantly higher level of support need on the CANS (p < 0.01)

Pediatric Brain Injury: (Soo et al., 2008)

  • Excellent correlations between Wee-FIM self-care and PCANS IADL items (r = -0.11) and between Wee-FIM self-care and PCANS psychosocial items (r = -0.29)
  • Significant ability of PCANS scores to discriminate between high and low functioning groups on the VABS Adaptive Behavior Composite (ABC) and the KOSCHI
    • Mann-Whitney U-tests indicated those with high functioning scores on the VABS ABC had significantly lower PCANS extent and intensity scores than those with lower functioning scores (p < 0.01)
    • Similar tests revealed that those in the higher functioning KOSCHI group had significantly lower PCANS intensity (p < 0.01) and extent (p < 0.05) scores compared to the lower functioning group

 

 

Content Validity

Pediatric Brain Injury: (Soo et al, 2008; p. 206)

  • The structure of the PCANS was derived directly from the CANS, but changes were required, both to the checklist of items, as well as the conceptual framework of measuring support need within a developmental context. Adapting the PCANS from the CANS involved three distinct phases, conducted over a 2-year period.
  • Item development was conducted with a group of experienced clinicians from multi-disciplinary backgrounds in pediatric brain injury rehabilitation representing occupational therapy, psychology and rehabilitation medicine.

 

Responsiveness

Brain Injury: (Soo et al., 2010)

  • Significant responsiveness at detecting changes over a 6-month period from the time of inpatient rehabilitation discharge. (ES = 0.98) (Soo et al, 2010; n = 40; assessed at inpatient rehabilitation discharge and 6 months)

 

Non-Patient

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Normative Data

Non-Patient: (Soo et al., 2010; n = 300; parents of typically developing children between the ages of 5 and 14 years, 30 for each single year of age; Australian sample; Pediatric Care and Needs Scale (PCANS))

Median Total Score (IQR) on PCANS by Age

Age

Median Total Score (IQR)

5

91 (27)

6

81 (35)

7

74.5 (44)

8

64 (29)

9

58.5 (29)

10

50.5 (26)

11

49 (27)

12

46.5 (27)

13

40 (29)

14

42 (28)

 

Bibliography

Soo, C., Tate, R. L., Anderson, V., & Waugh, M.-C. (2010). Assessing Care and Support Needs for Children With Acquired Brain Injury: Normative Data for the Paediatric Care and Needs Scale (PCANS). Brain Impairment, 11(2), 183–196.  

Soo, C., Tate, R., Hopman, K., Forman, M., Secheny, T., Aird, V., Browne, S., & Coulston, C. (2007). Reliability of the care and needs scale for assessing support needs after traumatic brain injury. The Journal of Head Trauma Rehabilitation, 22(5), 288–295.  

Soo, C., Tate, R.L., Williams, L., Waddingham, S.; & Waugh, M.C. (2008). Development and validation of the pediatric care and needs scale (PCANS) for assessing support needs of children and youth with acquired brain injury. Developmental Neurorehabilitation, 11(3), 204-214.  

Soo, C., Tate, R. L., Aird, V., Allaous, J., Browne, S., Carr, B., Coulston, C., Diffley, L., Gurka, J., & Hummell, J. (2010). Validity and responsiveness of the care and needs scale for assessing support needs after traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 91(6), 905–912.  

Tate, R. L. (2004). Assessing support needs for people with traumatic brain injury: the care and needs scale (CANS). Brain Injury, 18(5), 445-460. 

 


 

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