Research into Recovery and Wellbeing

A website about the work of the recovery research team at the Institute of Mental Health

The University of Nottingham

Adult Camberwell Assessment of Need (CAN) rating

How is the adult CAN scored?

The adult CAN score is the number of Unmet needs (the number of domains rated as Unmet – ranging from 0 to 22) and the number of Met needs (the number of domains rated as Met – again, ranging from 0 to 22).

What time period is covered by the adult CAN?

Needs in the last month are assessed.

Is it acceptable to combine the staff and service user adult CAN ratings?

No. Staff and service user ratings are different, so combining them to make a single rating will lose the information about where there are disagreements. Each assessment should be recorded separately.

Is it acceptable to use different sources of information?

For the service user rating, only their stated views should be recorded. 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, information from a referrer and other staff or agencies involved in the service user’s care.

Can I just do service user OR staff ratings?

Yes. Sometimes this may be necessary – for example, where the service user is unwilling to give their perspective on their needs. However, research indicates that staff and service users do not rate identically, so information is lost when only one perspective is assessed.

How long do adult CAN assessments take to complete?

In testing CAN-R, the staff interviews took on average 9 minutes to complete, and the service user interviews took 16 minutes. The CAN-C will take longer than this, since it involves negotiating an action plan with the service user for each domain in which a need is identified. The CANSAS takes less than 5 minutes to complete and the CANSAS-P up to 10 minutes.

How do I summarise the adult CAN ratings?

Summary sheets for CAN-R and CAN-C are available in the adult CAN book.

How is the need rating made?

The need rating for each domain is made in the same way:
0 = no serious problem (No need)

1 = no/moderate problem due to help given (Met need)
2 = serious problem (Unmet need)

9 = not known

A practical approach to rating the domain is to establish if there is a current serious problem. If there is the rating is 2 (Unmet need). If there is not, is this because the person is getting help (rating 1: Met need) or because there is no issue in this domain (rating 0: No need).

Just because there is currently no problem, the need rating is not automatically 0. For example, someone with diabetes who is physically well because of their prescribed insulin would be rated as 1 (Met need) for physical health. Similarly, a need can exist for a variety of reasons. Someone with a diagnosis of a mental illness involving the symptoms of psychosis may currently be unable to do their shopping because of a sprained ankle. They should be rated as having an Unmet need (need rating 2) in the Food domain, even though this need is not related to their mental health problems. A service user rating of 9 is made where the service user does not wish to discuss the domain, and a staff rating of 9 is made where the member of staff chooses not to assess the domain.

What is the need rating if the service user says there is still a serious problem despite receiving help?

Unmet need.

What is the need rating if the service user says they still experience some difficulties, despite receiving help?

If the service user perceives the intervention as reducing the problem to a moderate level, then the need rating is Met need. If they perceive the problem as still being serious then the need rating is Unmet need. If in doubt, ask whether they see the problem as manageable with the current level of help. The difference between a Met and Unmet need is a matter of judgement, and the judgement of the staff and the service user may differ.

What is the need rating when the service user refuses all help offered?

The service user rating is No need or Unmet need, depending on whether they perceive a need to exist. The staff rating is Unmet need. This is one reason why the presence of an unmet need should not be taken as showing inadequate care.

What is the need rating if the service user’s perception is that there is no problem, but they are receiving help?

Always record the service user’s stated perspective when making the user rating, even if this appears irrational or inconsistent with what is known about them. If they say that there is no problem, it may be helpful to ask if they are receiving any help in that area. If they are, ask them what the help is for. If they acknowledge that the help prevents the problem occurring, then the need rating is Met need. If they say that the help is not connected with the problem, or that they are not getting any help, then the need rating is No need.

Accommodation: the service user is in hospital

If a service user has appropriate accommodation outside hospital to which they are expected to return on discharge, the need rating is No need. Otherwise the need rating is Met need.

Accommodation: the service user lives with their parents

For the service user rating, ask whether they live with their parents because of mental health or other problems (no = No need, yes = Met or Unmet need).

The staff assessment may be that the service user is living with their parents because of their mental health problems (Met or Unmet need). If not, then the staff assessment will be that either most people like the service user (but without mental health problems) would still live with their parents (No need), or that most people like the service user would have left the parental home (Met or Unmet need).

Food: the service user cannot cook

Normally this would be rated Met need (if acceptable help is given) or Unmet need (if not). The exception is that in some cultures, men are not expected to know how to cook, in which case the rating is No need. Therefore (as always) cultural norms for people like the service user who do not have mental health problems should also be considered when rating.

Company: the service user says they are happy with their social life, but they have no friends

Rate No need. The staff rating may be different.

Safety to others and Alcohol - is there an error in the Met need example?

Yes - in the CAN book, the CAN-C and CAN-R examples for a Met need for these domains has been swapped in a printing error. The example of a Met need in the Safety to others domain should read 'Under supervision because of potential risk' and the example of a Met need in the Alcohol domain should read 'At risk from alcohol misuse and receiving help'.

Sexual expression: the service user has no sexual contact

Ask if they are happy with their current situation (No need), or see it as a problem (Unmet need).

Childcare: how is it rated when financial difficulties cause problems in this domain?

A need may exist for a number of reasons. If lack of money leads to childcare problems, then the need rating for Childcare is Unmet need.

Money: the service user has no money

Rate Met need if they are getting enough financial help from others, or Unmet need if their financial problems are not receiving enough help.

In CAN-R or CAN-C, how do I rate level of help given if a service has been offered but the service user has refused it?

Section 3 relates to actual receipt of help from formal services. If a service has been offered help but they have refused it, then they are not receiving any help and are rated No help.

How do I rate if the service user says they do not receive much help, but on further questioning a lot of help is received according to the anchor points?

Use the anchor points to rate the level.