TX HHS Form 3043. MH Child and Adolescent Needs and Strengths (CANS) - Age 6-17

Form 3043 is the Texas-adopted version of the Child and Adolescent Needs and Strengths (CANS) assessment for youth ages 6 to 17. It is used by mental health professionals to systematically evaluate a child’s risks, behavioral and emotional needs, life functioning, strengths, caregiver capacity, and cultural factors in order to support clinical decision-making, service planning, and program eligibility.

Purpose of Form 3043

The purpose of Form 3043 is to provide a standardized, evidence-informed framework for understanding a child or adolescent’s mental health needs and strengths. The assessment helps ensure that services are appropriate, proportionate, and responsive to actual risk and functioning rather than diagnoses alone.

This form is commonly required for eligibility determinations, level-of-care decisions, service authorization, treatment planning, and ongoing monitoring within Texas mental health programs.

When This Form Must Be Completed

Form 3043 is typically required in the following situations:

• Initial enrollment into publicly funded mental health services
• Requests for intensive or specialized services
• Periodic reassessments to monitor progress or changes in risk
• Transitions between levels of care or providers

The form is generally not required for informal counseling, private-pay services, or situations where a standardized needs assessment is not mandated by program rules.

Who Is Authorized to Complete the Form

Form 3043 must be completed by a trained and credentialed professional authorized to administer the CANS assessment. This usually includes:

• Licensed mental health clinicians
• Qualified mental health professionals (QMHPs)
• Program staff certified in the CANS methodology

Caregivers, parents, and youth provide information, but they do not independently complete or score the form.

Explanation of Key Sections

Identifying Information

This section captures the child’s name, date of birth, case identifiers, provider information, and assessment date. Accuracy is essential for record matching and program reporting.

Child Risk Behaviors

This section assesses immediate and historical risks such as suicide risk, self-harm, danger to others, sexual aggression, runaway behavior, delinquency, and fire setting. Ratings range from no evidence to acute need requiring immediate action.

Behavioral and Emotional Needs

Here, clinicians rate symptoms such as depression, anxiety, psychosis, impulse control, trauma adjustment, substance use, and anger control. Scores reflect severity and functional impact rather than diagnostic labels.

Life Domain Functioning

This section evaluates how the child functions in daily life, including family relationships, living situation, school performance, social functioning, development, communication, medical needs, and legal involvement.

Caregiver Strengths and Needs

If a caregiver is identified, this section assesses supervision capacity, involvement, organization, stability, health, stress, and access to resources. Caregiver functioning is critical to service planning.

Child Strengths

This section identifies protective factors such as family relationships, optimism, talents, community involvement, and natural supports. Strengths guide recovery-oriented planning.

Culture

Cultural considerations include language, identity, cultural stress, and rituals. These ratings help ensure services are respectful and appropriate.

Extension Modules

Certain ratings automatically trigger additional modules, such as suicide risk, violence, trauma, substance use, runaway behavior, juvenile justice involvement, school functioning, or psychiatric hospitalization history.

Practical Tips for Completing Form 3043

• Base ratings on observable evidence and reliable sources, not assumptions.
• Use the full rating scale rather than defaulting to mid-range scores.
• Complete required extension modules when triggered.
• Update the assessment when there are meaningful changes in risk or functioning.
• Ensure consistency between narrative information and numerical ratings.

Common Mistakes to Avoid

• Scoring based on diagnosis rather than current functioning
• Failing to complete required extension modules
• Overlooking caregiver needs and strengths
• Using outdated information
• Inconsistent ratings across related domains

Legal and Regulatory Context

Form 3043 is used within Texas public mental health systems that require standardized assessment tools for accountability, service authorization, and quality oversight. State policies mandate the use of validated instruments like CANS to ensure fair access to services and appropriate allocation of resources.

The completed form becomes part of the child’s official clinical record and may be reviewed during audits, utilization management, or care coordination.

Real-Life Situations Where This Form Is Used

• A clinician completes a CANS to determine eligibility for intensive community services.
• A reassessment shows reduced risk, supporting a step-down in services.
• A youth with escalating behaviors triggers additional safety planning.
• A care team uses strengths ratings to shape a recovery-focused plan.

Documents Commonly Used With This Form

• Psychosocial assessments
• Service plans or treatment plans
• Crisis and safety plans
• Progress notes
• Prior CANS assessments

Frequently Asked Questions

Is Form 3043 a diagnostic tool?

No, it assesses needs and strengths, not diagnoses.

How often must the CANS be completed?

It depends on program requirements and clinical changes.

Can caregivers see the results?

Results are often shared as part of collaborative planning.

What triggers extension modules?

Specific risk or need ratings automatically require them.

Does a high score mean automatic placement?

No, scores inform decisions but do not mandate outcomes.

Is training required to complete the form?

Yes, authorized users must be CANS-trained.

Related Forms

• Individualized Service Plan (ISP)
• Crisis Safety Plan
• Psychiatric Evaluation Forms
• Reassessment and Review Forms

Form Details

• Form Name: MH Child and Adolescent Needs and Strengths (CANS), Ages 6–17
• Form Number: 3043
• Program Area: Texas Public Mental Health Services
• State: Texas
• Revision Date: March 2019