Paediatric Care and Needs Scale 2

D
© Tate, Soo and Wakim; May, 2014

Client name: ____________________________

Date of interview: ________________________
PCANS-2
DOB: __________________ Age: ________
Date of ABI: _____________________________
Cause of ABI: ____________________________ RECORD
GCS/PTA/Severity (if known/applicable):
_______________________________________
Informant type: Parent / Other:
FORM D
_______________________________________
Date of Last PCANS-2:_____________________
Current Examiner’s Name: 15 years
_____________________ ______________
Have you attended PCANS-2 training: Yes / No

Instructions:
This questionnaire focuses on a range of activities children perform every day. For each activity please
indicate:
(1) Whether your child requires:
i. Physical assistance – someone to do the activity for them, hands-on assistance, help with
set-up;
AND/OR
ii. Supervision - verbal prompts or indirect supervision
(2) If no supports are needed then
0 = “none”
(3) If your child requires physical assistance and/or supervision for that activity, please indicate
whether the level they require is:
1 = “some” or
2 = “a lot”
These supports may be provided by you the parent/caregiver, a family member, a teacher, an external
service or other. Each rating is made according to how things are for your child now.
Note to clinician: For each applicable item, enter a score (0, 1, or 2) in both Physical assistance and
Supervision sections.

Influence of other Factors on Item Score

In the column “Other influences” record the presence of factors pertinent to any item that are not
resultant from the child’s ABI using the following abbreviations:
C=cultural beliefs or habits
N=non-ABI factors such as fractures, spinal cord injury occurring concurrently to the ABI
Pre=pre-existing health, medical, learning or developmental problems
O=other influences, e.g. medical conditions occurring since the ABI.
EXPLAIN ANY SUCH FACTORS FOR THIS CHILD________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
 Form

D © Tate, Soo and Wakim; May, 2014

Please consult manual for detailed item definitions

PCANS 2 FORM D – 15 years

Scoring instructions for clinicians
Items where expect independence (IND; white boxes) and emerging skills (EM, pale
grey boxes):
Physical assistance (fully assisted in doing activity, or hands-on help/set up):
0 = independent
1 = needs some assistance

Phys. Assistance

Other Influences
2 = needs a lot of assistance

Supervision

Comments
Supervision (needs verbal prompts or indirect supervision):
0 = independent
1 = needs some supervision
2 = needs a lot of supervision
ITEMS WHERE SKILLS NOT EXPECTED (NE; DARK GREY BOXES): DO NOT SCORE
Domain I. High level needs: * Items 1-3 scored as
Does your child require support (physical assistance or supervision) PA S 0=no support required
for the following? 2=needs support
1. Tracheostomy management * Items 1-3 are scored as 0 or 2. 0/2 0/2
Please circle correct score. If PA =2 then S score =2 by default for items 1-3 only.
2. Nasogastric/PEG feeding * 0/2 0/2
3. Bed mobility if unable to turn over independently in bed * 0/2 0/2
4. Management of wandering behaviour
5. Management of harmful behaviour (exhibits behaviours that have
the potential to cause harm to self or others)
6. Communicating basic needs due to language impairments
7. Eating
8. Transfers/indoor mobility
Total raw score: Domain I. High level needs
* Items 1-3 are scored as 0 or 2. Please circle correct score

Domain II. Personal hygiene:

Does your child require support (physical assistance or supervision) PA S
for the following?
IND 9. Continence: bladder and bowel during day
IND 10. Continence: bladder and bowel during night
IND 11. Toileting (includes hygiene and clothes management)
IND 12. Washing face/hands
IND 13. Brushing or combing hair
IND 14. Cleaning/brushing teeth
IND 15. Period management, shaving (if appropriate)
Total raw score: Domain II. Personal Hygiene

Domain III. Bathing/dressing:

Does your child require support (physical assistance or supervision) PA S
for the following?
16. Simple dressing and undressing including doing
IND
fasteners (e.g. buttons and zips)
IND 17. Dressing to suit the occasion
IND 18. Washing self in bath/shower
19. Putting on socks and shoes including fasteners (e.g.
IND
shoelaces)
IND 20. Washing hair
21. Forethought to ensure bath/shower safety (e.g. water
IND
temperature)
EM 22. Dressing to suit the weather
Total raw score: Domain III. Bathing/dressing

PCANS 2 Form D 15yrs / 1

 Form

D © Tate, Soo and Wakim; May, 2014

Scoring instructions for clinicians

Items where expect independence (IND; white boxes) and emerging skills (EM, pale
grey boxes):
Physical assistance (fully assisted in doing activity, or hands-on help/set up):
0 = independent
1 = needs some assistance

Phys. Assistance

Other Influences
2 = needs a lot of assistance

Supervision

Comments
Supervision (needs verbal prompts or indirect supervision):
0 = independent
1 = needs some supervision
2 = needs a lot of supervision
ITEMS WHERE SKILLS NOT EXPECTED (NE; DARK GREY BOXES): DO NOT SCORE
Domain IV. Food preparation activities:
Does your child require support (physical assistance or supervision) PA S
for the following?
IND 23. Using cups
IND 24. Preparing simple snacks (no cooking or mixing involved)
IND 25. Using cutlery
IND 26. Using jugs/carton/bottles (including when full/heavy)
IND 27. Using microwave/simple heating up of food
IND 28. Setting table, clearing table
EM 29. Cooking simple foods
EM 30. Preparing and cooking a hot meal
Total raw score: Domain IV. Food preparation activities

Domain V. Shopping:
Does your child require support (physical assistance or supervision) PA S
for the following?
IND 31. Simple shopping (school canteen)
IND 32. Shopping at local shops
IND 33. Shopping with a prepared shopping list
EM 34. Buying ingredients for preparing main meal
EM 35. Generating and using a shopping list
Total raw score: Domain V. Shopping

Domain VI. Home activities:

Please describe your child’s regular chores:
_________________________________________________________
PA S
Does your child require support (physical assistance or supervision
for the following)?
36. Placing clothes in laundry basket, putting clothes away
EM
in cupboard/drawers
37. Keeping tidy main living areas of home (their own
EM
belongings, toys)
EM 38. Tidying and cleaning own bedroom
EM 39. Making own bed
40. Doing regular chores for which they are responsible (e.g.
EM
taking out garbage)
EM 41. Washing up dishes
Total raw score: Domain VI. Home activities

PCANS 2 Form D 15yrs / 2

 Form

D © Tate, Soo and Wakim; May, 2014

Scoring instructions for clinicians

Items where expect independence (IND; white boxes) and emerging skills (EM, pale
grey boxes):
Physical assistance (fully assisted in doing activity, or hands-on help/set up):
0 = independent
1 = needs some assistance

Phys. Assistance

Other Influences
2 = needs a lot of assistance

Supervision

Comments
Supervision (needs verbal prompts or indirect supervision):
0 = independent
1 = needs some supervision
2 = needs a lot of supervision
ITEMS WHERE SKILLS NOT EXPECTED (NE; DARK GREY BOXES): DO NOT SCORE
Domain VII. Health, safety and medication use:
Please indicate the child’s regular medications (if applicable):
________________________________________________________
________________________________________________________ PA S

Does your child require support (physical assistance or supervision

for the following)?
42. Independently seeking adult support and guidance
IND
when needed
43. Following rules and safety precautions at school and in
IND
the community
IND 44. Following safety precautions at home
IND 45. Responding to novel/emergency situations
46. Dealing with vulnerability risks (e.g. opening front door
IND
to strangers & letting them in)
47. Using the internet safely (including understanding
EM
privacy issues, restricted sites)
EM 48. Responsible behaviour regarding drugs, alcohol or sex
49. Understanding and managing sexually transmitted
EM
diseases
EM 50. Able to use own (regular) medications
EM 51. Making and keeping health/medical appointments
Total raw score: Domain VII. Health, safety and
medication use

Domain VIII. Money management:

Does your child require support (physical assistance or supervision) PA S
for the following?
IND 52. Counting change accurately
IND 53. Saving for at least one major purchase
IND 54. Earning pocket money
55. Understanding concept of repaying loans from own
EM
pocket money
56. Having simple job such as paper round or delivering
EM
pamphlets (usually no money exchange involved)
EM 57. Babysitting and/or looking after younger siblings
EM 58. Accessing a bank account
59. Responsibly using own bank account (e.g. EFTPOS, ATM,
EM
internet banking)
Total raw score: Domain VIII. Money management

PCANS 2 Form D 15yrs / 3

 Form

D © Tate, Soo and Wakim; May, 2014

Scoring instructions for clinicians

Items where expect independence (IND; white boxes) and emerging skills (EM, pale
grey boxes):
Physical assistance (fully assisted in doing activity, or hands-on help/set up):
0 = independent
1 = needs some assistance

Phys. Assistance

Other Influences
2 = needs a lot of assistance

Supervision

Comments
Supervision (needs verbal prompts or indirect supervision):
0 = independent
1 = needs some supervision
2 = needs a lot of supervision
ITEMS WHERE SKILLS NOT EXPECTED (NE; DARK GREY BOXES): DO NOT SCORE
Domain IX. Everyday devices:
Does your child require support (physical assistance or supervision) PA S
for the following?
60. Simple use of everyday equipment (e.g. simple use of
IND TV, video, DVD, computer [including computer games],
simple email/mobile use)
61. Simple telephone use including answering phone calls
IND at home (e.g. getting the right person for the call and
taking messages)
IND 62. Dialling emergency numbers (understands concept)
63. Using home phone routinely and appropriately (e.g.
IND including making and answering calls, understanding
about cost of calls)
Total raw score: Domain IX. Everyday devices

Domain X. Transport and outdoor surfaces:

Does your child require support (physical assistance or supervision) PA S
for the following?
IND 64. Getting in and out of the car
65. Getting around in outside areas of the home, e.g. in the
IND
driveway, up and down the stairs
IND 66. Fastening seat belts
67. Road crossing (adequate understanding/judging of
IND
speed and time of approaching vehicles)
IND 68. Getting on and off bus
IND 69. Getting on and off train or tram
EM 70. Catching public transport to school and familiar places
71. Using public transport to get to unfamiliar
EM
places/complicated destinations
Total raw score: Domain X. Transport and outdoor
surfaces

PCANS 2 Form D 15yrs / 4

 Form

D © Tate, Soo and Wakim; May, 2014

Scoring instructions for clinicians

Items where expect independence (IND; white boxes) and emerging skills (EM, pale
grey boxes):
Physical assistance (fully assisted in doing activity, or hands-on help/set up):
0 = independent
1 = needs some assistance

Phys. Assistance

Other Influences
2 = needs a lot of assistance

Supervision

Comments
Supervision (needs verbal prompts or indirect supervision):
0 = independent
1 = needs some supervision
2 = needs a lot of supervision
ITEMS WHERE SKILLS NOT EXPECTED (NE; DARK GREY BOXES): DO NOT SCORE
Domain XI. Interpersonal relationships:
PA not scored for Interpersonal
Does your child require support (supervision and guidance) for the PA S Relationships domain
following?
IND 72. Having age-appropriate behaviour in the classroom
IND 73. Having age-appropriate behaviour at home
74. Forming friendships: Having a friend/s for 1 week to 1
IND
term
IND 75. Interacting appropriately with younger children
76. Maintaining friendships: Having established friend/s
IND
(i.e. for more than a year)
IND 77. Having appropriate manners in public
78. Other centredness: Reading situation/non-verbal cues
IND from others (e.g. knows when to stop annoying
behaviour)
IND 79. Interacting appropriately within peer group
IND 80. Having appropriate impulse control while playing
81. Conversation appropriateness: Turn-taking in
EM
conversations (not too talkative/quiet)
82. Monitoring own behaviour when interacting with others
EM
in public
83. Tactfulness and sensitivity (e.g. not making statements
EM
that may embarrass or offend others)
EM 84. Having appropriate intimate interactions with peers
Total raw score: Domain XI. Interpersonal relationships

Domain XII. Leisure, recreation and play:

Does your child require support (physical assistance or supervision) PA S
for the following?
85. Initiating play and being cooperative in small groups
IND
(two or three children)
86. Turn-taking while playing in large groups (four or more
IND
children)
87. Playing alone (includes initiating, planning and
IND
maintaining play)
IND 88. Simple use of the internet (e.g. pre-selected sites)
IND 89. Having a hobby or interest
IND 90. Participating in non-school activities (e.g. sports)
91. Time management and planning for recreational/school
EM
projects
92. Practical organising of recreational activities for a group
EM of friends including use of timetables (e.g. going to the
movies)
Total raw score: Domain XII. Leisure, recreation and play

PCANS 2 Form D 15yrs / 5

 Form

D © Tate, Soo and Wakim; May, 2014

Scoring instructions for clinicians

Items where expect independence (IND; white boxes) and emerging skills (EM, pale
grey boxes):
Physical assistance (fully assisted in doing activity, or hands-on help/set up):
0 = independent
1 = needs some assistance

Phys. Assistance

Other Influences
2 = needs a lot of assistance

Supervision

Comments
Supervision (needs verbal prompts or indirect supervision):
0 = independent
1 = needs some supervision
2 = needs a lot of supervision
ITEMS WHERE SKILLS NOT EXPECTED (NE; DARK GREY BOXES): DO NOT SCORE
Domain XIII. School:
Please indicate if child needs and/or receives integration support or
other informal educational support (tick):
 None  Needed  Received PA S
Please specify: ________________________________________

Does your child require support (physical assistance or supervision

for the following)?
IND 93. Paying attention for at least 15 minutes during class
IND 94. Writing short notes
IND 95. Understanding written notes
96. Giving correct name (Y/N), address (Y/N) and telephone
IND
number (Y/N)
97. Responding to multi-step instructions – at least 2-3
IND
components
98. Packing school bag appropriately (e.g. lunch, books,
IND
sports gear)
IND 99. Telling the time
IND 100. Getting to school on time
101. Working appropriately at school tasks (e.g. not
EM
becoming discouraged/quitting, stays on task)
EM 102. Completing homework
EM 103. Following school timetable (if appropriate)
EM 104. Using calendar/desk diary
105. Filling out application form or writing a
EM
formal/application letter
Total raw score: Domain XIII. School

Does your child require supports in any areas that have not been covered by this questionnaire?
Please specify:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

PCANS 2 Form D 15yrs / 6

Form

D © Tate, Soo and Wakim; May, 2014

THIS PAGE IS INTENTIONALLY LEFT BLANK

PCANS 2 Form D 15yrs / 7

 Form

D © Tate, Soo and Wakim; May, 2014

Paediatric Care and Needs Scale (PCANS-2)

Scoring Work Sheet for Form D *
Name: Date:

Column 1 Column 2 Column 3 Column 4 Column 5

Domain Mean
Number of Raw score (col. 1)
Raw score score
Number of items actually divided by number
(transfer (Type of support
Domain applicable administered (if of items actually
from record items
needs; possible
differs from administered
form) score range 0-2) to
column 2) (column 2 or 3)
2 decimal places
1. Physical Assistance
I: High level 8 _____ / _____
II: Personal hygiene 6 or 7 _____ / _____
III: Bathing / dressing 7 _____ / _____
IV: Food preparation 8 _____ / _____
V: Shopping 5 _____ / _____
VI: Home activities 6 _____ / _____
VII: Health, safety & meds 9 _____ / _____
VIII: Money management 8 _____ / _____
IX: Everyday devices 4 _____ / _____
X: Transport & outdoors 8 _____ / _____
XI: Relationships Not scored
XII: Leisure, rec & play 8 _____ / _____
XIII: School 13 _____ / _____
Intensity of support needs for Physical Assistance score
(sum of scores in Column 5; possible score range 0-24) (A)
Extent of support needs for Physical Assistance score
[mean of: Intensity total (A) ÷ number of domains (n=12)] (B)
(possible score range 0-2)
2. Supervision
I: High level 8 _____ / _____
II: Personal hygiene 6 or 7 _____ / _____
III: Bathing / dressing 7 _____ / _____
IV: Food preparation 8 _____ / _____
V: Shopping 5 _____ / _____
VI: Home activities 6 _____ / _____
VII: Health, safety & meds 10 _____ / _____
VIII: Money management 8 _____ / _____
IX: Everyday devices 4 _____ / _____
X: Transport & outdoors 8 _____ / _____
XI: Relationships 13 _____ / _____
XII: Leisure, rec & play 8 _____ / _____
XIII: School 13 _____ / _____
Intensity of support needs for Supervision score
(sum of scores in Column 5; possible score range 0-26)
(C)
Extent of support needs for Supervision score
[mean of: Intensity total (C) ÷ number of domains (n=13)] (D)
(possible score range 0-2)
Overall Intensity of support needs for Physical Assistance
and Supervision score: A + C (E)
(sum of above scores; possible score range 0-50)
Overall Extent of support needs for Physical Assistance and
Supervision score (B + D) ÷ 2 (F)
(possible score range 0-2)
NOTE: All calculations correct to 2 decimal places
* Refer to PCANS-2 Summary Score Forms for child’s age

PCANS 2 Form D 15yrs / 8

 PCANS-2 Summary Score Form (15 year old)
©Tate, Soo and Wakim, 2014

Child’s name: Date of assessment: Assessed by:

School year: MRN:

Summary Score Interpretation

Maximum
Score 2 SD Maximum
Score Child’s Age score of
Score Age SD above age possible
reference score Mean norms for
mean score
age group
Intensity of support:
A 0.36 0.32 1.00 0.98 24
Physical assistance
Extent of support:
B 0.03 0.03 0.09 0.08 2
Physical assistance
Intensity of support:
C 1.89 1.14 4.17 5.63 26
Supervision
Extent of support:
D 0.15 0.09 0.33 0.43 2
Supervision
Overall intensity of
E 2.25 1.33 4.91 6.22 50
support for PA and S
Overall extent of
F 0.09 0.05 0.19 0.24 2
support for PA and S

Domain Score Interpretation (maximum score =2)

PHYSICAL ASSISTANCE (PA) SUPERVISION

Score Max Score Max
Child’s
Child’s 2 SD score 2 SD score
Age Age Super- Age Age
Domain PA above of above of
mean SD vision mean SD
score age norms age norms
score
mean for age mean for age
I High level needs - - - - - - - -
Personal
II 0 0 0 0 0.05 0.12 0.29 0.50
hygiene
Bathing/
III 0 0 0 0 0.08 0.14 0.36 0.57
dressing
Food
IV preparation 0.02 0.06 0.14 0.25 0.11 0.10 0.31 0.38
activities
V Shopping 0.02 0.75 1.52 0.33 0.08 0.14 0.36 0.40
VI Home activities 0.07 0.15 0.37 0.60 0.70 0.53 1.76 2.0
Health, safety
VII and medication 0.09 0.12 0.33 0.44 0.25 0.20 0.65 0.75
use
Money
VIII 0.07 0.12 0.31 0.33 0.11 0.16 0.43 0.67
management
Everyday
IX 0 0 0 0 0.03 0.10 0.23 0.50
devices
Transport and
X outdoor 0.04 0.09 0.22 0.38 0.08 0.15 0.38 0.75
surfaces
Interpersonal
XI N/A N/A N/A N/A N/A 0.10 0.16 0.42 0.69
relationships
Leisure,
XII recreation and 0.03 0.06 0.15 0.25 0.13 0.10 0.33 0.38
play
XIII School 0.03 0.06 0.15 0.23 0.20 0.18 0.56 0.77

PCANS 2 Form D 15yrs / 9