Cultural Factors

These items identify linguistic or cultural issues for which service providers need to make accommodations (e.g., provide interpreter, finding therapist who speaks family’s primary language, and/or ensure that a youth in placement has the opportunity to participate in cultural rituals associated with their cultural identity). Items in the Cultural Factors Domain describe difficulties that children and youth may experience or encounter as a result of their membership in any cultural group, and/or because of the relationship between members of that group and members of the dominant society.

Health care disparities are differences in health care quality, affordability, access, utilization, and outcomes between groups. Culture in this domain is described broadly to include cultural groups that are racial, ethnic or religious, or are based on age, sexual orientation, gender identity or expression (SOGIE), socio-economic status and/or geography. Literature exploring issues of health care disparity states that race and/or ethnic group membership may be a primary influence on health outcomes.

It is it important to remember when using the CANS that the family should be defined from the individual youth’s perspective (i.e., who the individual describes as part of her/his family). The cultural issues in this domain should be considered in relation to the impact they are having on the life of the individual when rating these items and creating a treatment or service plan.

Question to consider for this domain: How does the youth’s membership in a particular cultural group impact his or her stress and wellbeing?

Basic Design for Rating Needs

Rating Level of Need Appropriate Action
0 No evidence of need No action needed
1 Significant history or possible need that is not interfering with functioning Watchful waiting/prevention/additional assessment
2 Need interferes with functioning Action/intervention required
3 Need is dangerous or disabling Immediate action/Intensive action required


This item looks at whether the youth and family need help with communication to obtain the necessary resources, supports and accommodations (e.g., translator). This item includes spoken, written, and sign language, as well as issues of literacy.

Questions to Consider

  • What language does the family speak at home?
  • Is there a youth interpreting for the family?
  • Does the youth or significant family members have any special needs related to communication (e.g., ESL, ASL, Braille, or assisted technology)?

Supplemental Information:  This item looks at whether the youth and family need help to communicate with others. This item includes both spoken and sign language. In immigrant families, the youth often becomes that translator.  While in some instance, this might work well, it may become a burden on the youth if unable to translate accurately because of their understanding of the situation, or become distressing (such as during a court hearing) or inappropriate for the youth to do so.


This item rates the youth and family’s access to and participation in cultural tradition, rituals and practices, including the celebration of culturally specific holidays such as Kwanza, Dia de los Muertos, Yom Kippur, Quinceanera, etc. This also may include daily activities that are culturally specific (e.g., wearing a hijab, praying toward Mecca at specific times, eating a specific diet, access to media), and traditions and activities to include newer cultural identities.

Questions to Consider

  • What holidays does the youth celebrate?
  • What transitions are important to the youth?
  • Does the youth fear discrimination for practicing their traditions and rituals?


This item identifies circumstances in which the youth and family’s cultural identity is met with hostility or other problems within their environment due to differences in attitudes, behavior, or beliefs of others (this includes cultural differences that are causing stress between the youth and their family). Racism, negativity toward sexual orientation, gender identity and expression (SOGIE) and other forms of discrimination would be rated here.

Questions to Consider

  • Has the youth experienced any problems with the reaction of others to their cultural identity?
  • Has the youth experienced discrimination?