Getting It Together for Abused Kids

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The number of child advocacy centers (CACs) in the United States today is 12 times as high as it was 12 years ago. Despite their growth and the key role they’ve played in increasing the availability of investigative and support services to physically and sexually abused children, the centers had never been rigorously evaluated. 

Until now.

Everything seems to be right on track, according to a four-site, quasi-experimental evaluation of CACs in Charleston, S.C., Huntsville, Ala., Dallas and Pittsburgh, spearheaded by researchers at the University of New Hampshire (UNH).

The study, funded by the U.S. Office of Juvenile Justice and Delinquency Prevention, showed that CACs have been “successful in doing just what they were designed to do,” the university said in a prepared statement, “namely, coordinating investigations of child abuse by bringing police, child protection, medical and mental health professionals together to help families in a child-friendly environment,”

That’s good news for the more than 600 communities and 160,000 children served by CACs each year.

Model embraced

The first CAC was established in Huntsville in 1984 by U.S Rep. Bud Cramer (D-Ala.) when he was district attorney for Madison County.

Cramer recognized that when social services and criminal justice systems worked ineffectively together, emotionally distressed children were often subjected to a disjointed, repetitive and sometimes frightening investigative process.

Cramer’s brainchild, the National Children’s Advocacy Center, teamed workers from law enforcement, criminal justice, child protective services (CPS), medicine and mental health.

That center served as the model for CACs in all 50 states and the District of Columbia, which collectively operate under the aegis of the National Children’s Alliance, the field’s membership association and accrediting body.

“I’m not sure exactly what it was about this model that developed so quickly, or was able to gain the national level of implementation that CACs did – but it did,” said Lisa M. Jones, research assistant and psychology professor at UNH’s Crimes Against Children Research Center.

NCA members, including all four study sites, must provide:

• A welcoming environment for interviews and family meetings, geographically separate from police stations, child protective services and courthouses.
• A multidisciplinary investigation team and coordinated forensic interviews – reducing the need for children to be interviewed multiple times.
• Regular follow-up case reviews by the team, to allow for planning refinements, information exchanges, team problem-solving and referrals for more services.
• Formal links to or on-site provision of medical evaluation, therapeutic intervention and victim advocacy services.

Impact Under Optimal Conditions

The evaluation by UNH is more of an “efficacy study,” which examines the impact of an intervention under optimal conditions, than an effectiveness study, which studies the impact of an intervention under more typical conditions, the authors say.

“What we decided to do with our study is take four very well-established CACs and find out how those four CACs are doing,” Jones said.

The things that those four CACs do well, “I think many well-established CACs are able to achieve,” Jones said. “And I think some of the problems we found with our CACs would probably be reflected in the larger field.”

The researchers identified communities without CACs in the same states as the four studied.

Finding comparison communities that were demographically similar to the CAC communities proved difficult, Jones said.

“The match was definitely imperfect. … We had to statistically control for that, as best as we could,” she said.

Case file reviews, observations and interviews with children and families revealed that CAC cases were more likely than those of comparison sites to include multidisciplinary team interviews (28 percent vs. 6 percent), videotaped interviews (52 percent vs. 17 percent), joint CPS-police investigations (81 percent vs. 52 percent) and multidisciplinary case reviews (56 percent vs. 7 percent).

In addition, police in communities with CACs were more likely to be involved in child sexual abuse investigations by child protective services, and children in the CAC sample were more than twice as likely to undergo forensic medical examinations.

The four CACs studied each provided private, comfortable areas designed for interviewing children, and 81 percent of their child interviews were conducted in those areas. At the comparison sites, child interviews took place at various locations, including schools, child protective services agencies, police stations and homes.

The impact on mental health services is unclear. Referrals for mental health treatment were provided in 72 percent of CAC cases, compared with 31 percent in the comparison cases.

However, in a subset of families interviewed face-to-face, 55 percent of caregivers from CACs and 53 percent from comparison sites said they or their children had received mental health services.

What Really Matters

Perhaps the most important measures taken by the study help explain what Jones saw as the rapid embrace of the CAC model among caregivers and children.

Seventy to 80 percent of the caregivers at CAC sites reported being highly satisfied with the investigation and interview procedures and with the environments for both, compared with about half of the caregivers at comparison sites. Those findings held even when controlling for such variables as caregiver support for the child, agency involvement in the case and case outcomes.

Even more significantly, children from CAC sites rated themselves as far less “scared” when they were interviewed than did children from comparison samples.

The researchers said they were not surprised to discover that the comparison communities – which were providing as least some CAC-like services and supports through informal arrangements – were also striving to provide services for child victims on at least some of the measures.

“We weren’t able to find communities that had nothing at all,” Jones said. “And I think that speaks to the level of innovation and efforts people are making in every community to try and make things better for kids.”