Program Goals/Target Population
The Children’s Advocacy Center (CAC) Model is a multidisciplinary, victim-focused program that delivers comprehensive, culturally competent care to diagnose and provide treatment for all types of child maltreatment cases, including physical neglect and abuse, incest, and extrafamilial sexual abuse (Edinburgh et al. 2008; OJJDP N.d.). The CAC model is designed to improve the overall forensic interviewing process and physical and mental health treatment for youth who have reported experiencing sexual abuse. The forensic interview typically consists of a structured conversation between the victim of sexual assault and a criminal investigator or forensic interview specialist, to elicit a detailed account of the victim’s experience. However, the traditional method of interviewing sexually abused or assaulted youth has also been criticized for being unnecessarily stressful and traumatic (Cross et al. 2007). One problem is the lack of coordination between agencies, which often leads to the victims being interviewed too many times and thus retraumatizing them. In addition, the lack of coordination often results in more stressful interview environments, such as in a police station, where the youth may believe they are in trouble (Cross et al. 2007).
Overall, the goal of the CAC model is to improve the delivery of care to youth victims of sexual abuse and assault, coordinate multiple investigations of the abuse and assault though an objective and nonrepetitive process, and reduce the harmful effects of sexual abuse and assault on youth and their families through an inclusive service center that emphasizes a child-focused approach (Wolfteich et al. 2007).
Services Provided
The CAC model includes the provision of services (which may vary from site to site) that coordinate with local child-friendly facilities to enable professionals from victim advocacy and child protective services, law enforcement and prosecution, and the medical and mental health fields to work together to investigate, prosecute, and treat child abuse. The team approach improves interagency communication, increases the effectiveness of the investigation and prosecution, and results in fewer interviews with and less trauma for the victim (OJJDP 2020). CAC models can be implemented in a variety of private, child-friendly locations to create less stressful interview environments, such as independent centers, prosecutor’s offices with separate entrances specifically for CAC-involved youth, or hospitals (Cross et al., 2007).
Hospital-based CAC patients receive comprehensive health care assessments, which involve the collection of information about the abuse, past medical history, a history from the adolescent’s perspective (which is videotaped), a complete physical exam, and treatment for prior abuse. If the abuse occurred within the previous 72 hours, CACs provide treatment for the injuries, collect forensic evidence (such as DNA), treat sexually transmitted infections (STIs), and assess victims for acute psychological trauma. Additionally, hospital-based CACs provide counseling referrals to child abuse victims based on the results of these health assessments.
Hospital-based CAC patients are examined using video colposcopy, as opposed to visual examinations, which are then reviewed by pediatricians with expertise in sexual abuse (rather than by nurses who are Sexual Assault Nurse Examiners, nurse practitioners, family physicians, pediatricians, emergency physicians, or internists). Experts in child sexual assault are considered to be less likely to misinterpret normal findings, compared with physicians who do not have specific experience in the area (Edinburgh et al. 2008).
Key Personnel
A multidisciplinary team is a common element of CACs. The hospital-based model is implemented by a team of pediatricians, nurse practitioners, nurses, and psychologists who provide forensic examinations, diagnoses, treatment, and ongoing therapeutic interventions and follow up.