Children’s Advocacy Centers at 25 years

Shelby made an outcry of abuse at the age of 15. For 10 years she had suffered emotional, physical, and sexual abuse at her father’s hands. But on October 22, 2010, when her father dropped her off at school, Shelby knew when she closed the car door that this would be the last time she saw him. Today, she was going to tell.
    It took every ounce of courage she had to walk into the counselor’s office and lay down this burden. When she found that all of the counselors were in a staff meeting, she almost turned and walked back out—but she was determined; she had come this far. She walked over to a teacher who just happened to be in the counselor’s office and told her about the abuse. The teacher reported it to authorities, and the investigators assigned to the case brought Shelby to the Bridge Children’s Advocacy Center (CAC) in Amarillo.
    Shelby received a forensic interview and had a medical evaluation at the CAC. The multidisciplinary team (MDT) at the center also arranged for her to participate in a one-party consent call with her father which was recorded by law enforcement. This evidence proved to be instrumental to the outcome of the case. Her father pled guilty to 14 counts of aggravated sexual assault with 40 years on each, and six counts of sexual assault with 20 years on each.  The sentences are running concurrently.   Because Shelby’s mother had not been in the picture since Shelby was 3 years old, the teenager was ultimately placed with an aunt and uncle (whom she now calls Mom and Dad) and received counseling through the CAC, which was very successful. In fact, in 2011, Shelby’s counselor set up a meeting with The Bridge MDT members because Shelby wanted to personally thank each of them and encourage everyone who works these cases to know that they do make a difference.

What is a CAC?
Since the incorporation of our state association, Children’s Advocacy Centers of Texas (CACTX), over half a million children like Shelby have walked through the doors of a Texas CAC. Our work is done through a network of 68 member centers which represent an official service area of 172 Texas counties. Annually, these programs serve almost 40,000 children each year, 75 percent of whom are involved in child sexual assault cases. Each center has core services and standards, as prescribed by the Texas Family Code, but each is customized to reflect the unique needs and culture of its area. Nationally, there are over 750 CACs, with at least one in every state.
    The Bridge CAC was the first children’s advocacy center in Texas (and is on the verge of turning 25 years old). With our own organization about to celebrate 20 years, we are excited to have this generous opportunity to reach out to one of our most critical partners and allies: Texas prosecutors. This article is meant to be a reflection of where we’ve been, a “state of the union” on where we are now, and an invitation to help us consider what’s next.

Our shared history
Each year, our network of 68 CACs partners with more than 200 district and county attorney’s offices. But the truth of the matter is, our special relationship with prosecutors goes much deeper than the interagency agreements signed between our centers and your offices.
    The history of the Texas network is as closely aligned with prosecutors as the development of the CAC model itself. In 1985, former U.S. Congressman and then-District Attorney Bud Cramer developed the vision for the CAC model and opened the first center in Huntsville, Alabama. In a recent article for Roll Call magazine, Cramer explains the frustration he felt prosecuting a child abuse case in the 1980s. During an interview with a young victim, her grandmother asked Cramer why her granddaughter had to give her statement once again when she had already spoken to 11 other professionals. She wanted to know why he couldn’t coordinate things with his colleagues. As many of you may remember, this lack of coordination not only created further trauma to child victims, but it also proved detrimental to the successful outcome of these difficult cases.
    Not unlike Congressman Cramer, during the 1980s and ’90s many prosecutors in Texas were searching to find a better way to successfully work crimes against children cases, particularly those involving child sexual assault. A series of high-profile cases shined a light on failures within our justice system, and a national conversation about this issue began. Child victims’ names you may recognize—Jacob Wetterling, Adam Walsh, Ashley Estell, and Christopher Woehlers—spurred necessary change at one end of the spectrum. However, on the other end, there was Kelly Michaels, the McMartins, and the Little Rascals daycare case where wrongful convictions resulted from bad evidence obtained through poor interviews. These high-profile, high-stakes cases had policy-makers and frontline professionals looking for better ways to do this work, keep kids safe, and ensure justice.
    Harsher penalties for sexual predators were passed, the sex offender registry was expanded, and word spread about the success of the CAC model. In Texas, concerned community members partnered with prosecutors, law enforcement, Child Protective Services (CPS), and medical/mental health professionals to develop the first few CACs. In a brief 10-year period (1995–2005), 46 more CACs opened their doors for services. It is no secret that Texas prosecutors, more often than not, served as the driving force during this era of rapid growth. It is a trend that continues today.
    While the laws and processes surrounding these cases have evolved over the years, the drive to develop a CAC today remains the same as it did for Congressman Cramer in 1985 and for the many Texas prosecutors who led the charge in their own communities. In short, these abuse cases with child victims are difficult. They are unlike any other that come across your desk and often present seemingly insurmountable challenges. Arguably the success of this model, and the reason it has grown so quickly in 25 short years, is because each required service and component was specifically developed in response to these challenges. From the child-friendly facility to the video-recorded forensic interview and team case staffing, this model works because it was intentionally designed to do so.
    Additionally, the CAC model is centered on the notion of systemic change. By partnering with the various entities involved in the system, we are better positioned to help these young victims as we change the process from the inside out. Our goal is to modify a justice system built for adults into one that contemplates, through each step of the way, the unique perspective and attributes of a child victim or witness. As the only nonprofit to play a role in the investigation of child-abuse cases, our approach often looks different from other worthy organizations assisting victims. We play an intentionally neutral role in these cases to ensure the integrity of our forensic interviews, but also to facilitate coordination among investigators and prosecutors to seek good outcomes for both the case and the child. Last year our network signed interagency agreements with more than 800 law enforcement jurisdictions, 200-plus district and county attorney offices, and every CPS region in the state.

Where we are today
While we are fortunate in Texas to have a well-developed network of CACs, our mission is far from accomplished. With the oldest CAC in Texas just shy of 25 years old we are, comparatively speaking, a young model moving through what we could classify as our teenage years. Not only do we need to expand the breadth of our services—there are still 82 counties outside of the official service area of a CAC—but we must also look at how to expand the depth of our services.
    This is why I am writing this article today and why I am so grateful to TDCAA for its inclusion. There is still much work to be done in making Texas a safer place for kids and ensuring that these victims receive both justice and healing. But if we are to be successful in the next 25 years, we are going to need the continued support, guidance, creativity, and momentum of one of our longest-standing allies, Texas prosecutors.
    As with any movement, we are hitting a juncture of transition. As district attorneys retire, founding CAC directors move on, and our network puts on a new face, we have to keep fueled with the same energy and commitment that got us where we are today.
    Not unlike other movements working for change, over the years our greatest spokespersons have been those who can articulate what it was like to work these cases before the CAC model, before multidisciplinary teams and joint investigations, and before recorded forensic interviews conducted by trained professionals in child-friendly facilities. Our survival and ability to thrive rests in the next generation’s acknowledgement and understanding of the past and willingness to embrace the change necessary for growth.

What’s next?
People often ask us “what’s next?” for our model and network. The truth of the matter is that, in large part, the answer rests with you, Texas prosecutors. As a team-based model, our work must be responsive to the needs and challenges encountered by our agency partners. We must adapt and expand our services as your work changes. As such, part of the impetus for this article is to encourage you to play a leadership role with your local CAC. Each center is required by statute to have representation on its board of directors by prosecution, law enforcement, and CPS, the purpose of which is to ensure that agency partners have the ability to share their needs and provide input at a governance level.
    Additionally, there are still 82 Texas counties outside of our official service area. While these counties are able to access courtesy services, children in these counties are not receiving the full array of CAC services as prescribed in the Texas Family Code. Typically, courtesy services involve a forensic interview at a neighboring CAC, but not a multidisciplinary team case staffing, mental health services for the child and non-offending caregiver, or family advocacy and support. If you are in one of the 82 counties not officially served by a CAC but are interested in making the full array of comprehensive services available to your community, reach out to CACTX to guide you through the process.
    There are two different ways to become part of an official CAC service area:
Join an existing CAC.  If your county is adjacent to the official service area of an existing CAC, you can work with that center to become part of its service area. This is where the majority of growth will come in the next few years. Due to sparse population, rural composition, and/or socio-economic factors, most of these counties are unlikely to establish and maintain an independent CAC. This year, three new counties were added to our network by joining an existing CAC: Sabine County joined the East Texas Alliance for Children in Lufkin, San Augustine County joined the Shelby County CAC in Center, and Lavaca County joined Norma’s House in Gonzales.
Start a new CAC. All centers in Texas are 501(c)(3) non-profit organizations. (To start a new CAC, a new non-profit will need to be formed or an existing non-profit will need to add a CAC program. For more information on how to begin this process, contact us at 512/258-9920 or email our program director, Catherine Bass, at [email protected] or me at [email protected]) This year, two new CACs were added to our network: Children’s Alliance Center for Palo Pinto County and Children’s Alliance of South Texas in Floresville, serving Atascosa, Wilson, Frio, Karnes, and LaSalle Counties.
    Prosecutors can also play a key role by serving as a voice for the CAC and the issue of child abuse within their communities. The CAC model can be confusing and the topic disturbing. Due to our role in the investigation, CACs often maintain a low profile in their communities. As a result, this population of victims and the center itself often go unnoticed or misunderstood. One of the strongest attributes we have is our relationship with our agency partners, and your voice can help the CAC to establish credibility in the community.
    Finally, prosecutor involvement and leadership on the multidisciplinary team is critical to a well-executed team investigation. While the benefits to a team approach are well-known, bringing together law enforcement, CPS, and medical and mental health professionals for collaboration is still difficult. With each discipline coming to the table with a different mandate, managing relationships can be challenging. It is often the case that our strongest teams—the ones that share information and work fastidiously to ensure that the child’s needs are at the forefront—have strong leadership from prosecution. If you are an elected DA or division head and cannot serve on the MDT yourself, consider assigning a specific prosecutor to serve on the team to ensure that a consistent voice from your office is providing guidance on these cases.

Our areas of focus
Of course, at CACTX we also have some ideas about where our network needs to head next. Here’s a look at our future goals:
•    Improving mental health services for CAC clients. Did you know that CACs are the sole provider of therapeutic recovery services for the majority of children impacted by sexual abuse? Over 80 percent of these cases will be closed by CPS once a determination of abuse is made. Therefore, these children will not go into foster care or family-based safety services where the State will provide mental health services through a Medicaid provider. Many of these children at our centers present with symptoms of extremely high trauma and depression, some of whom will actually qualify for a diagnosis of post-traumatic stress disorder. As such, CACTX is committing substantial resources over the next two years to ensure that our clinicians are skilled in treatment modalities that are evidence-based and proven to work. Additionally, we will continue to fight for the financial support required to comprehensively serve these victims.
•    Increasing access to medical evaluations. Nationally, 34 percent of alleged victims of child sexual abuse who receive a forensic interview also receive a medical evaluation. In Texas, the average is 21 percent and in rural communities it is 8. Multiple factors have led to this disparity, including a lack of qualified providers to conduct these exams, funding to pay for them, and knowledge of the importance of the medical exam, even when there may be no physical evidence. CACTX just completed a statewide research project that identified barriers in accessing medical evaluations. In the next two years, we will address these barriers by rolling out comprehensive training and technical assistance. Interestingly, we have found that medical exams are requested by investigators more frequently in counties where prosecutors emphasize the importance of medical evaluation.
•    Developing family advocacy services. Our goal through family advocacy is to ensure a continuum of care from initial investigation through prosecution and recovery. Family advocates exist to provide the family support, referrals for mental health services, and access to other social services and community resources. Child abuse, particularly sexual abuse, can dramatically alter household dynamics once a report is made and an investigation begins. Children must have support at home if they are to successfully move through the justice system. By ensuring the family’s basic needs are met, we hope to bring stability to the home during this time of crisis.
•    Access to justice for the most vulnerable. We identify the “most vulnerable” as children with disabilities, human trafficking victims, very young children, children with diverse cultural backgrounds, and children who have suffered extreme trauma. This summer we were proud to unveil a new Multi-Session Forensic Interview (MSFI) protocol at the TDCAA Crimes Against Children Conference. MSFI is an interviewing approach that spreads one interview out over multiple sessions. The purpose of this method is to provide certain categories of child victims additional time to make disclosures. Similar approaches have been proven to elicit 25 percent more information. If we cannot properly modify our services to meet these children where they are, we are ultimately denying this population access to justice. Training on this approach will roll out in December 2013.
•    Expanding services to additional categories of children. As our model has come of age, agency partners are realizing that the CAC model can assist victims in addition to those who have suffered sexual abuse. In our FY 2013 data, child witnesses to violent crime represented the highest growth category for first time services/interviews—a trend we believe will continue.
•    Keeping forensic interview techniques at the forefront. Each year we do a comprehensive review of our forensic interview curriculum to ensure it reflects the latest research in child development, memory, and suggestibility. The field of forensic interviewing has become more established over the last 25 years, but it is still relatively new. As we learn more about how children make disclosures, we must adapt our approach. Providing non-leading, legally defensible interviews is critical to the integrity of these cases and ultimately the interests of justice.

Thank you
On September 1, 2013, two new CACs opened in Texas expanding our service footprint to 172 counties. In both communities the district attorney’s office played a key leadership role in building community support, bringing together investigative partners, and lending credibility and momentum to the effort. On behalf of the 40,000 children served annually by our network and the hundreds more who will now have access through these new CACs, we are grateful to Texas prosecutors for their commitment. Our state is home to more CACs than any other state in the nation and our organization, the Texas chapter, is larger and more developed than our 49 counterparts.  Thank you for making Texas No. 1 in the nation within the CAC movement.