Below are the Standards for Accreditation by the National Children's Alliance and the Best Practices for CACs.
Standards for Accreditation by the National Children's Alliance
1. Having a CHILD FRIENDLY FACILITY: This ensures that the child is made as comfortable as possible to decrease the trauma of an investigation.
2. Presence of a MULTI-DISCIPLINARY TEAM: this is a team that works together in investigating alleged child abuse. In order to keep a child from having to go through multiple interviews by strangers, a trained forensic interviewer talks with the child while the other team members (law enforcement, child protective services, mental health, prosecution, victim advocacy, medical, and CAC as needed in the particular case) observe and gather the information they need.
3. A LEGAL ENTITY that takes responsibility for the program and fiscal operations.
4. CULTURAL COMPETENCE: While our staff members do not speak multiple languages, we have access to interpreters in case they are needed and our staff is frequently trained in providing services to clients of various cultures in a way that is most sensitive.
5. FORENSIC INTERVIEWS: Promoting legally-defensible, fact-finding interviews that are coordinated to avoid multiple interviews of the child.
6. MEDICAL EVALUATIONS: Provision of child-friendly medical evaluations either on-site or off-site by a Child Medical Evaluation Provider.
7. THERAPEUTIC INTERVENTION: Provision of specialized child abuse treatment, either on-site or through agreement with a local provider at no cost to the family.
8. VICTIM ADVOCACY/SUPPORT: Provision of advocacy to child victims and their non-offending caregivers throughout the investigative process and, when needed, the court process.
9. CASE REVIEW: Routinely, cases investigated at the center are to be reviewed by the MDT to ensure that as many resources as possible are being offered and that the cases are moving along as smoothly as possible.
10. CASE TRACKING: All cases and services provided are to be tracked in order to be good stewards of the support received as well as to add to the information that is available regarding incidence of child abuse and neglect and prosecution rates.
Best Practices of Accredited CACs
The following information was based on the Kauffmann report on child traumatic stress treatment and a poster presentation made by Tripp Ake, Ph.D & Tracee Washington, Ph.D of the Center for Child and Family Health in Durham, NC. The presentation was given at the 11th Annual "Reflections" Symposium on Child Abuse and Neglect. For references specific to this information, see the "Resource Links" page under Best Practices.
Evidence Based Practice is characterized by the following components:
1. Sound theoretical basis
2. Clinical literature regarding efficacy
3. Accepted in clinical practice
4. No evidence of substantial risk or harm
5. Manual sufficiently detailed to allow replication
6. Efficacy based on at least 2 randomized, controlled trials
7. Majority of outcome studies support efficacy
There were 6 categories of practice (well supported, efficacious treatment; supported and probably efficacious treatment; supported and acceptable treatment; promising and acceptable treatment; innovative and novel, and; experimental or concerning treatment). The following 3 treatment modalities fell within the top 3 categories and were therefore determined to be the definitive "best practices" treatments for traumatized children:
* Provide treatment for family with parent and child
Indications for use:
* When physical discipline is no longer a safe option due to physical abuse being by Caregiver
* When Caregiver displays abusive characteristics such as inappropriate expectations, tendency to be coercive or isolated, are often angry or sad, or have psychiatric disorders.
* When families demonstrate abusive characteristics such as coercive environments, general family stressors, have limited psychosocial resources, or are involved in unsafe community activities.
* Includes a 3 phase treatment process consisting of Child Treatment, including 1)coping skills; 2) discussion of family conflict; 3) graduated exposure exercise; 4) addressing of distorted cognitions about abuse; 5) psychoeducation about physical abuse; 6) anger & aggression management, and; 7) promotion of child's safety.
* Parent Treatment, including: 1) discussion of parental expectations; 2) addressing various perspectives and automatic thoughts involved in attributions and other cognitions; 3) identification of affect and regulation of same, and; 4) appropriate behavior management.
* Family Treatment, including: 1) abuse clarification; 2) safety and re-abuse prevention plan; 3) address appropriate roles in family structure, and; 4) improve communication and problem-solving skills.
* The treatment consists of 12-16 sessions and the modality is family therapy with time set aside for parent feedback.
* CDI consists of play therapy with the parent and child, who are observed by means of two way mirror or closed circuit equipment, with parent using "bug in the ear" for direction from therapist. The therapist codes the behavior for evaluation and meets with the parent afterwards for feedback on the session.
* Session goals are built around Pride, Reflection, Imitation, Description, and Enthusiasm (PRIDE).
* PDI goals are to improve compliance through effective commands characterized by Being specific, Every command being positively stated, Developmental appropriateness of statements, Individual rather than complex commands, Respectful and polite commands, Essential commands only being used, Choices being given when appropriate, and using neutral Tone of voice (Be Direct).
* Chaffin et al (2004) studied effectiveness with physically abusive parents.
* 19% of those parents involved had a re-report of abuse at 850 day follow-up.
* 49% who participated in community-based support group had a re-report of abuse at 850 day follow-up.
Developed by Sheila Eyberg, Ph.D.
Child Study Lab, Dept. of Clinical and Health Psychology, University of Florida
Adapted for maltreating families by Anthony Urquiza, Ph.D.
University of California Davis Medical Center
Deblinger, E. & Heflin, AH (1996). Treating Sexually Abused Children and Their Non-Offending Parents: A Cognitive Behavioral Approach. Newbury Park, CA: Sage Publications.
Hembree-Kigin, T. & McNeil, C. (1995). Parent-Child Interaction Therapy. Clinical Child Psychology Library Series, Springer Publications.
Kolko, D.J. & Swenson, C.C. (2002). Assessing and treating physically abused children and their families: A cognitive behavioral approach. Thousand Oaks, CA: Sage Publications.