Transcript Impact of Child Advocacy Centers (CACs)

What Outcomes Are Important
for CACs?:
Survey Results and
Implications
Ted Cross, Ph.D.
Lisa Jones, Ph.D.
Crimes Against Children Research Center
University of New Hampshire
Seventeenth National Symposium on Child Sexual Abuse
Huntsville, Alabama
March 13-16, 2001
Children’s Advocacy Centers
Play an Important Role

In 2000…
– 105,039 children received services from
CACs
– in 362 affiliated centers representing…
– 48 states, DC, and U. S. Virgin Islands
Growth of CACs
400
350
300
250
Number of
NCA
Centers
200
150
100
50
0
1994
2000
Many Other Organizations
Use Components of CACs

Multi-disciplinary investigation teams

Child-friendly facilities

Case review
Important Questions About
CACs

What is the impact of CACs on
children, families, and partner
agencies?

What is the impact of CACs on the
prosecution of child abuse and the
court system?

Are there other important outcomes of
CACs for their community?
National Trend Toward
Outcomes-Based
Accountability

Many systems are measuring outcomes and
being evaluated on them
– Education
– Health Care
– Mental Health
– Criminal Justice
– Child Welfare

CACs are likely to need to examine outcomes
Evaluation of CAC Outcomes
May Help...

Document the impact of CACs

Refine strategies for helping children
National Evaluation of
Children’s Advocacy Centers
(CACs)
Multi-year, multi-site study of the
efficacy of CACs
 CACs across the country participating in
evaluation
 Cases enrolled in the study starting
April 2001

One Step In The National
Evaluation:
Survey on CAC Outcomes

Identifies what outcomes are important
to professionals working in CACs

First data from the National Evaluation
Project
Development of the Outcome
Survey Instrument
Consulted standards of the National
Children’s Alliance
 Examined other publications about
CACs
 Consulted national CAC experts

Survey with 84 outcomes in 6 categories
2 Phases of CAC Outcomes
Investigation
outcomes
What happens during
investigations?
Postinvestigation
outcomes
What happens later?
3 “Groups” That Have CAC
Outcomes
Children and Families
 Agencies
 Communities

6 Categories of CAC Outcomes
PostInvestigation investigation
Children &
Families
X
X
Agencies
X
X
Communities
X
X
Survey Instrument Format
0-100 scale
 Most important outcome in each
category was scored 100
 Least important outcome was rated
relative to the most important outcome
 Other outcomes were scored inbetween

Outcomes In The Instrument
By Category
Investigation
Post-investigation
Child & Family 20 outcomes
17 outcomes
Agency
19 outcomes
15 outcomes
Community
13 outcomes
7 outcomes
RATE THE OUTCOMES SEPARATELY FOR EACH PAGE
Excerpt from the
Outcomes Survey
Child and Family Investigation Outcomes
On a scale from 0-100, please score the CAC outcomes on this page based on how important you think
they are for the CAC in your community. Give a score of “100” to the outcome that is most important to
you. Score the outcome that is least important to you between "0" and "100" based on how important it is
relative to your most important category. Now rate each of the other outcomes on the page relative to the
outcomes you chose as most and least important.
Investigation Outcomes:
Importance:
Fewer interviewers
___________
Fewer repetitive interviews
___________
Fewer interview settings
___________
Shorter interviews
___________
More effective interviews
___________
More thorough investigations
___________
Fewer medical exams
___________
Decreased discomfort/stress for family and child during investigation
___________
Child feels supported by someone on team
___________
The Sample
Professionals working in or with CACs
in the 5 national evaluation
communities
 Surveys were mailed to professionals
identified by each CAC as most
knowledgeable about it
 69 respondents returned the survey

Child & Family Outcomes
Child and Family
Investigation Outcomes
Avg.
More effective investigations
More thorough investigations
Fewer repetitive interviews
Fewer interviewers
Shorter interviews
30
40
50
60
70
80
90
100
Child and Family
Investigation Outcomes
Avg.
Child feels
supported
Child/family feel
less distress
Parent feels
supported
Parent feels more
respected
30
40
50
60
70
80
90
Child and Family
Investigation Outcomes
Avg.
Prompt delivery
of services
Increased
availability of
services
Increased use of
services
30
40
50
60
70
80
90
100
Child and Family
Investigation Outcomes

Outcomes rated as most important by
survey respondents:
– Increased quality of the child interview
– Increased support for the child
– Increased identification and delivery of
needed services during investigation

More important than:
– Specific limitations on interviews (fewer,
shorter, etc.)
– Improving experience for non-offending
caregiver
Child and Family
Post-Investigation Outcomes
Avg.
Child less likely to experience
repeat abuse
Decreased stress by child
Greater sense of justice by child
Greater satisfaction by child in
process
30
40
50
60
70
80
90
100
Child and Family
Post-Investigation Outcomes
Avg.
Decreased stress
by family
members
Greater
satisfaction by
family members
Greater justice
experienced by
family members
30
40
50
60
70
80
90
100
Child and Family
Post-Investigation Outcomes

Outcomes rated as most important by survey
respondents:
– Decreased chance that child will experience
further abuse.
– Improved emotional well-being for child.
– Decreased stress for child.

More important than:
– Satisfaction and sense of fairness for non-
offending caregivers.
Agency Outcomes
Important Agency
Investigation Outcomes
Avg.
Increased case
information
shared
Faster first
response time
Increased interagency
communication
30
40
50
60
70
80
90
100
Important Agency
Investigation Outcomes
Avg.
Accurate decisions about
allegations
Better case dispositions
More expertise available
Better evidence
30
40
50
60
70
80
90
100
Less Important Agency
Investigation Outcomes
Avg.
Better understanding of other
agencies
Decreased investigator burnout
Improved coordination with DV
investigations
Better location for observation of
interviews
30
40
50
60
70
80
90
100
Agency Investigation Outcomes

Outcomes rated as most important by
survey respondents:
– Faster response time
– Increased case information shared, inter-
agency communication,
– Better expertise, better evidence and more
accurate decisions
– Better case dispositions

More important than outcomes one step
removed from child and perpetrator
Important Agency
Post-Investigation Outcomes
Avg.
Increased % of at-risk children
protected
Increased % of substantiated cases
filed for prosecution
Increased % of convictions at trial
Increased % of confessions
30
40
50
60
70
80
90 100
Less Important Agency
Post-Investigation Outcomes
Avg.
Increased
arraignment
Increased %
dependency
filings
Increased % nonchild abuse
charges
30
40
50
60
70
80
90
100
Agency
Post-Investigation Outcomes

Outcomes rated as most important by
respondents:
– Increased % of at-risk children protected
– Increased prosecution, conviction at trial,
confessions

More important than more specialized law
enforcement or child protection outcomes
Community Outcomes
Important Community
Investigation Outcomes
Avg.
More resources
for investigation
Greater
adherence to best
practice
standards
30
40
50
60
70
80
90
100
Important Community
Investigation Outcomes
Avg.
Better coordination of
investigations
More joint training
Better relationships of
professionals with investigatory
agencies
30
40
50
60
70
80
90
100
Less Important Community
Investigation Outcomes
Avg.
Cross-agency
peer review
Reduced public
criticism of
investigation
Increased
uniformity in
media relations
30
40
50
60
70
80
90
100
Community
Investigation Outcomes

Outcomes rated as most important by
survey respondents:
– More resources and training for
investigation
– Adherence to best practice
– Coordination & relationships with
professionals

More important than:
– Cross-agency peer review and uniform
media relations
– Reduced public criticism
Community
Post-Investigation Outcomes
Avg.
More community resources for
child abuse
Growth in public awareness of
child abuse
Greater community support for
CACs
More private financial support for
agencies
30
40
50
60
70
80
90
100
Community
Post-Investigation Outcomes

Outcomes rated as most important by
survey respondents:
– Increased awareness of child maltreatment
and resources for victims in community

More important than:
– Support for CACs
– Increased private financial support of
agencies
How Much Do Professionals
Agree on Outcomes?
Very high agreement on very important
outcomes
 But people disagreed somewhat about
the importance of most outcomes
 “Low” importance scores were very
important to some people

Very high agreement on very high scores
10
8
Everyone rated
More Effective Interviews
greater than 80 in this site
6
4
2
Std. Dev = 4.68
Mean = 96
N = 14.00
0
82
42
2
More effective interviews
Some disagreement
even on important outcomes
7
6
17 of 20
people
gave
this > 70
5
3 people in this site
scored this 50 or less
4
3
2
Std. Dev = 19.93
1
Mean = 81
0
N = 20.00
3
13
8
23
18
33
28
43
38
53
48
63
58
73
68
83
78
93
88
98
Increased availability of needed services during investigation
"Low" importance scores
were very important to some people
5
4
5 of 19
people
scored
this > 90
Most people
in this site gave
this low scores
3
2
Std. Dev = 21.30
1
Mean = 73
N = 19.00
0
3
23
13
43
33
63
53
83
73
93
Improved coordination with domestic violence investigations
Conclusions
CACs Have Many Important Outcomes






Responding rapidly
Coordinating effectively
Investigating effectively
Making accurate decisions
Making appropriate dispositions
Reducing child & family stress
(cont.)
CACs Have Many Important Outcomes
Facilitating use of services
 Prosecuting offenders
 Reducing risk of re-offending
 Providing training
 Encouraging best practice

Possible Implications of
Numerous Outcomes
CACs have many demands on time and
resources
 Programs may need to develop
gradually over time
 Different CACs may specialize in
different outcomes
 CACs role in community larger than
coordinating investigations

Lack of Consensus on
Outcomes

Lack of consensus on the importance of
many outcomes underlines the need for
coordination, communication and
relationship-building

CACs may need to accommodate small
groups of their participants invested in
specific outcomes
No Simple Benchmark

Important outcomes tend to be holistic:
quality of response and child well-being

There is no simple benchmark

Number of interviews is potentially a
misleading indicator
Implications for
Program Evaluation

No simple measure of CAC success
may exist

Given the number of outcomes, CACs
may need to do a number of small,
focused evaluations over time