University of Nebraska-Lincoln A National Survey of Child Advocacy Centers: Interactions of National Children’s Alliance Membership, Facility Age, and On-Site Mental Health Services with the Number of Children Served Laura Hasemann, Christopher Campbell, Elaine K. Martin, Tiffany West, and David J. Hansen University of Nebraska-Lincoln Results Introduction Methods The primary function of Child Protective Services (CPS) is to investigate reports of child maltreatment in order to protect children from current and/or future abuse occurrences (Smith, Witte, & Fricker-Elhai, 2006). Historically, child abuse investigations involved repeated interviews by numerous agencies (e.g., law enforcement, child welfare) that rarely coordinated services or shared information (Smith, Witte, & Fricker-Elhai, 2006). Further, forensic interviews were frequently conducted in a variety of settings that were unfamiliar and potentially scary for children (e.g. CPS offices, police stations, hospitals, schools, courtrooms; Cross, Jones, Walsh, Simone, & Kolko, 2007). Additionally, the CPS investigation process was slow and difficult for families impacted by child maltreatment (Walsh, Lippet, Cross, Maurice, & Davison, 2008). Thus, the CPS investigative process and procedures became the target of much criticism in the early 1980’s (Jackson, 2004). In response to limitations in the investigative process, Child Advocacy Centers (CACs) began to emerge. Child Advocacy Centers were primarily designed to provide a safe, child-friendly environment for victims (and their families) to receive services following the disclosure of abuse or neglect (Cronch, Viljoen, & Hansen, 2006; Newman, Dannenfelser, & Pendleton, 2005). The CAC model advanced child forensic interviewing by conducting an array of investigations, supplying interviews administered by trained mental health professionals (Connell, 2009), and limiting excessive interviewing (Cross et al., 2007). The first CAC was started in Huntsville, Alabama in 1985 and there are currently more than 700 CACs across the nation. Child Advocacy Centers utilize a multidisciplinary team approach, in which individuals involved in the investigation (i.e. law enforcement, investigators, prosecutors, mental health professionals, and medical professionals) work together, share information, and decrease the amount of interviews conducted (Connell, 2009; Smith et al., 2006). Moreover, CACs provide clients with advocacy and support, numerous referrals for counseling services, and medical examinations (Newman et al., 2005; Smith et al., 2006). The National Children’s Alliance (NCA) is a national organization devoted to promoting and supporting community agencies that coordinated investigations and comprehensive responses to child maltreatment victims. In 1996, the NCA developed ten core standards that CACs had to comply with in order to gain full membership status (e.g. a multidisciplinary team, investigative child interviews, provision of mental health services; Jackson, 2004). Fully accredited members of the NCA have met all ten core components for NCA membership and are given a number of benefits (e.g. eligibility for support through grants, access to information and resources). Associate members lack implementation of all core components, but are working toward full membership. The NCA recently revised regulations concerning the mental health services provided by CACs, as these services are becoming increasingly important due to the negative consequences related to child maltreatment (Walrath, 2006). For instance, child maltreatment has been linked to a variety of problems including internalizing and externalizing behaviors, sexual behavior problems, poor self-esteem, suicidal ideation, posttraumatic stress symptoms, depression, and anxiety (e.g., Kendall-Tackett, Williams, & Finkelhor, 1993). The latest NCA regulations specify that: (a) mental health professionals must have prior experience working with children and child abuse cases; (b) opportunities for further training must be provided for professionals; and (c) mental health services, whether on-site or through other approved agencies, must be available to all CAC clients and non-offending family members (National Children’s Alliance, 2009). A recent national survey by Jackson (2004) found that on-site mental health services were provided at approximately 50% of CACs before the new regulations were put into place. However, little is known about the mental health services provided by CACs since the new regulation was implemented. The primary objective of the current study is to examine the relationship between NCA membership, the age of the facility, and the availability of on-site mental health services for children served in 2008. It was hypothesized that facilities with full membership would help more children than those with associate memberships due to the additional benefits obtained by being a full NCA member. It was also hypothesized that CACs with on-site mental health services would serve more people than CACs without on-site mental health services. This effect was anticipated because mental health services are readily available at the CAC, rather than referring clients to off-site mental health facilities. Lastly, it was hypothesized that well-established CACs (i.e., CACs that were older than ten years) would serve more people than new CAC facilities. This hypothesis was based on the assumption that recognition and community support increases with age. Participants In January 2009, a national survey was sent to the 745 accredited CACs of the NCA. A total of 215 CACs across the nation completed the survey. However, CACs that were considered non-members were excluded from analyses resulting in 147 total respondents. Of the participating CACs, 99 (67.3%) of the centers were full NCA members and 48 (32.7%) were partial members. Sixty-five (44.2%) CACs were younger than ten years-old and 82 (55.8%) were older than ten years-old. Furthermore, 76 (51.7%) CACs reported that they provide on-site mental health services and 71(48.3%) reported they did not provide on-site mental health services. Survey A survey was created based on previous literature on CACs and direct consultation with a local CAC Director. The survey was generated using Survey Monkey, an online survey package that allows for electronic survey creation, completion, and collection. The survey took approximately 10 minutes to complete and contained the following sections: background information, mental health services-general information, mental health services-feedback, mental health-challenges/barriers, on-site mental health services, multidisciplinary team, and client characteristics. Procedure The survey was sent to CAC directors via e-mail and a follow-up email was sent two weeks later. Child Advocacy Center executive directors were asked to complete the survey, but due to director’s time limitations, other staff members were allowed to assist in completing the survey. Centers that chose to participate were eligible to win one of two $50 prizes used towards the benefit of their agencies (toys, treats, etc.). All procedures were approved by the University of Nebraska-Lincoln Institutional Review Board. A 3-way between groups ANOVA was used to examine how the main effects and interactions of NCA membership, on-site mental health services, and facility age are related to the total number of children served in 2008. There was a significant interaction between the variables F (1, 139) = 3.98, p = .048 (Figure 1). Specifically, results revealed that, for full NCA members, CACs that are older than ten years with no onsite mental health services served significantly more children in 2008 than associate NCA members. However, for associate NCA members, CACs that are older than ten years with on-site mental health services served significantly more children in 2008 than did full NCA members. Further, for CACs less than ten years, there was no significant difference for on-site mental health and CAC membership in relation to the number of children served in 2008. Corresponding with the hypothesis, a significant main effect for age of the facility was found, F (1, 139) = 10.72, p = .001 (Figure 2). Results revealed that child advocacy centers that are older than ten years served significantly more people in 2008 than did CACs that are younger than ten years. Additionally, as hypothesized, a significant main effect for availability of on-site mental health services was found, F (1, 139) = 8.15, p = .005 (Figure 3). Child advocacy centers that offered on-site mental health services served significantly more people in 2008 than CACs that did not offer on-site mental services. Finally, , membership status with the NCA did not produce a significant main effect, F (1, 139) = .81, p >.05 Figure 2 Figure 3 Figure 1 Discussion Prior to this study, little was known about the relationship between NCA membership status and the availability of on-site mental health services for CACs. It is substantial to examine these variables, along with facility age, in order to determine what CAC features serve more maltreated children and protect them from current and/or future abuse. Results showed that overall, CACs older than ten years served more people than facilities younger than ten years. Further, CACs that do have on-site mental health services served more children than CACs that do not have on-site mental health services. Lastly, findings show CACs with full memberships and associate memberships served equal amounts of children. However, it was revealed that Full members without on-site mental health services that have been established more than ten years served more children than Associate members. A limitation to this study is that the survey was rather brief and did not assess for in-depth evaluation of specific mental health services provided at the CACs. Based on the busy schedules of CAC directors, the survey was designed to conveniently fit into their schedules and still capture the breadth of the services provided. However, as a result, the return rate of this compressed survey was average to most. Further research should examine CACs offering on-site and off-site mental health services in relation to the specific treatment techniques used by the mental health professionals (e.g. Trauma-Focused Cognitive Behavioral Therapy). This finding would give even more insight as to what specific aspects of CACs help serve maltreated children.