Fact Sheet: About NCA and CACs

NATIONAL CHILDREN’S ALLIANCE (NCA) is a national association dedicated to helping communities respond to allegations of child abuse in ways that are effective and efficient and put the needs of child victims of abuse first. As the accrediting body for nearly 1,000 Children’s Advocacy Centers (CACs) and Chapters in all 50 states, we provide training, financial support, technical assistance, leadership, national advocacy, and access to current research findings on a national level to CACs, developing centers, multidisciplinary teams (MDTs), and other child abuse professionals.

Our purpose is to unify and amplify a single-minded voice to help local communities provide comprehensive, coordinated, and compassionate services to victims of child abuse.

Why do children need Children’s Advocacy Centers?

An estimated 1,820 children died from abuse and neglect in the United States in 20211, the most recent year for which there is national data. But child abuse fatalities are not the only consequences  abused children suffer. Sexual abuse, physical abuse, and neglect are forms of adverse childhood experiences (ACEs) that researchers have linked to mental health problems, such as mood disorders, anxiety, substance abuse, and impulse control disorders.2 Child abuse often co-occurs with other ACEs, like witness to domestic violence or community violence, traumatic loss or separation, or sexual assault. Adults with multiple ACEs have even been shown to be more likely to endure poor health outcomes like diabetes, STDs, heart disease, and early death.

In short, without intervention, child abuse causes lifelong problems.

Children’s Advocacy Centers offer high-quality care so abused children can thrive. At a CAC, a coordinated team of experts in medicine, law enforcement, victim advocacy, mental health, and other disciplines holds offenders accountable and helps children and families heal in a comprehensive, seamless way so no future is out of reach.

In 2022, CACs around the country served 380,494 child victims of abuse, providing forensic interviews, evidence-based mental health treatments that are proven to reduce symptoms, case management, victim advocacy services, and more. CACs also provided more than 2.8 million people with abuse prevention education.

What is a CAC?

CACs are defined by the Children’s Bureau (U.S. Department of Health and Human Services) as Level 1 emergency responders.

CACs are how communities mount a coordinated response to allegations of child abuse. To understand what a CAC is, you must understand what children face without one. Without a CAC, a child may end up having to tell the worst story of his or her life over and over again, to doctors, police, lawyers, therapists, investigators, judges, and others. They may not get the help they need to heal once the investigation is over, either.

When police or child protective services believe a child is being abused, the child is brought to the CAC—a safe, child-focused environment—by a caregiver or other “safe” adult. At the CAC, the child tells their story once to a trained interviewer who knows the right questions to ask. Then, based on the interview, a multidisciplinary team that includes medical professionals, law enforcement, mental health providers, prosecution, child protective services, victim advocates, and other professionals make decisions together about how to help the child. Finally, CACs offer a wide range of services like therapy, medical exams, courtroom preparation, victim advocacy, case management, and more.

Without CACs, With CACs comparison graphic

Evidence from studies of mental health treatments

In a collaborative partnership among NCA, The Duke Endowment, Yale University, Children’s Advocacy Centers of North Carolina, and the South Carolina Network of Children’s Advocacy Centers, we launched an initiative to bring a promising, evidence-based treatment to children in the Carolinas who needed it. The Child & Family Traumatic Stress Intervention (CFTSI) has been proven to significantly reduce trauma symptoms of children as well as symptoms of the participating caregiver. It’s meant to fill the gap between acute interventions and longer-term treatments.

Many children came in presenting high levels of post-traumatic stress disorder (PTSD) symptoms. Caregivers also reported that their children had high levels of PTSD symptoms, as well as other problems like nightmares, feeling scared, feeling worried, having trouble concentrating in school, feeling lonely, not wanting to play, and having intrusive thoughts.

Diagram: Kids and Caregivers report kids have fewer PTSD symptoms after trauma treatment at CACs | Child reported PTSD Symptom Score, reduced from 20.86 to 8.96 after treatment | Caregiver-reported PTSD Symptom Score, reduced from 13.79 to 6.52 after treatment.

In the chart above3, the Child PTSD Symptom Scale (or CPSS, a common PTSD assessment for kids), shows the average child- and caregiver-reported symptom score before and after receiving the CFTSI therapy. Researchers and clinicians agree that scores of 11 or higher reflect significant distress, and indicate that a child may eventually qualify for a diagnosis PTSD upon further assessment. Children with scores of 15 or higher are almost certain to meet the full criteria for PTSD.

Children treated through this program whose symptoms were assessed before receiving CFTSI reported an average score of 20.86. On average, children reported high levels of trauma symptoms at the time they were first seen at the CAC. Following the brief mental health treatment, children and their caregivers both reported much lower levels of symptoms. Children reported with an average score of 8.96, which is below clinically significant levels.

Responses from caregivers

Children are usually brought to CACs by caregivers, who will support them in the months and years ahead as they recover from the abuse. NCA provides a standardized tool called the Outcome Measurement System (OMS) to CACs to collect feedback from caregivers and team partners to ensure CACs are doing the best possible job to support children and their families. More than 800 CACs participate in this program to ensure they are providing the highest quality care to caregivers.

Caregivers and kids feel safe

97% of caregivers agree their children feel safe at CACs.4

Caregivers feel informed

By the end of the first visit, 94% of caregivers report they know what to expect with the situation facing them and their children. Weeks later, more than 93% of caregivers still agree that, as a result of their contact with the CAC, they knew what to expect in the days and weeks after their visit.4 95% of caregivers agree they received information that helped them understand how to best keep their children safe in the future.4

Caregivers and kids leave feeling better

Nearly 97% of caregivers agree, if they knew anyone else who was dealing like a situation the one their family faced, they would tell that person about the CAC.4

Types of NCA Members/NCA Structure

Children’s Advocacy Centers (CACs) are child-focused, facility-based programs in which representatives from many disciplines work together to conduct interviews and make team decisions on cases of child abuse. CAC models for child abuse intervention are proven and effective, bringing together trained professionals to investigate and provide medical and mental health care as well as support to child victims of abuse, while holding offenders accountable through the court system. CAC locations are designed to create a sense of safety and security for child victims.

CACs associated with NCA undergo an accreditation process that follows a regularly updated set of 10 standards established by the NCA board of directors that ensure effective, efficient and consistent delivery of services. Once accredited, CACs then localize the standards to meet the unique needs of individual communities. The accreditation process ensures that CAC programs adhere to rigorous standards of quality service provision known to be effective in helping children heal from the effects of abuse, and once accredited, CACs must be re-accredited every five years.

CACs are located across the country with services that generally include:

  • Forensic interviewing services
  • Forensic medical evaluations
  • Victim advocacy and support
  • Specialized mental health services
  • Community education and outreach

State Chapters are member organizations made up of CACs within a given state, similar in structure to NCA. And, like the CACs they serve, no two Chapters are alike. State Chapters exist primarily to support their member CACs, assisting with the development, continuation, and enhancement of the CAC model as promoted by NCA National Standards for Accreditation. State Chapters also serve as a resource for their member CACs, facilitating a network within the state to support their members and the agencies involved in the investigation, treatment and prosecution of allegations involving child abuse. State Chapters are eligible to apply for accreditation with NCA, in a process that follows a separate set of standards from those for individual CACs.

Regional Children’s Advocacy Centers (RCACs) were established by the U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention. RCACs are funded separately from NCA, local CACs and State Chapters, but work in tandem with NCA to offer a full range of training, technical assistance, consultation and information to established and developing CACs. RCACs are also instrumental in assisting individual communities in developing a comprehensive and multidisciplinary approach to child abuse intervention, increasing community understanding of child abuse and assisting in the accreditation application process for local CACs by clarifying membership standards and conducting site visits. There are four RCACs located within accredited CACs throughout the country in the Northeast, Midwest, South and West. RegionalCACs.org has collective information, resources and links from all four regions.

To learn about the different membership types, click here.


We may be a young movement, but we’ve quickly made an impact. In 1988, representatives from Children’s Advocacy Centers around the country joined forces to establish the National Network of Children’s Advocacy Centers. A decade later, in an effort to reflect the Network’s national composition and focus, the National Network became known as National Children’s Alliance (NCA). In line with original intent, NCA continues to provide accreditation opportunities, financial assistance, training, technical assistance, research, and education to communities, child abuse professionals ,and the more than 900 Children’s Advocacy Centers throughout the United States in support of child abuse intervention, advocacy, and prevention.

1 U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2022). Child Maltreatment 2020. https://www.acf.hhs.gov/cb/research-data-technology

2 Centers for Disease Control, 1998.  https://www.cdc.gov/violenceprevention/aces/index.html

3 Ongoing National Children’s Alliance/Yale University/Duke Endowment study, Change in Trauma Symptoms in CFTSI Cases Completed at North Carolina and South Carolina Sites 3/1/15-1/31/16. N=97

4 National Children’s Alliance, Healing, Justice, & Trust: A National Report on Outcomes for Children’s Advocacy Centers, 2018.

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