What bits do what? An international lens on the complexities of the CAC model

In Australia, Children’s Advocacy Centers (CACs) have been raised as a way to improve responses to child abuse based on the demonstrated benefits of this approach in the United States. However, there are some important differences between jurisdictions in the U.S. and Australia that need to be considered in adapting the approach. For one, many Australian states and territories already have certain elements of the CAC model in place as part of their government response to child abuse (i.e. evidence-based interviewing models, multidisciplinary team meetings, child and family advocacy). With these core aspects of the model already functioning, the question then becomes: what benefits can we expect from applying the other National Children’s Alliance Standards for Accredited Members in jurisdictions that already have elements of cross-agency practice in place—including those within the United States?

With this question in mind, we partnered with Research Associate Professor Wendy Walsh from the University of New Hampshire’s Crimes against Children Research Center (CCRC) to begin addressing this problem. With help from the National Children’s Alliance, we undertook a survey of 361 CAC directors to try and address two simple questions: 1) What are the characteristics of CACs operating in the U.S.; and 2) what characteristics are associated with directors reporting good quality collaboration with the agencies involved in their MDT/CAC?

Characteristics of CACs in Practice

We observed that although most of the research on the effectiveness of CACs has been done with large CACs in urban areas, most of the CACs in the sample work in small communities. Most see less than 300 cases per year (52%) and have less than four staff members (51%), and a high proportion are in rural communities (45%). The starkest difference was in the degree of co-location of police, child protection, and prosecutors: only small proportions of CACs had all these workers co-located. In terms of providing therapeutic services, half of the CACs in the sample reported having mental health workers co-located, although less than half reported that mental health services were delivered by their own staff (38%).

Secondly, because of the differences in the characteristics of CACs, we undertook some statistical analysis in order to try to identify distinct types of CACs that might be useful for future research and policy development. We identified three distinct types of CACs:

1. A basic CAC that has the core features of holding MDT meetings, advocacy support and conducting forensic interviews;
2. A CAC with the resources and structure around it in order to provide a follow-up and support children and families to engage with therapeutic services; and
3. the full-service CAC with many different types of agencies attending MDT, lots of these agencies co-located, and with many services provided by staff of the CAC.

What we took from these findings was that while there is plenty of research on CACs, almost all of this research is on large, well-resourced CACs; as opposed to the types of CACs that are more common in practice. We currently lack the data in order to be able to make evidence-based decisions about the types of characteristics CACs should invest in, particularly for CACs working in small, rural counties. These findings have now been published in the journal Child Abuse & Neglect.

Characteristics Associated with High-Quality Reported Collaboration

The other part of the project was to see if the characteristics of CACs were associated with the directors’ reports of the quality of collaboration they had with the different agency/discipline groups at their CACs.

We found three factors that were associated with higher levels of reported collaboration:

1. having a joint performance measurement system (such as NCATrak);
2. having higher proportions of MDT members co-located; and
3. more frequent case reviews.

Having each of these features in place meant that CAC directors reported better quality collaboration with each of the agencies they worked with. As directors generally reported very high-quality collaboration with all the groups they worked with, the differences in quality of collaboration were quite small. We are currently in the process of adapting these findings into a journal article.

What Does It all Mean?

For readers, my sense is that this research underscores the importance of understanding the components of complex interventions like CACs. Considerable resources and interagency goodwill is put into holding multidisciplinary team review meetings, co-locating workers and services, and trusting non-police or non-CPS staff to undertake critically important interviews with children. Beyond basic compliance with NCA’s Standards, CACs offered a spectrum of responses, and we know very little about the effect of adding extra bits to the response—nor how different contexts (i.e. working in rural counties, providing a satellite service to other counties) might influence these effects.

Unsurprisingly, considering I am a researcher, I think there is a fair bit more research to be done to better understand how to plan and implement effective cross-agency responses like CACs. The core studies key to the evidence for CACs are now quite old, and may not reflect the reality of current practice in responding to abuse. In particular we’ve called for more focused research on small and rural-based CACs as a priority because of the difference between many of these models and the types of models that typically appear in the research literature.

Dr. James Herbert is a Post-Doctoral Research Fellow at the Australian Centre for Child Protection, at the University of South Australia. Dr. Herbert is a social researcher and evaluator focused on the development, implementation, and delivery of effective social programs. In particular his research focuses on the interaction of criminal justice, child protection, and mental health systems in responding to children affected by abuse, and characteristics of successful collaborations across sectors. You can read a report on the evaluation of first Australian Children’s Advocacy Centre here.