CHILDREN S ADVOCACY CENTER, INC. CRAWFORD COUNTY PROTOCOL OF SERVICES I. OVERVIEW A. INTRODUCTION This Protocol of Services for the Children s Advocacy Center, Inc. (CAC) was developed as a cooperative effort by a team of professionals from our community who share the commitment of treatment and prevention of child sexual abuse. Due to recent demands, the primary focus of serving child sexual abuse victims has now expanded to include victims of severe physical abuse, and children who have witnessed extreme acts of violence. We look to the National Children s Alliance (NCA) for guidance and leadership. Learning from past history of child sexual abuse cases and the NCA, we know that a multidisciplinary approach to child abuse investigations is a superior method for effective treatment, prosecution, and prevention of child abuse. The purpose of this Protocol is to guide individuals in various agencies to recognize and respond appropriately to concerns of child abuse. B. MISSION STATEMENT The mission of the Children s Advocacy Center, Inc. is to reduce the traumatic effects of abuse; protect children from maltreatment; seek justice for child victims; investigate abuse as a team and strengthen our community s ability to nurture children, while keeping the comfort and safety of the child the first priority. C. TEAM MEMBERS BY DISCIPLINE and OTHER ROLES The purpose of the team is to insure that persons conducting activities and providing services related to a child abuse case are able to conduct their work in a coordinated manner, maximizing positive outcomes for the child s safety, physical and emotional needs, and for justice. Please note that not all members of the team will be involved in all cases. Also, other agencies and disciplines may be involved at the discretion of the team, as needed. The multidisciplinary team consists of representatives from the following disciplines: 1. Social and Rehabilitation Services (SRS). The SRS representative shall be a Child Protection Services worker that is designated by the agency to work these cases. 2. Law Enforcement. The law enforcement representative shall be a sworn police officer with demonstrated experience in child abuse cases. 3. Medical Personnel. Physicians, nurses, and other medical professionals skilled in identifying and treating the medical needs and gathering evidence where there is a disclosure or concern of child abuse. Preferably, medical examinations shall be completed by a Sexual Assault Nurse Examiner (SANE). 4. Prosecution. An attorney from the appropriate county attorney s office with demonstrated interest in the child abuse cases. 5. Mental Health. Mental health professionals trained in treating child abuse including, but not limited to, emotional, physical and sexual abuse, general neglect, and medical neglect. 6. Child/Family Advocate. The Child/Family advocate shall be a staff member of the Children s Advocacy Center, Inc. with a demonstrated interest in child abuse. 1
7. Domestic Violence Crisis Center representative. This person shall be available to support the non-offending parent as appropriate. This representative shall be involved with any cases with domestic violence issues. 8. Other roles. In addition, the CAC shall include persons working in the following roles. With the agreement of CAC members with appropriate training, these roles may be filled by a member of the multidisciplinary team or by another person: a. Forensic Interviewer. The forensic interviewer interviews children when there is an abuse concern or disclosure. The interviewer should use The Finding Words model of interviewing. b. Team Coordinator. The team coordinator oversees the intake process, forensic interviews, team meetings, and all aspects of the CAC s response to cases. The Coordinator is typically the CAC child/family advocate, but may be a different team member as needed. II. PROCEDURES AND RESPONSIBLE PARTIES A. REFERRAL CRITERIA 1. An interview referral to the CAC must come from Social and Rehabilitation Services (SRS) or Law Enforcement. 2. Case tracking referrals may be made by members of the multidisciplinary team. These referrals will be accepted at the discretion of the CAC staff. 3. A referral is defined as a victim of sexual assault that is under 18 years of age. The CAC Executive Director may make an exception in regard to the client s age if the client has impaired mental abilities. 4. The allegations of abuse are defined as: sexual abuse, severe physical abuse, witness to violence, or a Drug Endangered Child. 5. Individuals or agencies making the referral agree and adhere to the CAC Protocol. 6. The referring agency must supply relevant demographic information, past history, a brief description of the allegations, alleged perpetrator name and relation to child, and members of the investigative team to the CAC. Please refer to the attached CAC Intake Form to note the necessary information. B. INITIAL REPORT AND TEAM NOTIFICATION 1. Reports of abuse will be made to Social and Rehabilitation Services (SRS) or the appropriate law enforcement agency. Reports made to law enforcement shall be forwarded as soon as possible to SRS for intake and screening decisions. 2. Each team member will follow the investigative policies of its respective agency. All child abuse cases will begin as team investigations by CAC team members representing SRS and law enforcement. Neither SRS nor law enforcement staff will initiate an investigation until it has been determined whether or not the team will investigate the case. 3. When an abuse report is received by SRS, they will notify the law enforcement agency involved. When a report is received by law enforcement, the assigned officer will notify SRS personnel at the first available time during regular business hours. The SANE, law enforcement, or SRS personnel will notify the CAC staff of the victim by calling the 24-hour pager number or the CAC business office. The investigation staff will review the case for possible team investigation. When an after-hours or weekend report of abuse is made, the 2
law enforcement officer shall immediately page the CAC to schedule a forensic interview as soon as possible. 4. If a medical provider has reason to suspect that a child has been abused, that person has the responsibility to report their concern immediately by phone to SRS or Law Enforcement. 5. When the CAC has been notified of a potential case by SRS, law enforcement, or a medical provider, the CAC staff person will screen the referral to ensure that it meets CAC criteria. Basic information will be taken (CAC Intake Form). If the criteria are met, the CAC staff person will complete the Intake Form and will coordinate an interview by contacting all members of the Team. After first being assured of the child s safety and documenting other important circumstances of the case, the interview and/or medical examination will be scheduled at the earliest appropriate time. 6. If the alleged abuse has occurred within 72 hours, a forensic interview and medical exam (based on the Section C, Part 3 criteria on Page 3) will be scheduled immediately by a CAC staff person. 7. If the alleged abuse has occurred more than 72 hours ago, a forensic interview will be scheduled within 7 days. The multidisciplinary team will make a group decision as to the medical exam at the time of the forensic interview. 8. The CAC has the direct responsibility or referring responsibility of the following activities, each of which may involve several other activities: a. Medical care of the child b. Notification of SRS and law enforcement, as needed c. Forensic interview of the child d. Medical/CAC releases and consents e. Mental health assessment, referral, and treatment of the child and immediate family members, pursuant to the abuse. f. Interaction with the non-offending parent 9. All members of the multidisciplinary team shall provide their investigative counterparts with any and all information pertinent to the investigation, unless otherwise directed by agency policy or state law. However, any and all information not specifically excluded as a violation of law or policy shall be shared. 10. Crime Scene: While the SRS investigators are not directly involved in search and seizure, it is encouraged they become knowledgeable about law enforcement procedure regarding crime scenes by attending investigation classes when available. This is to help SRS investigators to recognize a crime scene, exit the crime scene without disturbing evidence, and ensure crime scene preservation. C. MEDICAL EXAMINATION 1. It is the policy of the CAC to refer child victims of abuse for a medical exam under the following situations: A. The reported abuse has occurred within seven days of the interview. B. The allegations involved any type of penetration. C. If the alleged abuse is chronic. D. At the discretion of the multidisciplinary team. 2. The immediate goals of the medical exam include the following: 3
A. Insuring the health and safety of the child by conducting an exam of their genital areas. B. Reassuring the child and non-offending parent or caretaker regarding the child s body s functioning. C. Opportunity for disclosure. D. Collecting and securing forensic evidence. E. Documenting forensically significant findings. 3. Medical examinations shall be conducted by a Sexual Assault Nurse Examiner (SANE) at Mt. Carmel Regional Medical Center. A medical examination will take place as soon as possible in the urgent cases described below: A. Sexual abuse within the preceding 72 hours. B. Abuse causing obvious injury. C. Children who appear ill or physically distressed. D. Risk that evidence will be lost by a delay in the examination. In non-urgent cases, decisions about medical examinations may be made during regular business hours. If a child is taken to the hospital before a report is made to SRS or Law Enforcement, the SANE nurse must page a CAC staff person at pager number (620) 230-9154. At the time of the forensic interview, if a medical examination has not been conducted or scheduled, the CAC staff person will consult with the multidisciplinary team members to assess the need for a medical examination. All children with physical injuries or alleged to have been sexually abused should be examined by a physician or nurse examiner. If immediate medical attention is necessary, the child should be brought to the nearest emergency room. If a forensic interview has been completed before the medical examination, the CAC staff person must fax a brief description of the disclosure to the Sexual Assault Nurse Examiner prior to the examination. This will prevent repeated questioning of the victim while providing the necessary information to the examiner. D. CONSENT FORMS AND RELEASES In all cases, consent for the forensic interview will be obtained from the parent or guardian at the first in-person contact with the family. The CAC staff person is responsible for obtaining this signed consent form. The CAC seeks consent for the following items: 1. Videotaped forensic interview. 2. Photograph of the victim for CAC records. 3. Free exchange of information between CAC and multidisciplinary team members and agencies. 4. CAC personnel to maintain supportive contact with child and/or family. Consent for the medical exam will be obtained by the Sexual Assault Nurse Examiner at the time of the exam. 4
E. FORENSIC INTERVIEWS Location of Interview: Investigative teams should interview children at the Children s Advocacy Center, Inc. If this is not possible, the team members should keep the following information in mind. Choosing the location of the interview with the child is important and it is generally recommended that it occur in a neutral, child-friendly environment. When the team responds to an emergency at the hospital, it will be the objective of the team to get the facts and provide support and victim services information. Extended interviews may have to be conducted at the hospital, but if possible, they should be conducted at the Children s Advocacy Center, Inc. as soon as possible. Welcome: The child and person deemed to be the protective adult will be welcomed by the CAC staff and introduced to the individuals who will be participating in the interview. The interview will be conducted in a private, child-friendly, developmentally appropriate, and non-distracting manner. Prior to the child s interview, the CAC Child/Family Advocate will join the family to discuss the purpose of their visit to the CAC. The Advocate will also answer any preliminary questions that the family may have. The parent/guardian will receive a Parent s Guide, a list of their Client s Rights, and various brochures. During the child s interview, the parent or guardian, any siblings, or support persons will be in a separate family room. If deemed necessary, the CAC Child/Family Advocate or Executive Director will join the parent or guardian during the interview. Interview Process: Forensic interviews shall be conducted at the Children s Advocacy Center, Inc. by a CAC staff person, law enforcement officer, or a SRS social worker. All must be certified forensic interviewers, trained in the Finding Words method. At a minimum, interviews shall be observed by law enforcement, SRS, and the CAC Child/Family Advocate. Whenever possible, a representative from the County Attorney s offices shall be present. Law enforcement officers participating in the interview shall not be in uniform; uniformed officers shall avoid contact with the child victim. All law enforcement officers must remove their firearm, handcuffs, and badge and place them in the locked CAC safe in the observation room. Law enforcement, SRS, CAC Staff, and prosecution (whenever possible) will confer about the needed information for safety and for prosecution prior to the interview. The interviewer shall follow the APRI s (American Prosecutor s Research Institute) model of interviewing, RATAC (Rapport, Anatomy Identification, Touch Inquiry, Abuse Scenario, Closure). Anatomical drawings shall be used; anatomical dolls may be used at the discretion of the interviewer. Before the end of the interview, the interviewer shall excuse themselves to the observation room to make sure that all questions of the team have been answered. All interviews shall be videotaped and the tapes will be in police custody. If for any reason, a tape must remain at the CAC, the video will be locked in a filing cabinet in a secure office. Once these videos are picked up, the person taking possession of the tape must sign a Chain of Custody form that will be kept with the tape. The interview will be conducted in a space which in child-friendly and private, using a developmentally appropriate format. Observation of interview: Every forensic interview shall be observed by members of either Law Enforcement, SRS, CAC staff or prosecution. All team members in the observation room must sign the Sign-in Sheet to create a permanent record of their presence. All observers must actively listen to the interview, provide feedback to the forensic interviewer, and monitor the quality of the recording. 5
Post-interview briefing: After the interview, the CAC Child/Family Advocate will reunite the child with his/her parent or guardian. The child will have an opportunity to stay in the waiting room with a support person or advocate while the non-offending parent or guardian meets with the multidisciplinary team. The team and parent/guardian shall discuss the interview and the next steps of the investigation. The team will provide the parent/guardian with answers to their questions or concerns, make necessary referrals, and provide them with all team members contact information. Order of Interviews: The investigative team will decide on a case by case basis in which order it will interview the child/children, alleged perpetrator, siblings, parents (non-familial cases), and non-offending parent (familial cases.) Interview with Alleged Child Victim: The investigative team will determine how the child interview will be conducted. The team should decide who will take the lead in the interview (interview the victim); which will document the interview; and use the RATAC (Rapport, Anatomy Identification, Touch Inquiry, Abuse Scenario, Closure) method of interviewing children, developed by CornerHouse, whenever possible. Interview with Siblings/Other Possible Victims/Possible Child witness: Investigative team members should interview siblings, teachers, child care providers, or others who may have observed behavioral or physical changes in the child or may have heard statements made by the child which may support, explain, or provide additional information for follow-up interviews with the alleged victim, non-offending parent, or alleged perpetrator. Interview with Non-Offending Parent: The non-offending parent should be informed of the allegations, particularly with the child s account of the events. If the investigative team has reason to believe the child was abused, it needs to know if this parent is able and willing to protect the child and how this will be accomplished. The parent should be given the names of the investigative team, information on how to make contact with each of the team members, as well as telephone numbers for crisis and support services. After the interview of the non-offending parent is completed, the team will refer any victim(s) and non-offending family members to services appropriately addressing their present needs. Interview with Alleged Perpetrator: The law enforcement member of the investigative team is usually best prepared to do this, thus, they will always be required to be present during such interviews. Investigators shall take all precautions necessary to keep the alleged perpetrator away from the Children s Advocacy Center, Inc. Documentation via videotape, database, and report: At the end of the interview, a label will be placed on the videotape noting the name, date, and time of the interview, law enforcement and CAC case numbers. The case numbers will be entered into the CAC database, along with other demographic and case-tracking information. The database will be maintained in a secure area at all times. The lead law enforcement agency is responsible for completing the report of the forensic interview and any other interviews with persons relevant to the investigation. The forensic interviewer is also responsible for completing a report that will be turned into law enforcement 6
and the county attorney. These reports will be made available to child protection workers and to members of law enforcement involved in the case. Peer review of forensic interviews: When deemed necessary, the multidisciplinary team will conduct peer review of forensic interview sessions. These will typically take place at the monthly Case Review Team meeting. They will be coordinated by the CAC Child/Family Advocate and done in a supportive, non-judgmental, and collaborative manner. Additional peer review sessions may be held as needed when requested by a member of the multidisciplinary team. Case decision making: Once all the initial evidence has been gathered, the video taped interview conducted, and the forensic medical finding evaluated, the investigative team will determine if the abuse scenario is believable and who the perpetrator may be. This process pulls all the evidence together, including that which supports or refutes the allegation. The decision should be based on, but not limited to, six classes of evidence: 1. The child s statement. 2. Statements of other witnesses, including other children, non-offending parents, teachers, other professionals, and the perpetrator. 3. Medical findings. 4. Physical evidence. 5. Behavior indicators. 6. Any relevant psychological information involving the child, family, or alleged perpetrator. F. CHILD WITNESSES OF VIOLENCE If a law enforcement officer has encountered a child witness of a violent act, they may need to capture that child s statement on videotape. If this is necessary, the officer is to contact the CAC during regular business hours to schedule an interview time. This interview is exclusively at the discretion of the law enforcement officer. G. DRUG ENDANGERED CHILDREN PROGRAM In conjunction with the Kansas Bureau of Investigation (KBI), the CAC is assisting in a Drug Endangered Child (DEC) program. If a child meets the DEC criteria, the child will be interviewed at the CAC. The purpose of this interview is to assist the KBI and the county attorney in determining a Child In Need of Care (C.I.N.C.) case. The information obtained at this interview will not be used to incriminate the parent/guardian in a possible criminal case. The necessary criteria is as follows: 1. A drug-endangered child (DEC) is a child who is being exposed to an environment with conditions of contamination or hazardous life style that result in abuse, life or health endangerment, or neglect perpetrated on the child as a result of illicit drug use, sales, or manufacturing. A criminal violation threshold is met when elements of the contamination or hazardous life style meet the criteria of Kansas Statutes. Once the child has met the criteria as a DEC, they will be brought to the CAC for a forensic interview. A qualified representative from the KBI will conduct the interview. The CAC will 7
supply the facility and equipment for the interview, but no staff support. There will be no case tracking done at the CAC for these children at this time. Should the demand for case tracking arise at a later date, the CAC staff, Board of Directors, and KBI agents will discuss the option of case tracking. H. MENTAL HEALTH Child abuse represents a crisis for the child and the family. The need for mental health services as well as other sources of learning, coping and social support arises from this crisis. The role of mental health professionals is to safeguard the child s safety and to promote the child and family s understanding of the abuse experience. The professional works to restore the family s pre-crisis functioning and, if possible, promote healthy further development. Therefore, each victim and their family will receive an appropriate mental health referral at the time of the forensic interview. The CAC Child/Family Advocate will discuss the mental health process with the victim s parent/guardian. If the parent/guardian expresses concern about the ability to provide these services to their child, the CAC Child/Family Advocate will assist them in beginning the process by setting an initial meeting with the mental health facility. The progress of the child victim will be discussed at the Case Review Team meeting if deemed appropriate by the mental health professional. Extended Assessment: Referral for extended assessment may be made at any point in the investigative or case review process. In cases where the investigative team wishes to refer for extended assessment with a mental health therapist, the parent should be informed and the purpose of the extended assessment process explained. The name and telephone of the therapist to whom the child is being referred to should be provided. CAC-VOCA Flex Funds are available to qualified recipients. I. CASE REVIEW/CASE REVIEW PROCESS A. Case Review Team (CRT) A Case Review Team meeting will be held every month at the CAC or the County Attorney s office. Representatives from the following agencies are expected to attend this monthly meeting: 1. Law Enforcement (Police & Sheriff s Departments) 2. Social & Rehabilitation Services 3. Mental Health 4. County Attorney s Office (county that the case is or will be prosecuted in) 5. Crisis Resource Center of Southeast Kansas (Safehouse, Inc.) 6. Forensic Medical Professional 7. Children s Advocacy Center, Inc. From time to time, other professionals or interns may have reason to temporarily be a part of the CRT. They should sign the Confidentiality Form (detailed below) before attending meetings. As a general policy, interns should not comment on cases under review unless asked to do so by the CRT chair. B. Case Review Process 8
The agenda for case review team meetings would commonly include, but not be limited to, the following; 1. Facts of the case 2. Protection issues 3. Referrals 4. Extended assessment 5. Treatment issues 6. Medical examinations 7. Legal and evidentiary issues 8. Victim services 9. Mental health issues In order to better coordinate services and intervention, consistent case reviews are necessary. Every single open case will be reviewed at the CRT meeting every month to adequately track the case progress. Any cases that have special concern of an investigative member should be reviewed by the multidisciplinary team as soon as possible. Investigative teams wishing to schedule a case for review by the CRT should schedule their cases with the Child Advocate/Case Manager at the CAC who will prepare an agenda of scheduled cases for advanced distribution to all members of the CRT and applicable supervisors. The investigative team members presenting cases at the CRT meeting should come to the meeting prepared to present the information gathered. Chairing of the CRT will be the duty of the CAC staff. It is the policy of all agencies involved with this protocol that their staff designees will attend all scheduled CRT meetings to present their cases. Supervisors of the agencies covered by this agreement will attend as needed or as schedules allow. Members of the CRT may schedule additional meetings as needed. It is the goal of all agencies involved with this protocol to refer child sexual abuse victims as quickly and as early as possible to: 1.) Forensic exams, if needed, 2.) Mental health extended assessment, if indicated, 3.) Victim services. While these services will be covered in CRT meetings, investigative team members should refer children to appropriate services as soon as possible. C. Confidentiality Each member of the CRT and each person sitting in on CRT meetings will sign a document with the following wording: As a member of the CAC Case Review Team, I, within the bounds allowed by law, agree to maintain the confidentiality of all records and information on any abuse cases as outlined in the Kansas Child in Need of Care Code and presented at CRT meetings. I further agree not to release any records or information on any child sexual abuse case except as it relates to legitimate program operations of my agency. I agree that no general media or public access to information and records will be allowed. It will be the responsibility of the CRT chair to make sure that all guests attending CRT meetings sign a confidentiality agreement at the beginning of each meeting. III. AGREEMENTS 9
Statement of interagency agreement shall be read, signed, and agreed to by each member of the multidisciplinary team. 10