Understanding the Development and Impact of Child Advocacy Centres (CACs)

1. Child Advocacy Centre Model (CAC)

Child Advocacy Centres (CACs) and Child and Youth Advocacy Centres (CYACs)Footnote 3 arose out of a need to reduce stress placed on child/youth victims during sexual abuse investigations.

Approximately one in three Canadians experience abuse before age 15. While the accused are often strangers or acquaintances (e.g., a teacher, neighbour, or priest), a large portion are family relatives. For instance, in 2014, approximately 53,600 children and youth were victims of violent crime.Footnote 4 Approximately 16,300 (31%) of these young victims experienced family violence.Footnote 5

Canada’s former Chief Public Health Officer, Dr. Gregory Taylor, explained in 2016 that “family violence … takes many forms, ranges in severity, and includes neglect as well as physical, sexual, emotional, and financial abuse”.Footnote 6 Youth (between the ages of 12 and 17), females, Canadians living in the territories and Saskatchewan, and rural residents are more likely to experience family violence. Perpetrators tend to be parents (61%), as opposed to siblings or extended family members.Footnote 7 The most common type of family violence against children and youth is physical assault.

CACs also aim to address a lack of coordination between social services and the criminal justice system which resulted in victims being interviewed multiple times by different agencies, often by professionals untrained in child development. Moreover, locations of investigations, such as police stations, were not child-friendly. To prevent system-induced trauma which many consider another form of child abuse,Footnote 8 CACs coordinate services by bringing together professionals into a multi-disciplinary team (MDT) ideally, located in a single, child-friendly location. Today, police and child protection agencies may refer both victims and witnesses of various types of abuse and other offences to CACs.

“They just want to help regardless of the outcome. Their main goal is to help children. Every place needs a place like [a CAC]” (caregiver).

United States leadership

The United States is an international leader in the development, implementation, and research of CACs. The first CAC was developed in Alabama in 1985 and today, over 800 CACs operate in the United States.Footnote 9 The National Children’s Alliance offers a system of accreditation in the United States,Footnote 10 which identifies the following key elements of the CAC model:

However, the CAC model varies in practice. For instance, some sites offer only certain services, while others deliver services differently (e.g., on-site or off-site). As a result, different levels of accreditation exist to recognize the diversity of American CACs. In fact, the model is designed to be flexible, so CACs can meet the unique needs of communities and victims.

The United States also leads in research on CACs. The most prominent study was conducted in 2008 by Dr. Theodore Cross and colleagues from the University of New Hampshire’s Crimes Against Children Research Centre. The Cross Survey evaluated four American CACs in relation to nearby non-CAC communities.Footnote 13 This research found that, although CACs and comparison communities feature similar rates of prosecution and conviction, CACs offer more coordinated investigations, better access to medical exams, more referrals for mental health services, and higher levels of caregiver satisfaction with investigations. While children’s satisfaction did not differ between CAC and non-CAC communities, evidence suggested that CACs might reduce children’s fears during interviews. However, CACs did not reduce the number of interviews per child victim. This research, as well as a subsequent meta-study of the effectiveness of CACs by James Herbert and Leah Bromfield in 2015, has identified the MDT approach as the bedrock of the CAC model.Footnote 14 However, few studies have addressed whether CACs reduce trauma, which is the model’s goal.Footnote 15

Canadian model and history

The model’s development in Canada has been more recent, with the first Canadian CAC opening in Regina in 1997. As late as 2009, the former Federal Ombudsman for Victims of Crime, Steve Sullivan, voiced concern that “professionals were often working in isolation and do not communicate efficiently or effectively with the child and family, or with each other. The result is a fragmented, confusing, inefficient and expensive process.”Footnote 16 In response, the 2010 federal budget announced support for the creation and development of CACs through the Victims Fund under the Federal Victims Strategy (FVS). Further funding in the 2012 federal budget aimed to build the capacity of service providers who work with child and youth victims.

Interest in the CAC model has grown in Canada among all sectors.Footnote 17 As of 2016, the following CACs are operating in Canada, and at least seven other sites are currently developing or exploring the model:

Three sites consider themselves to be virtual models:

Research on Canadian CACs is limited. The Department of Justice Canada (the Department) worked with two organizations, Boost CYAC (Toronto) and Zebra Child Protection Centre (Edmonton), to explore the impact of amendments to the testimonial aids provisions of the Criminal Code passed in 2005.Footnote18 Academics such as Mireille Cyr, Kim Roberts, Nick Bala, and Alison Cunningham have also examined interview techniques, testimony, and other issues related to children in the criminal justice system.Footnote 19 However, research on services is limited to organizations’ internal program evaluations which are not always readily available to the public.

To support the development of Canadian CACs, the Department created a national database of CACs, which led to the first national CAC Knowledge Exchange in 2011 in Ottawa. This event brought together MDT partners from across the country to share knowledge of the CAC model, develop a common understanding of services provided, and discuss successes and challenges. A follow up meeting occurred in 2012 and a second knowledge exchange was held in 2013. These events sparked research on developing national guidelines for Canadian CACs, which included input from CAC stakeholders through a national network of CACs led by the Department of Justice, and work being undertaken in Ontario to support the development of CACs in that province.Footnote20 Partners agree that guidelines should promote consistency across the country, reflect how child abuse cases are handled in Canada as opposed to the United States, assist new organizations to establish CACs, and retain the integrity of the CAC model.Footnote 21 A report by Lorne Bertrand and colleagues offers evidence to support the recommended guidelines,Footnote22 which include, a child-focused setting, MDT, cultural sensitivity, forensic interviews, advocacy and support services, medical evaluation and treatment, mental health evaluation and treatment, case review, case tracking, and organizational capacity. These guidelines reflect the National Children’s Alliance standards in the United States.

Today, CACs also exist in Australia, Croatia, Cuba, Finland, Israel, Moldova, New Zealand, Norway, South Africa, Sweden, and the United Kingdom.Footnote 23