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

4. Operation of CACs

Governance Structures

The six CACs featured diverse governance structures, reflecting the flexibility of the CAC model. The most important elements identified to support service delivery were the need for open communication and a management board that was knowledgeable and supportive. The following outlines the different governance models among the six sites.

Caribou Child and Youth Centre is governed by the board of the Providing Assistance, Counseling & Education (PACE) Sexual Assault Centre. The Caribou Centre’s MDT is the main decision-making body for day-to-day operations.

SeaStar CYAC is governed by the IWK Health Centre. The steering committee is comprised of 22 partners from within and outside the health centre, while the MDT deals with day-to-day operations.

Koala Place CYAC is an independent, incorporated CAC with charitable status. It is governed by a 17-member board that includes partner agencies, three non-voting members, and an executive of three people.

Project Lynx identifies itself as a “virtual” CAC that operates out of the victim services office and RCMP detachment. Its governance structure features three levels: the directors group, the working group, and the coordination team.

Regina Children’s Justice Centre operates as a long-term partnership between the Regina Police Service and the Ministry of Social Services. Each partner contributes to the rent of the space, has their own supervisor and clerical staff and follows their own policies.

Sophie’s Place CAC operates out of the Centre for Child Development (CCD), a registered charitable society that provides general administrative, fiscal, and program oversight for Sophie’s Place. A steering committee develops confidentiality agreements, fundraising, and risk management, while the MDT supervises day-to-day services.

Since the CAC model relies on information sharing between partners, signed consent forms and memoranda of understanding (MOU) among partners are important. Three sites used signed consent forms to acquire caregivers’ consent to information sharing between MDT partners (although only 32% of cases at one site featured consent forms). Additionally, many sites developed MOUs among directors and partners. Such agreements fostered a better understanding of roles at the CAC, instructed how to collaborate and share information appropriately, and established a firm commitment among partners. Upper-level management committees that met frequently also encouraged information sharing.

Location and facilities

All six CACs are located in urban centres, although many serve rural residents, and the one virtual site serves the entire territory. There are four types of delivery models in the study. The following describes their location and the benefits and limitations of each model as described through the interviews.

The hospital-based CAC benefits from being able to offer on-site medical examinations. This is seen as increasing convenience and reducing hardship for clients who require a medical examination. This site also enjoys access to medical specialists at the health centre, such as pediatricians trained in child maltreatment. In comparison, victims at non-hospital-based CACs are referred to off-site health centres where they sometimes wait hours to be seen and often receive treatment from non-specialists or staff untrained in collecting legal evidence. Overall, researchers found that while on-site medical examinations are very convenient for clients, access to available and trained medical staff is more important regardless of location.

Two CACs are housed with other non-governmental organizations (i.e., a sexual assault centre and a child development centre) and benefit from a pre-existing infrastructure. Parent agencies have provided funding (e.g., paying for telephones, office supplies, and interview training) and programs, such as school workshops on sexual abuse (e.g., K-6 ‘Who Do You Tell? Program) and access to services for disabled children. Additionally, since a client may visit the site for several reasons, such co-location offers greater privacy.

Two CACs are not co-located with other agencies. The sites are located centrally to ensure convenience for clients. For one of the CACs, the cost for the facility is shared between two partner agencies, while the other CAC is working independently. This provides more flexibility in how the CACs operates, however, it also offers less privacy to clients since the reason for their visit is more pronounced.

A virtual model was chosen for one of the sites to accommodate the jurisdiction’s dispersed population and to serve as many clients as possible. The coordinator meets with clients at a government victim’s services unit and forensic interviews are conducted in a former cell at the RCMP detachment. Although the CAC has a strong victim advocate and a robust MDT response, clients and MDT members expressed a preference for a physical, child-friendly location to increase convenience and reduce stress. Since the study concluded, Project Lynx has made child friendly enhancements in some communities, identifying appropriate spaces for interviews, and adding comfortable furniture and décor. Improvements have also been made with technology and infrastructure in partnership with Court Services to enable out of courtroom testimony in all communities.

Some challenges the CACs faced at start-up included delays in locating and acquiring a location as well as issues with the set-up of equipment required for forensic interviewing. Challenges with the physical space also continue to exist for some CACs as they are taking on more cases and need to expand their space. While another CAC, currently housed within a parent organization, is considering creating its own board now that it has matured.

Overall, the research has found that a dedicated physical, child-friendly space is a core component of the CAC model. This is consistent with previous research and best practices of the National Children’s Alliance.Footnote 26 Caregivers and clients commented on the impact of the physical space on their experience with the CAC:

“It would be nice to have a dedicated space and it would help parents to have a visual of it all . . . [that] people are there for them . . . [It] would make a huge difference” (caregiver from the virtual model).
“It helps the way it’s decorated. I don’t want to be walking into a dark place . . . This is definitely better than going to the RCMP” (youth).
“I love coming to this place because I love playing with the toys. I got a stuffie. And we needed help with [what happened]” (child).

Child-friendly rooms at Caribou CYAC, Sophie’s Place CYAC, and Regina Children’s Justice Centre.

The MDT model

The MDT brings together law enforcement, child protection, prosecution (Crown), victim support and advocacy, medical, and mental health professionals, and the CAC staff into one team to coordinate investigation and intervention. Although the composition and approach to working as MDTs varies among the six CACs in this study, they all offered joint investigations between at least police officer and child protection worker.

Table 5 provides an overview of MDT membership by site. It also outlines the frequency of case review meetings, which vary from four times per year to twice a week. The frequency of meetings depends on protocols and the co-location of MDT members (although case review meetings can still occur if MDT members are not co-located). Regular meetings were important. One CAC that increased its frequency of meetings to monthly cited better follow-up with clients as a positive consequence. Examples of questions asked at meetings include: What was the outcome? What worked and why? What did not work and what could have been done differently?

Table 4: MDT Membership and Case Review Information
MDT Member Caribou SeaStar Koala Lynx RCJC Sophie’s Place
CAC coordinator/ victim advocate/ responder ★ ★ ★ ★ ★ ★
Law enforcement ✓ ✓ ★ ✓ ★ ★
Victim services ✓ ✓ ✓ ✓ ★ ★
Child protection ✓ ✓ ★ ✓ ★ ★
Crown ✓ ✓ ✓ ✓ ✓ X
Medical X ★ ✓ ✓ ✓ X
Mental health (counselling) ★ ★ ✓ ✓ X X
Other X X X ✓ X X
Frequency of Case Coordination/Review Meetings Once a Month Quarterly Once a Month Every 2 weeks Twice a week Once a Month
★ means they are part of the MDT and housed on site, at least for a portion of their time.
✓ means they are part of the MDT, but not on site.
X means they are not part of the MDT.

The best situation for MDTs is co-location, with law enforcement, child protection, and victim services housed at the same site with CAC staff such as the victim advocate. Co-location facilitates quick responses, information sharing, and coordinated support for clients. However, MDTs that are not co-located can still function well if they build trusting relationships, have well-negotiated and understood protocols, and hold regular case review meetings.

Building a MDT and developing MOUs often took longer than expected. For instance, where nurses were trained to provide specialized medical treatment, many were still concerned about being able to practise in the hospital and testify in court. Protocols for information sharing at all sites required negotiation and trust building. However, over the course of the study, communication between MDT members improved and responses were better coordinated, thus improving service to clients. Some CACs now provide mandatory training on collaboration to new MDT members.

CAC services

Many CACs added or expanded services, largely thanks to FVS funding throughout the five years of the study. New services included psychoeducational workshops on trauma for caregivers, therapy dogs, and a committee on vicarious trauma. New MDT members included a First Nations representative, and a victim advocate at the longest-standing CAC in the study. Therefore, despite different levels of development, all sites were continuously evolving to meet clients’ needs.

The one service that was offered across all six sites was victim advocacy (Table 5).

Table 5: On-Site Services by CAC
Service Caribou SeaStar Koala Lynx RCJC Sophie’s Place
Advocacy through a victim advocate ✓ ✓ ✓ ✓ ✓ ✓
Forensic interviewing ✓ ✓ ✓ X ✓ ✓
Child-friendly meeting places for information provision ✓ ✓ ✓ X ✓ ✓
Law enforcement support X X X X ✓ ✓
Social worker support X ✓ ✓ X ✓ ✓
Forensic medical examinations X ✓ X X X X
✓ means available on site (including full-time and part-time positions)
X means not available on site

The victim advocate is the centre of each CAC and the glue that holds the MDTs together. They are involved throughout the entire process, ensuring a welcoming atmosphere; acting as the central point of contact for victims and their families; answering questions; providing referrals, updates (e.g., about the court case), and information (e.g., about testimonial aids and victim impact statements); and/or liaising with other MDT members. The victim advocate’s impact on clients is evident:

“The victim [advocate] is our rock through the whole process. I don’t know what we would do without her” (caregiver).

Another caregiver described the victim advocate as “calming and re-assuring,” since they were with the CAC, their role was to support the family. While the victim advocate’s role varied by site (Table 6), their presence at the CAC is what mattered most. Advocates worked closely with victim services and court supports. They reached out to small and First Nations communities and maintained communication with clients throughout the process and even after file closure.

Table 6: Roles of the Victim Advocate
Roles Caribou SeaStar Koala Lynx RCJC Sophie’s Place
CAC administration ★ X ★ ★ X ★
Support for child/youth victims and families during forensic interviews ★ ★ ✓ X ★ X
Ongoing support for child/youth victims and families (‘listening ear’) ✓ ★ ★ ★ ★ ★
Follow-up and ongoing provision of information to child/youth victims and families ✓ ★ ★ ★ ★ ★
Court preparation and support ✓ X ✓ ✓ ✓ ✓
System navigator (e.g., providing referrals to other agencies) ✓ ★ ★ ✓ ★ ★
★ means this is a key role ✓ means this is a function sometimes undertaken
X means this is not part of the role

The second most common service available on site is forensic interviewing. A forensic interview is a structured conversation with a child/youth to gather detailed information about possible event(s) that they may have experienced or witnessed. It seeks information for criminal investigations, to assess the safety of the child’s living arrangements, and to determine the need for medical or psychological treatment. Most CACs used the Step-Wise Interview Technique,Footnote 27 while one site preferred Rapport, Anatomy Identification, Touch Inquiry, Abuse Scenario, and Closure (RATAC).Footnote 28 In some instances, forensic interviews were performed at a child’s school with mobile video/audio equipment.

Access to mental health services is also described as “limited”. Although one CAC had two part-time therapist positions, one spot was vacant during the study because the CAC could not afford to offer an attractive salary. Another site had a clinical social worker and psychologist. Four CACs refer clients to off-site mental health services, described as a ‘patchwork’ of programs with long wait lists (e.g., up to one year) and gaps in services for children/youth and specialized adult counselling. In some locations, victim services offer mental health treatment, but access sometimes depended on criminal charges and police reports. As a result, some caregivers access mental health services through private insurance or work.

Although it is not part of the CAC model, two sites offer therapy dogs as an additional service. These dogs calmed young victims before forensic interviews, during court preparation, and in at least one instance, a therapy dog provided support at the courthouse while a young CAC client awaited legal proceedings and testimony. One site has begun a seven-year commitment to working with a therapy dog. Another site is currently waitlisted for a Pacific Assistance Dogs Society (PADS) trauma dog. One MDT member described a dog’s impact as follows:

“There was a child that was so stressed there was no way that he/she was going to be interviewed. The child just sat and rubbed [the support dog’s] belly for a long time in the waiting room. To see if the child would be comfortable going into the interview room, we suggested that [the support dog] could help him/her choose a chair. Once the victim got in the room and sat in the chair that [the dog] chose, he/she seemed to settle. We said that [the dog] would be waiting just outside the door. The child had the interview… [which] would not have happened without the dog’s help.”

The flexibility of the CAC model has allowed for a number of innovative services. Some that were highlighted include:

Staff training

Access to training varies among the CACs. Two CACs provide mandatory initial training to MDT members on how to collaborate and work as a team, while another site uses roundtables to understand each member’s roles. All members can attend conferences or visit other CACs. Many MDT members have received training in forensic interviewing and/or child abuse and maltreatment. Some have been trained in cultural competency and diversity through their school or home organization (e.g. RCMP). Three sites that serve Indigenous communities have worked closely with First Nations (e.g. First Nations policing and child protection agencies) to improve cultural competency, including case planning with Elders. One site that serves a large immigrant population requires its MDT members to attend yearly cultural relations courses.

However, very little formal training and support is available to help MDT members cope with vicarious trauma, post-traumatic stress disorder (PTSD) and/or burnout, which was described by an interviewee as something that can “eat you alive.” Most police partners are required by their home organizations to de-brief with a psychologist annually, quarterly, or after major disturbing cases. One victim advocate has also been trained in compassion fatigue to support MDT members. Another site is currently creating a committee on vicarious trauma, while other partners explained that “if we need a day off or time for self, we are encouraged to do it.” However, support remains informal and most members rely on their home organizations for mental health services.

Outreach

CACs also educate local communities. Three sites hosted conferences, including one titled “Building Resiliency through Collaboration” in 2016 that was live-streamed and attracted 180 participants. Some CACs have also offered workshops for caregivers on coping with trauma. For instance, a series of trauma-informed workshops included Trauma and the Importance of Self Care, How to Support Your Child’s Healing: Becoming Your Child’s Emotion Coach, and More Emotion Coaching. This CAC also offers classes in meditation, trauma-informed yoga, mindful parenting, and strategies to navigate the legal system.