BEST PRACTICES

Below are the Standards for Accreditation by the National Children's Alliance and the Best Practices for CACs.

Standards for Accreditation by the National Children's Alliance

  • MULTI-DISCIPLINARY TEAM: a multidisciplinary team for response to child abuse allegations includes representation from law enforcement, child protective services, prosecution, medical, mental health, victim advocacy, and a children's advocacy center.
  • CULTURAL COMPETENCY & DIVERSITY: culturally competent services are routinely made available to all CAC clients and coordinated with the multidisciplinary team response.
  • FORENSIC INTERVIEWS: forensic interviews are conducted in a manner that is legally sound, of a neutral, fact finding nature, and are coordinated to avoide duplicative interviewing.
  • VICTIM ADVOCACY/SUPPORT: victim support and advocacy services are routinely made available to all CAC clients and their non-offending family members as part of the multidisciplinary team response.
  • MEDICAL EVALUATION: specialized medical evaluation and treatment services are routinely made available to all CAC clients and coordinated with the multidisciplinary team response.
  • MENTAL HEALTH: specialized trauma-focused mental health services, designed to meet the unique needs of the children and non-offending family members, are routinely made available as part of the multidisciplinary team response.
  • CASE REVIEW: a formal process in which multidisciplinary discussion and information sharing regarding the investigation, case status and services needed by the child and family is to occur on a routine basis.
  • CASE TRACKING: children's advocacy centers must develop and implement a system for monitoring case progress and tracking case outcomes for all MDT components.
  • ORGANIZATIONAL CAPACITY: a designated legal entity responsible for program and fiscal operations has been established and implements basic sound administrative policies and procedures.
  • CHILD FOCUSED SETTING: the child focused setting is comfortable, private, and both physically and psychologically safe for diverse populations of children and their non-offending family members.

  • Best Practices
  • Getting Started - Developing a CAC
  • CAC's within Tribal Regions
  • Children with Special Needs
  • NCA Mulit-disciplinary Team Standard
  • NCA Cultural Competency Standard
  • NCA Forensic Interviewing Standard
  • NCA Victim Advocacy Standard
  • NCA Medical Evaluation Standard
  • NCA Mental Health Standard

 

  • NCA Case Review Standard
  • NCA Case Tracking Standard
  • NCA Organizational Capacity Standard
  • NCA Child Focused Setting Standard
  • Sample Job Descriptions
  • The Evaluation of CACs
  • Human Trafficking
  • Service Animals
  • Vicarious Trauma

 

 

Best Practices of Accredited CACs
The following information was based on the Kauffmann report on child traumatic stress treatment and a poster presentation made by Tripp Ake, Ph.D & Tracee Washington, Ph.D of the Center for Child and Family Health in Durham, NC. The presentation was given at the 11th Annual "Reflections" Symposium on Child Abuse and Neglect. For references specific to this information, see the "Resource Links" page under Best Practices.

Evidence Based Practice is characterized by the following components:

  • Sound theoretical basis
  • Clinical literature regarding efficacy
  • Accepted in clinical practice
  • No evidence of substantial risk or harm
  • Manual sufficiently detailed to allow replication
  • Efficacy based on at least 2 randomized, controlled trials
  • Majority of outcome studies support efficacy

There were 6 categories of practice (well supported, efficacious treatment; supported and probably efficacious treatment; supported and acceptable treatment; promising and acceptable treatment; innovative and novel, and; experimental or concerning treatment). The following 3 treatment modalities fell within the top 3 categories and were therefore determined to be the definitive "best practices" treatments for traumatized children:

1. Trauma Focused - Cognitive Behavioral Therapy (TF-CBT)

Goals:

  • Effectively treating sexually abused children
  • Working with parents as an integral part of treatment

Indications for use:

  • 3-18 year old whose trauma results in behavioral and/or emotional problems and distress symptoms.
  • Treatment in these cases is conducted with the child and non-offending caregiver.
  • Child is not in acute distress/suicidal/actively psychotic.

Treatment characteristics:

  • May be used with traumatic loss/grief, physical abuse, etc.
  • Time limited, structured model consisting of 12-20 sessions
  • Therapist role is directive and active.

Supporting Research:

  • 9 randomized trials, 8 with sexually abused children
  • By comparison to nondirective, supportive treatments, TF-CBT treated clients showed improved PTSD, behavior, and depression symptoms.
  • PTSD improves more with child treatment.
  • Parental distress, parental support, and parental depression were improved by comparison to nondirective approaches.

Developed by Esther Deblinger, Ph.D.
Center for Children's Support, University of Medicine and Dentistry of New Jersey & Judith Cohen, M.D., and Anthony Mannerino, Ph.D.
Center for Traumatic Stress in Children and Adolescents
Alleghany General Hospital

3. Parent Child Interaction Therapy (PCIT)

Goals:

  • Enhancement of parent-child relationship
  • Improvement of parents' ability to effectively manage child's behavior

Indications for Use:

  • When parent-child relationship is characterized by patterns of negative interactions.
  • When parent is having trouble effectively managing child's behavior (parent is excessively punitive or permissive)

Treatment Characteristics:

  • PCIT has 2 treatment phases: 1) Child Directed Interaction (CDI), and; 2) Parent Directed Interaction (PDI).
  • The treatment consists of 12-16 sessions and the modality is family therapy with time set aside for parent feedback.
  • CDI consists of play therapy with the parent and child, who are observed by means of two way mirror or closed circuit equipment, with parent using "bug in the ear" for direction from therapist. The therapist codes the behavior for evaluation and meets with the parent afterwards for feedback on the session.
  • Session goals are built around Pride, Reflection, Imitation, Description, and Enthusiasm (PRIDE).
  • PDI goals are to improve compliance through effective commands characterized by Being specific, Every command being positively stated, Developmental appropriateness of statements, Individual rather than complex commands, Respectful and polite commands, Essential commands only being used, Choices being given when appropriate, and using neutral Tone of voice (Be Direct).

Research:

  • Chaffin et al (2004) studied effectiveness with physically abusive parents.

Findings:

  • 19% of those parents involved had a re-report of abuse at 850 day follow-up.
  • 49% who participated in community-based support group had a re-report of abuse at 850 day follow-up.

Developed by Sheila Eyberg, Ph.D.
Child Study Lab, Dept. of Clinical and Health Psychology, University of Florida

Adapted for maltreating families by Anthony Urquiza, Ph.D.
University of California Davis Medical Center

2. Abuse Focused - Cognitive Behavioral Therapy (AF-CBT)

Goals:

  • Address child's trauma symptoms
  • Address parenting attitudes and behaviors
  • Provide treatment for family with parent and child

Indications for use:

  • When physical discipline is no longer a safe option due to physical abuse being by Caregiver
  • When Caregiver displays abusive characteristics such as inappropriate expectations, tendency to be coercive or isolated, are often angry or sad, or have psychiatric disorders.
  • When families demonstrate abusive characteristics such as coercive environments, general family stressors, have limited psychosocial resources, or are involved in unsafe community activities.

Treatment Characteristics:

  • Includes a 3 phase treatment process consisting of Child Treatment, including 1)coping skills; 2) discussion of family conflict; 3) graduated exposure exercise; 4) addressing of distorted cognitions about abuse; 5) psychoeducation about physical abuse; 6) anger & aggression management, and; 7) promotion of child's safety.
  • Parent Treatment, including: 1) discussion of parental expectations; 2) addressing various perspectives and automatic thoughts involved in attributions and other cognitions; 3) identification of affect and regulation of same, and; 4) appropriate behavior management.
  • Family Treatment, including: 1) abuse clarification; 2) safety and re-abuse prevention plan; 3) address appropriate roles in family structure, and; 4) improve communication and problem-solving skills.

Developed by David J. Kolko, Ph.D.
University of Pittsburgh School of Medicine
Pittsburgh, Pennsylvania
www.pitt.edu/~kolko

References:

Deblinger, E. & Heflin, AH (1996). Treating Sexually Abused Children and Their Non-Offending Parents: A Cognitive Behavioral Approach. Newbury Park, CA: Sage Publications.

Hembree-Kigin, T. & McNeil, C. (1995). Parent-Child Interaction Therapy. Clinical Child Psychology Library Series, Springer Publications.

Kolko, D.J. & Swenson, C.C. (2002). Assessing and treating physically abused children and their families: A cognitive behavioral approach. Thousand Oaks, CA: Sage Publications.

National Child Traumatic Stress Network: http://www.nctsn.org
Kauffmann report and other materials, go to the above site, then to resource center, then general information, then best practices.

PCIT Lab (University of Florida Department of Clinical and Health Psychology): http://www.pcit.org

Abuse Focused CBT: http://www.pitt.edu/~kolko