CHICAGO CHILDREN’S ADVOCACY CENTER BOARD EDUCATION February 19, 2016
AGENDA • ChicagoCAC Mission, Vision, & Philosophy • Overview of CAC History and Child Abuse Statistics • ChicagoCAC Programs: - Education, Outreach and Prevention - Investigative and Advocacy Services - Family support services - MPEEC - Family Hope Center and PATHH
• Our Partners: – Medical, CPD, DCFS, SAO – How a case goes through our systems
Chicago Children’s Advocacy Center
Chicago Children’s Advocacy Center and our partners are the front-line responders in Chicago to reports of child sexual abuse, as well as reports of physical abuse of children under 3 years old.
ChicagoCAC is the city’s only not-for-profit organization that coordinates the efforts of child protection staff, law enforcement professionals, family advocates, medical experts and mental health clinicians under one roof. Our staff: • Facilitates our partners’ collaborative response • arranges families’ visits to the center, including provision of support services such as transportation and child life • conducts forensic interviews • provides family advocacy and crisis intervention services • provides mental health therapy • provides education and training in the community
Multi-disciplinary team partners • Illinois Department • Cook County Health of Children & Family & Hospitals System Services (DCFS) – forensic medical – child safety, protection and well-being
• Chicago Police Department – criminal investigation
• Cook County State’s Attorney’s Office – felony review
exams and holistic treatment
• Chicago Children’s Advocacy Center – coordination of investigation, and support services
Mission Uniting public, private, and community partners to ensure the safety, health and well-being of abused children. Vision To eliminate the suffering of abused children in Chicago.
CORE VALUES • Freedom from abuse and exploitation is a basic human right. • The Center is a safe place for everyone who enters its doors. • The collaborative process is the best approach to prevent and respond to child abuse. • Children and families deserve to receive the highest standard of care available. • Best-practice interventions can restore lives.
ChicagoCAC provides children with a safe place to share their story in their own words with experts who will listen to them, protect them and help them heal.
History of ChicagoCAC • Founded by former Chicago Mayor Richard M. Daley in 1998. • The city, county and state provided seed money and additional resources to build our 24,000 square foot center, which opened in 2001.
It’s our 15th year anniversary! In March 2015, we completed construction of an 18,000-square-foot expansion to better support the families we serve.
Growing & Giving • Improving the quality and number of child- and family-friendly spaces in which we serve our clients. • Shaping our physical environment to enhance collaboration among our professional teams. • Doubling our mental health program capacity by adding staff and dedicated therapy space. • Adding an education center to broaden our prevention efforts.
Why are we here?
Child abuse includes physical, sexual, and emotional abuse. Child abuse also includes neglect.
Child abuse occurs in all neighborhoods and communities, regardless of economic class, ethnicity, or religion.
1 in 7 girls 1 in 25 boys is sexually abused before turning 18.
Children with disabilities are three times more likely than children without them to be victims of sexual abuse. They are more vulnerable due to: – communication differences – reliance on others – often taught to be overly compliant
2,200 children are referred to ChicagoCAC for reports of sexual abuse each year.
VICTIM DEMOGRAPHICS • The highest representation of victims at ChicagoCAC are African American females • Most of the victims are between the ages of 7 and 12. • 25% of our Advocacy cases required a bi-lingual Advocate. • 9% of forensic interviews are done in Spanish
What happens at ChicagoCAC?
Before CACs: … an inefficient system… a traumatizing process. Teacher Counselor Lawyer Child Protection Investigator
Principal School Nurse Police Officer Nurse Social Worker Doctor
Specialized Social Worker Specialized Doctor
Detective Specialized Nurse
After CACs……
ØReduction in trauma experienced by the child ØIntegrity of collected evidence is maintained ØIncreased communication and collaboration ØEnhanced support to children and families
The CAC Movement
• A national movement in the 1980s and 90’s to pull together multidisciplinary teams to respond to abuse • There are over 800 CACs operating in the United States and around the world
ChicagoCAC: Trauma-Informed Environment • Realizes the widespread impact of trauma and understands potential paths for recovery;; • Recognizes the signs and symptoms of trauma in clients, families, staff;; • Responds by fully integrating knowledge about trauma into policies, procedures, and practices;; • Seeks to actively resist re-traumatization. SAMHSA
Who is ChicagoCAC? • • • • • • • •
Investigative and Advocacy Services Family support services Family Hope Center PATHH Collaboration Education, Outreach and Prevention External Affairs Operational support Fiscal management
FUNDING SOURCES Just like our programmatic work, our funding represents a public-private partnership. Through public grants, private foundations and individuals, all of our services are free of charge to every client.
REVENUE • • • • • • • •
City* State Private Grants Individuals, Events & Corporations Federal County Contributed Services & In-kind Training/Other
Total Revenue: FY2015
$3,744,420 $1,936,804 $1,030,020 $877,582 $198,209 $162,744 $97,374 $19,069 $8,066,222
Executive Management Team • • • • • •
Char Rivette Susan Hogan Michelle Swenson Trevor Peterson Jan Waters Shawnte Jenkins
• Meg O’Rourke • Michelle Medvin
Executive Director Chief Operating Officer Chief Financial Officer Chief External Affairs Officer Sr. Director Clinical Services Sr. Director Investigations and Advocacy Director of Strategic Initiatives Executive Assistant
Events: Getting Involved
We Exist: April 6, Daley Plaza
Luminary Award Dinner: May 12
Guys Night Out for the Kids
Kids Holiday Party: December
Stay in touch with us!
www.ChicagoCAC.org
Education Outreach and Prevention
EOP Department • Director of Strategic Initiatives • Manager of Education, Outreach and Prevention • EOP Specialist • Two interns
Faith-based communities
Schools
Sexual abuse prevention Youth-serving organizations
Families and communities
Our philosophy: As adults, we have a responsibility to protect the children around us. Every child deserves to live free of abuse.
20-40 percent of child sexual abuse is reported to authorities.
96 percent of the children seen at ChicagoCAC for sexual abuse investigations know the abuser personally.
Education and Outreach • Keeping My Family Safe: sexual abuse prevention for caregivers • Preventing, Recognizing and Responding to Abuse: training for schools, youth-serving orgs and community service agencies • Creating Safe Spaces: training and consultation to youth-serving orgs on enhancing policies, practices and trainings to prevent sexual abuse • Responding to Children’s Sexual Behaviors: training for child-serving providers • Erin’s Law: what schools need to know • Keeping Children with Special Needs Safe: prevention training for caregivers and providers • Road to Resilience: impact of trauma
Upcoming community training: Keeping Children Safe: Preventing, recognizing and responding to sexual abuse April 19
Spectrum of behaviors Green light behaviors
Positive and healthy
Yellow light behaviors
Concerning or inappropriate
Red light behaviors
Abusive and harmful
Community Collaborations ChicagoCAC convenes collaborative partnerships to prevent and respond to sexual abuse. Together, we aim to meet the needs of specific communities, taking their unique challenges and opportunities into account as we work to keep children safe and help them heal.
Coalition Against Sexual Abuse Against Children with Disabilities (CASACD) Our goals • Increase public awareness and prevention • Increase access to mental health services • Improve knowledge and expertise of responders • Increase legislative advocacy
Raising Awareness in Services and Empowerment in African American communities (RAISE) .
Our goals • Decrease stigma around mental health. • Increase access professional trainings internship opportunities. • Improve access to trauma-informed mental health services. • Cultivate safe spaces and opportunities for sexual abuse survivors
Community Advisory Council Our goal: broaden awareness of child sexual and physical abuse and ChicagoCAC as a community resource.
As adults, we have a responsibility to protect the children around us.
Advocacy and Investigative Services Department • Intake • Advocacy • Forensic Interviewing • MPEEC Program
The multi-disciplinary team approach (MDT)
Multi-disciplinary team partners • Illinois Department • Cook County Health of Children & Family & Hospitals System Services (DCFS) – forensic medical – child safety, protection and well-being
• Chicago Police Department – criminal investigation
• Cook County State’s Attorney’s Office – felony review
exams and holistic treatment
• Chicago Children’s Advocacy Center – coordination of investigation, and support services
How do cases get to ChicagoCAC?
Sexual Abuse allegations come through the DCFS Hotline and reports to police.
DCFS hotline accepts report. CPD patrol refers case to detectives. If the case meets our criteria, it is assigned to DCFS investigator and/or SIU detective at ChicagoCAC.
Reported abuse is referred to ChicagoCAC intake team.
The Intake Team: • is the family’s first contact with ChicagoCAC. • coordinates the investigation with the multidisciplinary team and arranges a family’s visit to the center, including transportation and child life. • provides initial information about what a visit to the center will entail, including the forensic interview, family advocacy services, and often a medical exam.
• works closely with the MDT to ensure that each team member is available to provide comprehensive services to the child and family during their visit to the center
Child abuse is reported, then…
Arrive for medical and FI
Collaboration
Initial contact with family
Family driven to center
Family Advocacy Orientation:
•
• • • •
Educate caregivers regarding child abuse investigative process and provide ongoing support and guidance Prepare child for forensic interview process Assist and support family during medical exam Provide caregivers education on the impact of trauma on children Inform on the importance of appropriate mental health services to minimize the trauma impact
Intervention: • Completes a screening to assess the family’s needs •
Assess the child’s and caregiver’s mental health to triage level of need and follow up
•
Makes recommendations for services and assist with the linkage to referrals
•
Provide crisis intervention
•
Provide Intensive Advocacy on cases with complex situations and significant risk factors
•
Ongoing collaboration with investigative team on safety concerns
•
Calls for case staffing as needed
Family Advocacy Follow up:
•
Ongoing follow up and support with child and caregivers (phone, follow up visit to Center, or in the community)
•
Continue assessment on interest of MH services as well as education on benefits for child and caregivers
•
Ongoing facilitation of communication with investigative team
•
Documentation of investigative case dispositions
A day at ChicagoCAC
Trauma-informed environment Family Advocacy
Child Abuse Pediatrician
Forensic Interview
Forensic Interviewer role Our forensic interviewers: •
provide children with a safe place to tell their story to experts who will listen to them, protect them and help them heal.
•
are specially trained to ask child victims a series of unbiased, nonleading questions to elicit information in an age- and developmentally-appropriate manner.
•
minimize trauma by ensuring that that the child is able to provide the account in their own words and only has to detail information to one adult.
•
are an important part of the investigative team!
Forensic Interviews
FI video
Warning……difficult material ahead!
Forensic interviewing A forensic interview is a developmentally sensitive and legally sound method of gathering factual information regarding allegations of abuse or exposure to violence. This interview is conducted by a competently trained, neutral professional utilizing research and practice- informed techniques as part of a larger investigative process.” (OJJDP, 2015, p. 3)
Forensic Interviews… • Minimize stress or trauma to the child • Maximize the information obtained • Maintain integrity of all the investigations
Who? • Any child ages 2-17 years old who have reported allegations of child sexual abuse alleged to have occurred in Chicago • Adults with disabilities who have reported sexual abuse • Child victims of or witnesses to violence (e.g. physical abuse, homicide) • Victims of human trafficking or commercial sexual exploitation • Courtesy cases (e.g. jurisdiction, FBI, Homeland Security)
ChicagoCAC Interview Process • Intake solicits information that could impact the interview process • Family Advocate orients child and family to Center • Child goes to Child Life • Pre-meeting with investigative team • Meeting with parent • Room set-up • Interview • Post-meeting
The Phased Interview • • • • • • •
Introduction of self and role Rapport building and narrative practice Rules Truth and lie Introduction of the topic of concern Details of abuse Concluding the interview
General components of ChicagoCAC forensic interviews
Clip from FI: Rapport
Clip from FI: Rules
Clip from FI: Disclosure
Strategies to Increase Accuracy and Decrease Suggestibility • • • • • • • •
Interview guidelines Promise to tell truth Interviewer demeanor Avoiding repeated questions Avoiding the introduction of information Addressing delayed disclosure Reliance on open-ended questions Use of anatomical diagrams – Children with disabilities
Specialized training q Forensic interviewers must complete nationally recognized forensic interviewing training (40 hours) q Forensic interviewers must participate in peer review monthly (local, regional, national) q Trained in presenting anatomically correct drawings for body part identification for young children q Trained in Prepare and Predict Model (developed by Department of Homeland Security) to introduce evidence in the forensic interview (photo arrays, pictures, text or chat logs) q Trained in Extended Forensic Interviewing (reluctant children, victims of sex trafficking, children with disabilities)
Questions?
Family Support Services
Child Life Services During their visit to the center, children are invited to participate in our child life program, where a team of child life specialists provide a developmentally- appropriate environment for our clients and their siblings.
Child Life Services •
• Canine Companionship • Music Magic • Child Life Chefs
Transportation
MPEEC Program and History • Mandated, coordinated, and collaborative response • DCFS investigations for life-threatening child abuse allegations for victims under 3 years of age • Mandate includes: – Centralized case coordination – Forensic medical evaluation – Criminal investigation – Child welfare investigation • 1998: Gabriella Manzardo • 2002 – Present: § Added additional injuries § Expanded capabilities to include off-site and second opinion cases
Who is MPEEC?
MPEEC in Action All Chicago children under 3 years of age who are reported to DCFS as being suspicious for life threatening physical abuse and/or neglect are mandated to received a medical evaluation by one of our Board Certified Child Abuse Pediatricians.
MPEEC Case Types Mandated On-Site • Victim under 3 years of age • Treated at MPEC Hospital • Allegations: q Head trauma q Internal injuries q Burns q Cuts, welts and bruises Second Opinion Case-by-case consideration
Mandated Off-Site • Victim under 3 years of age • Chicago resident • Treated at area hospital q Allegations: q Head trauma q Internal Injuries q Bone fractures
Collaboration
Police
Immediate Scene Investigations Thorough Caregiver Interviews
DCFS Investigators
Child Abuse Pediatrician
SAFE CHILDREN
Exchange of information with MDT throughout investigation
Why is collaboration important? • Studies indicate that a collaborative response to investigating certain types of pediatric injuries lead to life-saving interventions that protect young and vulnerable victims. • In Illinois, children under 3 experience the highest rates of physical abuse and neglect. • Nationally, of the 1,545 child abuse fatalities in 2011, 81.6 percent were younger than 4 years old. • When abuse is missed, repeat injury occurs in up to 80 percent of victims, with mortality rates as high as 50 percent.
MPEEC Injury Types (FY14) Number of Cases by Injury Type 55 48
17
28
23 1
Head Trauma
Bone Fractures
Cuts, Welts, and Bruises
Burns
Internal Multiple Injuries Traumatic Injuries
MPEEC Case Dispositions (FY14)
ChicagoCAC’s Family Hope Center
Mental Health Services at ChicagoCAC • Family Hope Center • PATHH Collaboration
A path to hope and healing…..
SERVICES • Individual therapy for children who have gone through an investigation at ChicagoCAC • Family work • Intensive case management
SERVICES • Caregiver support groups • Hope and Healing psycho-education groups • Adolescent groups
What does therapy look like for a child?
Why are we here? The impact of child maltreatment can be profound. Research shows that child maltreatment is associated with adverse physical and mental health outcomes, and those negative effects can last a lifetime, especially if left untreated. • ACE Study (link)
Children are often resilient. Healing from abuse is possible.
PATHH Collaboration Ensuring that children in the city of Chicago who have experienced sexual abuse have access to traumainformed treatment in a timely manner.
PATHH providers
Current PATHH Collaboration Goals • Understand the current capacity and need for mental health treatment in the city of Chicago. • Improve accessibility of victims of sexual abuse to evidencebased, trauma informed treatment through effective case coordination, improved service delivery and expansion of resources. • Increase knowledge and awareness of child sexual abuse among families in Chicago that have been impacted. • Measure and seek to improve the efficacy of services provided to children who have experienced sexual abuse in the city of Chicago and increase access to trauma-informed treatment.
Why PATHH?
Challenges for receiving mental health services • Large percentage of children who need mental health services do not receive any mental health treatment – 16% of those in need received mental health referral (Burns et al., 2004)
– 35%–58% of children who get a referral access services (Haskett, Nowlan, Hutcheson, & Whitworth, 1991;; Lane, Dubowitz, & Harrington, 2002;; Lippert, Favre, Alexander, & Cross, 2007).
– When referred, urban minority children often do not start treatment or participate beyond a few sessions (Gopalan et al., 2010)
Challenges for receiving mental health services • Long wait lists, lack of capacity • Societal ambivalence about mental health services (Finkelhor, Wolak, & Berliner, 2001)
– Ambivalence among minority populations sometimes based on negative views of previous services (Thompson et al, 2011)
• Substantial minority of nonoffending mothers have inconsistent or ambivalent responses to a child’s sexual abuse allegations (Elliott & Carnes, 2001) • Challenges for CACs (context, voluntary, disjointed systems, limited resources)
CACs have the potential to improve systems of care • CACs reach many vulnerable and victimized children: served 315,800 children nationally in 2014 (National Children’s Alliance)
• Growing recognition of the important role CACs can play in improving systems of care, including linking children and families to mental health services (e.g., Cross et al, 2008;; Jones & Walsh, 2010)
Initial challenges in Chicago • Chicago’s limited capacity within mental health community to serve children who have been sexually abused • Lack of data to inform practice • Need for evidence-informed treatment • Low engagement and retention rates • Families at highest risk need quicker access to treatment • Need for Spanish-speaking therapists • Treatment providers varied location, intake and case closing procedures, eligibility requirements, payment/insurance, transportation and treatment approach
Key Features of the PATHH Collaboration • Solid relationships among partner agencies, including coalition of providers that pre-dated funding • Commitment to serving this population • Non-competitive • Strong, shared mission • Steering Committee that guides decision-making • Funder collaboration • Commitment to evaluation and quality improvement
PATHH Goals 1. Understand current capacity and need for mental health treatment in the city of Chicago 2. Improve accessibility of victims of sexual abuse to evidence- based, trauma-informed treatment through effective case coordination, improved service delivery and expansion of resources 3. Increase knowledge and awareness of child sexual abuse among families in Chicago that have been impacted 4. Measure and seek to improve efficacy of services provided to children who have experienced sexual abuse in the city of Chicago and increase access to trauma-informed treatment
PATHH Strategies 1. Enhanced family advocacy services a. Family screening tool b. Motivational Interviewing
2. Improved referral system a. Triage b. Centralized wait list c. Consistent follow-up
TRIA 3
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3. Expanded capacity a. Funded slots b. Hope and Healing groups c. Learning Community
4. Enhanced evaluation and case tracking
1. Enhanced Advocacy Services • Pre-PATHH advocacy services • Post-PATHH advocacy services – Highly-valued family advocacy services – Professionalization of advocates
• Quality assessments of advocates and motivational interviewing TRIA 3
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Motivational Interviewing • Challenges identified through monitoring and evaluation – Advocates initially overly optimistic about engagement in MH services – After CWL, advocates gave more High Priority ratings in part to (appropriately) advocate for clients – When referred to specific provider, parents often didn’t have relevant information (e.g., location, transportation, scheduling, cost/insurance) TRIA 3
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2. Improved Referral System: Triage • Part of comprehensive assessment by Family Advocate • Purpose: inform decisions about how to allocate scarce resources • Three components/three levels – Chronicity, mental health, trauma history – Low, medium, high – Level of supports
TRIA 3
2
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GE
Triage Results • 45% of children were rated High Priority using the PATHH Triage Instrument – Higher % of High Priority cases since implementing Centralized Waiting List in April 2012 (54% since vs. 33% before)
• % High Severity for each of 3 triage indicators – Incident/Abuse: 18% – Past Trauma History: 72% TRIA 3
2
1
GE
– Child’s Mental Health Symptoms: 36%
Centralized Wait List • Resource management with family • Capacity management with partners • Continued relationship with dedicated capacity clients • Linkage process, administrative efficiencies • Data on system efficiencies and capacity • Quality Improvement of system capacity
3. Expanded Capacity • Funded treatment slots • Hope & Healing Groups • Learning Community/Collaborative
Next Steps for PATHH • Dedicated capacity • Family Hope Center • Structure to support PATHH • Intensive case management • Centralized Resource and Referral • Replication • Learning community
QUESTIONS?
MDT Panel
Multidisciplinary Team Panel • Cook County State’s Attorney’s Office • Stroger Hospital • Chicago Police Department • Department of Children and Family Services
Our Partners Chicago Police Department (27)
• Two Sergeants covering three shifts (7am3pm or 8am-4pm, 10am-6pm and 3pm-11pm) • Twenty-three detectives • Two administrative support police officers
Stroger Hospital (7)
• Four board certified child abuse pediatricians • One board certified child abuse pediatric fellow • One full-time registered nurse • One full-time medical technician
Our Partners DCFS (20) • Three Child Protection Supervisors (8:30-5:00) • Fifteen Child Protection Investigators • Two clerical support staff
Cook County State’s Attorney’s Office (8) • • • •
One deputy supervisor Four full time and one part time ASA Two clerical support workers One Victim Advocate/Outreach worker
Cook County State’s Attorney’s Office
Cook County State’s Attorney’s Office
The Cook County State’s Attorney’s Office is the second largest prosecutor’s office in the nation. Their role is to review cases presented by the Chicago Police for criminal charges and approve or reject the charges. A preponderance of the evidence is necessary for criminal charges.
Chicago Police Department
Chicago Police Department
Detectives come to ChicagoCAC because they have expressed a specific interest in child abuse cases. The role of Detectives is to consider all facts and evidence collected during the investigation, determine whether a child has been the victim of a crime, and request approval of criminal charges from the Cook County State’s Attorney’s Office. Chicago Police Department Detectives conduct interviews for children 13-17.
Sexual abuse can occur online.
INTERNET CRIMES AGAINST CHILDREN • Cook County State’s Attorney’s Office • Chicago Police Dept, Special Investigations Unit • Housed at ChicagoCAC
Cook County Health & Hospital System
ChicagoCAC Medical Clinic Four board-certified Child Abuse Pediatricians (CAP) from Stroger Hospital working at ChicagoCAC. CAPs: • expert doctors trained in recognizing signs of neglect, sexual and physical abuse. • conduct child-friendly, forensic medical exams. • collect evidence, document findings; sometimes use specialized cameras called colposcopes. After exam, physicians work closely with all of the partners to share results of the exam and ensure the child’s safety.
ChicagoCAC Medical Clinic • Forensic medical exams of suspected child abuse victims, including rape kits • Sexually transmitted disease screening and treatment • Lab and diagnostic tests • Initial exams and referrals for children who are pregnant • General physical exams to rule out health problems unrelated to the abuse • Referrals to follow-up social and medical services
Department of Children & Family Services
DCFS The role of DCFS is to ensure the safety, health and wellbeing of children and families. Child Protection Investigators (CPIs) at ChicagoCAC are unique in that they only investigate child sexual abuse allegations and travel to all parts of Chicago. CPIs complete substance abuse and domestic violence screenings, as well as comprehensive social history reports and home safety assessments with families.
Making a Report For DCFS to take the case the following must be true of the alleged perpetrator: • • •
Resides in the child’s home Is responsible for the child’s welfare Came to know the child through a position of trust, such as a mother, father, teacher, counselor, or coach
If the perpetrator does not fit within one of the above categories, the incident may be a crime and will be investigated by the police.
Questions?
Strategic Plan and the future of ChicagoCAC
Thank you for your participation and support! www.ChicagoCAC.org
