Center's goal: Minimize trauma in child abuse investigations
Posted November 26
SARTELL, Minn. — Colorful parrots and toucans, large dragonflies and wide-eyed frogs adorn the lobby and exam rooms at the new Child Advocacy Center in Sartell.
This place immediately signals to kids that it's designed for them.
It's a far cry from the sharp corners and granite of the St. Cloud police station. It's also not a space that reflects doom and gloom, or the trauma that comes with childhood abuse and sexual assault.
In a building separate from any law enforcement office or medical offices, children can be interviewed and given support services after accusations of abuse arise, the St. Cloud Times reports (http://on.sctimes.com/2fGLdcW ). The center is new for Central Minnesota. Other areas of the state have similar programs, and there are nearly 800 in the U.S.
By design, it avoids the intimidating and busy atmosphere of a police department and affords privacy that might not happen in a busy clinic waiting room, director Katie Boecker says. Police officers lock up their guns before entering rooms with the kids.
Children don't face a panel of interviewers or have to retell their story over and over to police officers, attorneys, social workers and doctors.
They tell their story once, to one person, in a quiet, private room. Their interviewer is trained to be neutral, to allow the child to lead the interview. It's designed so as not to lead a child to a story that isn't true, and to allow the child to share the stories they're ready to tell.
From another room, relevant members of the multidisciplinary team — law enforcement officers, prosecutors, child protection workers, medical personal and advocates for the child — observe via an audiovisual system. DVD copies of the interview can be made immediately and taken with them, for purposes of reports, investigation and filing charges.
In a separate room, the child's caregiver — a non-offending parent or family member, a foster parent or a social worker — can talk to another member of the team and hear about the medical and mental health services available to the family.
Before the story is finished being told, the family can already start to heal.
Next door, a child can be get a well-child exam by a doctor trained to work with children and victims of abuse. Previously, a child might only have a medical exam for the purpose of gathering evidence and had to see a doctor in the Twin Cities. But here, all children can be examined, close to home. If needed, more sophisticated imaging and other medical services are just blocks away.
"The overall message is: It's going to be OK. Your body is OK," Boecker said.
The center is one of seven in Minnesota. They're designed with the same, child-focused, multidisciplinary model and accredited through the National Children's Alliance. The local center will apply for accreditation in March next year.
The Central Minnesota center started seeing clients in September. As of Nov. 18, staff had handled 20 cases. So far, it's been working great.
One case dealt with an unlicensed daycare facility where a number of kids were allegedly abused, said Matt Engelking, chief of the juvenile division for the Stearns County Attorney's Office.
"In at least one of those instances, during a well-child exam, they disclosed some additional injuries which led to additional disclosures," he said. "That's the benefit of bringing these under one roof."
A key piece of the center is the forensic interview, designed to get as much relevant factual information from a child as possible. Some local law enforcement are trained in the technique.
"They come in with a very neutral approach," Boecker said. They'll start with a question like: "Do you know what brought you in here today?"
The goal is not to push an agenda, but to listen to what the child has to say and wants to say. If a child isn't ready to talk, then so be it. The interviewer doesn't go in looking to make a case. Perhaps, the incident was a misunderstanding or it was a false allegation.
"Sometimes, they'll walk out and not say anything," Boecker said.
Boecker's role is not only to manage the center but to focus on the healing of the child.
"A lot of this is just listening to them," Boecker said.
Sometimes the child's primary caregiver is too traumatized to offer the support a child needs, or they're the one causing the harm. The help extends to siblings and other family members as needed, just as the harm can.
"Victims receive wraparound services from the beginning," said Dave Hartford, director of St. Cloud Hospital Behavioral Health. The idea is to intervene early, to prevent further trauma or negative impacts down the road.
Certain therapeutic approaches aim to reduce negative emotional and behavioral responses following child sexual abuse, domestic violence, traumatic loss or other traumatic events. That could include nightmares, bed-wetting, no appetite or refusal to eat, stomach aches or missing school.
The center's location happens to be near the new site of CentraCare's behavioral health department. That means Boecker can actually walk kids and caregivers over, introduce them to staff and therapists and help them set up an appointment. That takes away from the anxiety leading up to an appointment.
It reduces fear for adult and child. They already know where to go, what the office will look like, who the staff is. That makes their chances of showing up for the appointment that much greater, Boecker said.
The center makes referrals to any appropriate service in the community, including the Central Minnesota Sexual Assault Center and Anna Marie's Alliance. In the past, it may have taken several months for a child or caregiver to even get in to see a therapist.
"They don't have three months," Boecker said. "They need that immediate follow-up. That's the role of the advocate."
There's some education to be done for the non-offending caregivers as well.
"That parent has to know how to help that child," Boecker said.
They also know the impact isn't over when the family leaves the center. Advocates serve as a main point of contact throughout the life the case. And Boecker says some may not need any follow up.
All of this comes out of more research and understanding in the medical community on how trauma can negatively affect kids well into adulthood.
"We've known for a long time, there are literally physical manifestations of childhood trauma and the medical community really hasn't gotten a good hold on it," said Janelle Kendall, Stearns County attorney.
The cases usually end up in the criminal justice and child protection systems, not necessarily in health care settings.
Trauma research includes the Adverse Childhood Experiences study, which looks at the effects of physical or sexual abuse. Kendall, members of law enforcement, public health and other county departments have been working to make the county more responsive to those needs.
"It's just kind of the 'Aha!' moment," Kendall said. "It just makes sense when you've been reading police reports your whole career."
She has witnessed victims and offenders who can't reason through things or see the options they have.
"When you look at how the human body would form if it's in fight or flight mode constantly," Kendall said, "it made a lot of sense. ... Physically, they don't have the capacity that other people may have. It's just outside their experience."
Child advocacy centers were one way to get directly at that issue of childhood trauma. There was a big hole of coverage in the middle of Minnesota, Kendall said. Child advocacy centers already operate in Fargo, Bemidji, Duluth, Minneapolis, St. Paul, Rochester and Winona.
The group received a $130,950 grant from the Minnesota Office of Justice Programs for startup costs for the center.
Current staff includes Boecker, a nurse and a child advocate, all employed by CentraCare. They're still looking for a medical director. Two local pediatricians work part-time at the center — Dr. Geri Jacobson and Dr. David Kruse. Both specialize in pediatrics for CentraCare Health.
One of the next steps for the team is identifying ways to make the center sustainable, through grants, fundraising and other means. Eventually, Kendall sees the center needing to handle 400 to 500 cases a year, easily.
The center is starting work in Stearns County, but hopes to expand to surrounding agencies. Agencies that want to use the child advocacy centers must agree to bring all child abuse cases to the CAC. Referrals come from child protection and law enforcement.
Kendall said funding for the center could be something they bring to county boards, especially if the center can show concrete savings in how child protection cases flow through the system.
Insurance can be billed for some of the health services, but that covers only a small percentage of the cost for the center, Hartford said. Families are not charged to use the advocacy center services.
There's a lot of work to getting all those systems to jive together.
"The model presupposes that law enforcement and child protection will allow health care into their investigations," Kendall said. "It has been a fascinating experiencing."
Each agency has a different objective. Law enforcement wants to identify crimes and evidence. The attorney's office is looking to prosecute. Child protection wants to protect the child and prevent more abuse. Medical services are concerned for the physical well-being and mental health.
"It was extremely complicated," Hartford said. "We had to work together to create something new that was really a collaborative effort."
The center helps agencies work across county lines — a key advantage because St. Cloud is in three counties.
Multiple agencies can get information without requiring the family and child to retell traumatic experiences.
"We are collapsing time frames, coordinating the information sharing with professionals, minimizing the amount of trauma," Engelking said. "It will all occur seamlessly under one roof."
The research tells them that prosecutions should become more efficient, with improved quality of evidence. It makes it easier for a family to go through the criminal justice process, too.
"Conviction rates end up being higher because the family sticks with it," Kendall said.
Members of the team have been passing along a story about a recent visit from a little girl. After a long day of interviews and exams, the child walked out of the center with a smile on her face. She said, "I love this place. When can I come back?"
"She felt safe," Boecker said. "We gave her exactly what we wanted."