ATTACHMENT 3 2023-RedBook-v5B-t-Final-Web (1).pdf

FRONT COVER
National Standards 
of Accreditation 
for Children’s Advocacy Centers
 2023 EDITION

This project was supported by grant #2018-CI-FX-K002 awarded by the Office 
of Juvenile Justice and Delinquency Prevention, Office of Justice Programs, 
U.S. Department of Justice. The opinions, findings, and conclusions or 
recommendations expressed in this project are those of the presenters and do 
not necessarily reflect those of the Department of Justice.

Table Of Contents
Introduction
4
Contributors
8
Standards
01. Multidisciplinary Team Standard
13
02. Diversity, Equity and Access of Services Standard
21
03. Forensic Interview Standard
25
04. Victim Support and Advocacy Standard
31
05. Medical Evaluation Standard
37
06. Mental Health Standard
43
07. Case Review and Coordination Standard
49
08. Case Tracking Standard
53
09. Organizational Capacity Standard
57
10. Child Safety and Protection Standard
63
Medical Appendix
67

Guiding Principles
Purpose of the Standards for Accredited 
Members:
The Standards for Accreditation for Children’s 
Advocacy Centers represent the evidence-
supported core competencies of the Children’s 
Advocacy Center (CAC) model.  They are 
explicitly developed, revised, and guided by 
the diverse ways in which CACs are organized, 
sponsored, structured, staffed, resourced, and 
housed in accordance with the unique factors 
in their respective communities. Moreover, the 
Standards are explicitly developed with values 
of diversity, equity, and inclusion in mind.
With continued growth in CACs throughout 
the United States, the Standards also seek to 
balance the goal of serving greater numbers 
of children and families with the critical need 
to sustain the integrity of the CAC model 
and its associated professional credibility. 
Furthermore, National Children’s Alliance 
(referred to hereafter as NCA) is committed 
to ensuring a fair, transparent, and equitable 
review process that recognizes the Standards 
as minimum standards of operation that are 
evidence supported, measurable, reviewed, 
and revised over time as research progresses 
and service needs evolve. In making the 
Standards measurable and the basis of 
measurement clear, NCA promotes the field’s 
recognition of the importance the Standards 
have for ensuring the delivery of high-quality, 
relevant, and accessible services to children 
and families served by CACs.
The Standards help ensure that all children 
across the U.S. served by Children’s Advocacy 
Centers receive consistent evidence-based 
and evidence-supported interventions that 
help them pursue safety, healing, and justice. 
In addition, the Standards also have several 
secondary purposes:
1.
to serve as a valuable roadmap for new
CACs as they develop;
2. to assist existing CACs in improving their
services to children and families;
3. to demonstrate the high-quality work of
Accredited CACs to stakeholders; and
4. to provide a compass to guide CACs,
MDTs, boards, and other stakeholders in
strategic planning and through leadership
transitions.
It is important to note that there is no 
hierarchy among the National Standards for 
Accreditation—all are equally important to the 
healthy functioning of a Children’s Advocacy 
Center.  Therefore, the order in this Standards 
document is not a rank ordering of importance. 
Careful attention should be given by CACs to 
each Essential Component, as they serve as a 
ladder of success to the Standard as a whole.
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Standards Revision Process
NCA’s Standards for Accredited Members 
are reviewed through a process coordinated 
by the Accreditation Department every five , 
consistent with the five-year period after which 
reaccreditation is required. NCA conducts 
regular reviews of the current Standards to 
ensure that they reflect relevant advances 
in evidence-based practices and are clear, 
concise, and set at appropriate thresholds. 
The first step of the process was the 
commission and publication by NCA of the 
Annotated Bibliography of the Empirical and 
Scholarly Literature Supporting the Standards 
for Accredited Members (hereafter referred to 
as the “Annotated Bibliography”). It was first 
published in 2011, reviewed and republished 
in the 2013 second edition and, most recently, 
reviewed and republished again in a 2019 third 
edition. (Relevant research published in the 
interim period was reviewed and added to the 
draft bibliography.) Research support for all 
existing standards was identified, providing 
good evidence that the existing standards and 
extant research were in alignment and pointed 
in new areas in which an evidence base has 
now developed. 
In addition to the 10 core CAC National 
Standards, and based on feedback from the 
field, NCA’s Board of Directors directed the 
Standards revision process to determine 
whether sufficient evidence existed to establish 
practice standards and guide CAC services in 
Commercial Sexual Exploitation of Children 
(CSEC), Prevention, and Physical Abuse.  Since 
every CAC does not provide these services, 
and yet practice standards are needed for 
those that do, the NCA Board determined 
that these three new standards will guide CAC 
services in these key areas at the discretion of 
the individual CAC seeking accreditation or 
reaccreditation. This means that these three 
Standards may be included in the review 
of site reviewers and CACs must opt-in for 
such additional review. These topic areas 
are included in the 2019 third edition of the 
Annotated Bibliography.
Beginning in July 2020, NCA conducted 
a stakeholder survey of Accredited CAC 
members, accreditation site reviewers, 
Regional CAC leaders, State Chapter directors, 
and NCA Board members and staff seeking 
feedback on the existing Standards as well as 
requesting input on additional areas of inquiry. 
During this time, the NCA’s Accreditation 
Department also reviewed accreditation 
outcome and evaluation data from the period 
between January 2017 and June 2020 to 
identify areas requiring further inquiry or 
clarification. 
During the summer of 2020, NCA hired 
two independent consultants to review the 
current Standards for Accreditation through a 
diversity, equity, and inclusion (DEI) lens. They 
each made DEI-relevant recommendations 
for each of the current Standards and their 
corresponding essential components, which 
were shared throughout the rest of the revision 
process.
After the collection, review and approval of 
the final bibliography and the outcome and 
evaluation data, the Accreditation Committee 
convened seven Standards Task Forces to 
examine the following individual or groupings 
of related standards: 
1.
Organizational Capacity, Case Tracking,
and Child Safety and Protection (formerly
Child-Focused Setting);
2. Multidisciplinary Team, Case Review and
Coordination (formerly Case Review), and
Forensic Interview;
3. Equity, Access, and Inclusivity of Services
(formerly Cultural Competency & Diversity)
and Victim Services & Advocacy;
NCA   |   NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS   |   2023 EDITION   •   PAGE   5

Accreditation Process
CACs applying for new accreditation 
or reaccreditation begin by filling out a 
comprehensive application detailing how the 
center meets each Standard. This application 
must include the required documentation that 
demonstrates how it meets the Standards. 
NCA staff then screen the application for 
completeness and provide it to a two-person 
site review team. The two site reviewers will 
review the application, contact the CAC 
director, and send any questions or requests 
for additional information before the scheduled 
site visit. 
The two-person site review team will conduct 
an on-site or virtual review within six months 
of submission of the application. The site 
review will include a meeting with board 
members, staff, and MDT members to review 
practices and documentation that demonstrate 
compliance with the Standards. Based upon 
their findings, the site review team completes 
a scoring form and makes a recommendation 
regarding the CAC’s accreditation status. 
NCA’s Accreditation Department reviews 
pending status recommendations, which 
occur when the CAC is deemed to have had 
4. Medical Evaluation and Physical Abuse;
5. Mental Health;
6. Prevention; and
7.
Commercial Sexual Exploitation of Children
(CSEC).
Each Task Force was composed of subject 
matter experts and representatives from 
Regional CACs, Chapters, NCA member 
CACs, NCA site reviewers and NCA senior 
staff. Special care was taken to ensure that 
each Task Force included representatives 
who are experienced with CACs of diverse 
organizational structure, caseload, geography, 
and service population size and demographics. 
Each Task Force member also participated in 
a required implicit bias training prior to the 
first meetings held in October 2020. Each 
Task Force met monthly to discuss proposed 
revisions to their assigned Standards, 
completing this work in the spring of 2021. 
A final review period of the full set of revisions 
was conducted in spring of 2021 by a Readers’ 
Pool selected from across all seven Task 
Forces. Feedback from the Readers’ Pool 
and a DEI consultant was reviewed by NCA’s 
Accreditation Department and senior staff. 
The final draft version of the revised Standards 
was submitted to NCA’s Executive Committee, 
which reviewed it in May 2021 for any final 
revisions. It was then submitted to the full 
Board of Directors for a vote at their June 
2021 meeting. At that time, the 2023 Edition 
of the Standards for Accredited Members was 
approved, and it was subsequently announced 
at NCA’s 2021 Leadership Conference. This 
allows a number of months for CACs to 
complete their accreditation process before 
the revised Standards become effective for all 
CACs on January 1, 2023. 
All CACs seeking accreditation for the first 
time, whether applying as a brand-new center 
or as a center in another membership category, 
will be reviewed and evaluated based on the 
Standards in effect during the year in which 
they apply. Accredited Centers will continue 
to need to engage in reaccreditation every 
five years on a rolling basis from their previous 
accreditation. 
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deficits in one or more of the Standards. NCA’s 
Board of Directors reviews the findings and, 
if in agreement, approves the site reviewer 
recommendations and awards accreditation. 
Centers are notified of the outcome of the 
review process at this time. 
CAC’s who are accorded pending status 
are given a one-year period to implement 
and document a corrective action plan that 
demonstrates compliance. At the end of this 
pending period, the corrective action plan 
documentation is reviewed by the original two 
site reviewers, the Accreditation Department, 
and NCA’s Board of Directors. The Board 
makes the final determination regarding 
compliance and either awards or denies 
accreditation accordingly. Centers denied 
accreditation have the option to appeal the 
denial decision or begin a new accreditation 
process.
NCA   |   NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS   |   2023 EDITION   •   PAGE   7

Name
Employer
Abbie Newman, JD
Mission Kids Child Advocacy Center
Adebimpe Adewusi, MD
CARES Northwest
Althea Miller
Harford County Child Advocacy Center
Amelia Siders, Ph. D.
Children's Advocacy Centers of Michigan
Amy Russell, JD
Arthur D. Curtis Children's Justice Center
Antoinette Laskey, MD
University of Utah, Primary Children's Hospital
April Leming
Children's Advocacy Centers of Texas
Betti Mucha
Perry-Jackson Child Advocacy Center
Billie Larkin
NCA Site Reviewer
Brenda George
Children's Alliance of Montana
Caitlin Bentley
Ohio Network of Children's Advocacy Centers
Caitlin Massey
Strafford County Child Advocacy Center
Cameo Stanick
Hathaway-Sycamores Child and Family Services of Los Angeles
Carole Swieckie
Dee Norton Child Advocacy Center
Carrie Little
Children's Advocacy Centers of Oklahoma
Cathy Brittis
CAC at Children's Hospital at Dartmouth
Channing Petrak, MD
Pediatric Resource Center
Char Rivette
Chicago Children's Advocacy Center
Charles Wilson
Consultant
Chelsea Churchill
Children's Advocacy Centers of Texas
Chris Kirchner
Children's Advocacy Centers of Pennsylvania
Chris Newlin
National Children's Advocacy Center
Claudnyse Holloman
Voices for Children Advocacy Center
Corey Brodsky
Midwest Regional Children's Advocacy Center
Crimson Barocca
Baltimore Child Abuse Center
Dana Sawyer
Western Regional Chidlren's Advocacy Center
Darby Geller
SAFE Center
David Finkelhor, Ph. D.
Crimes against Children Research Center, University of New 
Hampshire
Deana Joy
Children's Advocacy Centers of North Carolina
Contributors
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Name
Employer
Debra Poole, Ph. D. 
Central Michigan Univeristy
Diana Schunn
Child Advocacy Center of Sedgwick County
Dominic Prophete, JD
Wynona's House Child Advocacy Center
Dr. Trinity Ingram-Jones
The Cottage
Eileen Caraker
Gloucester County Children's Advocacy Center
Elizabeth LeTourneau, Ph. D.
Johns Hopkins University
Ellen Morrissey
Children's Advocacy Centers of Texas
Ernestine Briggs-King, Ph. D.
Duke University
Gene Klein
Project Harmony
Greg Flett
Southern Regional Children's Advocacy Center
Isha Metzger, Ph. D.
University of Georgia, The EMPOWER Lab
Jane Braun
NCA Site Reviewer
Janet Fine
NCA Site Reviewer
Jasmine Mau-Mukai
Hawaii State Chapter of Children's Justice Centers
Jeffrey Wherry, Ph. D.
UT Health Science Center at Tyler
Jessica Miller
The Gingerbread House
Johanna Hager
Braveheart Children's Advocacy Center
John Pizzuro
Commander New Jersey State Police
Jordan Benning
Midwest Regional Children's Advocacy Center
Joyce Moran
Southern Virginia Child Advocacy Center
Julie Porterfield
Emerald Coast Children's Advocacy Center
Julie Stauffer
CornerHouse
Karen Farst, MD
University of Arkansas for Medical Sciences
Karen Hangartner
Southern Regional Children's Advocacy Center
Karla Tye
Children's Advocacy Centers of Mississippi
Kasey Jackson
Children's Advocacy Centers of Texas
Kathryn Flack
West Virginia Child Advocacy Network
Katie Connell
Federal Bureau of Investigations
Kelly DaCunha
Baltimore Child Abuse Center
Kelly Kinnish
Georgia Center for Child Avocacy
Kimberly Mangiaracino
Children's Advocacy Centers Of Illinois
Kori Stephens
Resonance Rising
Kristy Brodeur Dermody
CALICO Center, Children's Advocacy Centers of California
NCA   |   NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS   |   2023 EDITION   •   PAGE   9

Name
Employer
Laura Gapske
First Witness Child Advocacy Center
Laura Ng
Chicago Children's Advocacy Center
Leigh Bolin
Resource Center for Parents & Children
Libby Nicholson
CARE House
Libby Ralston
Dee Norton Child Advocacy Center
Linda Cordisco Steele
National Children's Advocacy Center
Lindsay Jordan
Children's Advocacy Centers of Texas
Lisa Conradi
The Chadwick Center at Rady Children's Hospital
Lori Frasier, MD
PinnacleHealth Children's Resource Center
Luis Acuna-Pilgrim
Children's Advocacy Centers of Texas
Marcia Milliken
Minnesota Children's Alliance
Mark Hudson, MD
Midwest Regional Children's Advocacy Center
Maureen Fitzgerald
Children's Advocacy Centers of Washington
Maureen O'Connell
Midwest Regional Children's Advocacy Center
Melissa Brunner
Southern Regional Children's Advocacy Center
Melissa Ewer
New Mexico Children's Alliance
Melissa Snow
National Center for Missing & Exploited Children
Michele Mullen
Northeast Regional Children's Advocacy Centers
Michelle Thames
SafeSpot Children's Advocacy Center
Nydia Monagas, Psy. D.
New Jersey Children's Alliance
Pam Karalunas
NCA Site Reviewer
Patti Terzian
Western Regional Children's Advocacy Center
Paul DiLorenzo
Philadelphia Children's Alliance
Paula Condol
Dakota Children's Advocacy Center
Peter Boser
New Jersey Children's Alliance
Rachel Niemiec
Massachusetts SANE Program/Norfolk Advocates for Children
Regan Stewart, Ph. D.
Medical University of South Carolina
Rita Farrell
Zero Abuse Project
Ruby Nelson
Prince Georges County Department of Social Services Child 
Advocacy Center
Sabina Alic
Nebraska Alliance of Children's Advocacy Centers
Salli Kerr
Western Regional Chidlren's Advocacy Center
Sara Lee
Midwest Regional Children's Advocacy Center
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Name
Employer
Sarah Forrest
Nebraska Alliance of Children's Advocacy Centers
Shawna Pagano
Pat's Place Child Advocacy Center
Stacie LeBlanc, JD
The Up Institute - APSAC
Sue Ascione
Northeast Regional Children's Advocacy Center
Susan Goldfarb
Children's Advocacy Center of Suffolk County
Suzanne Starling, MD
The Chadwick Center at Rady Children's Hospital
Tammi Pitzen
Children's Advocacy Center of Jackson County
Ted Cross, Ph. D.
The Children & Family Research Center, University of Illinois
Teresa Smith, Ph. D.
Northeast Regional Children's Advocacy Centers
Terri Covington
Consultant
Tifanie Petro
Children's Home Child Advocacy Center
Tina Morgan
NCA Site Reviewer
Tom Knapp
South Carolina Network of Children's Advocacy Centers
Tomiko D. Mackey
Family Crisis Services of Northwest Mississippi
Tony DeVincenzo
Northeast Regional Children's Advocacy Center
Tracey Tabet
Utah Children's Justice Centers
Vickie Melvin
Philadelphia Children's Alliance
Vicky Gwiasda
Western Regional Chidlren's Advocacy Center
Victor Vieth, JD
Zero Abuse Project
Wendy Lane, MD
Baltimore Child Abuse Center; Howard County Child Advocacy 
Center
Wendy Loomis
Child First Advocacy Center
Teresa Huizar
National Children's Alliance
Kim Day
National Children's Alliance
Kristie McKenney
National Children's Alliance
Alyson MacKenzie
National Children's Alliance
Alyssa Todd
National Children's Alliance
Blake Warenik
National Children's Alliance
Michelle Miller, Ph. D.
National Children's Alliance
Jan Lutz
Indiana Chapter of National Children's Alliance
NCA   |   NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS   |   2023 EDITION   •   PAGE   11

PAGE   12   •   NCA   |   NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS   |   2023 EDITION

01. Multidisciplinary Team
Standard 01
Multidisciplinary 
Team
A multidisciplinary team response to child abuse 
allegations includes representation from the following:
• Law enforcement
• Child protective services
• Prosecution
• Medical
• Mental Health
• Victim Advocacy
• Children’s Advocacy Center
NCA   |   NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS   |   2023 EDITION   •   PAGE   13

01. Multidisciplinary Team
Rationale 
A committed and effective multidisciplinary 
team (MDT) with a shared common goal is the 
foundation of a Children’s Advocacy Center 
(CAC). An MDT is a group of professionals 
from specific and distinct disciplines that 
collaborates from the point of report and 
throughout a child and family’s involvement 
with the CAC. MDTs coordinate investigations 
and service delivery to mitigate potential 
trauma to children and families, to keep open 
the lines of communication and maintain 
transparency and foster trust, and to help 
optimize a quality response overall, while 
preserving and respecting the rights of the 
clients, and the mandates and obligations of 
each agency. 
A CAC is an agency or organization that 
facilitates the interagency coordinated 
response. All MDT representatives contribute 
their knowledge, experience and expertise for 
a coordinated, comprehensive, compassionate 
response that is relevant and accessible to its 
clients. Quality assurance and a review of the 
effectiveness of the MDT’s collaborative efforts 
are also critical aspects of the MDT response. 
The core MDT must be composed of 
representatives from law enforcement, child 
protective services, prosecution, medical 
providers, mental health providers, victim 
advocates, MDT leadership, and CAC staff. 
CAC staff may provide any of the above 
functions, or additional functions, such as 
forensic interviewers. Some CACs, including 
those in small or otherwise under-resourced 
rural communities, may employ one person 
to fill multiple roles. For example, the 
CAC director may also serve as the victim 
advocate, or a CPS worker may function as a 
forensic interviewer and a caseworker. What 
is important is that clear boundaries are 
maintained between each function, and that 
the MDT response is inclusive of and utilizes 
all of the required functions outlined in these 
Standards. 
MDTs may be expanded to include 
professionals with other relevant roles and 
responsibilities, including guardians ad 
litem, adult and juvenile probation officers, 
dependency (civil) attorneys, out-of-home 
care licensing personnel, federal investigators, 
school personnel, domestic violence providers 
and others as deemed necessary and 
appropriate for an individual child, family or 
community on a case-by-case or routine basis. 
Generally, a coordinated MDT approach results 
in efficient interagency communication and 
information sharing, ongoing collaboration of 
key individuals, and a network of support for 
children and families. Each agency benefits 
from the knowledge and expertise of MDT 
colleagues, thorough and shared information, 
and improved and timely gathering of 
evidence that guide individual and collective 
interventions and help ensure the most 
efficacious outcomes for the clients and all 
of the MDT partners. CACs function within 
a trauma-informed framework designed 
to reduce harm and support healing. MDT 
interventions in a neutral, child-focused 
CAC setting are associated with clients 
experiencing less anxiety, having to undergo 
fewer interviews, and seeing more appropriate 
and timely referrals for needed services 
and meaningful participation by clients in 
the protective services, criminal justice, and 
other systems where applicable. In addition, 
a coordinated MDT response can empower 
parents and other caregivers to protect and 
support their children throughout the life of the 
case and beyond. 
01. Multidisciplinary Team
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01. Multidisciplinary Team
BENEFITS OF THE MDT 
APPROACH BY MDT FUNCTION
Law Enforcement 
•
May generate additional evidence to create
a stronger case that is less reliant on only
the victim’s disclosure.
•
Support and advocacy functions are
attended to by other MDT partners, leaving
law enforcement personnel more time to
focus on their investigatory role.
•
Enhanced collaboration between
investigative partners results in a better
understanding of family dynamics and
improved response to child protection
issues.
CPS 
•
Contributes historical family information,
which enhances MDT’s abilities to
foster child safety and provide parental
support and assistance with service
plans, minimizing need for escalated CPS
interventions.
•
Provides additional support and
intervention in cases where safety cannot
be assured.
Medical Providers 
•
History and other information obtained
during the coordinated forensic interview
prevents unnecessary duplication of effort
and guides medical decisions.
•
Provide consultation on specialized medical
evaluations and interpretation of medical
findings and reports.
Mental Health Providers 
•
Contribute valuable information to the
MDT regarding the child’s emotional
state, treatment, and other service needs,
and are able to participate in the criminal 
justice process and other systems where 
necessary. 
•
Help ensure that trauma-informed and
culturally relevant assessment, treatment,
and related services are routinely made
available and accessible to children and
families.
Victim Advocates 
•
Provide crisis assessment and intervention,
safety planning, referrals for additional
services, ongoing support, information and
case updates, and court advocacy where
necessary in a timely manner.
•
Help ensure the MDT’s ability to anticipate
and respond effectively to the specific
needs of children and their families; lessen
the stress of, and afford legal rights and
meaningful participation in, various systems
and the court process; and increase
access to services and resources for the
child and family, including crime victims’
compensation.
Prosecutors 
•
Provide information about the criminal
justice process, victim rights, and seek
input from children and families to inform
decisions.
•
Integrate input from MDT members
to optimize ability to hold offenders
accountable and ensure community safety.
Children’s Advocacy Center
•
Coordinates the MDT response to ensure
the child and family are receiving non-
duplicative services.
•
Offers a child-focused setting where
trained professionals conduct forensic
interviews and other needed services are
provided.
NCA   |   NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS   |   2023 EDITION   •   PAGE   15

01. Multidisciplinary Team
Essential Component A:
The MDT Coordinator/Facilitator coordinates 
and facilitates the day-to-day information 
sharing and activities of the MDT. The MDT 
facilitator/coordinator must complete training 
that includes a minimum of eight hours 
of instruction. (This may be the same or 
different from the person who facilitates 
case review sessions, as some case reviews 
are facilitated by MDT members.)
Training topics which cover the function of the 
MDT Coordinator/Facilitator may include:
•
Developing and maintaining relationships
with and among MDT members
•
Defining roles and responsibilities of team
members
•
Defining mission, vision, and values of the
MDT
•
Managing change and turnover on the
MDT
•
Navigating and resolving conflict
•
Knowledge of evidence-informed team
development models
•
Facilitating shared decision-making
•
Ensuring adherence to MDT agreements
and protocols
•
Understanding of the various meeting
structures that support effective teams
•
Facilitating effective communication
processes
•
Creating psychological safety
•
Training in implicit bias and how it impacts
the MDT
•
Building resilience for the MDT
STATEMENT OF INTENT 
The person designated to coordinate and 
facilitate the MDT should have training 
experience in team facilitation to ensure a 
fully inclusive and participatory process that 
will ultimately benefit the child client MDT 
coordinators/facilitators may come from a 
variety of professional backgrounds.  Often 
they have subject matter expertise in child 
abuse, child abuse investigations, or other 
human services occupations. However, 
facilitating a team of multidisciplinary 
professionals is a unique skill set.  It requires 
an understanding of group dynamics, conflict 
resolution techniques, and team problem-
solving.  This requires specialized training in 
order to set the MDT Facilitator/Coordinator up 
for success.  The MDT Facilitator/Coordinator 
may be a person employed by the CAC 
who has another role in addition (such as an 
Executive Director, forensic interviewer, or 
victim advocate) or may exclusively act as the 
MDT Coordinator/Facilitator.  In some CACs 
this person also facilitates case review.  In 
others, an MDT member may facilitate case 
review while the MDT Coordinator/Facilitator 
is responsible for coordinating day to day 
information-sharing.  However, it is constructed 
the CAC must be able to identify this role, 
who fills, it and the role must be viewed by the 
team as the go-to by MDT members for case 
coordination, information-sharing among team 
members, and addressing team functioning.  
The CAC employee who fills this role must 
have the required baseline training.  In the rare 
instance in which someone outside the CAC 
plays this vital role, the training requirement 
does not apply (though is highly encouraged).
Essential Component B
The designated MDT facilitator must 
demonstrate participation in continued 
education in the field of child maltreatment 
and/or facilitation for a minimum of eight 
contact hours every two years.
STATEMENT OF INTENT
The CAC must provide ongoing opportunities 
for the MDT facilitator/coordinator employed 
by the CAC to receive ongoing training. It is 
important that team facilitators remain current 
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01. Multidisciplinary Team
on developments in facilitation and other 
relevant fields of practice to further enhance 
their expertise.
Essential Component C
The CAC/MDT has, and facilitates, a 
written interagency agreement signed 
by authorized representatives of all MDT 
members that clearly commits the signed 
parties to its collaborative multidisciplinary 
response to reports of child abuse and the 
needs of children and families it serves. The 
interagency agreement must include:
1.	 Law enforcement
2.	 Child protective services
3.	 Prosecution
4.	 Mental health
5.	 Medical 
6.	 Victim advocacy
7.	 Children’s Advocacy Center
STATEMENT OF INTENT:
Written agreements formalize commitment to 
the overall CAC mission and goals, interagency 
cooperation and collaboration, and adherence 
to CAC/MDT policies ensuring consistent, high 
quality, trauma-informed and culturally relevant 
practice. Whether written agreements are 
referred to as memoranda of understanding 
(MOUs) or interagency agreements (IAs), or 
something else, they must be signed by the 
leadership of participating agencies (e.g., 
police chiefs, prosecuting attorney, agency 
directors or department heads, supervisors, 
etc.) or their authorized designees. These 
documents should be developed with input 
from the MDT, reviewed annually, and revised 
and re-executed when necessary to reflect 
changes in leadership/signatories, practice, or 
policy.
Essential Component D
Written protocols and/or guidelines address 
the functions of the MDT, the roles and 
responsibilities of each discipline/role and 
their interaction with the CAC throughout 
the life of the case, including the role of the 
MDT facilitator/coordinator. Protocols are 
developed with input from the MDT, updated 
and signed by all MDT partner agencies 
minimally every three years. The protocols 
should be reviewed annually and updated as 
needed to reflect current practice between 
three-year signing cycles. 
STATEMENT OF INTENT:
The active involvement and commitment 
of all of the MDT agency leaders and their 
representatives are critical to ensuring that the 
policies and protocols by which investigations 
are conducted and services provided are 
consistently followed.
Essential Component E
All core members of the MDT, including 
appropriate CAC staff, are routinely and 
actively involved in investigations, case 
management and/or MDT interventions 
throughout the life of the case, in accordance 
with the defined needs of children and 
families and the case.
STATEMENT OF INTENT:
The purpose of multidisciplinary involvement 
for all interventions is to assure the unique 
needs of children and families are assessed 
and addressed. Coordination and collaboration 
among MDT members allow for informed 
decision-making to occur at all stages of the 
case to ensure optimal benefit to children and 
families. Multidisciplinary intervention begins 
at initial report and includes, but is not limited 
to, child protection and/or law enforcement 
response, forensic interviews, pre- and post- 
forensic interview meetings, consultations, 
advocacy, medical and mental health 
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01. Multidisciplinary Team
screening, assessment and treatment, referrals 
for other services, case review and possible 
prosecution.
Essential Component F
CAC/MDT members participate in effective 
information sharing that is consistent with 
legal, ethical, and professional standards of 
practice and ensures the timely exchange of 
case information within the MDT.
STATEMENT OF INTENT:
Regular and effective communication and 
information sharing minimizes duplicative 
efforts, enhances decision-making, and 
maximizes the opportunity for children and 
families to receive the services they need. 
Understanding of issues of confidentiality 
and privacy and relevant legal and ethical 
obligations must be considered and respected.
Essential Component G
The CAC has written documentation 
describing how information sharing is 
communicated among MDT members and 
how confidential information is protected.
STATEMENT OF INTENT:
Most professions represented on the MDT 
have legal, ethical, and professional standards 
of practice with regard to client privacy, 
confidentiality and privileged communications. 
The standards and requirements may differ 
across disciplines. States may have relevant 
laws in addition to the federal Health 
Information Portability and Accountability Act 
(HIPAA) that govern such practices. The CAC/
MDT must create written confidentiality and 
information-sharing guidance that align to 
these standards and specifically apply to the 
MDT members, staff, and volunteers. 
Essential Component H
The CAC provides routine opportunities 
for MDT members to give feedback and 
suggestions regarding procedures and 
operations of the CAC/MDT. The CAC has a 
formal process for reviewing and assessing 
the information provided.
STATEMENT OF INTENT:
CACs should have both formal and informal 
mechanisms for eliciting regular feedback 
from MDT members regarding the operations 
and administration of the CAC (e.g., 
transportation for clients, use of the facility, 
equipment upgrades, etc.) and MDT issues 
(e.g., communication, case decision-making, 
documentation and record-keeping, conflict 
resolution, training, etc.). 
CACs should foster opportunities for 
open communication in order to create an 
atmosphere of trust and respect and to enable 
MDT members to share responsibility for 
enhancing the quality of the MDT response 
with their ideas and concerns. Various methods 
for eliciting feedback and/or suggestions from 
MDT members may be utilized, including the 
Outcome Measurement Survey (OMS) tool 
team satisfaction survey, suggestion boxes and 
MDT meetings specifically scheduled for this 
purpose, among others.
Essential Component I
The CAC/MDT annually provides and/
or facilitates relevant training or other 
educational opportunities focused on issues 
relevant to investigation, prosecution, 
and service provision to children and 
their nonoffending caregivers. The CAC 
demonstrates documented MDT member 
participation in this annual professional 
development. 
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01. Multidisciplinary Team
STATEMENT OF INTENT:
Ongoing learning is critical to the successful 
operation of CAC/MDTs. The CAC identifies 
and/or provides relevant educational 
opportunities for MDT members, including 
topics that enhance the knowledge and skills 
of MDT members, collaborative work across 
disciplines and a deeper understanding of 
each discipline’s role in service provision.  
This may include directly providing training 
to MDT members, sharing opportunities to 
attend conferences, and/or online training 
opportunities offered by the State Chapter, 
Regional CACs, or state or national training 
providers.
Essential Component J
The CAC/MDT provides formal orientation 
for new MDT members regarding CAC/MDT 
process, policies and procedures, and code of 
conduct. 
STATEMENT OF INTENT:
New MDT members arrive experienced in 
their profession but often inexperienced 
with multidisciplinary team principles and 
practice. Providing an orientation for new 
MDT members ensures that they understand 
how the team functions, what is expected of 
their role, and how each member of the team 
contributes to the case and to better child 
outcomes. Orienting team members well at the 
beginning can reduce confusion and conflict 
and contribute to better overall team function.
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02. Diversity, Equity, and Access
PAGE   20   •
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|   2023 EDITION

02. Diversity, Equity, and Access
Standard 02
Diversity, Equity, 
and Access 
The Children’s Advocacy Center provides culturally 
responsive services for all CAC clients throughout the 
duration of the case.
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02. Diversity, Equity, and Access
Rationale
Cultural responsiveness is the ability to 
understand and consider different cultural 
backgrounds of the clients to whom you 
offer services. It also demonstrates the 
capacity to learn from and relate respectfully 
with people from both similar and different 
cultural backgrounds, requiring the ability 
to appreciate, understand and interact with 
members of diverse populations within the 
local community. Cultural responsiveness 
is a fundamental component of the CAC 
philosophy and is as central to operations 
as developmentally appropriate, child-
focused, and trauma-informed practice. Like 
developmental considerations, cultural norms 
influence nearly every aspect of working with 
children and families, such as welcoming a 
child and family to the child advocacy center, 
employing effective forensic interviewing 
techniques, assessing the likelihood of abuse, 
selecting appropriate mental health providers, 
and securing services that are relevant and 
accessible to a child and family. To effectively 
meet clients’ needs, the CAC and MDT must 
be willing and able to understand the clients’ 
worldviews, adapt practices as needed, and 
offer assistance in a manner in which it can be 
utilized. Striving toward culturally responsive 
services is an important and ongoing endeavor 
and an integral part of a CAC’s operations and 
service delivery. 
Proactive, culturally relevant planning and 
outreach should focus on culture, experience of 
acculturation, ethnicity, religion, socioeconomic 
status, disability, gender, gender identity 
and expression, and sexual orientation. 
These factors contribute to a client’s lived 
experiences and perspectives, and they must 
be considered and accommodated throughout 
the investigation, intervention, and case 
management processes. Addressing these 
factors in a culturally sensitive environment 
helps children and families of all backgrounds 
and experiences feel welcomed, valued, 
and respected by staff, MDT members and 
volunteers.
The CAC and its partners develop policies, 
procedures and practices that are designed 
to reduce disparities in access to services 
and outcomes from services provided. The 
CAC and MDT actively express values and 
understanding of equity and inclusion and 
those values are evident in practice.
Essential Component A
The CAC in, partnership with the MDT, 
conducts a community assessment at a 
minimum of every three years, which includes:
1.	 Community demographics
2.	 CAC client demographics
3.	 Analysis of disparities between these 
populations
4.	 Methods the CAC utilizes to identify and 
address gaps, disparities and/or inequities 
in services
5.	 Strategies for outreach to unserved or 
underserved communities, in alignment 
with identified disparities
6.	 A method to monitor the effectiveness of 
outreach and intervention strategies 
STATEMENT OF INTENT: 
In order to serve a community in a culturally 
responsive manner, a CAC, in partnership 
02. Diversity, Equity, and Access
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02. Diversity, Equity, and Access
with its MDT, must complete a comprehensive 
assessment of the entire community and 
jurisdiction they serve. The assessment should 
focus on a range of issues, including, but not 
limited to, race, ethnicity, gender, gender 
identity and expression, sexual orientation, 
disabilities, income, geography, religion, and 
culture. The assessment should inform the 
development of goals and strategies that 
ensure the CAC delivers high-quality, relevant, 
and accessible services to all children and 
families in need. 
Essential Component B
The CAC must ensure that provisions are 
made for non-English-speaking and deaf 
and hard-of-hearing children and their family 
members throughout the investigation, 
intervention, and case management 
processes.
STATEMENT OF INTENT: 
The ability to effectively communicate is critical 
in creating an environment in which children 
and families feel comfortable and safe and are 
respected and supported. Language barriers 
may hinder the ability for children and families 
to understand the CAC and MDT process/
roles, and to communicate their concerns 
and decisions regarding the investigation and 
intervention services. Language barriers may 
also compound children and families’ feelings 
of fear, anxiety, and confusion. Language can 
significantly impact the CAC and/or MDT’s 
abilities to both share with, and obtain accurate 
information from, the child and family. The 
CAC must explore a variety of resources 
or solutions to ensure adequate provisions 
are made to overcome language and 
communication barriers. In order to protect 
the integrity of the investigation and services, 
care should be taken to ensure appropriate 
interpreters are utilized. CACs must not utilize 
children or client family members to interpret 
for MDT members. 
Essential Component C
CAC services are accessible and tailored to 
meet the various individualized and unique 
needs of children and families throughout 
the investigation, intervention, and case 
management process.
STATEMENT OF INTENT: 
It is the responsibility of the CAC and MDT 
members to understand and tailor services to 
the diverse backgrounds and unique needs 
of the children and families being served. 
Ascertaining the client’s background from the 
client allows CAC/MDT members to better 
understand child and family perceptions 
of past and present abuse and trauma, 
attributions of responsibility, and experience 
of acculturation and comprehension of laws. 
In addition, it allows the CAC/MDT to address 
any religious or cultural beliefs that may affect 
disclosure, needed services and access to 
them, and to recognize the impact of prior 
experience with police and government 
authorities both in this country and in their 
countries of origin. Furthermore, the CAC’s 
investigation and case management services 
must be accessible and responsive to children 
with physical disabilities, cognitive delays, and 
medical and mental health disorders. With 
knowledge, preparation and necessary skills, 
the MDT can obtain as complete and accurate 
information as possible and more effectively 
understand and respond to the child and 
family’s needs.
Essential Component D
The CAC demonstrates ongoing efforts 
through formal policies, procedures and 
practices to recruit, hire, and retain staff, 
volunteers, and board members who reflect 
the demographics of the community. 
STATEMENT OF INTENT: 
Actively seeking to recruit, hire, and retain 
staff, volunteers, and board members who 
reflect the demographics of the community 
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02. Diversity, Equity, and Access
and the clientele served is critical to achieving 
an overall response to children and families 
that is inclusive, relevant, and effective.
Essential Component E
The CAC values Diversity, Equity, and 
Inclusion (DEI) and requires CAC staff to 
participate in DEI training a minimum of eight 
hours every two years.
Examples of training topics could include:
•
Implicit bias
•
Microaggressions
•
Organizational learning
•
Building a culture of inclusion
•
Reducing disparities in services
STATEMENT OF INTENT: 
Understanding and integrating issues 
of diversity, equity and inclusion are not 
accomplished in a single training. Valuing DEI 
in all CAC activities requires an intentional, 
ongoing, and evolving exploration of its 
personal and professional meaning and 
implications for how staff interact with, and 
provide services and support to, clients and 
communities with diverse backgrounds and 
needs. Participating in this minimum number of 
hours of training every two years demonstrates 
a baseline commitment to ensuring that these 
critical issues become part of the CAC staff’s 
individual and collective responses to the 
children, families, and communities they serve.  
Essential Component F
The CAC values Diversity, Equity, and 
Inclusion (DEI) and annually provides 
MDT members access to DEI training and 
information. The CAC documents training 
opportunities (whether provided directly or 
through access to other organizations) and 
MDT participation.
Examples of training topics could include:
•
Implicit bias
•
Microaggressions
•
Organizational learning
•
Building a culture of inclusion
STATEMENT OF INTENT: 
Understanding and integrating issues of 
diversity, equity and inclusion into professional 
practice are not accomplished in a single 
training. Valuing DEI in all activities of MDT 
members, both individually and collectively, 
requires an intentional, ongoing, and evolving 
exploration of the personal and professional 
meaning of DEI and how it impacts the 
accessibility of services and support to their 
clients. Participating as a team in DEI training 
helps demonstrate a baseline commitment 
to these critical issues that enhance the 
individual and collective responses to the 
children, families, and communities that all 
MDT members serve. Quality DEI training 
and resources are offered through many 
organizations. Many available online trainings 
and other resources are available free of 
charge. A good place to start is to ask your 
State Chapter and/or Regional Children’s 
Advocacy Center about available resources.
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03. Forensic Interview
Standard 03
Forensic 
Interview 
Forensic interviews are coordinated to avoid duplicative 
interviewing and are conducted in a manner that is 
legally sound and of a neutral, fact-finding nature.
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03. Forensic Interview
Rationale:
The purpose of CAC forensic interviews is to 
facilitate information gathering from children to 
determine whether abuse occurred and, if so, 
the nature of the allegations. This information 
is intended to contribute to accurate and fair 
decision-making by the MDT members relative 
to the criminal justice, child protection and 
relevant service delivery systems. Forensic 
interviews are conducted in a manner that is 
developmentally and culturally responsive, 
unbiased, fact-finding and legally sound. 
When a child is unable to provide information 
regarding any concern of abuse through the 
forensic interview process, other interventions 
to assess the child’s safety and well-being are 
required.
The CAC/MDT must adhere to research-based 
forensic interview guidelines that create an 
interview environment that enables free recall, 
minimizes interviewer influence, and gathers 
information needed by all the MDT members 
in order to avoid duplication of the interview 
process. The CAC/MDT must monitor these 
guidelines over time to ensure they reflect 
current research-based practice, and CAC/
MDT protocols and practices need to be 
congruent. 
Forensic interviews are the foundation for 
multiple CAC/MDT functions, including 
child protection and criminal investigations, 
prosecution, and implementation of services 
critical to helping ensure children and families’ 
paths toward safety, healing, and justice. The 
child’s experience during the initial forensic 
interview may significantly impact the child’s 
understanding of, and ability to respond to, 
the ensuing steps in the various aspects of the 
intervention process. 
Skilled forensic interviewing by appropriately 
trained individuals requires an appropriate 
neutral setting and effective communication 
among MDT members. While CACs vary with 
regard to who conducts forensic interviews, 
the role must be fulfilled by an appropriately 
trained, qualified, supervised professional 
who engages in peer review and ongoing 
professional development. This may include 
a CAC-employed forensic interviewer, law 
enforcement officers (local, state, and/or 
federal), CPS workers, or others determined by 
the CAC/MDT in accordance with the resources 
available in their respective communities. At 
a minimum, any professional in the role of 
a forensic interviewer must have initial and 
ongoing formal forensic interviewer training 
that is approved by National Children’s Alliance 
(NCA) for purposes of accreditation. State laws 
may also dictate which professionals can or 
should conduct forensic interviews. 
The CAC/MDT’s written documents must 
include the general interview protocol, 
guidelines for selecting an appropriately 
trained interviewer, specifications for sharing 
of interview information among MDT 
members, and a mechanism for collaborative 
case planning, peer review and continuing 
education. Additionally, for CACs that conduct 
Extended Forensic Evaluations, an additional 
protocol for this purpose must also be 
articulated.
Essential Component A
Forensic interviews are provided by MDT/CAC 
staff with specialized training in conducting 
forensic interviews.
The CAC must demonstrate that all forensic 
interviewer(s) have successfully completed 
03. Forensic Interview
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03. Forensic Interview
training that includes the following elements:
1.	 Minimum of 32 hours of instruction and 
practice
2.	 Evidence-supported interview protocol
3.	 Pre- and post-testing that reflects 
understanding of the principles of legally 
sound interviewing
4.	 Child development; question design; 
implementation of protocol; dynamics of 
abuse; disclosure process; diversity, equity, 
and inclusion; and suggestibility
5.	 Practice opportunities with a standardized 
evaluation process
6.	 Required reading of current articles 
specific to the practice of forensic 
interviewing
Curriculum must be included on NCA’s 
approved list of nationally or state-recognized 
forensic interview trainings or submitted with 
the accreditation application for review and 
approval.
STATEMENT OF INTENT:
The CAC/MDT must have a process to ensure 
initial forensic interview training for anyone 
conducting a forensic interview at the CAC. 
While MDT members may have received 
general interview training, conducting forensic 
interviews of children in the context of an MDT 
response requires specialized training and 
qualifications.  
Essential Component B
Individuals who conduct forensic interviews 
must demonstrate participation in ongoing 
education in the field of child maltreatment 
and/or forensic interviewing for a minimum of 
eight contact hours every two years.
STATEMENT OF INTENT:
The CAC/MDT must provide ongoing 
opportunities for professionals who conduct 
forensic interviews to receive specialized 
training. It is vitally important that forensic 
interviewers remain current on developments 
in forensic interviewing and other relevant 
fields of practice to further enhance their 
expertise.
Essential Component C
CAC/MDT forensic interview protocols must 
reflect the following items:
1.	 Case acceptance criteria
2.	 Criteria for choosing an appropriately 
trained interviewer (for a specific case)
3.	 Personnel expected to attend/observe 
the interview on-site, specifically including 
those with investigative responsibilities for 
the case
4.	 Information sharing and communication 
between the MDT and the forensic 
interviewer before and after the interview
5.	 Use of interview aids 
6.	 Use of interpreters
7.	 Recording and/or documentation of the 
interview
8.	 Interview methodology (i.e., state- or 
nationally recognized forensic interview 
training models)
9.	 Introduction of evidence in the forensic 
interviewing process
10.	Sharing of information among MDT 
members 
11.	A mechanism for collaborative case 
coordination
12.	Criteria and process for conducting a 
multi-session or subsequent interview
13.	The use of technology for remote live 
observation of the forensic interview using 
a secure method (if applicable)
14.	The criteria and process for the use of 
tele-forensic interviews (if applicable)
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03. Forensic Interview
STATEMENT OF INTENT:
The forensic interview process must be 
described in comprehensive detail in the 
agency’s written guidelines or agreements. 
These guidelines help ensure consistency and 
quality of interviews, inform MDT discussions 
pre-and post-interview, and support 
subsequent decision-making. Technology now 
makes it possible to both conduct and observe 
(in real time) forensic interviews online and 
remotely. Centers that wish to do either or both 
should clearly identify in the written guidelines 
or agreements the circumstances in which this is 
allowed and the process for doing so. Children 
who receive a tele-forensic interview must be 
afforded the full range of CAC services and 
MDT interventions as with any other clients. 
Care must be taken that the use of remote 
live observation does not result in the need 
for repeated interviews or miscommunication 
between team members. And any use of 
remote live observation requires the team’s 
written guidelines and agreements to outline 
who may do so, and under what circumstances.  
Essential Component D
The CAC allows for real-time observation of 
forensic interviews by MDT members.
STATEMENT OF INTENT: 
In order to create a psychologically safe space 
and lessen or eliminate the need for duplicative 
interviews, interviewers should be observed 
by MDT members in a space other than the 
interview room. The MDT should also have the 
ability to communicate with the interviewer in 
some manner to provide input and feedback 
during the real-time interview with the child to 
reduce the need for additional interviews.
Essential Component E
MDT members with investigative 
responsibilities on a case must participate 
in live/real-time observation of forensic 
interviews to ensure necessary preparation, 
information sharing and MDT/interviewer 
coordination throughout the interview and 
post-interview process.
STATEMENT OF INTENT:
MDT members, as defined by the needs of 
the case, are present to observe the forensic 
interview and participate in pre- and post-
interview discussions. This practice provides 
MDT members with access to the information 
necessary to fulfill their respective investigatory 
and related professional roles. MDT members 
who are present for forensic interviews typically 
include local, state, federal or tribal child 
protective services, and law enforcement; 
others may vary based on the circumstances of 
each case.
Essential Component F
Cases meeting the CAC case acceptance 
criteria, as outlined in the MDT protocol, have 
forensic interviews conducted at the CAC, 
or through a secure tele-forensic method, a 
minimum of 75% of the time.  
STATEMENT OF INTENT:
Forensic interviews of children, as defined 
in the CAC/MDT’s written protocols, will be 
conducted at the CAC, where the MDT is best 
equipped to meet the child’s needs during the 
interview. 
Written protocols must also address the rare 
occasions when interviews may need to take 
place outside the CAC with the agreed-upon 
forensic interview guidelines utilized. Some 
CACs have established interview rooms outside 
of the primary CAC, such as at a satellite 
office. In an alternate setting, MDT members 
must assure the child’s comfort, privacy and 
protection from alleged offenders and others 
who may unduly influence the child. Remote or 
tele-forensic interviews may also occur when 
appropriate and/or necessary to increase access 
and utilization of CAC forensic interviews. All 
such alternatives must be agreed upon by the 
MDT and codified in the written protocols. And 
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03. Forensic Interview
any alternative must continue to afford child 
clients the full range of CAC services.
CACs are encouraged to develop policies 
that will provide the most comprehensive 
services and benefits to all children in their 
communities. Case acceptance criteria may 
include various types of abuse, other forms of 
direct or indirect exposure to violence/trauma, 
jurisdictional issues, and the ages of children, 
among others.
Essential Component G
Individuals who conduct forensic interviews 
must participate in a structured forensic 
interviewer peer review process a minimum 
of two times per year. Peer review serves as a 
quality assurance mechanism that reinforces 
the methodologies utilized and provides 
support and problem solving for participants. 
Structured peer review includes:
1.	 Ongoing opportunities to network with, 
and share learning and challenges with, 
peers
2.	 Review and performance feedback on 
actual interviews in a professional and 
confidential setting
3.	 Discussion of current relevant research 
articles and materials and implications for 
forensic interview practice
4.	 Training opportunities specific to forensic 
interviewing of children and CAC-specific 
methodologies.
STATEMENT OF INTENT:
Participation in peer review is vital for quality 
assurance of forensic interviewers and allows 
for the further development and enhancement 
of their skills based on new research and 
developments in the field. Peer review is a 
complement, not a substitute, for supervision, 
as well as multidisciplinary case review and 
case planning. 
Essential Component H
The CAC/MDT coordinates information 
gathering, including history taking, 
assessments and forensic interview(s) to avoid 
duplication.
STATEMENT OF INTENT:
All members of the MDT need information to 
complete their respective assessments and 
evaluations. Whether it is initial information 
gathered prior to the forensic interview, history 
taken by the medical provider, or intake by the 
mental health or victim services provider, every 
effort should be made to avoid unnecessary 
duplication of information gathering from the 
child and family members and ensure effective 
information sharing among MDT members.
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04. Victim Support and Advocacy 
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04. Victim Support and Advocacy 
Standard 04
Victim Support  
 and Advocacy  
Victim support and advocacy services are provided 
to all CAC clients and their caregivers as part of the 
multidisciplinary team response.  
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04. Victim Support and Advocacy 
Rationale:
Research demonstrates that parent/caregiver 
support is essential to reducing trauma and 
improving outcomes for children and family 
members. Client access to, and participation 
in, investigation, prosecution, treatment, 
and support services are core components 
of MDT response, and are informed and 
supported by coordinated victim advocacy 
services. Up-to-date information and ongoing 
access to comprehensive services are critical 
to a child and family’s well-being and ability 
to participate in an ongoing investigation, 
possible prosecution, intervention, and 
treatment. 
Victim support and advocacy responsibilities 
are implemented consistent with legal and, 
where relevant, state constitutional victims’ 
rights and the complement of services in the 
CAC’s coverage area. Many members of the 
MDT may advocate for children and families 
within their discipline systems or agencies. 
However, victim advocacy is a discipline 
unto itself with a distinct and central role on 
the MDT. Victim advocates provide services 
and resources to ensure a consistent and 
coordinated comprehensive network of 
support for each child and family. 
Children and families in crisis need assistance 
in navigating the multiple systems involved 
in the CAC response. More than one victim 
advocate may perform these functions at 
different points throughout a case, requiring 
continuity and consistency in service 
delivery. Coordination of victim support is 
the responsibility of the CAC and must be 
defined in the CAC/MDT’s written documents, 
including understanding of relevant statutes 
and ethics regarding confidentiality and 
privilege. Specific victim support services may 
be provided in a variety of ways, as dictated by 
the needs of the CAC clients and case, such as: 
•	
Employing staff members with varying job 
titles to perform advocacy functions (e.g., 
family advocates, care coordinators, victim 
advocates and child life specialists, among 
others) 
•	
Linking with local community-based 
advocates, including, but not limited to 
domestic violence advocates, rape crisis 
counselors, Court Appointed Special 
Advocates and advocates at culturally 
specific organizations 
•	
Linking with system-based advocates 
(e.g., law enforcement victim advocates, 
prosecutor-based victim witness 
coordinators) 
•	
Combining victim support services 
depending upon the individual needs of 
children and families 
All advocates who serve on the MDT and 
are providing services to CAC clients must 
meet the prescribed training and supervision 
requirements. This includes advocates on staff 
at the CAC and/or advocates from outside 
organizations providing advocacy services and 
serving as members of the MDT.
Essential Component A
Comprehensive, coordinated victim support 
and advocacy services are provided by 
designated individual(s) who have specialized 
training that includes a minimum of 24 hours 
of instruction, including, but not limited to:
1.	 Dynamics of child abuse
2.	 Trauma-informed services
3.	 Crisis assessment and intervention
4.	 Risk assessment and safety planning
04. Victim Support and Advocacy 
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04. Victim Support and Advocacy 
5.	 Professional ethics and boundaries
6.	 Understanding the coordinated 
multidisciplinary response
7.	 Understanding, explaining, and affording 
of victim’s legal rights
8.	 Court education, support, and 
accompaniment
9.	 Knowledge of available community and 
legal resources, referral methods and 
assistance with access to treatment and 
other services, including protective orders, 
housing, public assistance, domestic 
violence intervention, transportation, 
financial assistance, and interpreters, 
among others as determined for individual 
clients
10.	Cultural responsiveness and addressing 
implicit bias in service delivery
11.	Caregiver resilience
12.	Domestic violence/family violence/
children’s exposure to domestic violence 
and poly-victimization
STATEMENT OF INTENT 
Victim support and advocacy is fundamental 
to the MDT response. These professional 
support/advocacy responsibilities may be 
filled by a designated victim advocate who is 
an employee of the CAC or another victim-
serving agency. Another MDT member with 
appropriate experience and training in victim 
advocacy may also serve in this role; however, 
in doing so, it must not conflict with the other 
MDT functions they may have. 
Essential Component B
Individuals who provide victim advocacy 
services for the CAC must demonstrate 
participation in ongoing education in the field 
of victim advocacy and child maltreatment 
consisting of a minimum of eight contact 
hours every two years.
STATEMENT OF INTENT 
The CAC and/or MDT must provide initial 
and ongoing opportunities for professionals 
who provide advocacy services to receive 
specialized training and peer support. As with 
all other disciplines represented on the MDT 
and serving CAC clients, it is vitally important 
that victim advocates remain current on 
developments in fields relevant to their delivery 
of services to children and families.
Essential Component C
Victim advocates serving CAC clients must 
provide the following constellation of services:
1.	 Crisis assessment and intervention, risk 
assessment and safety planning and 
support for children and family members 
at all stages of involvement with the CAC
2.	 Assessment of individual needs, cultural 
considerations for child/family and help to 
ensure those needs are being addressed 
in concert with the MDT and other service 
providers
3.	 Presence at the CAC during the forensic 
interview in order to participate in 
information sharing with other MDT 
members, inform and support the 
family regarding the coordinated, 
multidisciplinary response, and assess 
needs of children and nonoffending 
caregivers
4.	 Provision of education and assistance 
in ensuring access to victim’s rights and 
crime victim’s compensation
5.	 Assistance in procuring concrete services 
(housing, protective orders, domestic 
violence intervention, food, transportation, 
public assistance, civil legal services, etc.)
6.	 Provision of referrals for trauma-focused, 
evidence-supported mental health and 
specialized medical treatment, if not 
provided at the CAC
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04. Victim Support and Advocacy 
7.	 Facilitating access to transportation to 
interviews, court, treatment, and other 
case-related meetings
8.	 Engagement with the child and family to 
help them understand the investigation/
prosecution process and help ensure 
understanding of crime victims’ rights 
9.	 Participation in case review to 
communicate and discuss the unique needs 
of the child and family and associated 
services planning; and help ensure the 
coordination of identified services and that 
the child and family’s concerns are heard 
and addressed
10.	Provision of case status updates to the 
family, including investigations, court date, 
continuances, dispositions, sentencing 
and inmate status notification (including 
offender release from custody)
11.	Provision of court education and 
support, including court orientation and 
accompaniment
STATEMENT OF INTENT
While the particular combination of services 
required will vary based upon the child 
and family’s unique needs and the legal 
requirements of any civil and/or criminal cases, 
all children and families need support in 
navigating the various systems they encounter 
that are often unfamiliar to them. Crisis and 
risk assessments and intervention, advocacy, 
and support services will help to identify 
the child and family’s unique needs, reduce 
fear and anxiety, and expedite access to 
appropriate services and resources. Families 
can be assisted with crisis management, 
including problem solving, access to critical 
treatment and other services, and ongoing 
education, information, and support. Crises may 
recur with various precipitating or triggering 
events, including, but not limited to, financial 
hardships, child placement, arrest, change/
delay in court proceedings and preparation 
for court testimony. Children may experience 
crisis and trauma, including suicidal ideation, 
at unanticipated times. Many CACs provide 
advocacy services for children and their family 
members on-site and/or through linkage 
agreements with other community agencies or 
system-based providers.
State and federal laws require that victims 
of crime, including victims of child abuse, 
are informed of their rights as crime victims, 
including information about, and eligibility for, 
crime victim compensation. Caregivers who 
are affected by the crime are also entitled 
to services and may be eligible for victim 
compensation. Generally, children and their 
families will be unfamiliar with their legal rights. 
Therefore, information regarding rights and 
services should be routinely and repeatedly 
explained at the outset of their involvement 
with the CAC/MDT and made available to all 
children and their caregivers.
Essential Component D
Active outreach and follow-up support services 
for caregivers consistently occurs.
STATEMENT OF INTENT 
Often, families have never been involved in 
this multi-system response, which can prove 
intimidating and confusing. Active outreach 
requires follow-up with families beyond initial 
investigation, assessment, and crisis response. 
Follow-up services after the initial contact at 
the CAC must include ongoing, regular contact 
until the CAC concludes its involvement with 
the case. 
In the aftermath of victimization, the child 
and family typically feel a significant loss of 
control. Education provides information that 
is empowering. Victim education must be 
ongoing and even repetitive as needed, as 
families may be unable to process so much 
information at one time, particularly in the 
midst of a crisis. The family may be dealing with 
immediate safety issues and may be coping 
with the emotional impact of the initial report 
and ensuing forensic interview and investigation 
process. They may need a variety of concrete 
medical, mental health, and social services. 
As the case dynamics change, and as the case 
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04. Victim Support and Advocacy 
proceeds through the various systems, the 
needs of the child and family will also change. 
It is important that their needs continue 
to be assessed, so that additional relevant 
information, support, and services can be 
offered and so that said services are accessed 
and relevant.
Essential Component E
The CAC/MDT’s written protocols/
guidelines include availability of victim 
support and advocacy services for all CAC 
clients throughout the life of the case and 
participation of victim advocate(s) in the MDT 
case review. This participation must be in 
accordance with legal requirements regarding 
confidentiality.
STATEMENT OF INTENT 
Because victim support/advocacy is a central 
function of the CAC response, the availability 
and provision of ongoing victim support and 
advocacy by designated, trained individuals 
must be included in the CAC/MDT’s written 
documents. Service coordination, both within 
and outside the CAC, must be clearly defined, 
including the role of the victim advocate during 
the interview process, follow-up, and case 
review.
Essential Component F
Coordinated case management must occur 
with all individuals providing victim advocacy 
services to CAC clients.
STATEMENT OF INTENT 
If multiple advocacy agencies share the 
delivery of services, the CAC is responsible for 
establishing protocols and linkage agreements 
agreed upon by the MDT that clearly define 
the victim advocacy roles and ensure seamless 
coordination of victim advocacy services.
In any community or jurisdiction a CAC serves, 
there may be various agencies and programs 
providing advocacy and support services to 
child and adult victims and survivors who have 
experienced abuse and trauma. In addition to 
victim advocates who may be employed by the 
CAC, there may be advocates on staff in law 
enforcement agencies, prosecutors’ offices, 
domestic and sexual violence community-
based agencies, hospitals, and CASA 
programs, among others. While specific job 
titles may vary, children and families engaged 
with the CAC/MDT may also be receiving 
services from some or all of these agencies/
programs. To better understand each other’s 
roles, optimize cross-referrals for CAC clients, 
avoid unnecessary duplication and ensure 
meaningful coordination of services, the CAC 
must develop a process for achieving these 
goals in collaboration with one another. This 
process will need to include understanding 
and respect for issues of confidentiality and 
methods for sharing case-specific information 
accordingly. 
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05. Medical Evaluation
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05. Medical Evaluation
Standard 05
Medical 
Evaluation
Specialized medical evaluation and treatment services 
are available to all CAC clients and are coordinated 
as part of the multidisciplinary team response.  
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05. Medical Evaluation
Rationale
All children who are suspected victims of 
child sexual abuse are entitled to a medical 
evaluation by a health care provider with 
specialized training and expertise. The 
collection and documentation of forensic 
findings are vital. However, the referral of 
children for medical examinations should 
NOT be limited to those where forensically 
significant findings are anticipated. Medical 
evaluations should be prioritized as emergent, 
urgent, and non-urgent based on specific 
screening criteria. Said criteria must be 
developed by specially trained and skilled 
medical providers, who may be those serving 
on local multidisciplinary teams. Additional 
considerations include the ability to conduct 
follow-up examinations to reassess findings 
and conduct further testing where deemed 
necessary. 
A medical evaluation holds an important place 
in the multidisciplinary assessment of child 
abuse. An accurate and complete history is 
essential in making medical diagnoses and 
determining appropriate treatment of child 
abuse. Recognizing that there are several 
acceptable models that can be used to obtain 
a history of the abuse allegations, and that 
forensic interview techniques are specialized 
skills that require training, information 
gathering must be coordinated with the MDT 
to avoid duplication. Because many children 
are familiar with the helping role of doctors 
and nurses, they may disclose information to 
medical personnel that they might not share 
with investigators. In fact, some children are 
able to describe residual physical symptoms 
to medical providers even when no injury is 
seen. If a nonmedical member of the MDT is 
conducting the in-depth forensic interview, 
further medical history will still likely be needed 
from the caregiver and/or child to complete 
the medical evaluation. As such, information 
gathering and sharing must be coordinated 
to avoid duplication and help ensure a 
comprehensive response (see Med-Appendix 
1 for an example of Components of Medical 
History for Child Sexual Abuse Evaluation).
Essential Component A
Medical evaluations are conducted by health 
care providers with specific training in child 
sexual abuse who meet at least ONE of the 
following training standards:
1.	 Child Abuse Pediatrics Subboard eligibility 
or certification
2.	 Physicians without board certification 
or eligibility in the field of child abuse 
pediatrics, advanced practice nurses, 
and physician assistants should have a 
minimum of 16 hours of formal didactic 
training in the medical evaluation of child 
sexual abuse (see Med-Appendix 2)
3.	 Sexual assault nurse examiners (SANEs) 
without advanced practitioner training 
should have a minimum of 40 hours 
of coursework specific to the medical 
evaluation of child sexual abuse followed 
by a competency- based clinical 
preceptorship with an experienced 
provider in a clinical setting, where the 
SANE can demonstrate competency in 
performing exams (see Med-Appendix 2 
or IAFN guidelines)
STATEMENT OF INTENT
Physicians, advanced practice nurses, physician 
assistants and SANEs without advanced 
practice training may all engage in medical 
evaluations of child abuse. Due to differences 
05. Medical Evaluation  
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05. Medical Evaluation
in foundational training in pediatric assessment 
by provider type (see Med-Appendix 2), the 
above training and eligibility standards must 
be met by the health care provider of a CAC 
(regardless of whether the exams are occurring 
on- or off-site). 
All providers should be licensed to practice 
and be in current good standing by their 
corresponding state board of practice 
regulation. Nurses must practice within the 
scope of their applicable state nurse practice 
acts. A medical director (physician or advanced 
practice nurse) is needed for non-advanced 
practice nurses to assist with the development 
of practice protocols and the treatment 
needs of the patient, including referrals for 
other medical or mental health issues that 
are discovered during the evaluation. The 
medical director may or may not also meet 
qualifications as an “advanced medical 
consultant” (as defined in the “Continuous 
Quality Improvement” section) who can 
perform review of examination findings. If 
the medical director does not also serve as 
a medical provider for the CAC, this person 
should, at a minimum, be familiar with the 
essential components of the medical standard 
and the mission of the CAC. 
Some CACs have qualified medical providers 
as full- or part-time staff, while others provide 
this service through affiliation and linkage 
agreements with local providers or regional 
facilities. Whether the exams occur on-site 
or off-site, or by CAC staff or via a linkage 
agreement, the medical provider must meet 
the Training and Eligibility Standards for 
Training (above) and Continuous Quality 
Improvement. 
Continuous quality improvement (CQI) for the 
CAC’s medical component: 
The medical provider must be familiar and 
up to date with published research studies 
on findings in abused and non-abused 
children, sexual transmission of infections in 
children, and current medical guidelines and 
recommendations from national professional 
organizations such as the American Academy 
of Pediatrics Committee on Child Abuse and 
Neglect, the American Professional Society 
on the Abuse of Children, and the Centers 
for Disease Control and Prevention. Accuracy 
in interpretation of examination findings is 
vitally important to the child, family, and the 
MDT as a whole. The medical provider must 
provide documentation of participation in 
CQI activities, including continuing education 
and expert review of positive findings with an 
“advanced medical consultant” in order to stay 
current in the field of child sexual abuse.
Essential Component B
Medical professionals providing services to 
CAC clients must demonstrate continuing 
education in the field of child abuse consisting 
of a minimum of eight contact hours every 
two years.
Teaching experience in the area of child abuse 
that is approved to provide CEU or CME 
activity also qualifies for ongoing education 
credit.
Essential Component C
Medical professionals providing child 
sexual abuse evaluations to CAC clients 
must demonstrate that all findings deemed 
abnormal or “diagnostic” of trauma from 
sexual abuse have undergone expert review 
by an “advanced medical consultant.”
•	
Expert review with a child abuse 
pediatrician is preferred and can occur 
in multiple ways, including via a direct 
linkage agreement with a specific provider, 
through myCasereview sponsored by the 
Midwest Regional CAC, or through other 
identified state-based medical expert 
review systems that have access to an 
“advanced medical consultant.”
•	
Physicians or advanced practice nurses can 
also provide said review if they have the 
following qualifications:
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05. Medical Evaluation
	
Ε
Meet the minimum training standards 
outlined for a CAC medical provider
	
Ε
Have performed at least 100 child 
sexual abuse exams
	
Ε
Are current in CQI requirements
The CAC and medical provider must work 
collaboratively to establish a method to track 
de-identified case information as part of the 
CQI process (see Med-Appendix 3).
STATEMENT OF INTENT 
The accuracy and integrity of forensic medical 
evaluation findings is critically important in child 
sexual abuse cases. While a small percentage 
of medical evaluations result in a positive or 
diagnostic finding for sexual abuse (about 
3–5% in the literature), it is critical to both the 
future safety of the child and the integrity of 
any criminal justice case that the findings are 
accurate. Research indicates that the most 
important in diagnostic accuracy over time 
is consistent review. Because a false positive 
(“overcalling”) can lead to a miscarriage of 
justice, given the reliance of MDT members on 
medical findings in making charging decisions 
and the reliance on such findings at trial, it is 
essential to have 100% of all medical findings 
diagnostic for child sexual abuse reviewed by 
an advanced medical consultant.  
The medical provider must be able to provide 
documentation of participation in expert review 
with an “advanced medical consultant” on all 
abnormal sexual abuse exams for the purpose 
of CAC case-tracking information that could 
be requested for review in the accreditation 
process. 
The providers who qualify as “advanced 
medical consultants” to offer expert review 
of examination findings are listed above in 
the essential component, as is the critical 
importance of collaboratively establishing the 
required CQI process.  
Essential Component D
Specialized medical evaluations for child 
clients are available on-site or through 
linkage agreements with other appropriate 
institutions, agencies, or providers.
STATEMENT OF INTENT 
Specialized medical evaluations can be 
provided in a number of ways. Some CACs 
have a qualified medical provider who comes to 
the center on a scheduled basis, while in other 
communities, the child is referred to a medical 
clinic or health care agency for this service. 
CACs need not be the primary care provider, 
but they must have protocols in place outlining 
and facilitating the linkages to a facility with a 
qualified medical provider and other needed 
health care services.
Essential Component E
Specialized medical evaluations are available 
and accessible to all CAC clients regardless of 
ability to pay.
STATEMENT OF INTENT 
In many communities, the cost of a medical 
evaluation is covered by public funds. In other 
settings, limited public funding requires that 
individuals who can pay or are insured cover 
the cost of their own examinations, or for those 
clients who require support, MDT members 
can help facilitate reimbursement through 
victim compensation. Regardless of the source 
of funding for the examinations, ability to pay 
should never be a factor in determining who is 
offered and able to access a medical evaluation.
Essential Component F
CAC/MDT written protocols and guidelines 
include access to appropriate medical 
evaluation and treatment for all CAC clients.
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05. Medical Evaluation
STATEMENT OF INTENT 
Because medical evaluations are a critical 
component of the CAC’s multidisciplinary 
response, the CAC’s written protocols must 
detail how its clients access these services. 
Many CACs provide services to victims of 
physical abuse and neglect as well as to 
victims of sexual abuse. All CACs must have 
written protocols and agreements outlining 
how medical evaluations for all types of abuse 
and neglect should occur. CACs that provide 
medical evaluations for sexual abuse, but not 
specifically for physical abuse or neglect, must 
include written procedures for how to access 
medical evaluations for alleged physical abuse 
or neglect, including treatment for injuries and 
management of emergency or life-threatening 
conditions that may become evident during a 
sexual assault exam.
Essential Component G
CAC/MDT written protocols and guidelines 
include the circumstances under which a 
medical evaluation for child sexual abuse is 
recommended, provided, and accessed.
STATEMENT OF INTENT 
The purpose of a medical evaluation in 
suspected child abuse extends far beyond 
providing an evidentiary examination for the 
purpose of the investigation. The primary 
goals of the medical evaluation are to: 
•	
Help ensure the health, safety, and well-
being of the child 
•	
Evaluate, document, diagnose and address 
medical conditions resulting from abuse 
•	
Differentiate medical findings that are 
indicative of abuse from those which may 
be explained by other medical conditions 
•	
Document, diagnose and address medical 
conditions unrelated to abuse 
•	
Assess the child for any developmental, 
emotional, or behavioral issues needing 
further evaluation and treatment and make 
referrals as necessary 
•	
Educate the child and family regarding all 
aspects of the medical examination and 
outcomes 
•	
Provide support relative to any 
recommended next steps and reassurance 
regarding child’s overall health and well-
being
•	
Make recommendations regarding mental 
health and other services to address 
trauma related to the abuse/assault in 
coordination with other members of the 
MDT/CAC 
CACs differ in their practices for how 
medical evaluations are made available. The 
MDT’s written protocols or agreement must 
include qualified medical input to define the 
referral process and how, when and where 
examinations are made available. Examinations 
can be differentiated between those needed 
emergently (without delay), urgently (scheduled 
as soon as possible with a qualified provider), 
or nonurgently (scheduled at the convenience 
of family and provider but ideally within 1–2 
weeks). Some patients may also benefit from 
a follow-up examination (see Med-Appendix 
4). CACs are responsible for ensuring that 
exams are performed by experienced, 
qualified medical providers at the appropriate 
location and time, and that examinations are 
photo-documented to minimize unnecessary 
repeat examinations. This often requires initial 
conversations with emergency departments 
and primary care providers to develop a 
process for referral to the specialized medical 
provider as defined by the needs of the child.
Essential Component H
Documentation of medical findings is 
maintained by written record and photo-
documentation. Medical records storage must 
be HIPAA compliant. The medical records 
storage must be secured, sufficiently backed 
up and accessible to authorized personnel 
in accordance with all applicable federal and 
state laws.
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05. Medical Evaluation
STATEMENT OF INTENT 
The medical history and physical examination 
findings must be carefully, thoroughly, and 
legibly documented in the medical record. 
The medical record should also include a 
statement as to the significance of the findings 
and treatment plan. Medical records should 
be maintained in compliance with federal 
rules governing protection of patient privacy. 
Medical records may be made available to 
other medical providers for the purpose of 
needed treatment of the patient and to those 
agencies mandated to respond to a report of 
suspected child abuse. Even in situations where 
the medical record can legally be provided 
without separate written consent or court order, 
a log of disclosures should be maintained with 
the medical record in accordance with federal 
privacy rules (see Med-Appendix 5). 
Diagnostic-quality photographic documentation 
of the ano-genital exam findings should be 
obtained in all cases of suspected sexual abuse 
using still and/or video documentation. This 
is particularly important if the examination 
findings are thought to be abnormal. 
Photographic documentation allows for 
review for CQI and for obtaining consultation 
or second opinion and may also obviate the 
need for a repeat examination of the child. 
CACs should have policies in place for storage 
and release of examination images that 
protect the sensitive nature of the material. 
In the uncommon exception that photo-
documentation is not possible due to the child’s 
discomfort with the equipment or equipment 
malfunction, diagram drawings with detailed 
written description of findings should occur. 
Detailed procedures for the documentation 
and preservation of evidence (labeling, 
processing, and storing) in written protocols 
and agreements can help to assure the quality 
and consistency of medical evaluations. Such 
protocols can also serve as a checklist and 
training document for new medical providers. 
Many states have mandated forms for recording 
findings of a sexual assault exam and guidelines 
for the preservation of evidence.
Essential Component I
MDT Members and CAC staff are trained 
regarding the purpose and nature of the 
medical evaluation for suspected sexual abuse. 
Designated MDT members and/or CAC staff 
educate children and caregivers regarding the 
medical evaluation.
STATEMENT OF INTENT 
The medical evaluation for suspected child 
sexual abuse often raises significant anxiety 
in children and their caregivers, usually due to 
misconceptions about how the examination 
is conducted and what findings, or lack of 
findings, mean. An appropriately trained 
medical provider performing the examination 
typically addresses this anxiety. In many 
CAC settings, the client is introduced to 
the examination by nonmedical personnel. 
Therefore, it is essential for nonmedical MDT 
members and CAC staff to have the training 
needed to explain the nature and purpose of a 
medical evaluation, and to respond to common 
questions, concerns, and misconceptions, to 
similarly ease anxiety.
Essential Component J
Findings of medical evaluations are shared with 
the MDT in a routine, timely and meaningful 
manner.
STATEMENT OF INTENT 
Because the medical evaluation is an important 
part of the response to suspected child abuse 
and neglect, findings of the medical evaluation 
should be shared with, and explained to, the 
MDT in a routine and timely manner to facilitate 
discussion of concerns, and ensure case 
decisions can be made effectively. The legal 
duty to report findings of suspected child abuse 
to child protective services is an exception 
outlined by the HIPAA privacy requirements, 
allowing for ongoing relevant communications 
between and among the members of the MDT.
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06. Mental Health 
Standard 06
Mental 
Health  
Evidence-based, trauma-focused mental health services, 
designed to meet the unique needs of the child and caregivers, 
are consistently available as part of the multidisciplinary team 
response. 
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06. Mental Health 
Rationale
A CAC’s mission is to promote and foster 
safety, healing and justice for children and 
families. The common focus of the MDT 
is to foster healing and avoid potential 
retraumatization of children and families by the 
systems designed to respond to their needs. 
The CAC’s response begins at first contact 
with the child and family. Without effective 
therapeutic intervention, many children who 
have experienced trauma may suffer ongoing 
or long-term adverse social, emotional, 
developmental and health outcomes. 
Evidence-based treatments and other practices 
with strong empirical support help reduce 
the impact of trauma and the risk of future 
abuse and other negative consequences. 
For these reasons, an MDT response must 
include screening for trauma exposure and/
or symptoms by identified members of the 
MDT as part of the MDT response, who then 
use that information to link to mental health 
services for assessment and trauma-focused 
mental health treatment for child victims and 
caregivers. 
Evidence shows parental/family support is 
often the key to the child’s recovery and 
ongoing protection, and mental health services 
are often an important factor in a caregiver’s 
capacity to support their children. Therefore, 
family members may benefit from counseling 
and support that aids in addressing the 
emotional impact of abuse allegations and 
related emotional triggers, and in reducing 
or eliminating the risk of future abuse. Mental 
health treatment for caregivers is a critical 
component of CAC services, given that many 
may have trauma histories themselves or are 
current victims of intimate partner violence. 
Such services include information, support 
and coping strategies for themselves and their 
children about sexual abuse, dealing with 
issues of self-blame and grief, family dynamics, 
parenting education and the impact of abuse 
and trauma histories. Siblings, other children 
in the family such as cousins, and, in some 
cases, extended family members may also 
benefit from opportunities to discuss their 
own reactions and experiences and to address 
family issues within a confidential therapeutic 
setting. The nature of the impact on children 
and families underscores the importance of 
collaboration with community providers to 
improve outcomes for their health and well-
being. The CAC case review process provides 
a vehicle for these collaborative discussions.
Essential Component A
Mental health services are provided by 
professionals trained in delivering trauma-
focused, evidence-supported mental health 
treatment. All mental health providers for 
CAC clients, whether providing services on-
site or by referral and linkage agreement with 
outside individuals and agencies, must meet 
the following training and education/license 
requirements:
EDUCATION/LICENSE REQUIREMENT
1.	 The CAC must demonstrate that its mental 
health provider(s) meets at least ONE of 
the following academic training standards:
A.	 Master’s degree/licensed/certified in a 
related mental health field.
B.	 Master’s degree in a related mental 
health field and working toward 
licensure; supervised by a licensed 
mental health professional.
06. Mental Health   
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06. Mental Health 
C.	 Student intern in an accredited mental 
health related graduate program, when 
supervised by a licensed/certified 
mental health professional. Both 
the student intern and supervising 
licensed mental health professional 
must meet the indicated 40-hour 
training requirements.  Students who 
are currently enrolled in a training to 
deliver an EBT may provide services to 
children as a part of their EBT training.
TRAINING REQUIREMENT
2.	 The CAC must demonstrate its mental 
health provider(s) has completed 40 
contact hours in training and consultation 
calls to deliver an evidence-supported 
mental health treatment to children who 
have experienced trauma from abuse. 
(Examples include TF-CBT, PCIT, AF-CBT, 
CFTSI, EMDR — see “Putting Standards 
into Practice”). Training programs that 
include fewer than 40 hours (including 
consultation calls) may be supplemented 
with contact hours in evidence-based 
assessment.
Essential Component B
Clinicians providing mental health treatments 
to CAC clients must demonstrate completion 
of continuing education in the field of child 
abuse, trauma, clinical practice and/or cultural 
applications consisting of a minimum of eight 
contact hours every two years.
STATEMENT OF INTENT
Because new research constantly emerges 
regarding the efficacy of mental health 
treatment modalities and the importance of 
ensuring cultural relevance of said services, it 
is vital for clinicians to remain updated about 
new research, evidence-supported treatment 
methods, and developments in the field that 
would help ensure the delivery of high-quality, 
relevant, and accessible services to clients.
Essential Component C
Evidence-supported, trauma-focused mental 
health services for the child client are 
consistently available and include:
1.	 Trauma-specific assessment of traumatic 
events and abuse-related trauma 
symptoms to determine the need for 
treatment;
2.	 Evidence-based assessments to inform 
treatment;
3.	 Individualized treatment plan based 
on assessments that are periodically 
reassessed;
4.	 Individualized evidence-supported 
treatment appropriate for the child clients 
and other family members; 
5.	 Child and caregiver engagement in 
treatment; 
6.	 Monitoring of trauma symptom reduction;
7.	 Referral to other community services as 
needed.
All services should be culturally informed and 
culturally responsive.
STATEMENT OF INTENT
The above description of services should 
guide discussions about expectations with 
all professionals who may provide mental 
health services, whether on-site or by referral 
and linkage agreement. This will ensure that 
appropriate, relevant, and accessible services 
are available for child clients and that the 
services are outlined in linkage agreements.
Essential Component D
Mental health services are available and 
accessible to all CAC clients regardless of 
their ability to pay.
NCA   |   NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS   |   2023 EDITION   •   PAGE   45

06. Mental Health 
STATEMENT OF INTENT
CACs have a responsibility to identify and 
secure alternative funding sources to ensure 
all children and caregivers have access to 
appropriate, specialized mental health services.
Essential Component E
The CAC/MDT’s Interagency Agreement/MOU 
or written protocols and guidelines include 
access to appropriate trauma-informed mental 
health assessment and treatment for all CAC 
clients.
STATEMENT OF INTENT
Because mental health is a core component of 
a CAC’s multidisciplinary team response, the 
CAC/MDT’s Interagency Agreement/MOU or 
written protocols and guidelines must detail 
how such care may be provided and accessed 
by all CAC clients.
Essential Component F
The CAC/MDT’s written protocols and 
guidelines define the role and responsibility of 
the mental health professional(s) on the MDT, 
to include:
1.	 Attending and actively participating in 
MDT case review and case management
2.	 Sharing relevant information with the 
MDT while protecting the clients’ 
right to confidentiality and the mental 
health professional’s legal and ethical 
requirements
3.	 Serving as a clinical consultant to the MDT 
regarding child trauma and evidence-based 
treatment
4.	 Monitoring and sharing with the MDT the 
child’s and caregiver’s engagement in, and 
completion of, treatment.
STATEMENT OF INTENT
Evidence shows the importance of collaboration 
among community professionals serving 
children and families to improve outcomes. A 
trained mental health professional participating 
in the MDT case review process assures that 
the child’s and caregiver’s treatment needs and 
mental health can be monitored, assessed and 
reassessed, and taken into account as the MDT 
makes case decisions. In some CACs, the child’s 
and caregiver’s treatment provider(s) serves in 
this role; in others, it may be a mental health 
consultant.
Essential Component G
The CAC/MDT’s written protocols and 
guidelines include provisions about the sharing 
of mental health information and how client 
confidentiality and mental health records are 
protected in accordance with state and federal 
laws.
STATEMENT OF INTENT
The forensic process of gathering evidentiary 
information and determining what the child 
may have experienced is separate from mental 
health treatment processes. Mental health 
treatment is a clinical process designed to 
assess and mitigate the long-term adverse 
impacts of trauma and/or other diagnosable 
mental health conditions. Every effort should 
be made to maintain clear boundaries between 
these roles and processes. 
Each CAC must be aware that medical and 
mental health treatment records containing 
identifiable protected health information (PHI) 
are protected by HIPAA. Records pertaining 
directly to an investigation of child abuse can 
be exempt from HIPAA and do not require 
caregiver consent for release. The CAC should 
maintain a log of disclosures of medical and 
mental health treatment information per HIPAA 
regulations. 
MDT protocol must include specific guidelines 
for the MDT and mental health providers 
regarding what and how information can be 
shared with the MDT during case review, in 
accordance with state laws and professional 
ethical practice standards. 
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06. Mental Health 
Essential Component H
The CAC must provide services for caregivers 
to address:
1.	 Safety and well-being of the child
2.	 Caregiver involvement in their child’s 
treatment when appropriate
3.	 Emotional impact of abuse allegations
4.	 Risk of future abuse
5.	 Issues or distress that the allegations may 
trigger, including own history of trauma 
and/or current experience of abuse, 
violence and/or other trauma
These services may be provided directly by 
the CAC and/or with linkage agreements with 
other appropriate providers.
STATEMENT OF INTENT
Evidence clearly demonstrates that caregiver 
support is essential to sibling support, the 
recovery of children directly experiencing 
or exposed to abuse and violence, and 
overall family functioning and well-being. 
CACs have long provided such supportive 
services for caregivers and siblings through 
support groups, mental health services and 
ongoing follow-up, either on-site or by linkage 
agreement. 
It is important to consider the range of mental 
health issues that could impact the child’s 
recovery or safety with particular attention to 
the caregiver’s mental health, substance abuse, 
domestic violence, and other trauma history. 
Caregivers, siblings, and other family members 
may benefit from assessment, support, and 
mental health treatment to address the 
emotional impact of abuse allegations, reduce 
or eliminate the risk of future abuse, and 
address issues that the allegations may trigger. 
Assessments and supports may be provided by 
clinicians, victim advocates or others, either on 
staff at the CAC or via linkage agreement.  
Essential Component I
Clinicians providing mental health treatment 
services to CAC clients must participate 
in ongoing clinical supervision and/or 
consultation.  
STATEMENT OF INTENT
Clinical supervision and/or consultation with 
others trained in evidence-based treatment is 
necessary to ensure appropriate and quality 
services to the clients. Moreover, this clinical 
supervision is required for licensure in many 
states. Individual and/or group supervision 
options for meeting this standard include: 
•	
Supervision by a senior clinician on staff at 
the CAC  
•	
Supervision with a senior clinician in the 
community who serves children and 
families and accepts referrals from the 
CAC (when a CAC does not have more 
than one clinician)  
•	
Participation in a supervision call with 
mental health providers from other CACs 
within the state, either individually or as a 
group  
•	
Participation in a State Chapter or one or 
more CAC contracts with a senior clinician 
to provide supervision and consultation 
calls 
Most clinical professions (i.e., clinical social 
workers, licensed professional counselors, 
marriage, and family therapists, etc.) have 
a structure for clinicians to become clinical 
supervisors. CACs may wish to investigate 
this option in their state. CACs can also 
negotiate Trauma-Focused Cognitive Behavior 
Therapy (TF-CBT) master trainers for ongoing 
clinical consultation. As supervision for one 
evidence-based treatment does not necessarily 
encompass all the clinical interventions needed 
within a CAC, comprehensive interventions will 
need to be addressed throughout ongoing 
clinical supervision. 
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07. Case Review and Coordination 
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07. Case Review and Coordination 
Standard 07
Case Review and 
Coordination  
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.
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07. Case Review and Coordination 
Rationale 
Case review is the formal process that enables 
the MDT to monitor and assess its independent 
and collective effectiveness so as to ensure the 
safety and well-being of children and families. 
The process encourages mutual accountability 
and helps to assure that children’s and families’ 
needs are met sensitively, effectively and in 
a timely manner. Case review serves multiple 
purposes: 
•	
Experience and expertise of MDT members 
is shared and discussed  
•	
Collaborative efforts are fostered 
•	
Formal and informal communications are 
promoted 
•	
Mutual support is provided  
•	
Protocols and procedures are reviewed
•	
Informed, collective decisions are made 
•	
Services are coordinated 
Case review must occur at least once a month. 
Its focus is on planning and monitoring current 
cases. It is a formal process that serves as 
a complement to ongoing case discussions 
among the MDT partners. Every CAC must 
implement a defined process and set the case 
criteria for review. The method and timing of 
case review may vary to fit the unique needs 
of a CAC community. For example, some 
CACs review every open case, while others 
review only complex or problematic cases or 
cases involved in prosecution. Representatives 
from each core discipline on the MDT must 
participate and provide input at case review. 
Confidentiality should be addressed in the 
CAC’s written protocols or guideline, in 
keeping with state and/or federal laws and 
professional ethics that govern information 
sharing among MDT members, including 
during case review.
Essential Component A
The CAC/MDT’s written protocols/guidelines 
include criteria for case review and case 
review procedures.
The CAC/MDT’s written documents must 
include:
1.	 Purpose of meetings  
2.	 Frequency of meetings
3.	 Designated attendees
4.	 Case selection criteria and process for 
developing case review agenda
5.	 Designated facilitator and/or coordinator
6.	 Mechanism for distribution of agenda and 
cases to be discussed
7.	 Procedures for addressing follow-up 
recommendations
8.	 Location of the meeting — may be in 
person or virtual
STATEMENT OF INTENT
To maximize efficiency and to enhance the 
quality of a comprehensive case review, the 
CAC’s written documents clearly define the 
process and expectations for all MDT partners.
07. Case Review and Coordination
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07. Case Review and Coordination 
Essential Component B
An intentional forum for the purpose of 
reviewing, collaborating, and coordinating 
cases is conducted at least once a month.
STATEMENT OF INTENT
Case review affords the MDT the opportunity 
to review active cases, provide updated case 
information, address obstacles to effective 
investigations and service delivery, and 
coordinate interventions. It is a planned, 
regularly scheduled meeting of all MDT 
partners and occurs at least once a month for 
cases coming from the CAC’s primary service 
area. Case review is a formal process that is 
conducted in addition to informal discussions 
and pre- and post-interview meetings.
Essential Component C
MDT partner agency representatives actively 
participating in case review must include, at a 
minimum:
1.	 Law enforcement
2.	 Child protective services
3.	 Prosecution
4.	 Medical
5.	 Mental health
6.	 Victim advocacy 
7.	 Children’s Advocacy Center
STATEMENT OF INTENT
Full MDT participation at case review allows 
for the contributions of diverse professional 
perspectives and expertise to optimize 
informed decision-making, case planning and 
coordinated service delivery. Case review 
must be attended by the identified agency 
representatives capable of making, informing 
and/or advocating for independent and 
collective decisions and providing the team 
with knowledge and expertise of their specific 
professions. All those participating should 
be familiar with the CAC/MDT process and 
the purpose and expectations of case review. 
Forensic interviewers, irrespective of which 
agency employs them, must be present at case 
review. Moreover, it is strongly encouraged 
that case review participants be those who are 
actively working on the cases under review in 
order to ensure direct communication between 
all parties. This does not preclude additional 
agency representatives or supervisors from 
participating as well. Participation in person 
is optimum; however, participation can be 
accomplished virtually as necessary to ensure 
the participation of all required disciplines and 
to respond to public health emergencies.
Essential Component D
Case review is an informed and collaborative 
decision-making process with input from all 
MDT partner agency representatives.
Generally, the case review process should 
include:
•	
Review of forensic interview outcomes
•	
Discussion, planning and monitoring of the 
progress of the investigation
•	
Review of medical evaluation findings
•	
Discussion of child protection and other 
safety issues
•	
Input for prosecution and sentencing 
decisions
•	
Discussion of emotional support and 
treatment needs of children and family 
members and strategies for meeting those 
needs
•	
Assessment of the family’s reaction and 
response to the child’s disclosure and 
involvement in the criminal justice and/or 
child protection systems
•	
Review of criminal and civil (dependency) 
case updates and ongoing involvement 
with the child and family as well as 
disposition
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07. Case Review and Coordination 
•	
Provisions for court education and court 
support and accompaniment
•	
Discussion of issues of cultural relevance 
and needs unique to individual children 
and families, including issues pertaining to 
access to services 
•	
Ensuring that all children and families 
are afforded the legal rights and 
comprehensive services to which they are 
entitled
•	
Discussion of how the CAC and MDT 
intervention is impacting the child and 
their family, including positive changes and 
challenges
•	
Child well-being and outcomes, as available
STATEMENT OF INTENT
In order to make informed case decisions, 
optimize service delivery and improve 
client outcomes, essential information and 
professional expertise are required from all 
disciplines. Decisions and interventions must 
be made with the input, discussion and support 
of all involved professionals, and efforts 
must be coordinated, comprehensive and 
nonduplicative. The process and facilitation 
must ensure there is equitable participation 
and discussion among all MDT members to 
adequately address their respective and shared 
goals, mandates, interventions and services, 
questions, concerns, and outcomes.
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08. Case-Tracking
Standard 08
Case-Tracking   
Children’s Advocacy Centers must develop and 
implement a system for monitoring case progress and 
tracking case outcomes for all MDT components.
NCA   |   NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS   |   2023 EDITION   •   PAGE   53

08. Case-Tracking
Rationale
Case-tracking systems are able to collect 
and document essential demographic 
and case information and investigation/
intervention outcomes as well as generate 
statistical reports. The data collected is useful 
for monitoring ongoing case progress and 
program evaluation to inform continuous 
quality improvement, enabling MDT members 
to provide accurate information on the current 
status and disposition of cases to clients, and 
providing critical support for seeking funding 
and responding to grant requirements. 
Data collected nationally from all local 
programs, relevant statewide and regionally, 
are useful for advocacy, research, and 
legislative purposes to advance the field of 
child maltreatment. It may also be required 
for federal funding reporting requirements. 
Each CAC utilizes the case-tracking system 
that suits its determined needs and is able 
to be supported by its available resources. 
Any case-tracking system implemented must 
be compliant with all applicable privacy and 
confidentiality requirements.
Essential Component A
The CAC/MDT’s written protocols/guidelines 
includes the case-tracking process and 
information gathered through case closure at 
the CAC, including final civil and/or criminal 
disposition.
STATEMENT OF INTENT
Case tracking provides a mechanism for 
monitoring case progress throughout the 
multidisciplinary interagency response. 
Often, MDT members will have a system to 
collect their own agency data; however, the 
MDT response requires the sharing of this 
information among its members to better 
inform individual and collective decision-
making, ensure accurate updates to children 
and families, and inform quality improvements 
in coordinated service delivery. The CAC/
MDT’s written documents must detail the 
CAC’s purpose, information to include, and a 
process for case tracking.
Essential Component B
The CAC tracks and, at a minimum, is able 
to retrieve and report NCA Statistical 
Information.
NCA statistical information includes the 
following data:
1.	 Demographic information about the child 
and family
2.	 Demographic information about the 
alleged offender
3.	 Type(s) of alleged abuse
4.	 Relationship of alleged offender to child
5.	 MDT members’ involvement with children 
and families and relevant outcomes
6.	 Criminal charges filed and case 
dispositions
7.	 Child protection outcomes
8.	 Status/follow-through of medical and 
mental health referrals
08. Case-Tracking  
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08. Case-Tracking
STATEMENT OF INTENT
CACs are required to demonstrate the ability 
to collect and retrieve case-specific information 
for all CAC clients. This includes basic 
demographic information, services provided, 
and outcome information contributed by MDT 
partner agencies in a thorough and timely 
fashion. Codifying case-tracking procedures 
in CAC/MDT’s written documents underscores 
its importance and helps to assure the MDT 
members are accountable to each other and, 
ultimately, to the children and families they 
individually and collectively serve.
Essential Component C
An individual is identified to implement the 
case-tracking process.
STATEMENT OF INTENT
Case tracking is an important function of 
the CAC that requires dedicated time and 
accuracy in its implementation. A designated 
individual(s) must be identified to implement 
and/or oversee the case-tracking process, 
and the number and type of individual(s) 
charged with this responsibility is determined 
by the CAC’s staffing and case volume. Some 
CACs define case tracking as part of the MDT 
coordinator’s or case manager’s role. Some 
dedicate a staff position, part- or full-time, for 
data collection and database maintenance, or 
assign the responsibility to an administrative 
assistant. Other programs utilize trained 
volunteers (who have signed confidentiality 
agreements) to input data.
Essential Component D
The CAC/MDT’s written protocols/guidelines 
must outline how MDT partner agencies 
can access case-specific information and 
aggregate data for quality assurance, quality 
improvement, funding, and research purposes.
STATEMENT OF INTENT
Because case data may be useful to MDT 
members for a variety of purposes, it is 
important that all members have access to 
aggregate and/or specific case information 
as determined through discussions with 
all participating agencies. Policies must 
also include how the release of this data 
to participating agencies and other parties 
complies with confidentiality requirements.
Essential Component E
The CAC collects client feedback to inform 
client service delivery.
STATEMENT OF INTENT
Continuous quality assurance is the hallmark of 
a well-functioning CAC. This requires seeking 
feedback directly from clients regarding their 
experiences with all aspects of CAC services 
so that improvements may be made as needed 
on an ongoing basis. Soliciting client feedback 
can be accomplished through the use of 
various tools including, but not limited to, client 
satisfaction surveys. To optimize the quality 
of the feedback received, survey instruments 
need to be valid and reliable. CACs that 
actively participate in NCA’s Outcome 
Measurement System (OMS) can be assured 
they meet and exceed this requirement.
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09. Organizational Capacity 
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09. Organizational Capacity 
Standard 09
Organizational 
Capacity 
A designated legal entity responsible for program 
and fiscal operations has been established and 
implements basic sound administrative policies and 
procedures.
NCA   |   NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS   |   2023 EDITION   •   PAGE   57

09. Organizational Capacity 
Rationale
Every CAC must have a designated legal 
entity responsible for the governance and 
implementation of its operations. This entity 
oversees ongoing business practices of the 
CAC, including setting and implementing 
administrative policies, hiring, and managing 
personnel, obtaining funding, supervising 
program and fiscal operations, and long-
term planning. CAC organizational structure 
depends upon the unique needs and resources 
of its community; it may be an independent 
nonprofit agency, a component of an umbrella 
organization such as a hospital or nonprofit 
human service or victim service agency, or part 
of a governmental entity, such as prosecution, 
social services, or law enforcement. Each 
of these options has strengths, limitations 
and implications for collaboration, planning, 
governance, community partnerships and 
resource development. Regardless of where 
the program is housed or under what legal 
auspices, all CACs must create a structure 
such that participating agencies feel equal 
investment in, and collaborative responsibility 
for, its operations and services.
Essential Component A
The CAC is an incorporated, private nonprofit 
organization, government-based agency, 
tribal entity, or a component of such an 
organization, agency, or tribal entity.
STATEMENT OF INTENT
The CAC has a defined organizational identity 
that ensures appropriate legal and fiduciary 
governance and organizational oversight. This 
is critical to the ability to maintain, grow and 
ensure sustainability of the CAC and all of its 
components and services.
Essential Component B
The CAC maintains, at a minimum, current 
general commercial liability, professional 
liability, directors’ and officers’ liability, and 
cyber liability insurance as appropriate for its 
organization.
STATEMENT OF INTENT
Every CAC must provide appropriate insurance 
for the protection of the organization and its 
personnel. Nonprofit CACs, including those 
that are a component of an umbrella nonprofit 
or nonprofit hospital, must carry, at a minimum, 
general commercial liability, professional 
liability, cyber liability, and directors’ and 
officers’ liability insurance. Government-
based CACs must carry, at a minimum, 
general commercial liability, professional 
liability, and cyber liability insurance or 
provide documentation of comparable 
coverage through self-insurance. CACs should 
consult with appropriate risk management 
professionals to determine appropriate types 
of insurance and any additional levels of 
coverage needed, including renters, property 
owners and automobile insurance, depending 
upon their individual needs.
Essential Component C
The CAC has administrative policies and 
procedures that apply to staff, board 
members, volunteers, and clients.
Every CAC must have written policies and 
procedures that govern its administrative 
operations. Administrative policies and 
procedures must include, at a minimum:
1.	 Personnel policies, procedures, and 
documents
09. Organizational Capacity
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09. Organizational Capacity 
A.	 Job descriptions for all positions
B.	 Anti-discrimination policy
C.	 Conflict of interest policy
D.	 Whistleblower policy
E.	 Social media use policy
2.	 Financial management policies and 
procedures
A.	 Accounting policies and procedures 
that demonstrate adequate internal 
controls and segregation of duties
B.	 Credit card usage policy
3.	 Safety and security policies and 
procedures
A.	 Code of conduct (this should guide 
behavior between staff, between staff 
and team members, and between 
staff/team members and clients)
B.	 Child protection policies, including the 
obligation to report abuse
C.	 Emergency response policies 
D.	 Building security and safety policy and 
procedures
E.	 Anti-Violence in the Workplace policy
F.	 Weapons on premises policies and 
procedures
G.	 Drug usage policy
H.	 Smoke-free environment
4.	 Information technology policies
A.	 Document retention and destruction 
policies
B.	 Data security policies
C.	 Confidentiality policies — HIPAA 
requirements
STATEMENT OF INTENT
The CAC has clearly developed organizational 
policies and procedures that ensure 
appropriate administrative governance. This 
is critical to the ability to maintain, grow and 
ensure sustainability of the CAC and all of its 
components and services. 
Essential Component D
The CAC is required to conduct an annual 
independent financial audit when its annual 
actual expenses meet or exceed $750,000. 
Organizations whose annual gross expenses 
fall below $750,000 and meet or exceed 
$200,000 must conduct a CPA-completed 
financial review. Those organizations with 
gross annual expenses below $200,000 
must provide their Board-approved financial 
statements.
STATEMENT OF INTENT
Confidence in the integrity of the fiscal 
operations of the CAC is critical to the long-
term sustainability of the organization. An 
annual independent audit is one tool to assess 
for fiscal soundness and internal controls for 
financial management. A financial review is 
sufficient for those CACs with annual actual 
expenses equal are less than $750,000 and that 
meet or exceed $200,000. CACs with annual 
budgets below $200,000 must provide their 
Board-approved financial statements.
Reporting Requirements for Audited Financial 
Statements: All centers with annual actual 
expenses (as determined by United States 
generally accepted accounting principles) 
that meet or exceed $750,000 are required 
to have an audit of their financial statements. 
If a management letter is prepared by the 
independent accountant (CPA), it should be 
included with the audit report.
Reporting Requirements for Reviewed Financial 
Statements: All centers with annual actual 
expenses (as determined by United States 
generally accepted accounting principles) less 
than $750,000 that meet or exceed $200,000 
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09. Organizational Capacity 
are required to have a review of their financial 
statements. The review must be in compliance 
with SSARS 19. If a management letter is 
prepared by the independent accountant 
(CPA), it should be included with the review 
report.
Essential Component E
The CAC has, and demonstrates compliance 
with, written screening policies for staff, 
board members and volunteers that include 
national criminal background, sex offender 
registration, and child abuse registry checks, 
and it provides training and supervision to 
staff and on-site and/or ongoing volunteers. 
In discussion with its Board and MDT, a CAC 
must determine what is a disqualifying finding 
in a background check.
STATEMENT OF INTENT
Due to the sensitive and high-risk nature 
of CAC work, it is imperative that the CAC 
conduct a formal screening process for staff. 
This process should be documented in a 
written policy. Staff must receive initial and 
ongoing training and supervision relevant to 
their role. 
In addition, volunteers perform a wide variety 
of functions within CACs, and CACs can attract 
volunteers who are emotionally unprepared for 
the nature and expectations of the work and/
or individuals who have potential to be, or have 
current or past histories as, offenders. Due to 
the sensitive and high-risk nature of CAC work, 
it is imperative that the CAC also conducts a 
formal screening process for on-site volunteers. 
Upon placement, volunteers must receive 
training and supervision relevant to their roles.
For similar reasons, screening must be 
conducted for board members as they serve 
and publicly represent the CAC in a variety of 
ways, both on- and off-site.  
Essential Component F
The CAC has a written succession plan to 
ensure the orderly transition and continued 
operation of the CAC.
STATEMENT OF INTENT
A succession plan assists in guiding the CAC 
through, and safeguarding the CAC against, 
unplanned or unexpected changes. This kind 
of risk management, mission and business 
continuity is equally important in facilitating 
a smooth transition when leadership change 
is predictable and planned. A succession 
plan outlines leadership development and 
emergency responsibilities for the CAC, and 
it reflects its commitment and helps ensure a 
sustained, healthy functioning organization. 
The plan should be developed specific to 
the uniqueness of the CAC and include, at a 
minimum:
•	
Temporary staffing strategies
•	
Long-term and/or permanent leadership 
replacement procedures
•	
Cross-training plan
•	
Financial considerations 
•	
Communication plan
•	
Key positions/functions essential to the 
operation of the CAC 
Essential Component G
The CAC has addressed its sustainability 
through the implementation of a current 
strategic plan approved by the governing 
entity of the CAC.
STATEMENT OF INTENT
In order to assure long-term viability of the 
organization, the CAC must have a plan that 
addresses programmatic and operational 
needs. The governing entity for such a plan 
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09. Organizational Capacity 
may be an oversight committee or a board 
of directors, as appropriate for the individual 
CAC’s organizational structure and needs. 
In general, in order to be considered 
current, a strategic plan should be no more 
than three to five years old. It should be 
actively implemented, and there should be a 
mechanism in place to monitor the progress on 
the plan.
Plan should include at, a minimum:
•	
Stakeholder input in plan creation
•	
Goals, objectives, and timeline
•	
Review and approval by CAC board or 
relevant governing body
Essential Component H
The CAC promotes employee well-being by 
providing training and resources regarding 
the effects of vicarious trauma, providing 
techniques for building resiliency, and 
maintaining organizational and supervisory 
strategies to address vicarious trauma and its 
impact on staff.
STATEMENT OF INTENT
To help ensure the health and well-being of all 
employees and improve employee retention, 
the CAC must raise awareness about the 
impact of work-related trauma exposure 
through training and develop organizational 
practices that identify and mitigate against 
negative consequences for staff, the delivery 
of quality of services, and staff turnover. 
This includes identifying the risk of vicarious 
trauma for frontline staff and those exposed 
to the associated trauma of the work more 
indirectly. It also includes providing techniques 
for individual self-care and resiliency building 
as well as integrating and maintaining 
organizational and supervisory strategies 
to address and respond to vicarious trauma 
among all staff.
Essential Component I
The CAC provides training opportunities and 
resources on vicarious trauma and building 
resiliency to all MDT members.
STATEMENT OF INTENT
CACs have a primary role in building and 
enhancing the functioning of the MDT. A 
highly functioning MDT assures vicarious 
trauma is acknowledged and addressed and 
has an awareness and understanding of the 
importance of work-related trauma exposure 
and its potential consequences. While MDT 
partner agencies have primary responsibility 
for the health and well-being of their respective 
staff, the CAC is responsible for providing 
access to training, ongoing recognition, and 
discussion and strategies to collaboratively 
address vicarious trauma and help build team 
members’ resiliency. Moreover, the health of 
the MDT as a whole directly impacts service 
delivery to children and families. Therefore, 
attention to this issue is important for helping 
to ensure high-quality services and improve 
outcomes for abused children and families.
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10. Child Safety and Protection
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10. Child Safety and Protection
Standard 10
Child Safety  
and Protection   
The CAC is comfortable, private and both physically and 
psychologically safe for diverse populations of children and 
their family members.
NCA   |   NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS   |   2023 EDITION   •   PAGE   63

10. Child Safety and Protection
Rationale
A CAC requires a separate, child/youth-
focused setting that provides a safe, 
comfortable, and neutral place where forensic 
interviews and other CAC services can be 
appropriately provided for children and 
families. While every center may look different, 
the criteria below help define specific ways 
the environment can help children and families 
feel physically and psychologically safe and 
comfortable. These include making sure 
the physical setting meets basic child safety 
standards, ensuring alleged offenders do not 
have access to the CAC, providing adequate 
supervision of children and families while they 
are on the premises, and creating a welcoming 
environment that reflects the diversity of clients 
served. 
There is no one right way to build, design 
or decorate a CAC. The CAC should have 
adequate square footage for its determined 
on-site operations and conform to generally 
accepted safety and accessibility guidelines, 
fire codes, etc. Consideration should be given 
to future growth and the need for additional 
space as caseloads increase and additional 
program components are needed. Care should 
be taken to ensure MDT members have access 
to workspace and equipment on-site to carry 
out the necessary functions associated with 
their roles on the MDT, including, but not 
limited to, meeting with families, participating 
in forensic interviews and sharing necessary 
information. 
Special attention should be given to designing 
and decorating the client service areas to 
reflect the community’s diverse population. 
The appearance of the CAC can help facilitate 
the participation of children and families in the 
process, largely by helping alleviate anxiety 
and instill confidence and comfort in the 
intervention system. It should communicate, 
through its design, decor, and materials, that 
the CAC is a welcoming place for all children 
and their nonoffending family members.
Essential Component A
The CAC is a designated, task-appropriate 
facility or space that:
1.	 Is maintained in a manner that is physically 
and psychologically safe for children and 
families
2.	 Provides observation or supervision of 
clients within sight or hearing distance by 
CAC staff, MDT members or volunteers at 
all times
3.	 Is convenient and accessible to clients and 
MDT members
4.	 Is appropriate for the delivery of CAC 
services
5.	 Provides age-appropriate and culturally 
diverse toys and other resources that are 
childproofed, cleaned, and sanitized to be 
as safe as possible.
STATEMENT OF INTENT
The CAC is a child focused setting that ensure 
both physical and psychological safety for 
all children and families. Special attention 
should be paid to the location, design and 
accessibility of the CAC for the children, 
families and MDT members that utilize the 
center.
10. Child Safety and Protection
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10. Child Safety and Protection
Essential Component B
The CAC has, and abides by, written policies 
and procedures that ensure separation of 
victims and alleged adult offenders during the 
investigative process and throughout delivery 
of services at the CAC. CACs may provide 
services to youth with problematic sexual 
behaviors, but they must have developed and 
implemented appropriate safety protocols to 
protect other children receiving services at 
the CAC.
STATEMENT OF INTENT
The CAC has written policies and procedures 
that ensure the separation of victims and 
alleged offenders during the investigative 
process and throughout delivery of the full 
array of CAC services. During the investigative 
process, logic dictates that children will not feel 
free to disclose abuse if an alleged offender 
accompanies them to the interview and/or 
remains on location throughout the duration 
of intervention. This separation of children 
from alleged offenders should also extend to 
children and perpetrators in unrelated cases. 
In addition, caregivers may also be at risk of 
abuse and violence by alleged offenders and 
are in need of physical and psychological 
safety for themselves and their children. If a 
CAC shares space with an existing agency 
that provides services to offenders, facility 
features and scheduling must assure separation 
between children and family members and 
alleged offenders. 
Many CACs serve a vital role in their 
communities by providing services for children 
with problematic sexual behaviors. CACs that 
offer services to this population should have 
policies and procedures in place to maintain 
physical and psychological safety for other 
child victims and their families visiting the CAC.
Essential Component C
The CAC makes reasonable accommodations 
to make the facility physically accessible.
STATEMENT OF INTENT
This requirement is for new buildings and 
custom-designed facilities. CACs operating 
in older buildings or facilities must make 
reasonable accommodations to make the 
facility physically accessible to clients and 
family members, CAC staff and MDT members. 
If the CAC cannot be structurally modified, 
arrangements for equivalent services should be 
made at alternate locations within or outside 
the facility. CACs must be in compliance with 
guidelines stipulated in the Americans with 
Disabilities Act (ADA) and/or state legislation.
Essential Component D
Separate and private area(s) are available for 
confidential case consultation and discussion, 
for meetings or interviews, and for clients 
awaiting services.
STATEMENT OF INTENT
To ensure a physically and psychologically 
safe environment for children and families, 
confidentiality and respect for client privacy 
is of paramount concern in a CAC. CAC staff 
and MDT members require privacy to discuss 
cases with children or families in a location 
where visitors or others not directly involved 
with the case may overhear them. Separate 
areas should also be available for private family 
member interviews and so that individual 
family members may privately discuss aspects 
of their case with staff and MDT members. 
Care should be taken to ensure that private 
meeting areas are not only physically separate 
but also soundproofed, so conversations 
cannot be overheard. Some centers place 
soundproofing materials in or on walls when 
building or refurbishing their centers. Others 
place stereos or sound machines in rooms to 
block sound.
NCA   |   NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS   |   2023 EDITION   •   PAGE   65

10. Child Safety and Protection
Essential Component E
CACs are required to implement a code of 
conduct for staff and MDT members ensuring 
the safety of children and families. The 
code of conduct must include child abuse 
prevention practices. Staff members must 
have received and agreed to the code of 
conduct. MDT members must be informed 
of the CAC’s code of conduct and the 
expectation that it guides work within the 
CAC.
Code of conduct content must include:
•	
Child safety and well-being as a primary 
priority and value in the CAC and one that 
guides policy and practice decisions.
•	
Contact not related to CAC service 
provision between staff and a child/client 
is prohibited.
•	
Physical contact between child/client and 
staff/MDT members must be consistent 
with the safety and well-being of the child/
client.
•	
Staff interaction with child clients should 
be interruptible and/or observable.
•	
It is the duty of staff to report suspected 
child abuse.
STATEMENT OF INTENT
A code of conduct is a set of rules around the 
behavior for CAC staff and MDT members, 
and it acts as an explicit expression of personal 
and professional expectations in their work 
with one another and with clients. It also serves 
as an external statement of the CAC/MDT’s 
commitment to its core values and principles 
for interdisciplinary, cross-agency work. In 
addition, a code of conduct helps provide 
for a healthy work environment for staff and 
MDT members, and thereby helps ensure 
the delivery of high-quality, relevant, and 
accessible child- and family-centered services. 
In the event of any violations of stated codes of 
conduct, it also provides an understanding of 
how to report and/or address them. 
Essential Component F
A child safety assessment must be conducted 
annually to ensure that the building and CAC 
space is a safe and child-focused setting for 
children and their families.
STATEMENT OF INTENT 
Core to CACs is their ability to provide a 
setting that underscores the critical importance 
of providing and/or restoring a sense of safety, 
both physically and psychologically, for children 
and families in crisis. Safety must be assured if 
children and families are able to participate in 
forensic interviews, investigations, evaluations 
and identified services. As such needs and 
safety measures change or are updated, 
assessments must be conducted at least 
annually.
Essential Component G
CAC staff are mandatory reporters. CACs are 
required to ensure that mandated reporter 
training is provided to all staff and volunteers. 
Updates to state statutes and mandated 
reporter laws must be provided to staff and 
volunteers annually, if applicable. 
STATEMENT OF INTENT
Given the nature of the work of CACs/MDTs, 
all those involved in the delivery of services 
to children and families must be trained and 
understand the requirements of mandated 
reporter laws and the procedures for reporting 
known or suspected instances of child abuse 
and neglect. Annual training is important to 
ensure that changes in the law and/or agency 
reporting procedures can be understood and 
observed.
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Medical Appendix
Medical Evaluation 
Standard 
Appendices
The sample resources in the appendix are intended for 
resource and example only and are not intended to dictate 
how an individual CAC would address specific issues in the 
medical standard
NCA   |   NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS   |   2023 EDITION   •   PAGE   67

Medical Appendix
History of Present Illness (HPI):
•	
History of the event:
	
Ε
What happened, when, where, who was 
involved
•	
History of the contact:
	
Ε
Body sites involved, actions involved, 
associated symptoms
•	
What has happened since the event?
	
Ε
Physical/emotional symptoms/behavioral 
response
	
Ε
Safety threats, bullying, school performance
	
Ε
Family relationships
•	
What response has already occurred?
	
Ε
Prior medical exam and treatment
	
Ε
Interview by investigators or CAC staff
	
Ε
Counseling/mental health screening
Past Medical History (PMH):
•	
Significant Illnesses/Surgeries/Hospitalizations
•	
Development (including sexual development and 
menstrual history in girls)
•	
Behavioral, educational or mental health issues
•	
Prior abuse and sexual history including 
consensual partners
•	
Medications, allergies and vaccination history 
(esp. HPV and Hep B)
Family History (FH):
•	
Significant health problems in parents, siblings 
and close relatives.
Social History (SH):
•	
Home composition, violence in the home, 
substance abuse by patient or those in the 
home.
•	
Does the patient feel safe and supported by 
current caretakers?
•	
Prior child welfare involvement in the family.
Review of Body Systems (ROS): Ongoing or current 
problems/concerns (usually 10 systems)
•	
HEENT - Head, Eyes, Ears, Nose, Throat
•	
Respiratory-breathing
•	
Cardiac- heart
•	
Hematology- bruising or bleeding
•	
Endocrine - glands,weight gain/loss
•	
Neurology-headaches, seizures, balance
•	
Gastrointestinal-nausea, vomiting, constipation, 
diarrhea, rectal pain/bleeding/DC
•	
Genitourinary-discharge, burning, dysuria, 
bleeding, pain, lesions
•	
Musculoskeletal-(muscles, bones and joints
•	
Skin- rashes, lesions, tattoos, bruises
Appendix 1  
Medical History for Child Sexual Abuse
COMMON COMPONENTS OF MEDICAL HISTORY FOR POSSIBLE SEXUAL ABUSE
(Needed to guide testing, treatment and make diagnosis)
Sources: Child, Parent/caregiver, Investigator/FI, social work/advocate, medical records. Coordination and 
collaboration should occur to avoid duplication in the child being asked to recount details of the abuse event.
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Medical Appendix
IMPORTANT DEFINITIONS
Didactic Training
Didactic training for CAC medical providers should 
cover examination positions (supine, lateral, knee 
chest), examination techniques (gathering of 
forensic evidence, samples for STI testing, labial 
traction, use of cotton swab with pubertal females 
to demonstrate edges of hymen, foley catheter, 
etc), and the review of multiple examples of:
A.	 anatomical variants
B.	 acquired or developmental conditions that 
mimic abuse
C.	 accidental trauma and sexual abuse trauma
D.	 STIs and forensic evidence
Competency Based Clinical Preceptorship
A preceptorship has a clinical training component 
that provides observation and training with 
an experienced examiner. The length of the 
preceptorship is determined by the time it 
takes the trainee to demonstrate competency in 
obtaining medical history, using appropriate exam 
techniques, obtaining diagnostic quality photo-
documentation, and applying strategies for testing 
and prophylaxis for STIs and pregnancy.
TABLE 1: MEDICAL DISCIPLINES, NCA TRAINING REQUIREMENTS AND 
CREDENTIALING ENTITY
Foundational Training 
Requirements
NCA Training 
Requirements
Licensing Entity
Physician  
(MD or DO)
Undergraduate Degree
4 years of Medical School
3 years of Residency
1-3 years of Fellowship (optional)
ü
16 hours of formal 
didactic training in  
the medical 
evaluation of Child 
Sexual Abuse
State Medical Board
Pediatrics, 
Family 
Medicine, or 
other physician, 
Undergraduate Degree
4 years of Medical School
3 years of Residency
State Medical Board
Child Abuse 
Pediatrician
Undergraduate Degree
4 years of Medical School
3 years of Residency
3 years of Child Abuse Fellowship
Board certification in Child Abuse 
Pediatrics
No additional training 
requirements
 State Medical Board
Appendix 2  
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Medical Appendix
Foundational Training 
Requirements
NCA Training 
Requirements
Licensing Entity
Advance Practice 
Nurse (APRN), 
Nurse Practitioner 
(NP), Pediatric 
Nurse Practitioner 
(PNP)
Undergraduate Degree
2 years of Graduate School
Certification Exam
ü
16 hours of formal 
didactic training in the 
medical evaluation of 
Child Sexual Abuse
State Nursing Board
Physician’s 
Assistant (PA)
Undergraduate Degree
2 years of Graduate School
Certification Exam
State Licensing Board
Sexual Assault 
Nurse Examiner 
(SANE)- Adult and 
Pediatric 
Nursing Degree (RN or BSN)
Licensure Exam
Adult and/or pediatric and 
adolescent SANE training 
consistent with IAFN guidelines 
Competency Based Clinical 
Preceptorship 
Providers who have completed 
SANE training and preceptorship 
may also choose to apply 
for SANE-A and/or SANE-P 
certification by IAFN.
ü
40 hours of formal 
didactic training in the 
medical evaluation of 
Child Sexual Abuse
ü
Competency Based 
Clinical Preceptorship
State Nursing Board
Some states have state-
specific forensic nursing 
requirements. 
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Medical Appendix
Continuous Quality 
Improvement
IMPORTANT DEFINITIONS
Continuous Quality Improvement
is the process-based, data-driven approach to 
improving the quality of a product or service. 
It operates under the belief that there is always 
room for improving operations, processes, and 
activities to increase quality.
Advanced Medical Consultant 
A Child Abuse Pediatrician, Physician or 
Advanced Practice Nurse who:
1.	 Has met the minimum training outlined for 
a CAC provider (see above)
2.	 Has performed at least 100 child sexual 
abuse examinations
3.	 Current in CQI requirements (continuing 
education and participation in expert 
review on their own cases)
Expert Review
Expert review of examination findings is a 
de-identified continuous quality improvement 
(CQI) activity and is NOT a consultation/second 
opinion.
1.	 The CAC should nclude in their policies and 
procedures the documentation procedure 
for continuous quality improvement .
2.	 The CAC should track examinations 
determined to be abnormal, using either 
a patient log kept in a secured location or 
through the MDT case review process. The 
number of abnormal exams and percent 
of exams reviewed by an expert provider 
should be available if requested for site 
review purposes/practice audits.
3.	 The medical provider or organization who 
provides the expert review should maintain 
a de-identified log noting how many 
times they have provided examination 
review for a specific provider. Notation of 
whether consensus was reached is also 
recommended.
4.	 A  MOU to delineate roles and 
expectations between the CAC/medical 
provider and the person serving as the 
expert reviewer outlining the roles and 
responsibilities should be considered.
EXPERT REVIEW
NCA Medical Standard for Accreditation 
states that “all medical professionals providing 
services to CAC clients must demonstrate 
that 100% of all findings deemed abnormal 
or “diagnostic” of trauma from sexual abuse 
have undergone expert review by an advanced 
medical consultant”.
A.	 Advanced Medical Consultants as 
defined above should also have 
abnormal exams reviewed by another 
expert.
B.	 An abnormal exam is one that has 
acute or healed physical findings in 
the anogenital area indicating that 
abuse/assault has occurred. Laboratory 
testing for STIs or pregnancy and DNA 
evidence collection are NOT included 
in the definition of an abnormal exam.
Appendix 3  
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Medical Appendix
SAMPLE EXPERT REVIEW LOG
Below is a sample table that can be created in an Excel document or preferred database to track the 
review of abnormal exams by an advanced medical consultant. It is recommended that every CAC 
Medical provider keep such a log on file for review by NCA Site Reviewers.
Date
Site/examiner
Pre/post 
puberty
Examiner findings/
concerns
Reviewer findings
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Medical Appendix
SAMPLE LANGUAGE FOR MEMORANDUM OF UNDERSTANDING WITH ADVANCED 
MEDICAL CONSULTANT
MOU for Expert Review of Examinations with Abnormal Findings
It is understood that the examination review services represent a continuous quality improvement 
(CQI) activity and are not intended to serve as medical consultation or provision of direct patient 
care so results of CQI activity should not be documented in the patient’s medical record. It is the 
responsibility of the medical provider of the CAC to document the findings of the examination in the 
patient’s medical record, establish referral protocols with the CAC’s medical director, communicate 
the findings with the appropriate MDT members and be available for case review and court testimony 
if needed. This MOU for examination review services does not act as or substitute for the role of the 
local medical director of the CAC.
A process for tracking information from the examination review process is needed for both CQI as well 
as for application for accreditation/re-accreditation with the National Children’s Alliance.
The CAC and/or the medical provider will maintain a de-identified log of the number of cases in which 
the medical examination was deemed to represent an abnormal examination. An abnormal exam is 
defined as an exam in which acute or healed genital or anal injuries are identified as consistent with 
sexual abuse . Abnormal laboratory tests (sexually transmitted infections and pregnancy) and results 
of biologic evidence collections are not included in the definition of abnormal exams for the purpose 
of this examination review activity.
The medical provider of the CAC will maintain a log documenting the number of cases with abnormal 
findings submitted for expert review. Patient information on the log will either be de-identified or 
maintained in a secure, locked location to protect sensitive health information.
The medical provider serving as the expert reviewer will maintain a de-identified case log listing the 
date, examiner and whether the reviewer agreed with the examiner’s conclusion of abnormal findings 
on the examination.
Logs should be maintained for a minimum of 5-years to coincide with the cycle for re-accreditation.
CAC Director	 	
	
	
	
	
Date
CAC Medical Provider	
	
	
	
Date
Expert Reviewer	
	
	
	
	
Date
NCA   |   NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS   |   2023 EDITION   •   PAGE   73

Medical Appendix
Appendix 4  
Examination Referral and Timing
IMPORTANT DEFINITIONS
Suspected victim of sexual abuse
A suspected victim of sexual abuse may be identified by the following criteria:
1.	 Disclosure of abuse
2.	 Witness of abuse by an adult or child
3.	 Exposure to high-risk offender (i.e. adult in possession of child pornography, sibling/household 
contact of a child victim)
TABLE 2: TIMING OF MEDICAL EXAMINATIONS1
Timing of Exam
Medical Indications
Indications for 
emergency  
evaluation
Exam scheduled 
without delay
•	
Medical, psychological or safety concerns such as acute 
pain or bleeding, suicidal ideation, or suspected human 
trafficking
•	
Alleged assault that may have occurred within the 
previous 72 hours (or other state-mandated time interval) 
necessitating collection of trace evidence for later 
forensic analysis
•	
Need for emergency contraception
•	
Need for post-exposure prophylaxis (PEP) for STIs 
including Human Immunodeficiency Virus (HIV)
Indications 
for urgent 
evaluation
Exam scheduled 
as soon as 
possible with 
qualified provider
•	
Suspected or reported sexual contact occurring within 
the previous 2 weeks, without emergency medical, 
psychological or safety needs identified
Indications for 
non-urgent 
evaluation
Exam scheduled 
at convenience 
of family and 
provider but 
ideally within 1-2 
weeks
•	
Disclosure of abuse by child, sexualized behaviors, sexual 
abuse suspected by MDT, or family concern for sexual 
abuse, but contact occurred more than 2 weeks prior 
without emergency medical, psychological or safety 
needs identified
1	
Adams JA, Kellogg ND, Farst KJ, Harper NS, Palusci VJ, Frasier LD, Levitt CJ, Shapiro RA, Moles RL, Starling SP, 
Updated Guidelines for the Medical Assessment and Care of Children Who May Have Been Sexually Abused, Journal of 
Pediatric and Adolescent Gynecology (2015), doi: 10.1016/j.jpag.2015.01.007.
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Medical Appendix
Timing of Exam
Medical Indications
Indications 
for follow-up 
evaluation
As determined by 
qualified provider
•	
Findings on the initial examination are unclear or 
questionable necessitating reevaluation
•	
Documentation of healing/resolution of acute findings
•	
Confirmation of initial examination findings, when initial 
examination was performed by an examiner who had 
conducted fewer than 100 such evaluations
•	
Further testing or treatment for STIs 
THE 5 P’S
Other indications for medical evaluation even if outside of the DNA collection window 
1.	 Pain/bleeding with/after contact
2.	 Potential for STI’s due to nature of contact
A.	 Many STI’s do not cause symptoms
3.	 Perpetrator exposed
A.	 Sibling/household contacts of the alleged offender
4.	 Pornography (child) use by caregiver/household contact
5.	 Patient/parent concern
A.	 Patients often have distorted thoughts of body due to perpetrator manipulation
B.	 Initial partial disclosures are common
NCA   |   NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS   |   2023 EDITION   •   PAGE   75

Medical Appendix
Appendix 5  
Disclosure Log for Protected Health Information (PHI)
Maintain in patient’s chart
Date
Type of PHI 
disclosed
Entity receiving 
PHI
Purpose of 
Disclosure 
(Investigation, 
billing, continuity of 
care…)
Person making 
disclosure
PAGE   76   •   NCA   |   NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS   |   2023 EDITION

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