Factors affecting child welfare and protection workers' intention to quit: a cross-sectional study from Norway.

INTRODUCTION: High turnover rates have been a problem for Norwegian child welfare and protection services for years. The main aim of this study was to identify which factors affect Norwegian child welfare and protection (CWP) workers intention to quit their job and whether there is a difference between experienced (< 3 years) and less experienced workers. METHODS: A cross-sectional survey was performed among 225 Norwegian child welfare and protection workers. Data were collected using a self-report questionnaire. Turnover intention was examined using a variety of job demands and resources as possible predictors. T tests were used to study mean differences in variable scores between experienced and less experienced workers and linear regression analysis was employed determining predictors of intention to quit. RESULTS: For the total sample (N = 225) the most important predictors for intention to quit were workload, burnout, engagement, and views on leadership. Higher emotional exhaustion and cynicism, and low professional efficacy predicted a higher score on the intention to quit scale. High engagement and leadership satisfaction predicted lower scores. The effect of workload was moderated, such that intention to quit among less experienced workers increased more with high workload than it did among more experienced child welfare workers. CONCLUSIONS: The conclusions are that job demands affect experienced and less experienced CWP workers differently and that when designing preventive efforts to reduce turnover this must be considered.

Partnering to implement the Global Initiative for Childhood Cancer in the Americas: prioritizing systems strengthening.

Working with PAHO/WHO to prioritize childhood cancer in the context of systems strengthening is central to St. Jude Children's Research Hospital (SJCRH)'s role as WHO Collaborating Centre for Childhood Cancer. This manuscript focuses on how SJCRH and PAHO/WHO have partnered to apply C5 (Country Collaboration for Childhood Cancer Control) to define and implement priority actions regionally, strengthening Ministry programs for childhood cancer, while implementing the Global Initiative for Childhood Cancer since 2018. Using C5, a tool developed by SJCRH, PAHO/WHO and SJCRH co-hosted regional/national workshops engaging authorities, clinicians and other stakeholders across 10 countries to map health systems needs and prioritize strategic activities (spanning Central America, Dominican Republic, Haiti, Brazil and Uruguay). SJCRH provided English/Spanish/Portuguese C5 versions/templates for analysis/prioritization exercises, and worked with PAHO/WHO and country teams to implement C5, analyze findings, and develop outputs. In an eight-country regional workshop, countries defined priorities within national/regional initiatives and ranked their value and political will, incorporating country-specific surveys and stakeholder dialogues. Each country prioritized one strategic activity for 2022-2023, exchanged insights via storytelling, and disseminated and applied results to inform country-specific and regional action plans. National workshops analyses have been incorporated into cancer control planning activities and collaborative work regionally. Implementation success factors include engaging actors beyond the clinic, enabling flexibility, and focusing on co-design with stakeholders. Joint implementation of C5 catalyzed prioritization and accelerated strategic activities to improve policies, capacity, and quality of care for children in the Americas, supporting Ministries to integrate childhood cancer interventions as part of systems strengthening.

La colaboración con la OPS/OMS para priorizar el cáncer infantil en el contexto del fortalecimiento de los sistemas es fundamental para la labor del St. Jude Children's Research Hospital (SJCRH) como centro colaborador de la OMS contra el cáncer infantil. Este artículo se centra en la alianza entre el SJCRH y la OPS/OMS en la aplicación de la herramienta C5 (colaboración nacional para el control del cáncer infantil) para definir y ejecutar medidas prioritarias a nivel regional, fortalecer los programas contra el cáncer infantil del ministerio y poner en marcha la Iniciativa Mundial contra el Cáncer Infantil desde el 2018. Con C5, una herramienta elaborada por el SJCRH, la OPS/OMS y este hospital organizaron conjuntamente talleres regionales y nacionales con autoridades, personal médico y otras partes interesadas en diez países para determinar cuáles son las necesidades de los sistemas de salud y priorizar las actividades estratégicas (en América Central, República Dominicana, Haití, Brasil y Uruguay). El SJCRH proporcionó versiones y plantillas de C5 en inglés, español y portugués para actividades de análisis y priorización y trabajó con la OPS/OMS y los equipos de país para ejecutar la herramienta C5, analizar los resultados y elaborar productos. En un taller regional de ocho países, se definieron las prioridades en las iniciativas regionales y nacionales, se clasificó su valor y la voluntad política y se incorporaron encuestas específicas para cada país y diálogos con las partes interesadas. Cada país priorizó una actividad estratégica para el período 2022-2023, intercambió ideas por medio de narrativas, y difundió y aplicó los resultados para fundamentar planes de acción tanto regionales como específicos para el país. Los análisis de los talleres nacionales se han incorporado a las actividades de planificación del control del cáncer y al trabajo colaborativo a nivel regional. Entre los factores de éxito de la ejecución se encuentra involucrar a los agentes más allá de lo clínico, permitir que haya flexibilidad y centrarse en un diseño elaborado en colaboración con las partes interesadas. La ejecución conjunta de la herramienta C5 catalizó la priorización y aceleró las actividades estratégicas para mejorar las políticas, la capacidad y la calidad de la atención infantil en la Región de las Américas y brindó apoyo a los ministerios para integrar las intervenciones contra el cáncer infantil en el fortalecimiento de los sistemas.

A colaboração com a OPAS/OMS para priorizar o câncer infantil no contexto do fortalecimento dos sistemas é fundamental para o papel do St. Jude Children's Research Hospital (SJCRH) como Centro Colaborador da OMS para o Câncer Infantil. Este artigo mostra como o SJCRH e a OPAS/OMS se associaram para aplicar a ferramenta C5 (Colaboração Nacional para Controle do Câncer Infantil), com o propósito de definir e implementar ações prioritárias regionalmente, fortalecendo programas ministeriais para o câncer na infância, durante a implementação da Iniciativa Global para o Câncer Infantil desde 2018. Com auxílio da C5, uma ferramenta desenvolvida pelo SJCRH, a OPAS/OMS e o SJCRH organizaram conjuntamente oficinas regionais/nacionais com a participação de autoridades, profissionais de saúde e outras partes interessadas em 10 países, com a finalidade de mapear as necessidades dos sistemas de saúde e priorizar atividades estratégicas (abrangendo América Central, República Dominicana, Haiti, Brasil e Uruguai). O SJCRH forneceu versões/modelos da C5 em inglês, espanhol e português para exercícios de análise/priorização e colaborou com a OPAS/OMS e as equipes dos países para implementar a C5, analisar resultados e desenvolver produtos. Em uma oficina regional com oito países, foram definidas as prioridades das iniciativas nacionais/regionais e classificados seu valor e vontade política, incorporando levantamentos nacionais e diálogos entre as partes interessadas. Cada país priorizou uma atividade estratégica para 2022-2023, trocou conhecimentos por meio da narração de histórias e disseminou e aplicou os resultados para informar planos de ação nacionais e regionais. As análises das oficinas nacionais foram incorporadas às atividades de planejamento para controle do câncer e ao trabalho conjunto no âmbito regional. Entre os fatores de êxito da implementação estão o engajamento de agentes de fora do segmento da saúde, a oferta de flexibilidade e a ênfase no planejamento conjunto com as partes interessadas. A implementação conjunta da C5 catalisou a priorização e acelerou atividades estratégicas para aprimorar as políticas, a capacidade e a qualidade da atenção às crianças nas Américas, apoiando os ministérios na integração das intervenções contra o câncer infantil como parte do fortalecimento dos sistemas.

A Comparison of the Readiness of Youth Service Agencies to Implement a Technology-Based Toolkit to Support Treatment Delivery.

Implementation initiatives and technology-based resources aim to address barriers to Evidence-Based Practice (EBP) use by creating generalizable techniques that can be used for a variety of youth-serving agencies. However, research has not carefully examined unique differences between agency types or individual programs in readiness to use such technologies and implementation strategies. The current study explored differences between community mental health clinics and child advocacy centers on organizational cultural factors (e.g., ability to change and commitment for change) to implement a novel technology-based toolkit to support delivery of Trauma Focused Cognitive Behavioral Therapy (TF-CBT). Results indicated that TF-CBT providers from child advocacy centers reported greater commitment to change and more support to use the technology-based system than those from community mental health centers. Findings suggest that implementation initiatives should address the needs of individual agencies and service settings and adaptations should be explored to best meet the needs of these settings.

Tailored interviewing to uncover the perspectives of children with multiple disabilities on daily activities: A qualitative analyses of interview methods and interviewer skills.

INTRODUCTION: Uncovering the perspective of children with multiple disabilities is important in health care to enable person-centred health care. For occupational therapists, uncovering the child perspective on meaningful activities is necessary to set appropriate goals for treatment. It is not always evident that children with multiple disabilities can express themselves in an interview. The interviewer should adapt his communication to the child. In literature, alternative communication is widely studied, but a clear algorithm for deciding what to use to successfully gain insight into the child perspective is missing. This study aims to identify helpful interview techniques and interviewer skills and how they can be used to effectively uncover the perspective of children. METHODS: Videos of nine interviews with children with a mitochondrial disorder, conducted by an occupational therapist, were analysed by five researchers. The interviews were analysed to see how well the interviewee had obtained the child's perspectives followed by observation of communicative abilities of the child and the types of questions the interviewer asked. A qualitative directed content analysis of the semi-structured interviews followed. FINDINGS: An interview pattern was observed in the children's communication leading to six successful interviews. Children communicated verbally on four different levels and also used non-verbal communication. The interviewer used five types of questions, which varied between and within the children. The content analysis resulted in two themes: parental influences and interviewer skills. CONCLUSION: Results show the importance of matching the type of questions to the verbal communication level of the child and revealed several interviewer skills and techniques. An overview to guide tailor-made interviewing is presented. The interviewer has a major role in successful interviewing and thus in enabling the inclusion of the child perspective in research and care.

Implementation of A Care Process Model for Pediatric Traumatic Stress in Child Advocacy Centers: A Mixed Methods Study.

Child Advocacy Centers (CACs) are well-positioned to identify children with mental health needs and facilitate access to evidence-based treatment. However, use of evidence-based screening tools and referral protocols varies across CACs. Understanding barriers and facilitators can inform efforts to implement mental health screening and referral protocols in CACs. We describe statewide efforts implementing a standardized screening and referral protocol, the Care Process Model for Pediatric Traumatic Stress (CPM-PTS), in CACs. Twenty-three CACs were invited to implement the CPM-PTS. We used mixed methods to evaluate the first two years of implementation. We quantitatively assessed adoption, reach, and acceptability; qualitatively assessed facilitators and barriers; and integrated quantitative and qualitative data to understand implementation of mental health screening in CACs. Eighteen CACs adopted the CPM-PTS. Across CACs, screening rates ranged from 10% to 100%. Caregiver ratings indicated high acceptability. Facilitators and barriers were identified within domains of the Consolidated Framework for Implementation Research. Qualitative findings provided insight into adoption, reach, and caregivers' responses. Our findings suggest screening for traumatic stress and suicidality in CACs is valued, acceptable, and feasible. Implementation of mental health screening and referral protocols in CACs may improve identification of children with mental health needs and support treatment engagement.

Confidence, Training and Challenges for Canadian Child Advocacy Center Staff When Working with Cases of Online and In-person Child Sexual Exploitation.

Child Advocacy Centers are interdisciplinary hubs that play a vital role in responding to child maltreatment, especially sexual abuse. Sexual abuse cases increasingly involve an online component, but no studies have examined the experience of Child Advocacy Center staff in dealing with online sexual exploiftation. This study surveyed 37 staff at five Child Advocacy Centers in Alberta, Canada to understand their ability to recognize and respond to concerns about online and in-person sexual exploitation of their clients. The majority of respondents (54%) dealt with cases that involved grooming, luring, sexual abuse and child sexual abuse imagery (also known as child pornography) in the last year. Staff were equally confident in their ability to recognize and respond to grooming, luring, sexual abuse and child sexual abuse imagery. However, staff were more likely to have formal training in identifying sexual abuse and less likely to encounter difficulties in responding to sexual abuse relative to grooming, luring or child sexual abuse imagery. Clinicians used similar therapies when working with youth impacted by sexual abuse versus child sexual abuse imagery. Given that most Child Advocacy Center staff in our sample dealt with online child sexual exploitation, additional training in this area may be warranted.

[Response to the COVID-19 Pandemic in Chile, Colombia, and Peru from a children's rights perspectiveResposta à pandemia de COVID-19 no Chile, Colômbia e Peru com foco nos direitos da criança]. / Respuesta con enfoque de derechos de la niñez frente a la pandemia por COVID-19 en Chile, Colombia y Perú.

OBJECTIVE: Describe the strategies established by Chile, Colombia, and Peru during the first year of the COVID-19 pandemic and compare them from a children's rights perspective. METHODS: A qualitative study with comparative analysis of public policies was conducted around seven cat-egories constructed by the Latin American Chapter of the International Society for Social Pediatrics and Child Health, based on the Convention on the Rights of the Child. Country documents were selected based on convenience sampling and were analyzed in deliberative dialogues. RESULTS: 173 documents from the three countries were reviewed. There was convergence around: prioritization of prevention of community transmission of the virus over promotion of the exercise of children's rights; lack of participation of children and adolescents in the process of developing public policies; and lack of progress in the recognition and protection of the exercise of children's rights overall. There were no major divergences beyond identified inequality gaps grounded in the reality of each country. CONCLUSION: The pandemic has affected the functioning of the economic, social, health, education, environmental, and governance systems in these three countries. While this study shows progress in the inclusion of the children's rights approach in formulated policies, the recognition of children and adolescents as holders of social and political rights could allow the construction of collective alternatives that guarantee health and well-being for all people throughout the life course.

OBJETIVO: Descrever as estratégias que foram utilizadas por Chile, Colômbia e Peru durante o primeiro ano da pandemia de COVID-19 e compará-las a partir da perspectiva dos direitos da criança. MÉTODOS: Realizou-se um estudo qualitativo de análise comparativa de políticas públicas, tomando como eixo sete categorias construídas pelo Capítulo Latino-americano da International Society for Social Pediatrics & Child Health a partir da Convenção sobre os Direitos da Criança (CDC). A seleção de documentos dos países foi feita por conveniência, e sua análise ocorreu mediante diálogos deliberativos. RESULTADOS: Foram revisados 173 documentos dos três países. A prioridade da prevenção da transmissão comunitária do vírus destaca-se por sua convergência, em detrimento da promoção do exercício dos direitos da criança, da falta de participação de crianças e adolescentes no processo de formulação de políticas públicas e da falta de progresso no reconhecimento e proteção da efetivação de todos os seus direitos. Não houve grandes divergências além das lacunas de desigualdade identificadas com base na realidade de cada país. CONCLUSÕES: A pandemia afetou o funcionamento dos sistemas econômico, social, de saúde, educação, meio ambiente e governança desses três países. Embora este estudo mostre avanços na inclusão da perspectiva dos direitos da criança e do adolescente nas políticas formuladas, a compreensão deles como sujeitos sociais e políticos titulares de direitos pode permitir a construção de alternativas coletivas que garantam saúde e bem-estar a todas as pessoas ao longo do curso da vida.

Human Trafficking Cases Presenting within Child Advocacy Centers.

Although human trafficking of minors is an increasing concern within the United States, very little information is known about how trafficking cases are processed within child advocacy centers (CACs). The current study addresses this gap in the literature by providing descriptive information about victims, service referrals, and prosecutorial outcomes for human trafficking cases presenting at CACs across a Midwestern state. The data originates from a state-wide study focused on understanding the scope of human trafficking cases. Specifically, the dataset includes 210 youth presenting at CACs over a three-year period of time. In this sample, the typical human trafficking case involved sex trafficking of a self-identified white female victim, with an offender known to the victim. Most child survivors passing through CACs were referred to medical and mental health services, although these service referrals did not greatly differ across at-risk versus substantiated trafficking cases. Overall, the findings suggest that CACs are uniquely positioned to encounter human trafficking cases and provide needed services to trafficking survivors. Finally, recommendations are provided for CACs regarding the intake and identification of trafficking cases more broadly.

Protective and Supportive Injunctions for Children Exposed to Sexual Abuse: The First Data from Turkey.

Child sexual abuse (CSA) requires multidisciplinary approach by forensic, social, and medical services, thus Child Advocacy Centers (CACs) have been established to evaluate CSA cases in Turkey. At CACs the social needs of children are assessed by social workers. Protective and supportive injunctions (PSIs) are considered at each step of evaluation and are proposed to child courts. This study aimed to evaluate PSIs at a local CAC, which is one of the leading CACs in Turkey. The study group consisted of children and adolescents exposed to CSA admitted to Izmir CAC between April 2014 and April 2015. Socio-demographic characteristics, social investigation reports, psychiatric reports, and proposed PSIs were evaluated. The rate of social investigation necessity was 28.3% (n = 113), and the rate of being proposed for at least one PSI was 24.3% (n = 97). The most common proposed injunctions were maintenance care injunctions (n = 47; 48%) and counseling injunctions (n = 46; 47%). The rate of proposed PSIs was significantly higher in adolescents, incest cases and abuse types including penetration than in the other groups. This is the first study to evaluate PSIs in the child protection system. Our results provide data about the risk groups that need PSIs among the victims of CSA cases.

Disordered Eating Attitudes and Behaviors in Maltreated Children and Adolescents Receiving Forensic Assessment in a Child Advocacy Center.

Previous studies have indicated that childhood sexual abuse (CSA) and other forms of child maltreatment (CM), as well as their subsequent posttraumatic symptoms, are significant risk factors for the development of disordered eating behaviors and attitudes and eating disorders (EDs). However, there are no known reports of CM based on forensic interview and assessment that have been linked to disordered eating behaviors and attitudes, or eating disorders (EDs), especially in children and adolescents. We, therefore, examined the hypothesis that ED-related symptoms would be significantly associated with trauma-related symptoms in children with reported maltreatment. Girls (n = 179, 11.9 ± 2.4 years) and boys (n = 99, 11.7 ± 2.8 years) referred for forensic assessment of alleged maltreatment completed the Kids' Eating Disorders Survey, the Eating Disorders Inventory for Children (EDI-C), the Trauma Symptom Checklist for Children, and the Adolescent Dissociative Experiences Scale, among others. Significant positive correlations between most EDI-C subscale scores and most TSC-C subscale scores (PTSD, dissociation, anxiety, depression, sexual concerns) were found (p ≤.001) in the total sample and girls alone. Participants with credible, substantiated disclosures had significantly higher scores on several ED-related measures than those with non-credible, non-substantiated disclosures. Linear regression analysis indicated that PTSD and dissociative symptoms were significant predictors of EDI-C scores in those with substantiated disclosures (p ≤.001). Findings support the hypothesis that ED-related symptoms are significantly linked to authenticated CM.

An Overview of a Hospital-Based Child Advocacy Center's Experience from Turkey.

The purpose of the present study was to investigate sociodemographic variables, features of sexual abuse (SA), and first psychiatric evaluation results of abused children, and to analyze the relation of the psychiatric evaluation results to the children's age and gender, type and duration of abuse, abuser-child relationship, and marital status of the children's parents, at one of the most experienced Child Advocacy Centers (CACs) in Turkey. All data were obtained from reports prepared by child and adolescent psychiatrists. The sample of this study consists of 436 child sexual abuse (CSA) cases who admitted Izmir CAC between April 2014 and November 2015. The statistical analyses yielded significant relations between psychiatric symptoms and chronic abuse, the gender of the children, and type of abuse. Suicidal ideation and behaviors due to sexual abuse (SA) were also examined. According to our results, it is fair to say that children exposed to SA benefit from immediate psychiatric help because of their vulnerability for psychiatric disorders due to abuse. In this context, CACs are very important multidisciplinary establishments to determine children's multiple needs to ease their trauma with collaborative teamwork. Psychiatric evaluation should be part of this multidisciplinary context.

Outcry Consistency and Prosecutorial Decisions in Child Sexual Abuse Cases.

This study examines the correlation between the consistency in a child's sexual abuse outcry and the prosecutorial decision to accept or reject cases of child sexual abuse. Case-specific information was obtained from one Texas Children's Advocacy Center on all cases from 2010 to 2013. After the needed deletion, the total number of cases included in the analysis was 309. An outcry was defined as a sexual abuse disclosure. Consistency was measured at both the forensic interview and the sexual assault exam. Logistic regression was used to evaluate whether a correlation existed between disclosure and prosecutorial decisions. Disclosure was statistically significant. Partial disclosure (disclosure at one point in time and denial at another) versus full disclosure (disclosure at two points in time) had a statistically significant odds ratio of 4.801. Implications are discussed, specifically, how the different disciplines involved in child protection should take advantage of the expertise of both forensic interviewers and forensic nurses to inform their decisions.

Child and youth advocacy centres: A change in practice that can change a lifetime.

While often a silent and invisible issue, childhood trauma is pervasive, and has profound individual, societal and economic impacts. Many forms of childhood trauma exist, including child physical and sexual abuse. Given the prevalence, impact and availability of prevention and intervention approaches, child abuse deserves the same level of awareness, policy priority and investment as is directed to other issues of significant public health importance. The complex issue of child abuse requires a coordinated multifaceted response, which minimizes system trauma and revictimization for the child and family. The Child and Youth Advocacy Centre (CYAC) model brings together various sectors to create an integrated, multidisciplinary response that is client-centred and trauma-informed. To ensure that all children, youth and their families who have experienced maltreatment have access to the CYAC model of care when needed, sustainable funding investment in CYACs should be a priority for government at all levels.

Psychometrics of a Child Report Measure of Maternal Support following Disclosure of Sexual Abuse.

The study examined a new child report measure of maternal support following child sexual abuse. One hundred and forty-six mother-child dyads presenting for a forensic evaluation completed assessments including standardized measures of adjustment. Child participants also responded to 32 items considered for inclusion in a new measure, the Maternal Support Questionnaire-Child Report (MSQ-CR). Exploratory factor analysis of the Maternal Support Questionnaire-Child Report resulted in a three factor, 20-item solution: Emotional Support (9 items), Skeptical Preoccupation (5 items), and Protection/Retaliation (6 items). Each factor demonstrated adequate internal consistency. Construct and concurrent validity of the new measure were supported in comparison to other trauma-specific measures. The Maternal Support Questionnaire-Child Report demonstrated sound psychometric properties. Future research is needed to determine whether the Maternal Support Questionnaire-Child Report provides a more sensitive approximation of maternal support following disclosure of sexual abuse, relative to measures of global parent-child relations and to contextualize discrepancies between mother and child ratings of maternal support.

"I Only Want to Know What You Know": The Use of Orienting Messages During Forensic Interviews and Their Effects on Child Behavior.

The purpose of this research was to evaluate orienting messages within the CornerHouse Forensic Interview Protocol in two formats: provided both at the outset and as needed throughout the interview compared to previous practice in which orienting messages were provided only as the opportunity arose. Through the content analysis of 120 videotaped forensic interviews and corresponding case files in which children were interviewed for sexual abuse allegations, results suggest that the use of orienting messages both at the beginning and as needed lead to significantly more autonomous responses from children, that use of more orienting messages was significantly related to more autonomous responses from children, and that the specific orienting messages of "can't/won't say" and "ask me a question" significantly predict more autonomous responses among children. Implications for practice include the use of orienting messages as a way to provide a respectful and safe experience for children participating in forensic interviews.

The Continuum of Disclosure: Exploring Factors Predicting Tentative Disclosure of Child Sexual Abuse Allegations During Forensic Interviews and the Implications for Practice, Policy, and Future Research.

When a child sexual abuse investigation ensues, many children do not disclose readily to professionals. Defining disclosure beyond the disclosure versus nondisclosure dichotomy is essential, yet little research exists on factors associated with a continuum of disclosure, including active and tentative disclosure. Through the coding of 196 forensic interviews using content analysis and subsequent regression analysis, findings suggest that children of color, children abused by adults, unintentional initial disclosure, and those lacking family support were more likely to tentatively disclose in this study. Implications include a need to understand tentative disclosure as part of a normal continuum of disclosure within court proceedings and investigations of abuse allegations.

An innovative approach to providing collaborative education to undergraduate students in the area of child maltreatment.

Frontline workers in the area of child welfare often enter the field without having taken any specialized coursework in the area of child maltreatment. This article discusses an interdisciplinary certificate program that is specifically designed to teach persons from various academic areas the knowledge and skills necessary to work with children who experience maltreatment. The child advocacy studies certificate program specifically focuses on coursework in the area of child maltreatment and child advocacy to better train future frontline workers in their vital roles. This certificate will decrease underreporting of child abuse cases by mandated reporters by making them more aware of the signs and symptoms of child maltreatment and also give students a greater understanding of how to work with individuals from various fields.

Forensic Interviews for Child Sexual Abuse Allegations: An Investigation into the Effects of Animal-Assisted Intervention on Stress Biomarkers.

The use of therapy animals during forensic interviews for child sexual abuse allegations is a recommendation by the Therapy Animals Supporting Kids Program to help ease children's discomfort during the forensic interview process. Based on this recommendation, this study incorporated a certified therapy canine into the forensic interview process for child sexual abuse allegations. This study investigated changes in salivary cortisol, immunoglobulin A, blood pressure, and heart rate as a result of forensic interview phenomenon (e.g., outcry) incorporating animal-assisted intervention versus a control condition in children (N = 42) interviewed for alleged child sexual abuse. The results supported significantly greater heart rate values for the control group (n = 23) who experienced sexual contact and/or indecency than the experience of aggravated sexual assault compared to no difference in HR for the intervention group (n = 19). The results suggest that the presence of the canine in the forensic interview may have acted as a buffer or safeguard for the children when disclosing details of sexual abuse. In the intervention group, children's HR was lower at the start of the forensic interview compared to the control group. Finding an effect of having a certified handler-canine team available during the forensic interview on physiological measures of stress has real-world value for children, child welfare personnel, and clinical therapists. It is suggested that animal-assisted intervention be expanded to children facing other types of trauma and to treatment programs for child survivors of sexual abuse.

A national survey of child advocacy center directors regarding knowledge of assessment, treatment referral, and training needs in physical and sexual abuse.

Mental health services are a core component of child advocacy centers in the United States. Child advocacy center directors were surveyed about (a) trauma and posttraumatic stress disorder; (b) referral criteria for treatment of abuse victims; (c) evidence-based treatments for abused children; (d) reliable, valid, and normed measures helpful in assessment; and (e) training needs. Directors accurately identified posttraumatic stress disorder symptoms, but additional symptoms were misidentified. Directors identified best practices for assessment and treatment, but they misidentified non-evidence-based practices. Primary reasons for referral for services included severity of abuse and emotional response of the child. However, referrals based on assessment findings were not a high priority. Directors expressed some training needs for staff consistent with issues identified in the study.

Team Functioning and Performance in Child Advocacy Center Multidisciplinary Teams.

The quality of teamwork in Child Advocacy Center (CAC) multidisciplinary teams is likely to affect the extent to which the CAC model improves outcomes for children and families. This study examines associations between team functioning and performance in a statewide sample of CAC teams. Multidisciplinary team members (N = 433) from 21 CACs completed measures of affective, behavioral, and cognitive team functioning. Team performance was assessed with three measures: team member ratings of overall performance, ratings of mental health screening/referral frequency, and caregiver satisfaction surveys. Linear mixed models and regression analyses tested associations between team functioning and performance. Affective team functioning (i.e., liking, trust, and respect; psychological safety) and cognitive team functioning (i.e., clear direction) were significantly associated with team members' ratings of overall performance. Behavioral team functioning (i.e., coordination) and cognitive team functioning were significantly associated with mental health screening/referral frequency. Team functioning was not associated with caregiver satisfaction with CAC services. Aspects of team functioning were associated with team members' perceptions of overall performance and mental health screening/referral frequency, but not caregiver satisfaction. Understanding associations between team functioning and performance in multidisciplinary teams can inform efforts to improve service quality in CACs and other team-based service settings.