• By Kevin Mount
  • Posted on Wednesday 09th July, 2008

The jury's still out – and the trial was too late

The need to evaluate the effectiveness of any intervention experimentally before scaling it up for general use is these days so widely accepted that it obscures some aspects of the bigger picture: some programs that are part of the furniture of social care practice have never been properly evaluated at all.In the US and the UK there are examples of initiatives rolled out nationally in response to a policy change or in desperation in the aftermath of scandal without any hard evidence to suggest they might do any good. US Child Advocacy Centers (CACs) are in that category.They began to be set up in 1992 to make criminal investigations of sexual abuse child friendlier and increase the number of successful prosecutions. The investment was a worthy enough response to research that showed children were often re-victimized by the investigative process and put at higher risk of long-term damage. While it may have made sound commonsense to imagine that a more sensitive process would benefit the children who experienced it and so strengthen the legal process, CACs were established as a national institution under a policy directive without clear guidelines as to how they should be designed. Now, with more than 700 accredited but widely varying CACs in place across the country, the evidence emerging about their effectiveness from the first detailed review is far from conclusive.This complicated set of factors has been the focus of a special issue of the journal Child Abuse and Neglect supervised by Kathleen Faller from the School of Social Work at the University of Michigan and Vincent Palusci from the Child Protection Center at Wayne State University. The articles they summarize all refer to a study conducted by the Crimes Against Children Research Center at the University of New Hampshire and funded by the US Office of Juvenile Justice and Delinquency Prevention. The Center evaluated four well-established Advocacy Center programs by comparing them to the equivalent child forensic interview provision in communities there were no CACs. The New Hampshire researchers examined and compared around 1500 randomly selected cases over a two-years period. Children at CACs were more likely to have an interview in a child-friendly setting. Non-CAC investigations were more likely to be conducted at a police station, in school, at social services agencies or at home. CAC children also reported being less scared during the investigation, although they were more likely to undergo a medical examination and were required to have more interviews. All too the good.As for the second aim – to increase the number successful criminal prosecutions – the picture is more complex. Most of the articles were silent on the issue or pointed to problems analyzing the available data. Faller and Palusci themselves were the exception. They consider CACs to have failed to deliver in the courtroom and suggest three reasons.Firstly, they argue that the standard of proof required to convict is so high that most cases are failures when measured by that criterion. Secondly, testifying in court can have a detrimental impact on child well-being, especially where repeated court appearances are required, possibly resulting in the child electing not to testify or not feeling able to say much. Thirdly, they say the prospect of prison rather than rehabilitation for perpetrators may well cause the defense to try to discredit the child, the investigators and the parent – and to do so in a courtroom arena beyond the reach of any CAC. Finally, they point to wide variability among CACs and the lack of any optimum model. The four CACs used in the journal articles suggest that they were developed from the ground up, making consistent evaluating problematic. Taken as a whole, the evidence suggests that some aspects of CACs have the potential to contribute toward better outcomes, but that many are falling short of their original aims. It is one of many such cases where the jury is still out; but the need to evaluate any intervention before it is rolled out nationally is surely beyond reasonable doubt. ReferencesCross T, Jones L, Walsh W, Simone M and Kolko D (2005). “Criminal investigations of child abuse: The research behind best practice”, Trauma, Violence & Abuse, 6, 254-268. Faller K, and Palusci V J (2007). “Children’s advocacy centers: Do they lead to positive case outcomes?” Child Abuse & Neglect, 31, 1021-1029.

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