A child draws as part of a therapy program designed to help kids deal with trauma.
A child draws as part of a therapy program designed to help kids deal with trauma. Hidajet Delic/AP

Children’s Advocacy Centers make sure kids only have to tell their story of abuse once.

On a recent visit to Safe Shores, a Washington, D.C., center that supports victims of child abuse, executive director Michele Booth Cole told me about a 10-year-old girl who came to the center after her father sexually abused her.

During her first five therapy sessions, the girl didn’t speak at all. In the sixth session, she began to use a sand tray—in which children use toy figures to create scenes. The first scene she created showed her alone and isolated, with a bridge separating her from a cluster of adults. After making the tableau, the girl began to speak, talking for an hour and a half with the therapist.

Months later, the girl made another scene in the sand tray. This one depicted her in the center of a group of adults, with a palm tree shading her.

“She had a different sense of safety at that point,” said Cole. “She was at the center of people’s care and concern.”

Thirty years ago, the process that such an abuse victim would have undergone would have been very different. The girl would have been forced to tell her story of abuse multiple times. Over and over, she’d have been asked to repeat the details of the traumatic encounter—to a parent, a principal, a police officer, a doctor, a lawyer, a staff member at Child Protective Services. And that process, say abuse experts, only makes things worse: The retelling harms kids by making them relive their trauma with interlocutors who generally aren’t trained how to respond effectively.

“It’s common for kids to think that abuse is their fault, that they brought it on themselves because of something thing said or did,” said Teresa Huizar, executive director of the National Children’s Alliance, a nonprofit that helps communities serve victims of child abuse. “A trained therapist will correct this misunderstanding, but without that support, the idea can become embedded in the way children think about themselves.”

In the 1980s, as awareness of this problem grew in the psychiatric community, the federal government began to disperse seed money for facilities called Children’s Advocacy Centers, or CACs, that were designed to help abused children and their families. CACs ensure that the documentation of a child’s story of abuse happens only once: A trained staff member conducts a videotaped interview with the child so that professionals involved in the case, including prosecutors, can access the information without having to elicit it time and again from the victim. After the story is told for this purpose, the child is referred to medical and mental health services. “This keeps the system from further traumatizing kids,” said Huizar.

The first CAC opened in 1985 in Huntsville, Alabama; there are now more than 850 of them in both rural and urban locales. Safe Shores is Washington, D.C.’s CAC, and Huizar’s nonprofit serves as the national umbrella organization and accrediting body for these centers.

Ted Cross, a senior research specialist at the University of Illinois School of Social Work who has conducted research on CACs, said the centers’ separation of the two interventions—forensic and therapeutic—is critical for the child, but is also important for practical reasons. “You don’t want the therapeutic work to taint a criminal investigation,” he said. “If a child is in therapy at the same time that the forensic interview takes place, the attorney representing the offender can say the therapist planted the idea of abuse in the child’s head.”

This last point is of particular importance in the wake of high-profile “false memory” cases involving children, such as the infamous McMartin Preschool trial during the 1980s, in which therapists’ interviewing techniques were so suggestive that the children falsely accused their teachers of abuse.

Children who have suffered abuse can use toy figurines to help tell their story therapeutically. (Mimi Kirk/CityLab)

Today, once the child is in counseling, the therapist’s goal is to help them again tell their story—but on the child’s own terms. This often occurs through writing, art, or via the toy figures on the sand tray. “Through this telling the child can put what happened to them in context and see that it’s not their entire truth,” said Cross. “They can develop coping methods and feel empowered.”

Safe Shores is housed in a former elementary school, and the environment is a far cry from that of a police station or medical facility. Colorful children’s artwork graces the walls, and the building was redesigned to let in as much light as possible, with no dark corners or hidden spaces where a child might feel uncomfortable or vulnerable. In addition to conducting forensic interviews and offering therapy, Safe Shores finds out what children and their (non-offending) caregivers immediately need, such as money for food, transportation, and utility bills, and connects them with services that can help. “You’ve got to treat the whole family, because the situation affects the whole family,” said Cole.

Children’s art can be found throughout Safe Shores, the Washington, D.C., Children’s Advocacy Center. (Mimi Kirk/CityLab)

Kids that come to the center for a forensic interview can also choose brand new clothes from a small room packed to the ceiling with jeans, t-shirts, sweaters, underwear, and socks. (Siblings partake as well.) Many of the families who come to Safe Shores can’t afford new clothes, so the service is a special treat and helps the child feel cared for and positive about the center. All of the services Safe Shores provides are gratis, and Cole said they never ask about insurance. “That’s a barrier, and we want the families to continue to reach out to us,” she said.

Safe Shores offers a range of other services, including caregiver support groups and teacher training programs to help educators learn how to detect when a child is being abused, and what steps to take to report it. Abused children, for instance, may begin to exhibit behaviors such as bedwetting or insomnia, or will suddenly be disruptive in school. “Any kind of change is a clue,” said Cole. “If a kid who is usually outgoing suddenly becomes quiet and reserved, that can be a sign.”

Cole and Cross both stressed that children who report abuse are almost always telling the truth. “The rate of false disclosures has been wildly overstated,” said Cross. “Children need to be believed.”

Cross’s research on CACs, which compared communities with the centers to those without, showed many benefits of the model, including more children referred to medical exams and mental health services and caregivers reporting positive experiences. The centers are also more likely to provide a supportive and effective physical setting for the forensic interview. “At home, the child may not feel safe if the abuser is a family member, while at a police station they may feel blamed,” Cross said.

Rural areas are more likely to lack CACs, and urban CACs are often overextended. Huizar noted that while San Diego has 10,000 cases of child sexual abuse a year, the city’s CAC is only able to serve 2,500 of them—and the waiting list for therapy is several months long. More rural CACs are also usually less developed than urban ones like Safe Shores. “There’s perhaps one full-time employee who does the interviews, coordinates the services, and manages the facility,” said Cross.

These constraints show how the biggest issue for CACs—whether urban or rural—is resources. The federal government provides just $21 million a year for all 854 centers, so CACs must aggressively fundraise. “Many of these centers have very tight budgets,” said Cross. “The good news is we have the tools to support children effectively and help them recover. But the challenge is getting the tools and training to the communities—and that takes funding.”

Funding from the Annie E. Casey Foundation was provided to support our project "The Kids’ Zone."

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