Contemporary and Innovative Practices in Child and Youth Advocacy Centre Models

By Annick St-Amand, Pearl Rimer, Danielle Nadeau and 2 more

Child Advocacy Centres (CACs), also known as Child & Youth Advocacy Centres (CYACs), Children’s Houses, and Barnahus, are a child-focused trauma-informed approach to improving the multidisciplinary response to abuse and violence in the lives of children and youth. Contemporary and Innovative Practices in Child and Youth Advocacy Centre Models brings an international perspective to contemporary and innovative CAC practices around the world. It provides a range of perspectives offering valuable insights, suggestions, and advice to stimulate ideas for establishing, growing and modifying a CAC model and multi-agency collaboration in order to build capacity to respond to the incredibly diverse types of cases, children, youth and families that come through a CAC’s doors.

As authors explore diverse sociolegal, demographic and cultural contexts within different service environments, they draw attention to successes but are also honest about challenges, barriers, and potential pitfalls.

• Language: English
• Publisher: Presses de l'Université du Québec
• Release date: Apr 19, 2023
• ISBN: 9782760555402

Book preview

Introduction

James Herbert

Wendy Walsh

Pearl Rimer

Annick St-Amand

Danielle Nadeau

Child Advocacy Centres (CACs), also known as Child & Youth Advocacy Centres, Children’s Houses, and Barnahus, are a common approach to improving the multidisciplinary response to abuse and violence in the lives of children and youth. Centres operate on the principle of a comprehensive system response and establishing agreed-on standards and procedures to facilitate timely communication and information sharing, as well as reducing redundancy and streamlining activities. CACs also have procedures cognizant of and sensitive to the needs of trauma-affected children and youth. From their origins in the Southern United States in the 1980s, CACs have proliferated in the United States, and have been adapted and implemented across Europe, Canada, and Australia. Many more models exist internationally that are similar to the CAC approach, without explicitly calling the approach a CAC (see Herbert & Bromfield [2018] for a national review of approaches in Australia compared to common CAC standards).

Observing the rapid changes in practices and new approaches to responding to emerging challenges, the editorial team wanted to compile this book to highlight the varied multi-agency practices occurring in different jurisdictions across the world, and to encourage mutual learning from the experiences of different groups implementing and adapting the CAC approach in their context. Drawing on editors from Canada, the United States and Australia, all with considerable connections to policy, research and practice worldwide, the aim of the book is to bring an international perspective that represents new and interesting solutions to emerging problems and responses to violence against children and youth. The included chapters feature authors from seven countries, considering issues related to multiagency responses in diverse sociolegal, demographic and cultural contexts.

1. Origin and purpose of the Child Advocacy Centre approach

Child Advocacy Centres have a well-mythologized origin story linked to Alabama District Attorney Robert E. Bud Cramer and his reaction to the story of a young girl who had experienced a response to child sexual abuse as traumatic as the abuse itself (Yeaman, 1986). The prevailing approach at that time was for individual agencies to take responsibility for decision-making, and largely informal systems for communicating information and decisions across the agencies involved. This meant that multiple law enforcement agencies, state child protection authorities, prosecutors, health/medical professionals, and support/therapeutic professionals responding to the case resulted in highly distressing repeated disclosures by children, often inappropriate interviews of children by untrained professionals, and long delays in case responses where contact with other agencies was needed. The long-term well-being and recovery of the child and family tended to be secondary considerations to the needs of the criminal justice and child protection systems, with children and families having to navigate complex service systems to find specialized child abuse counselling.

Cramer became a federal congressman, and with his support, the CAC model subsequently spread across the United States through a bill to fund CACs nationwide and to establish the National Children’s Alliance (NCA) that develops standards for CACs in the United States. The Native American Children’s Alliance serves the Native American and Alaskan communities. Built around a Multidisciplinary Team (MDT) approach, CACs are modelled on a constantly developing set of standards aimed at facilitating work across agencies (Herbert & Bromfield, 2016 ; National Children’s Alliance, 2021) :

» MDT : Cases are managed by teams of the disciplines and agencies that have the responsibility for child abuse in that jurisdiction (e.g., police, law enforcement, child protection, medical, mental health, and victim advocacy). Procedures for this more holistic team-based approach are expected to apply trauma-informed principles.

» Forensic interviews : Interviewers are trained, experienced and use evidence-based interview protocols. Depending on the jurisdiction, members of the team can observe interviews through an observation room, allowing for the interviewer to receive feedback and to verify that all the information required is collected.

» Victim support and advocacy : Children and families are offered the services of an advocate who supports them from the initial investigation to the completion of the criminal justice process, or when further services are no longer needed. Advocates act as the contact point for the family, and typically have an important role in engaging families with supportive therapeutic services.

» Child-focused/trauma-informed setting : CACs are designed to create safe spaces for children and families that are welcoming, minimizing stress, discomfort or intimidation, and the avoidance of re-traumatization. Staff are trained to recognize and respond to signs of trauma, and there is a focus on developing trust and building on strengths. Centres aim to feature child-friendly and developmentally appropriate furniture, toys and decor reflective of the cultural diversity of clients served.

» Mental health services : Trauma-informed and evidence-based mental health services are available onsite or by direct referral.

» Medical examinations : Available either onsite or by direct referral.

» Case review : Members of the MDT meet regularly to conduct a case review to share information and outline progress.

» Case tracking : A shared information or tracking system is used to monitor progress and actions in the case across agencies and systems.

» Cultural competency and diversity : Consideration of cultural appropriateness in all elements of practice.

» Organizational capacity : Organizations have the resources to organize ongoing training and professional development of staff.

While regularly updated, the standards have remained mostly consistent over time. Similar principles have since been adopted in Canada and the European Union, with some adaptation for the needs of the local context (Child Advocacy Centres/Child & Youth Advocacy Centres across Canada, 2021 ; Haldorsson, 2019).

Studies and evaluations of CACs have generally found that children have a better experience when their case is managed through a CAC, are more likely to be referred to services and that, depending on the comparison group, better criminal justice outcomes are obtained (Elmquist et al., 2015 ; Herbert & Bromfield, 2016 ; Nwogu et al., 2015). Early studies tended to find marked differences between CACs and their comparison conditions on criminal justice outcomes (e.g., Bradford, 2005 ; Turner, 1997). The first large-scale multi-site evaluation of CACs (Cross et al., 2008) found that while CAC sites generally did not differ from comparison sites on prosecutions and convictions, communities with CACs appeared to have better coordinated investigations, increased rates of referral and higher caregiver satisfaction with the process.

While much of the early focus of CACs was on minimizing the distress due to the criminal justice process, CACs have increasingly taken a broader focus on the accessibility of services and children’s well-being. Literature reviews have highlighted the increasing importance of outcomes related to service accessibility and recovery from trauma (Herbert & Bromfield, 2019 ; Westphaln et al., 2021). Especially as many of the elements of CACs diffuse into broader practice (e.g., specialized interviewing, child sensitive environments), CACs have continued to adapt to respond to the needs of children present in CACs, in particular increased understanding about complex trauma, problematic sexual behaviours, child trafficking, technology-facilitated abuse, and the importance of culturally responsive modes of talking about and treating child abuse.

2. Overview of sections

This book aims to provide an internationalized view of contemporary and innovative practices in multi-agency responses and capturing most recent efforts to improve the quality of services provided to children and the quality of collaboration between disciplines/agencies. It is separated into sections that reflect the areas of interest and discussion about CACs that came from the editors’ initial meetings, which organizes the chapters into key themes.

The first section is framed by reflecting the overall state of play for multi-agency responses, noting that much of the research and scholarship on CACs is dated, and that there have been significant developments in practice. Chapters in this section focus on developments in forensic interviewing practices, forensic medical examinations, supports for child witnesses in a CAC, and broader consideration of the challenges of authentic collaboration between agencies. The section sets the broad scene of adaptation of CAC standards to different service environments, and highlights existential questions for CACs in understanding their purpose and balancing the influence of the different agencies required for CACs to work.

The second section tightens the focus on practice in the context of providing services for specific cases and social realities. Along with the diversity of settings, CACs must build the capacity to respond to incredibly diverse types of cases ; the chapters in this section provide some specific examples of how this occurs in contemporary practice. They cover how cultural responsiveness is put into practice in CACs in a range of contexts (e.g., Canada, Israel), procedures for accommodating children that may be unable or unwilling to disclose initially, and adaptation of CAC practices for rural centres.

The third section targets prevention and therapeutic services in the context of CAC models, with chapters highlighting efforts to integrate prevention programming into the work of CACs, and the success of initiatives to improve the accessibility of mental health services accessed through CACs. This focus on reducing re-victimization and the provision of services to address the effects of abuse reflects changes in the focus of CACs from aiming for the arrest and prosecution of offenders to being more focused on addressing the needs of children and families. The section concludes with a chapter examining innovative responses to problematic sexualized behaviour in the context of North American CACs.

The final section highlights current evaluations of and research into CAC models, with a particular focus on the performance of CACs against expected standards. Chapters in this section include learnings from the implementation and evaluation of different CACs and analyses of the rates of therapy utilization in CACs. The section provides a broad outline of current research and scholarship into CACs reflecting the contemporary challenges of policy and practice in this space.

Overall, the book outlines a progression in CACs from the adoption of a set of agreed standards, to efforts to adopt a more dynamic and inclusive approach, to practice. This includes the recognition of the need to foster the inclusion of diverse populations of children and their families, as well as different practice contexts that may present challenges to standard practices. Across countries, it is clear that CACs have pivoted from minimizing the distress associated with the justice system to having a primary focus on providing support and delivering or facilitating the delivery of targeted therapeutic services. This was evident in the volume of work on therapy, but also in the critical scholarship about the experiences of children in CACs and how different purposes and agendas are reflected in multi-agency meetings. The book provides a broad and multifaceted insight into current practices and research on CACs to date, with a hope of continuing examination and improvement of the critical work of responding to abuse and violence in the lives of children and youth.

References

BRADFORD, A. B. (2005). Legal outcomes as effectiveness research of forensic interviewing at the Child Advocacy Center of East Alabama [Unpublished doctoral dissertation]. Auburn University.

CHILD ADVOCACY CENTRES/CHILD & YOUTH ADVOCACY CENTRES ACROSS CANADA. (2021). National guidelines for Canadian Child Advocacy Centres/Child & Youth Advocacy Centres. <https://cac-cae.ca/wp-content/uploads/CAC-CYAC-National-Guidelines-October-2021-FINAL.pdf>, Retrieved May 28, 2022.

CROSS, T. P., JONES, L. M., WALSH, W. A., SIMONE, M., KOLKO, D., SCZEPANSKI, J., LIPPERT, T., DAVISON, K., CRYNES, A., & SOSNOWSKI, P. (2008). Evaluating Children’s Advocacy Centers’ response to child sexual abuse. Juvenile Justice Bulletin, 106, 1-11.

ELMQUIST, J., SHOREY, R. C., FEBRES, J., ZAPOR, H., KLOSTERMANN, K., SCHRATTER, A., & STUART, G. L. (2015). A review of Children’s Advocacy Centers’(CACs) response to cases of child maltreatment in the United States. Aggression and Violent Behavior, 25, 26-34.

HALDORSSON, O. L. (2019). Barnahus quality standards : Guidance for multi-disciplinary and interagency response to child victims and witnesses of violence. Council of the Baltic Sea States Secretariat and Child Circle. <https://www.barnahus.eu/en/wp-content/uploads/2020/02/Guidance_short_A5-FINAL.pdf>, Retrieved May 28, 2022.

HERBERT, J. L. & BROMFIELD, L. (2016). Evidence for the efficacy of the Child Advocacy Center model : A systematic review. Trauma Violence & Abuse, 17(3), 341-357.

HERBERT, J. L. & BROMFIELD, L. (2018). National comparison of cross-agency practice in investigating and responding to severe child abuse. Australian Institute of Family Studies. <https://aifs.gov.au/cfca/sites/default/files/publication-documents/47_national_comparison_of_cross-agency_practice_in_investigating_and_responding_to_severe_child_abuse.pdf>, Retrieved May 28, 2022.

HERBERT, J. L., & BROMFIELD, L. (2019). Multi-disciplinary teams responding to child abuse : Common features and assumptions. Children and Youth Services Review, 106, 104467.

NATIONAL CHILDREN’S ALLIANCE (2021). National standards of accreditation for Children’s Advocacy Centers : 2023 Edition. <https://www.nationalchildrensalliance.org/wp-content/uploads/2021/10/2023-RedBook-v5B-t-Final-Web.pdf>, Retrieved May 28, 2022.

NWOGU, N. N., AGRAWAL, L., CHAMBERS, S., BUAGAS, A. B., DANIELE, R. M., & SINGLETON, J. K. (2015). Effectiveness of Child Advocacy Centers and the multidisciplinary team approach on prosecution rates of alleged sex offenders and satisfaction of non-offending caregivers with allegations of child sexual abuse : A systematic review. JBI Evidence Synthesis, 13(12), 93-129.

TURNER, G. C. (1997). Evaluating the interdisciplinary team approach to child sexual abuse investigation : A retrospective chart review comparing multi-agency and interdisciplinary investigatory approaches (Publication No. 9735203) [Doctoral dissertation, New York University]. ProQuest.

WESTPHALN, K. K., REGOECZI, W., MASOTYA, M., VAZQUEZ-WESTPHALN, B., LOUNSBURY, K., MCDAVID, L., LEE, H., JOHNSON, J., & RONIS, S. (2021). Outcomes and outputs affiliated with Children’s Advocacy Centers in the United States : A scoping review. Child Abuse & Neglect, 111, 104828.

YEAMAN, J. M. (1986). Facilitating prevention and prosecution of child sexual abuse through the multi-disciplinary assessment team. Current Municipal Problems, 13(2), 228-233.

Part

1

Overall state of play

Chapter

1

Children’s Advocacy Centres and child forensic interview protocols

¹

Dana Hartman

Rayna Enriquez

Annika Melinder

Susan Hardie

Miranda Kramer

Gail S. Goodman

In this chapter, we provide a brief introduction and history of the Children’s Advocacy Centre (CAC) model in the United States (US) and describe its current features. To illustrate a variety of approaches, we also briefly describe CAC models in Iceland, Norway, and Brazil. These international comparisons are instructive for how various judicial systems, particularly criminal justice systems, deal with cases of child abuse, especially child sexual abuse (CSA). With a focus on child forensic interview protocols, we : a) review findings that contributed to interview protocol development within CACs ; b) describe two of the major child forensic interview protocols in use today ; and c) address how CAC models in four countries (the US, Iceland, Norway and Brazil) have implemented these protocols. We also discuss research on evaluating CACs and their use of forensic interview protocols per country. We end with suggestions for further research in this area.

1. A brief introduction and history

Increased recognition of CSA as a serious societal problem has heavily influenced the development of CACs. Although children who have experienced or witnessed trauma other than CSA are also interviewed at CACs, CSA cases often predominate. In 2021, CACs across the US responded to 249,879 reported cases of CSA, compared to 76,489 cases of child physical abuse and 29,926 cases of neglect (National Children’s Alliance, 2021). One reason for the predominance of CSA cases is that, compared to most other forms of child maltreatment, CSA cases are less likely to include physical evidence. Rather, these cases often rely strongly on children’s recounting of what happened. As a result, good quality interviewing is especially necessary for responding to CSA. Thus, this chapter will focus on CACs’ CSA investigations.

The 1970s and 1980s saw CSA become a public issue. Up until that point, many considered CSA to be a taboo topic, and many societies did not realize its prevalence. Survey research by sociologists Diana Russell and David Finkelhor documented that CSA was experienced far more often than American society realized, but was rarely reported to authorities. To do this sensitive research, Russell (1986) went door-to-door to interview women about having possibly experienced CSA. Separately, Finkelhor (1984) conducted survey work that made it clear that college students were no exception to having experienced CSA. Books such as The Best Kept Secret by Florence Rush (1981), a social worker, detail how societies condoned CSA for hundreds of years (e.g., via child marriage laws). The feminist movement of the 1970s also led the charge for society to do more to end the sexual exploitation and rape of children (Angelides, 2004). The plight of children who had experienced sexual abuse became a worldwide concern.

As the prevalence of CSA was recognized across the US and worldwide, and as legal reforms started to reflect this reality, questions arose about how best to investigate and prosecute CSA. In many high-profile cases around the world, the interviewing of children became a major point of contention. Research also uncovered secondary victimization of child victims in the legal system (Goodman et al., 1992). CACs provide a more child-friendly approach and have come to play a crucial role in forensic interviewing and prosecutions of crimes against children.

2. Children’s Advocacy Centres in four countries

2.1 Criminal legal systems

The legal systems within which CACs operate have implications for how CACs conduct investigations and the role of CACs in criminal court cases. Because we focus in this chapter on the US, Iceland, Brazil and Norway, we will briefly describe key elements of their legal systems, starting with the Nordic countries of Iceland and Norway.

Many European countries, including most Nordic countries, such as Iceland, rely on an inquisitorial system of law. The main premise of the inquisitorial system is that a detailed investigation and examination of evidence is the best way to reach the truth. A judge operates as a fact finder, and often oversees and is involved in the pre-trial investigation and the questioning of witnesses in court ; the judge has wide discretionary power. In some countries, there may be a panel of judges per case. For example, Iceland does not utilize jury trials, but often more than one judge hears the evidence and decides the trial outcome.

Norway’s legal system is also largely inquisitorial, but with some components of an adversarial system as well. Judges typically play a more active role in cases than in the US. For example, in Norway the judges may decide to adjourn the hearing in order to obtain new evidence. A relatively unique part of the Norwegian legal system is that, at least in lower courts (e.g., district courts), laypersons or professionals may serve on judges’ panels (The Courts of Norway, 2019). However, for more serious crimes, an adversarial legal model is gaining ground.

In comparison, the US—and, to a growing extent, Brazil—relies on an adversarial legal system, based on the belief that the truth will emerge from two competing sides each making their own presentation to the court. However, in criminal cases in Brazil, the judge (rather than a jury) determines the trial outcome. In the US adversarial system, which often relies on citizen-based juries, the judge presides over the trial and acts as a referee between the defence and the prosecution. Judges are not actively involved in pre-trial investigations or in soliciting witness evidence.²

A unique feature of the adversarial system in the US rests on the Sixth Amendment to its Constitution, which specifies the rights of defendants at trial to confront and cross-examine accusing witnesses, even child victims. The Sixth Amendment thus limits flexibility in the US, with effects on the role of US CACs. In other countries—even those that adhere to an adversarial system of justice—, greater protection of child victims from the distress of testifying at trial is constitutionally possible, often via CACs.

2.2 Children’s Advocacy Centres in the United States

In the US, the Department of Justice oversees funding for CACs. To receive accreditation and grants,³ CACs in the US must include several components : a child-appropriate facility that involves a multidisciplinary team (MDT) ; culturally competent policies and practices ; forensic interviews conducted in an objective, nonduplicative manner ; and therapeutic intervention. The National Children’s Alliance (NCA) updates the standards for accreditation every 5 years, and helps CACs meet the new standards of practice (National Children’s Alliance, n.d.). This ensures accredited CACs offer only the highest quality, research-supported care to their clients. In some states, children under certain ages (e.g., 14 years old) must be interviewed in CACs in CSA cases.

Each accredited CAC contains an MDT, typically representing law enforcement, mental health, medicine, child protection, victim advocacy, and prosecution. They work collaboratively for the best interest of the child and toward a successful prosecution. Trained social workers, psychologists, or police officers conduct the child forensic interviews, which are observed by a prosecutor as well as members of the MTD, and are regularly video recorded. By allowing observation of the forensic interview, the number of interviews conducted over the course of an investigation is reduced, while also ensuring legal professionals’ needs are met and their questions are answered. All 939 US CACs share a mission to diminish the negative long-term outcomes from the legal process, and to facilitate investigations and prosecutions involving child victims and child witnesses.

2.3 Iceland’s Barnahus

Iceland was the first Scandinavian country to establish a Barnahus. The Barnahus’s primary objective in Iceland, as in all of Scandinavia, is to strengthen children’s legal rights. Other Scandinavian countries, such as Norway, would go on to base their own CACs on Iceland’s Barnahus model. Indeed, these countries now share a set of operational practices (the European Barnahus Standards)—such as using evidence-based forensic interview protocols, providing medical evaluations and psychological support, ensuring equal access to services for all child victims, as adapted to each country’s unique culture and legal systems (Haldorsson, 2019).

The Government Agency for Child Protection operates the Icelandic Barnahus in Reykjavik. Interviewers are typically trained social workers, not police officers. The Icelandic Barnahus aims to prevent re-traumatization through medical and psychotherapeutic support, as well as to reduce the number of investigative interviews. As a rule, there is a separation between investigation and therapeutic services ; the person who performs the forensic interview does not conduct therapy. The forensic interview occurs first. Therapeutic intervention is based on individual assessment following the forensic interview(s). The therapy offered is trauma-focused.

2.4 Norway’s Barnehus

The Norwegian Barnehus model operates in 11 different communities across Norway. Forensic interviews are conducted by specially trained police officers. The Barnehus offers medical care and therapeutic assessment and treatment, as well as interdisciplinary collaborative support services in the child’s local community after the forensic interview(s) (Statens Barnehus, n.d.). As acknowledged by Norway, the United Nations Convention on the Rights of the Child (Article 12) states that child witnesses have the fundamental right to be heard in matters that affect their lives and well-being. In Norway, therefore, children must be informed in a developmentally appropriate manner about why they are being interviewed (Norway Criminal Procedure Act, 1981 ; United Nations Convention on the Rights of the Child, 1991). Some may consider it potentially biasing or suggestive for the interviewer to explain to the child why the child is at the Barnehus and undergoing a forensic interview. Therefore, maintaining the child’s right to know the reason for the interview must be carefully balanced with the need for unbiased accuracy.

2.5 Brazil’s integrated care centres and special testimony rooms

The Brazilian versions of CACs can be divided into two categories : 1) Integrated Care Centres, which handle child protection matters ; and 2) Special Testimony rooms, which are used for testimony at trial. In 2017, the government instituted a new law providing guidelines for forensic interviews and services for children in the legal system. This included the mandatory video recording of child forensic interviews and the use of a forensic interview protocol. Additionally, it provides children and adolescents⁴ the right to be heard at trial via closed-circuit TV (called special testimony) rather than in the courtroom.

Special testimonies are, in effect, CAC-like interviews, associated with courtroom hearings, conducted by a person in the child protection or psychology fields. The child provides testimony in a special room so that they are protected from any contact with the alleged perpetrator (Roque et al., 2021). This special interview room in the courthouse is connected to the courtroom by cameras and microphones, and the whole interview is seen and heard by those in the courtroom. The judge, prosecutor, and defence attorney may ask questions to the child through an electronic connection to the person conducting the interview. It is now required that these procedures are followed for all children under 7 years old. However, victims of sexual violence are also afforded these accommodations up to and including age 17.

Implementation of this new law has increased the importance played by Brazil’s Integrated Care Centres and Special Testimony rooms in their judicial system, as they act as coordinating centres for investigations, as well as places for children and adolescents to provide their testimony. In the past several years, the number of Integrated Care Centres and Special Testimony rooms has increased exponentially to more than 900 throughout Brazil.

2.6 Commentary

The legal context influences the implementation of the CAC model in the various countries described. In Nordic countries, children’s statements in sexual abuse cases at CACs become their testimony at trial. Cross-examination is included within the forensic interview ; the defence attorney’s questions are asked via the forensic interviewer. In Brazil, Integrated Care Centres and Special Testimony rooms serve the function of the Nordic CACs, in that they protect children from testifying in the courtroom and having to face the defendant. This stands in contrast to US policies, where the Sixth Amendment makes these accommodations difficult. CACs in the US nevertheless provide vital legal and child protection functions as forensic interview centres, often with coordinated services (e.g., mental health interventions, medical evaluations and care).

3. Child witness research and interview protocols

CACs play a central role in child forensic interviewing. Research into science-based forensic interview protocols began in earnest in the early 1980s (Goodman, 1984). At that time, sensational preschool cases involved interviews of young children that were criticized as overly suggestive and possibly producing false reports of CSA. The movement to combat CSA was faltering, and the issue of how best to interview children in such cases was centre stage.

3.1 Early research

Motivated by the controversies regarding how best to interview children, scientific studies of child witnesses increased dramatically. Several key publications that helped advance the understanding of child victims were particularly relevant to the development of CACs. Tedesco and Schnell (1987) documented that for children, one of the most difficult parts of legal involvement is multiple interviews. As Faller (2015, p. 37) later explained, The process of having to repeatedly disclose what was, for many children, a shameful and frightening experience, to multiple adult strangers was felt to be traumatic. Another key study was conducted by Goodman et al. (1992), who followed CSA victims through criminal prosecutions. The children were often so fearful of the defendant that they had difficulty answering prosecutors’ questions in court. Several non-offending parents indicated that a video-recorded interview should be used in court rather than having the child appear in person. Such findings stimulated the development of CACs.

Also important to the development of CACs was research into how best to obtain the most accurate and complete reports from children. Much of this research was undertaken as laboratory studies, which possess a high degree of methodological rigour. In such studies, children’s reports were quite brief but accurate when asked free recall questions (e.g., What happened ? ; Goodman & Reed, 1986). Rudy and Goodman (1991) reported that even many older preschoolers were not highly suggestible about abuse-related information (e.g., He took your clothes off, didn’t he ?). However, 3-year-olds, compared to older children, made more errors to direct questioning (e.g., Was he wearing a red shirt ?), including misleading questions (e.g., He took his shirt off, right ? when the man had not done so), and even older children could be misled (Poole & Lindsay, 2001). Although laboratory research is best suited to examine children’s memory and suggestibility for neutral, non-abusive events, these studies were influential.

Around the same time, children’s reports in actual cases of child victimization were being studied (e.g., Bidrose & Goodman, 2000). Terr’s (1984) research on children’s reports of the kidnapping of their school bus highlighted the general accuracy of the children but also their misperceptions (e.g., regarding time), as did research by Pynoos and Nader (1989), who studied children’s reports of a schoolyard shooting. Only a few studies, however, directly addressed CSA allegations (Terr, 1988). Leander et al. (2007) found that in documented CSA cases (e.g., perpetrator photographed), children gave detailed reports of non-sexual experience, but less detailed and more indirect reports of the sexual acts (see also Saywitz et al., 1991). Protocols needed ways to obtain sexual act disclosures while avoiding controversial questioning.

Research consistently showed the importance of taking a child’s developmental level into account. For example, as children age, their ability to retrieve memories on command improves (Krojgaard et al., 2017), their linguistic capabilities and vocabulary grow, and they often develop a better understanding of the types of information relevant to a forensic context (Saywitz & Snyder, 1996), all of which are important when conducting forensic interviews. Studies, such as the ones described above, have influenced present-day CAC protocols by informing interviewers and protocol developers of the types of questions that elicit the most accurate information from children, and show how development affects children’s responses. Based in large part on the above research, many recent interviewing protocols advocate for the use of open-ended questions that encourage the child to form their own narrative (e.g., Tell me everything you remember.). This research changed the nature of child forensic interviewing ; it provided a science-based approach.

3.2 Child forensic interview protocols

Prior to the development of current protocols, many CACs invented their own in-house protocols. They often included a brief developmental assessment for young children, differentiation of the truth and a lie, substantive questioning about the allegation or suspicion using a funnel technique (starting with open-ended questions and then using direct questions to target specific details), and a closing to make sure the child knows how to contact safe adults. Many early protocols included the use of human figure drawings or anatomically detailed dolls.

A few prescient researchers realized early on the need for research on interviewing strategies and the development of science-based protocols to promote children’s accuracy. Early research on the Narrative Elaboration Technique (Saywitz & Snyder, 1996), the Stepwise Interview (Yuille et al., 1993), and the Cognitive Interview for Children (Saywitz et al., 1992) continue to serve as vital influences on protocols in use to date.

Interview protocols are an important consideration within the larger CAC framework, as they guide interviewers on how best to conduct legally acceptable interviewing. The goal is to obtain information from children in a way that maximizes accuracy and minimizes distress. Although popular interview protocols try to maximize the amount of information obtained through responses to free-recall questions (e.g., Tell me everything that happened), the additional cues in direct questions assist children in searching their memory for specific content (e.g., Did he touch you on your stomach ? ; Hershkowitz et al., 2011). Still, child forensic interviewing is not easy. Interviewers must balance many competing concerns, including obtaining sufficient information from children while not putting words in their mouths. Achieving this balance is an example of how research-based forensic interview protocols can assist the interviewer in conducting a developmentally appropriate and legally sound interview.

Although several protocols have been developed over the years (e.g., the Dialogical Communicative Model [DCM] used for young children in Norway’s Barnehus ; Langballe & Davik, 2017), we focus on two that have been widely used and/or researched : the National Institute of Child Health and Human Development (NICHD) Investigative Interview Protocol and the National Children’s Advocacy Center (NCAC) Child Forensic Interview Structure. A few countries, such as Iceland and Brazil, have adopted for their CACs a national child forensic interviewing strategy based on NICHD or NCAC protocols, described next.

3.3 National Institute of Child Health and Human Development (NICHD) protocol

Lamb, Sternberg, and colleagues created the NICHD protocol, to be used internationally, that elicits accurate and informative accounts from children through primarily open-ended free-recall prompts and open-ended follow-up questions with a narrative-focused structure (Lamb et al., 2007 ; Orbach et al., 2000). The protocol provides the interviewer with step-by-step instructions on how to progress through the interview while still maintaining some flexibility. It begins with an introductory phase during which the expectations and ground rules for the forensic interview are explained. The child is told that in their role as the informer, they can say I don’t know, I don’t remember, and I don’t understand, and they can correct any incorrect statements. The importance of telling the truth throughout the interview is emphasized, but the NICHD protocol does not include discussion of the difference between telling the truth and telling a lie.

Following the introductory phase, the child practises narrative elaboration (Saywitz & Snyder, 1996), while the interviewer also builds rapport in this pre-substantive phase. In this phase, the interviewer uses open-ended prompts to ask the child questions about themselves unrelated to the abuse (e.g., Tell me about things you like to do). Rapport building is emphasized in forensic interviewing to make the child feel comfortable enough to disclose details about the trauma they may have experienced (Hershkowitz, 2011). Building rapport improves children’s productivity and the completeness of their disclosures during forensic interviews, and increases resistance to suggestive questioning (Saywitz et al., 2019). This phase provides an opportunity to adjust to the narrative-focused conversation style of the interview.

Following this pre-substantive phase, the NICHD interview protocol transitions into the substantive phase with the interviewer asking the child about the allegations through non-suggestive prompts (e.g., Tell me why you came to talk to me today). This gives the child the opportunity to disclose the abuse, after which the interviewer may use an open-ended follow-up prompt to initiate the free-recall phase. After the child’s narrative, the protocol dictates that the interviewer asks open-ended follow-up questions to address incident-specific information. When narrative-focused open-ended prompts are exhausted, the NICHD protocol suggests utilizing direct questions to target specific details of a memory account. Although the NICHD protocol recommends avoiding the use of closed-ended questions, such as direct questions (Wh questions, for example, Who did this to you ?) or option-posing questions (e.g., Were the pants on the floor, the bed, or a chair ?) as researchers find them to be potentially biasing (Ahern et al., 2016 ; Lamb et al., 2007), direct questions have proven to be useful, if not necessary, in obtaining specific details about information the child has already provided (Stolzenberg et al., 2021).

Before the interview ends, the NICHD protocol dictates there should be a break. During this time, the interviewer reviews the information obtained and gathers any additional questions from colleagues observing the interview. These colleagues are usually in a separate observation room, and the purpose of their presence may vary across interviews and countries (see Section 2). At the end, the interviewer gives the child an opportunity to ask questions.

After implementing the NICHD protocol, forensic interviewers used significantly more open-ended questions, less suggestive prompting, and fewer option-posing questions, and they obtained more detailed responses (Lamb et al., 2007 ; Orbach et al., 2000). A meta-analysis by Benia et al. (2015) found that 3- to 14-year-olds provided more detailed responses to open-ended questions and less detailed responses to suggestive prompts when interviewed using the NICHD protocol than children interviewed without the NICHD protocol (Ball et al., 2017).

3.4 National Children’s Advocacy Center protocol

The National Children’s Advocacy Center (NCAC) recommends the Child Forensic Interview Structure (the NCAC protocol) for use in US CACs. This is due to concerns that adherence to the NICHD script gives the conversation a stilted quality, often interfering with interviewer engagement and listening to the child (NCAC, 2018, p. 1). Although the NCAC protocol contains many of the same elements as the NICHD protocol, it gives the interviewer greater flexibility to adapt to the case at hand.

A key difference between the NICHD and NCAC protocols is that rather than using the more generic prompts provided in the NICHD protocol (e.g., Has anyone been bothering you ?), the NCAC recommends a pre-interview MDT meeting. During this meeting, the details of the case are reviewed and a coordinated effort is put forth to write a series of increasingly focused prompts that are tailored to that specific child and the details of their case. These prompts can include direct questions to the child (NCAC, 2018). Furthermore, the NCAC protocol encourages the use of media aids, such as free drawing or writing, to elicit further memory that is facilitated through context reinstatement. Allowing the child to draw has also proven to reduce anxiety and indicates the child’s level of development (Faller, 2007 ; Katz et al., 2014 ; Macleod et al., 2016). The use of media aids also includes the possibility to utilize human figure drawings to assist in clarifying details and events that the child disclosed. For example, these drawings may be used if the child struggles with the vocabulary to explain what happened, or feels too embarrassed to verbalize it.

3.5 Interview protocols are evolving : A toolbox approach

Protocols are evolving based on new scientific findings. For example, the United Kingdom (UK) initially adopted the Stepwise Interview developed by psychologist John Yuille (1993) in Canada. His protocol was based on a funnel approach and permitted anatomically detailed dolls and other props. Based on newer research, the UK followed with the Memorandum of Good Practice (Davies & Westcott, 1999) and eventually the Achieving Best Evidence and the PEACE approach (Bull, 2019). The PROMISE model was established for European CACs based, in part, on the NCAC protocol. As another example, the NICHD protocol added more rapport building.⁵

Protocols are, at best, a standardized and structured set of science-based techniques that aim to maximize children’s accuracy of report. Some parts of protocols are legally or intuitively determined rather than scientifically supported (Brubacher et al., 2019), and different protocols manifest the science-based principles somewhat differently. Saywitz et al. (2017, p. 235) proposed that rather than interviewers feeling that they have to follow protocols ’to the T,’ interviewers may want to learn the techniques, read about the scientific basis for them, and select the techniques that appear most appropriate for the children and situations at hand. This toolbox approach provides maximal flexibility, as is often needed when working with children. However, less experienced forensic interviewers may want to start with a standardized protocol.

4. Examples of countries’ protocol approaches

4.1 United States protocol

There is no national protocol for the US (Children’s Bureau, 2017). Each jurisdiction is free to use a science-based protocol or not, but the NCA requires a justifiable protocol for CAC funding. Most US forensic interviewers attended NCAC trainings (Fessinger & McAuliff, 2020).

In 2015, the US Department of Justice released a bulletin on best forensic interview practice guidelines, providing guidance for CACs in the US (Newlin et al., 2015). It recommended the following : a) forensic interviews should take place as soon as possible after the allegation of abuse is made ; b) there should be some form of electronic recording of the interview ; c) the interview room itself should not contain any items that could be used for play (e.g., fantasy play) ; d) interviewers should be cognizant of their own biases and ensure that the interview is not conducted in a leading manner ; e) interviewers should try to obtain as much information as possible through