children’s advocacy centers north dakota sustainability plan · training and education of team...

Children’s Advocacy Centers

of North Dakota

Growth and Sustainability Plan 2017

The Children’s AdvocacyCenters of North Dakota(CACND) is a network of Children’sAdvocacy Centers (CACs) working toensure that every child and adolescentin North Dakota alleged to be a victim ofabuse has access to a multidisciplinaryteam approach to investigation, treatmentand care in a safe, family focusedenvironment.

A Children’s AdvocacyCenter (CAC) is a victim-focused,community-oriented, safe facility in whichmembers of a multidisciplinary team(MDT), including victim protection, socialservices, law enforcement, prosecution,victim advocacy and the medical andmental health communities, worktogether to provide a comprehensive,coordinated and compassionateinvestigation and intervention of victimabuse allegations.

National Children’sAlliance AccreditedMembersThe National Children’s Alliance is anation-wide not-for-profit membershiporganization whose purpose is toempower local communities to providecomprehensive, coordinated andcompassionate services to victims ofvictim abuse. The NCA accredits ChildrenAdvocacy Centers based on nationallyrecognized standards. .

The Children’s Advocacy Centers of NorthDakota serve the children and adolescents of

CHILDREN’SADVOCACYCENTERSOF NORTH DAKOTA

CHILDREN’SADVOCACYCENTERSOF NORTH DAKOTA

In 2015 the Children’s Advocacy Centers of North Dakota administered

15,975 direct service to 2,563 children with a statewide, combined budget of

66%

34%

3%

38%

37%

22%

3%

97%

69%14%

1%12%

1%

3%

INTRODUCTION

A Children’s Advocacy Center is a child‐friendly facility where multidisciplinary teams, including

representatives from social services, law enforcement, prosecution, medical, mental health and

advocates can collaborate on child abuse investigations and intervention. In effort to be good

stewards of North Dakota’s resources, the Children’s Advocacy Centers of ND (CACND)

examined data and service provision across the state by way of a Growth and Sustainability

Assessment. Our vision is that eventually every child in North Dakota (ND) who needs it will

have reasonable, consistent access to the full array of evidenced‐based Children's Advocacy

Center (CAC) services and an effective, multidisciplinary response to his/her case and his/or

care.

To accomplish this vision CACND strives for:

Onsite Child Advocacy Services in every community with 100,000 or more people

Forensic Interviewing services within a 1 ½ hour drive for

children/families/professionals

Expert Medical Services within a 1 ½ hour drive and 24 hour coverage

Evidenced Based Mental Health Services within the 8 Human Service Regions of ND

Initial and on‐going Advocacy – Offered to all families initially and ongoing as

appropriate

Multidisciplinary Team Case Review Meetings of cases seen at the CAC’s

Training and Education of team members through peer review, local CAC trainings and

statewide trainings

CACND collected information and data from the ND of Human Services, the ND Bureau of

Criminal Investigation, the three accredited CAC’s of ND and their satellites, the National

Children’s Alliance, and the ND Census. This data was mapped to show areas serviced and gaps

where we can focus effort in the state. Several factors specific to ND that were taken into

account including:

The ND census grew substantially (a 12.7% increase) from 2010 – 2016 going from a population of 672,591 to 757,952. In contrast, the population growth in the United States during that same time was only 4.7%. (U.S. Census Bureau, Population and Housing Unit Estimates. Annual Estimates of the Population for the U.S., States, Counties, Cities, and Towns, and Puerto Rico: April 1, 2010 to July 1, 2015.

https://www.census.gov/quickfacts/table/PST045216/38,00 ) This was largely a result of the Oil Boom that happened in the state during those years.

Children under the age of 18 is 23.3% of the population. The majority of North Dakota counties (33 of 53) had an increase in the number of children from 2013 to 2014, with the fastest growth located in western North Dakota (McKenzie 24%, Stark 13%, Williams 11%, and Divide 9%). (The Annie E. Casey Foundation. (2016). ND Kids Count 201 Fact Book.

Baltimore, MD: Center for Social Research North Dakota State University. http://www.ndkidscount.org/publications/factbook/completefactbook/NDKCFactBook_2016.pdf ) ND CAC’s have responded to this population growth by expanding and opening up four satellite offices in the past six years.

ND is a large state covering 70,762 miles per square foot with 40% of the state population living in rural areas. This makes providing services by expert level providers especially difficult, as 60% of the state does not have the population to sustain such services.

ND historically has based its services on a regional system dividing the state into 8 geographically positioned regions. Each region serves a designated multi‐county area, providing array of human service programs including counseling and mental health services, substance abuse treatment, disability services and other human services. The ND Bureau of Criminal Investigations (ND’s state law enforcement) also has offices in the eight regions of ND. Each of the eight regions is geographically centered around a larger “hub” city and each of these “hub” cities are approximately an hour and a half driving distance from the next closest hub. Because of the common use of the regions in ND by our partner agencies, CACND has used this system as a backbone for CAC services in ND and established a vision for an hour and a half access for all CAC services.

The information in this report is presented by Region vs. by County. With so much of the state being rural, many of smaller counties reported zero cases during the year, and incidence rate data corresponded with that. Presenting the information by county made the data look skewed.

Although ND is divided up regionally, all CAC’s in ND believe it is best to not have a “service area”, making the service area for each CAC the entire state. We believe that children, families and agencies should seek services at the CAC that makes sense to

them and their case. In most cases, this may mean the CAC that is the closest but all CAC collaborate with each other and see cases across the state.

ND has a Statewide Interagency Agreement that has a signature page for social services, law enforcement and prosecution of all the 53 counties in ND. The statewide agreement also has signatures from several regional, state, federal and tribal partners. The agreement is reviewed annually and updated when new leadership enters their role. All counties in ND have used CAC’s on a regular basis. The map below shows the usage of CAC’s in 2016. All of the counties not served in 2016 have a child population of <1000 and may not have reportable cases every year.

The information in this report was based off data from 2015 because that is the most recent published report of Child Welfare Data Snapshot from the ND Department of Human Services. Because of that, all other statewide data pulled, including that of the ND BCI and the ND CACs used data from 2015 for consistency.

Currently, the CACND supports three accredited Child Advocacy Centers (CACs) and their four

satellite locations in the state of North Dakota. These sites include the Dakota Children’s Advocacy

Center in Bismarck and their satellite in Dickinson, Northern Plains Children’s Advocacy Center and

their satellites in Williston and Be court, and Red River Children’s Advocacy Center in Fargo and

their satellite in Grand Forks. CACND, as a leading resource for these CAC’s, provides targeted

assistance with the development, continuation, and enhancement of the CAC model throughout the

state.

This assessment identified the scope of services provided by current CACs, their satellites and Multidisciplinary Team partners in the state of North Dakota, and identified strengths in services as well as areas of continued growth. CAC data was compared against three sets of data to determine these strengths and gaps:

Incidence Rate as determined by the US Department of Health and Human

Services

Actual reports of suspected sexual abuse as reported to the ND Department of

Human Services and law enforcement agencies

Reasonable Standards set by the CACND board

RESULTS

TRENDS In the state of ND, the number of

child abuse reports were

consistent between 2012 and

2016; ranging from a low of

6,170 in ND in 2013 and a high of

6,647 in 2016. Overall, the total

number of reports increased by

477 during this time. * The Annie E. Casey Foundation. (2016). ND Kids

Count. Retrieved from http://www.ndkidscount.org/data.php .

When child abuse is reported, it may be referred to a Child Advocacy Center by Social Services, Law

Enforcement, and occasionally by a Medical Provider. During this same period, referrals to CAC’s

in ND have substantially increased over the past several years, increasing in numbers of over

1000 children seen. However, referrals have been leveling off in the past 3 years.

CAC SERVICES COMPARED WITH THE INCIDENCE RATE

U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2017). Child Maltreatment 2015. Available from http://www.acf.hhs.gov/programs/cb/research-data-technology/statistics-research/child-maltreatment.

CACND’s goal is to serve at least 75% of the cases that fit our criteria for services. Regions

outlined in red do not meet the 75% standard of cases referred to a Children’s Advocacy

Center. Use of the CAC should be encouraged, especially in regions with a large discrepancy

between the number of cases served by a CAC and the estimated rates of child maltreatment.

CACND meets this standard in four out of the eight regions. The data also shows that out of

those four, three already have CAC services (Williston, Fargo and Grand Forks). Services in

Williston started in 2017 so this could explain the difference in that region. There currently is

no on‐site services in the Jamestown Region, although all of those counties routinely refer

children to CAC’s in Bismarck and Fargo.

SEXUAL ABUSE CASES REPORTED VS. REFERRED

*This map depicts cases of reported sexual abuse vs cases of referred to a CAC for sexual abuse only. While CAC’s

see other forms of maltreatment sexual abuse accounts for 70% of all cases seen at ND’s CACs. Sexual abuse data

was used due to the discrepancy and availability of other forms of maltreatment across the state. Thus numbers of

CAC seen will differ from this map and others uses in this report.

CACND’s goal is to serve at least 75% of the cases that fit our criteria for services. Regions

outlined in red do not meet the 75% standard of cases referred to a Children’s Advocacy

Center. Use of the CAC should be encouraged, especially in regions with a large discrepancy

between the number of cases served by a CAC and the number of sexual abuse reports. The

data shows that most regions in ND meet this standard. Fargo and Grand Forks are close to

meeting the standard and already have CAC services in their region. Discussions in these

counties are ongoing and both regions are very committed to making sure children who need a

CAC get there.

*

*

REASONABLE STANDARDS

Children’s Advocacy Centers of North Dakota determined the Reasonable Standards for the

state. These standards were established as a vision for service provision in the state for

reasonable, consistent access to the full array of evidenced‐based CAC services and an

effective, multidisciplinary response to his/her case and his/or care. This vision includes:

Onsite Child Advocacy Services in every community with

100,000 or more people

The CAC’s in ND meets this standard, having a CAC or satellite in all communities of 100,000

people or more. The largest counties in North Dakota are: Cass (Fargo) – 175,249,

Burleigh/Morton 125,296 Grand Forks (Grand Forks) – 71,083, Ward (Minot) – 70,210, Williams

(Williston) – 34,337, Stark (Dickinson) 31,199, Stutsman (Jamestown) – 21,128

https://www.northdakota‐demographics.com/counties_by_population . Although Stutsman

County does not have enough population to meet this standard, geographically services in this

area may make sense in the future.

Forensic Interviewing services within a 1 ½ hour drive for

children/families/professionals

ND CAC’s have on‐site forensic interviewing services in seven locations: the three

accredited CAC’s and the four satellite locations. All services are within a 1 ½ drive for

children, families and professionals. Forensic Interviewers in the state are a mix of trained

team members and staff. CACND supports the Forensic Interviewers in ND by offering

quarterly peer review for all trained Forensic Interviewers in the state. CACND also offered

an Advanced Forensic Interviewing course in 2017 for providing Forensic Interviews for

Commercial Sexual Exploitation of Children to 17 Forensic Interviewers. CACND’s goal is to

offer an Advanced Forensic Interview course every three years in the state.

Expert Medical Services within a 1 ½‐hour drive and 24‐hour

coverage

ND CAC’s currently all contract for Medical providers trained in pediatric abuse exams.

Medical providers in ND serve most of the state with gaps in the NW, NE and SE part of the

state. The NE portion of the state does currently have trained medical providers, however,

24/7 coverage is not always provided. CACND supports the medical providers through

purchasing and disseminating the Quarterly Update to medical providers quarterly. In

2015 CACND also brought in a PSANE training to train providers across the state. CACND

trained 22 providers in 4 regions of ND. CACND’s goal is to offer an Advanced PSANE

training every three years in the state.

Evidenced Based Mental Health Services within the 8

Human Service Regions of ND

ND CAC’s have a mix of on‐site and contract Mental Health providers trained in Evidenced

Based Trauma Focused Therapy. All services are within a 1 ½ drive for children, families

and professionals. CACND also collaborates with the Treatment Collaborative for

Traumatized Youth in ND (TCTY). The Treatment Collaborative for Traumatized Youth

(TCTY) is a network of clinicians whose mission is to implement, evaluate, and sustain the

practice of evidence‐based mental health treatments for children who have experienced

traumatic life events. Since 2006, TCTY has trained approximately 380 clinicians in ND

including all eight of the Human Service Centers in ND. CACND supports clinicians in ND by

providing stipends to advanced on‐going training. In 2017 CACND provided an Advanced

TFCBT in Trafficking for 25 clinicians from every region in ND, Creative Counseling for

Traumatize Youth for 100 clinicians and an Evidence Based Assessment Learning

Collaborative for eight clinicians. CACND’s goal is to offer an Advanced Mental Health

training every three years in the state.

Initial and on‐going Advocacy – Offered to all families

initially and ongoing as appropriate.

All ND CAC’s have on‐site Advocacy services either through staff or through in‐kind staff.

All CAC client and their families are assigned an Advocate to provide them support and

help them navigate the system. CACND is a part of the ND Victim Services Workgroup

which is a collaborative taskforce working to address the needs of all crime victims by

maximizing resources and eliminating duplicative funding efforts. CACND supports

Advocates in ND with quarterly Advocacy trainings/meetings, stipends for on‐going

training, as well as sponsoring their membership and providing travel stipends to the ND

Victims Advocate Association (NDVAA) meetings. The ND Victim Assistance Association is

an association of and for professionals who provide direct services to victim and witnesses

of crime within the criminal justice system in North Dakota. NDVAA meetings happen

biannually. CACND’s goal is to offer an Advocacy training opportunities at quarterly

meeting.

658

1

790

2889

649

481

640

70

520

Advocacy Services Provided2015

Criminal Justice Support

Emergency financial assistance

Emotional Support

Follow Up

Information

Tangible Advocacy

Personal Advocacy

Phone Contact/Information andReferral

Referral for Services, Supports,Resources and Programs

Multidisciplinary Team Case Review Meetings of cases seen

at the CAC’s

CAC’s in ND currently participate in on‐site Case Review at 13 different communities in ND,

including all four of the Native American Reservations. All cases seen at CAC’s are eligible to be

staffed at Case Review. CAC’s survey team members on an annual basis. 98 % of team members

surveyed in 2016 agree that Case Review is useful in the development of cases.

Training and Education of team members through peer

review, local CAC trainings and statewide trainings

CACND has trained or provided stipends to all of the CAC’s and trained 472 team members and staff

in 2016. CAC’s in the state offer a variety of training opportunities to MDT members including

statewide conference, lunch and learns, webinars CACND supports Multidisciplinary Team (MDT)

Training in ND through training opportunities and by providing stipends to advanced on‐going

training.

SUMMARY AND RECOMMENDATIONS

North Dakota has grown substantially in the past six years and CAC’s in the state have worked to match the growing needs of the state growing from three CAC sites in the state to seven. In order to access growth and sustainability needs CACND compared state and CAC data in three areas to look for strengths and gaps in services 1) CAC Services Compared with the Incidence Rate 2) Sexual Abuse Cases Reported Vs Referred and 3) Reasonable Standards set forth by the CACND Board to. The Children’s Advocacy Centers in ND will utilize the results of this growth assessment to inform and guide its support of efficient growth for any additional CAC’s and/or satellites in ND, taking into account the need for services in the state and the most efficient use of state and local dollars in providing those services. This assessment clearly identified the scope of existing services provided by current CACs in the state of ND. It also identified gaps in CAC services, which fall outside of the parameters of the “one and a half hour recommendation.”

CAC Services Compared With the Incidence Rate: Cases seen at CAC’s matched the incidence

rate in four out of the eight regions. Of the four Regions where the amount of cases were

substantially lower than the incidence rate, three of them already have on‐site CAC services.

The Williston Region just started satellite services last month. With these on‐site services, it is

expected that cases in that region should increase. Grand Forks and Fargo also have onsite CAC

services with a satellite and accredited center, respectively. The Jamestown Region currently

does not have onsite CAC services, but does utilize CAC services for their counties.

Sexual Abuse Cases Reported Vs Referred: Cases seen at CAC’s matched the number of cases

reported to law enforcement and social services in four of the six regions. The Regions of Fargo

and Grand Forks were just under the 75 % standard.

Reasonable Standards: The CACND Board delegated seven service provisions for CAC’s in the

state to meet our vision of eventually every child in North Dakota (ND) who needs it will have

reasonable, consistent access to the full array of evidenced‐based Children's Advocacy Center

(CAC) services and an effective, multidisciplinary response to his/her case and his/or care.

Onsite Child Advocacy Services in every community with 100,000 or more people

Met

Forensic Interviewing services within a 1 ½ hour drive for children/families/professionals

Met

Expert Medical Services within a 1 ½ hour drive and 24 hour coverage

Some Gaps

Evidenced Based Mental Health Services within the 8 Human Service Regions of ND

Met

Initial and on‐going Advocacy – Offered to all families initially and ongoing as appropriate.

Met

Multidisciplinary Team Case Review Meetings of cases seen at the CAC’s

Met

Training and Education of team members through peer review, local CAC trainings and statewide trainings

Met

Given this, the recommendations for CAC’s in ND and their provision of service are:

To share this report with partners, state agencies and legislators. Provision of this report to interested stakeholders may increase understanding of both child abuse and CAC service provision in, and beyond, the state of North Dakota.

CACND should continue to work with its funders and the ND State Legislature to recognize and fund the use of satellites in ND to ensure coverage for child abuse victims.

CACND should look into options for the Jamestown region to increase services and access to CAC’s for the children, families and advocacy in this region.

Discussions should continue in the Fargo and Grand Forks region to look at the discrepancies of numbers seen vs reports made/incidence rates. The Fargo region has already entered into a process to do a broader Community Assessment and has held discussions with team partners to look at decencies.

CACND should continue to collaborate with its medical partners in the state to identify solutions in covering the gaps in medical coverage.

On‐going training opportunities for the specialties is an important piece of maintaining standards and should continue to be a priority for ND.

To continue to monitor the newly established satellite services in the Williston Region to ensure services are meeting this region’s needs.

CACND should consider surveying MDT partners and stakeholders across the state to measure opinions and service areas and usage in the state. CACND could utilize resources within the Outcome Measurement System to facilitate this.

In summary, it is understood that community stakeholders have expert knowledge of their

communities, and this report is a starting point so that communities may incorporate the data into

their own planning.

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