Inside the application, site audit, and review of two Indiana CACs
The agendas are set, the teams are ready, every inch of the building is cleaned, the mini-fridge is stocked, and everyone is aware of what’s happening today. For a while, it seemed the last six to nine months had been a steady chronicle of to-do lists, checklists, and documentation. Now it was a blur, and to Emily Perry and the team at all three Susie’s Place CACs, it was their day to shine. A day to prove to National Children’s Alliance (NCA) site reviewers what they do daily — and to themselves.
Angie Marsh and the team at Dunebrook have a similar, albeit different, experience 200 miles north around the same time near the end of 2022. Months of legal wrangling, contracts, agreements, MOUs, and reminders to her team have come down to a marathon of Zoom meetings connecting the Michigan City, Indiana, CAC with NCA site reviewers scattered across the country.
At Susie’s Place, Emily Perry has undergone site reviews before for Centers in Avon and Bloomington, but in late summer 2022, they’re up for renewal along with their Terre Haute Center’s first independent review as a standalone facility. Her team has chosen an in-person site review at all three locations. The Chapter provides ongoing technical assistance for all Indiana CACs preparing for accreditation and reaccreditation, helping to ensure that all NCA standards are being met.
Think about your site review from the moment you submit the application
“You start thinking about your site visit as you’re completing the application because what you put in your application you have to demonstrate when they’re on-site with you,” says Susie’s Place Executive Director Emily Perry. “For me, I’m starting to formulate my plan of what I want to showcase in my facilities and with my teams while I’m crafting the application. If you have to make changes in your Center between the submission and review, you think about those things during writing.”
At Dunebrook, Executive Director Angie Marsh recalls, “From the time we submitted, it was just a whirlwind to go through and figure out what we didn’t have already. I submitted it knowing we had a June [2023] deadline to submit it and knew we didn’t have everything in place to be accredited right away.” After your initial application, a site reviewer will go through each step, using a checklist to show you what a team needs to complete.
“One good example, which everyone has to do, is walk through your facilities with a clipboard and ensure every area is safe, child-friendly, and accessible to all children and families that need access. Make sure you have plugs in your outlets, all entrances and exits can be traversed by a wheelchair, ensure you have bookcases attached to the wall, and so on,” says Perry.
Marsh had a similar experience at Dunebrook. “I had to identify all the houseplants and Google to see if they were poisonous. And because we are an umbrella organization, there are other people in the office, and somebody vacuumed and didn’t put a safety plug back in an outlet. I double-checked those and noticed for the first time they put Lysol and cleaning agents on top of the shelves that a kid might be able to reach. It made me rethink and take things in critically,” she says, noting that many things seemingly disappear into the background when you walk into the same space every day.
“Just being organized helped. I didn’t even know how to be organized!” Marsh laughs, asking herself, “How do I keep this? I scanned everything since ours was virtual, but all the components to each MDT standard were scanned into a folder named appropriately,” she says.
Throughout the entire process, Perry and Marsh turned to the Indiana Chapter for technical advice. “Without [Chapter Director] Jan’s knowledge of the process and resources she made available to Susie’s Place, we would have run into barriers we could not navigate. She’s a guiding light for each of Indiana’s CACs seeking accreditation,” says Perry. The Chapter has aided dozens of Indiana CACs through a successful accreditation.
Coordinating interviews with the broader MDT is the biggest challenge
Both Perry and Marsh agree the hardest part of the accreditation process and site review isn’t collecting all the documentation, wiggling all the shelves, tucking away the cleaning supplies from a child’s reach, or even the time to fill out the application. It’s coordinating all the interviews with each multidisciplinary team member (MDT). Each team member, from law enforcement to mental health and medical teams, prosecutors, and caseworkers, has to be available for a one-to-one interview with the NCA site review team on a single day.
“Some of my team would just look at you blankly when you explained [accreditation], and they’d say, ‘Do whatever you need to do’. They saw it as a ‘CAC thing’, not an MDT/togetherness thing. To them, it was nothing necessary for their job or agency. They were cordial to get things I needed but to participate and ask if they could help, they didn’t take that role, and it’d slip on their back burner,” says Marsh.
To resolve this, Marsh used a clever change in words. “I stopped saying the CAC was being accredited. That instead, the MDT was being accredited.” That simple reframing helped spur many members of the team to get involved.
Perry’s team had to coordinate members across three locations with a service region spanning dozens of counties. “Medical, mental health, law enforcement, DCS, and prosecutors with varying degrees of interest in the process are part of the challenge after submitting the application,” she said.
“Keeping them on board with all the best practices is hard. You know the review is always coming up because you’re always trying to wrangle these cats back to the corral — thinking, we can’t be having a tiff about this because we have our site review in six weeks,” recalls Perry. “That truly is the most stress-inducing part of the process. I can’t control those things. They’re variable wild cards.”
Perry advises a CAC pursuing accreditation to involve the whole team early. “Talk about it all the time so they understand the importance of accreditation and the impact on the CAC, and they understand the standards and expectations of their practice,” she says. “The accreditation process truly is an opportunity to improve your MDT and your process overall. If you treat it that way, it can be beneficial, but if you treat it like jumping through hoops, it doesn’t provide that.”
Have a backup plan on the day of the site visit
Both Perry and Marsh’s Centers passed their accreditation site visits on the day of the event. At Susie’s Place in Terre Haute, the only minor hiccups were a site reviewer that got lost driving between the CAC and the local police department to discuss case review. “One thing that I would do differently is drive them or give them more directions. They wanted to go on their own, though. Make sure you have good contact information for your site reviewers.”
Also in Terre Haute, the mental health team lacked one certificate for training. They completed the training, and Perry sent it to the NCA within two weeks after the site visit.
Still, Perry pushed everyone to prepare in case some members of the MDT were called into an emergency or unavailable. “We had plans to have another prosecutor sit in case review, or if our prosecutor is in a jury trial, we could do a Zoom meeting before or after the site visit,” she says. “That’s not ideal, but you need to have those conversations with the site reviewer before they arrive.”
At Dunebrook, Marsh and her team typically operate most meetings virtually, so they opted for the entire site review process to occur virtually. Their only hiccup was a rogue Zoom host. “Somehow, one of the reviewers became the host of my meeting, and she needed to jump off to start with another review meeting, which abruptly ended the meeting for everyone,” Marsh recalls with a laugh.
“We had great participation,” Marsh adds. “We sent out a week or so before just who would be participating, and we had time slots allotted for them. NCA sent us an agenda of what they wanted to see each half hour, and we could rearrange it a little depending on schedules. They sent breakout room links, and I’d pass those on to the MDT,” says Marsh. Site reviewers also sat in on a board and case review meeting and quietly observed the team’s interaction.
“It ran quicker virtually because there’s not a lot of side chatter or lunch breaks,” says Marsh. I think it depends on your CAC and what you like to do.”
Make site review and accreditation a team effort
At Susie’s Place, Perry and her team asked for the reviewer’s preferred lunch times, meal preferences, hotel options, allergies, and favorite drinks weeks in advance. “It was stressful for us, but we were excited because we believe in what we’re doing and want to show that. We want you to see the good work happening here, not an ‘Oh my gosh, you’re going to discover something!’.”
In a natural extension of the CAC’s mission to kids and families, Perry adds, “This is our time to shine, and that’s what we wanted to do: treat them like guests in our home and feel welcome with a seamless transition from one component to the next,” says Perry.
“Accreditation was pretty much what I thought it’d be,” says Marsh. “But don’t be afraid to ask other directors and team members for help. Because until you have struggled with that, you might not know who to contact.”
“I struggled to get the head of the hospital to sign a linkage agreement,” says Marsh. Leaning on her connections, the head of the nursing staff discovered the agreement was stuck in the hospital’s legal department. “They were concerned about specific language in the agreement. So we reworded one thing to meet their legal team and our standard. But having someone advocate for us helped,” says Marsh.
At Susie’s Place, Perry involved all her 20-member staff and the dozens of MDT members. “Some CACs have one person, and they do it all on their own, but we really involved everyone in all our locations. Because of that, they felt such pride the day of the review — it exuded when our site reviewers spoke with our staff,” says Perry.
Indiana Chapter Director Jan Lutz says, “National Children’s Alliance accreditation is no easy task. It’s more than just meeting Standards; accreditation gives validation that Children’s Advocacy Centers are providing best practice services for children and families.” She adds, “The Indiana Chapter is incredibly pleased that both Susie’s Place-Terre Haute CAC and Dunebrook’s CAC qualified.”
