Updated CAC accreditation standards include a focus on safety, mental health, and equity

CACs can also grade against new, optional prevention, human trafficking, and physical abuse standards

New standards for child advocacy center accreditation formally take effect January 1, 2023. These are part of a five-year revision and update cycle, updating the 2017 standards with clarifications designed to improve CAC governance, prevention education, access, and more. The results are a rigorous series of measures that will impact teams working at and families visiting CACs.

Indiana Chapter Director Jan Lutz facilitated over forty discussions with various subject matter experts and National Children’s Alliance staff across the United States. Lutz is one of the nation’s leading experts on NCA accreditation standards and works as a site reviewer. “The subject matter experts take this seriously, and NCA does, too. These experts understood the importance of reviewing each of the standards,” says Lutz.

Standard 1 – Multidisciplinary Team Standard

‘Of the ten existing standards, the most change comes with the multidisciplinary team (MDT) standards,” she says. “Everyone decided it was important for CACs to establish—or reestablish—a strong relationship among MDT members.”

  • Requires a single MDT Coordinator at the CAC.
  • Requires the MDT Coordinator receive 8 hours of specialized training to start and 8 hours every two years of refresher training.

“In most cases, the MDT Coordinator will be the person that organizes and facilitates case review, but not always. Prosecutors in some states and CACs run case reviews,” says Lutz. 

In either case, the MDT Coordinator is responsible for understanding team dynamics, conflict management, and relationship building. A necessary skill amid high-stress work and high turnover in child welfare and protection staff. 

Standard 2 – Diversity, Equity, and Access of Services Standard

Formerly known as the cultural competency standard, Standard 2 has been expanded and clarified to address documented situations across the country.

  • Standard 2 still requires a community assessment designed to document and understand the racial, ethnic, income, and overall needs of the area the CAC serves.
  • Clarifies how to ensure and train qualified interpreters for non-English speaking clients. This also includes deaf and hard-of-hearing clients who may need sign language interpreters. Fort Wayne’s Bill Lewis Center has shown how interpreters matter.
  • Requires CACs to establish consistent, clear, and formal policies for recruiting, hiring, and training board members and staff in ways that reflect the demographics of the area they serve.
  • Requires CAC staff to participate in at least 8 hours of DEI training every two years and opens this training to non-CAC staff team members like law enforcement.

Lutz believes the Standards Committee made an effort to “Strengthen the training and hiring requirements so CACs and boards better understand the importance of the standard.”

Standard 3 – Forensic Interview Standard

A forensic interview is the number one reason a child and family come to a CAC. “We’ve added some clarification around the ‘75% rule’, which says 75% of the kids that should be coming to the CAC are coming to the CAC,” says Lutz. 

The MDT and the CAC determine which cases should come to the Center. For instance, adults with special needs or children who have been taken to a hospital. “Language was changed to make sure CACs consistently collect data to the best of their ability and conduct forensic interviews through a secure tele-forensic method,” says Lutz.

Standard 4 – Victim Support and Advocacy Standard

“Language was added to clarify a few things, but most changes come in training requirements. Training is now 24 hours and 12 special components, up from 9. A lot of that has to do with DEI opportunities and making sure Victim Advocates have everything they need to work with different cultures, orientations, religions, ethnicities, and more,” says Lutz.

Standard 5 – Medical Evaluation Standard

“The prior standard said 50% of cases deemed ‘medically abnormal’ had to be reviewed by a medical expert. Now we’re saying a medical expert must review 100% of those cases,” says Lutz.

In practice, most CACs who encountered an abnormal medical case—such as a child with an STD that could not have been obtained any other way—were already ensuring they saw a medical expert.

Standard 6 – Mental Health Standard

Standard 6 has been revised to ensure, “Someone treating a child or adult is trauma-focused and has the skills to fit their needs,” says Lutz. 

  • CACs are responsible for offering mental health care to children and caregivers regardless of their ability to pay.
  • There are 7 components of care, including ongoing monitoring of trauma symptom reduction, and each treatment plan is individualized, relevant, and based on scientific evidence.

Standard 7 – Case Review and Coordination Standard

  • Adds a requirement the purpose of the meeting is included and denotes whether a meeting is virtual or in-person.

“We discovered many case review meetings were done without much structure. The new standard requires the multidisciplinary team define the purpose of the case review,” says Lutz. 

The goal is to create an intention forum for the review, collaboration, and coordination of further services cases might benefit from at least once a month. 

“Case review is a collaborative session to ensure the family is getting everything they need,” says Lutz.

Standard 8 – Case Tracking Standard

  • Clarifies some language, but no significant changes from the 2017 standards

Standard 9 – Organizational Capacity Standard

“This standard is increasingly about policies and procedures that help give teams structure,” says Lutz. 

  • Requires CACs to write a team and staff Code of Conduct policy.
  • Adds requirements for whistleblower protections, anti-violence, and emergency response policies.
  • Requires CACs to have social media policies that also include board members.
  • Requires policies for credit card usage, conflict of interests, and other financial matters.
  • Includes significant additions of data security and privacy protection policies.

“It’s becoming more apparent in the CAC movement we need leaders with business acumen and skills that haven’t been high on the list when appointing or hiring new Executive Directors,” says Lutz. “We’ve often promoted from within, but a forensic interviewer may not have the accounting skills to run a CAC. I’m more and more asked to educate hiring committees about interviewing skills and writing better job descriptions.”

“Everything is being strengthened to ensure privacy, reduce liability, and even cybersecurity insurance,” says Lutz. 

“And we continue to focus on resilience because we’ve not been good about it. Staff who are there for the child no matter what has resulted in CACs burning out some very talented people. We have resiliency training requirements for staff now and can also provide it to MDT members.”

Standard 10 – Child Safety and Protection Standard

Children and families who come to a CAC expect safety from threats, perpetrators and suspects, and even CAC staff. 

  • Requires constant observation or supervision by CAC staff, MDT members, or volunteers.
  • Requires policies for working with hyper-sexualized or problematic behaviors.
  • Ensures CACs have signage and protocols for dealing with fires, tornadoes, and other natural threats.
  • Requires new protocols for dealing with active shooter threats.
  • Includes requirements CAC staff understand mandatory reporting laws in their state.

“We wanted an even higher expectation, including everything from conducting nationwide and not just state-level background checks to ensuring bookcases and furniture are secured so they don’t topple over on kids in a waiting room,” says Lutz.

Three new optional standards

There are three new optional standards CACs can choose to be graded against. These include prevention education, human trafficking, and understanding physical abuse from a medical perspective, which defines training medical professionals must have to fully understand trauma-informed care.

Read the 3 new optional standards (PDF)

New standards take effect January 1, 2023

“I’m so proud of NCA and the work they and our subject matter experts have done,” says Lutz. We have these standards to make sure CACs do good work.”

“The big plus for me is what I learned listening to and being part of the conversations about these standards is not something I could begin to gather on my own or pay for,” says Lutz. “I learned more and understand the importance of these standards, including why they were developed, and how they continue to be developed by the needs of the people in the field.”

Indiana has 11 NCA accredited CACs. New accreditation standards take effect January 1, 2023 for CACs to meet by their next site review, and the next major revision will come in 2028. 

Download the 2023 NCA Accreditation Standards (PDF)

Download the 2023 “Putting Standards into Practice” guide (PDF)

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