For young victims of physical and sexual abuse, the assault is sometimes just the first trauma. Often they suffer again in the hospital, where they are examined and treated; in the police station, where they have to repeat their stories; and in the courtroom, where they come face to face with their abusers.
But at Cooper-Anthony Mercy Child Advocacy Center at Mercy Hospital Hot Springs, Ark., caregivers have developed a better way to treat and protect children. They provide a spectrum of services on-site, assuring children receive both comprehensive and ongoing care. The approach recently earned the center accreditation from the National Children's Alliance, the accrediting agency for children's advocacy centers.
"Too many children have to go through the very stressful process of telling their story over and over to strangers," said Mercy Child Advocacy Center Director Janice McCutcheon. Health care and justice system professionals "care about children, they want to help children, but they don't always understand the best way to help children."
At the Mercy Child Advocacy Center, "instead of the burden of the investigation being on the child's shoulders, it's on the adults' shoulders which is how it should be," said McCutcheon. The center provides medical evaluation, therapeutic interventions and advocacy for children who have suffered abuse. Most meetings with law enforcement officials happen here. Since children become familiar with the center, they come to feel safe and validated, said McCutcheon.
Recently, the center added free ongoing mental health services for children. Currently the center offers individual counseling, and it hopes to add support groups. "Being on the front lines of abuse, I always say we are the first step of healing," McCutcheon said. "We help them to be able to verbalize their fears and feelings of being betrayed."
The counseling not only facilitates the healing process, but it also prepares children for the daunting legal battle ahead.
"To be in a courtroom with strangers and to have to share what has happened to them is very intimidating," said McCutcheon. "For them to sit in the same room as the offender takes so much courage, and our therapist is there to help them with that."
Compassionate fact finding
Before arriving at Cooper-Anthony Mercy Child Advocacy Center, McCutcheon worked as a forensic interviewer for Benton County, Ark.'s advocacy center. She was, in fact, the first forensic interviewer in the state. During her tenure, the prosecution rate of child abusers increased by a staggering 1,000 percent.
"I saw a need," said McCutcheon. "As a child advocate in that center, I witnessed an interview of two boys by a caring detective, but he had no training. He had no training in how to ask non-leading questions and conduct an interview that would stand up in court. He also didn't understand child development. You can't talk to a 5-year-old child the way you can talk to a 13-year-old child, and you can't talk to a 13-year-old the way you would talk to a 17-year-old. I knew there was a better way."
Serious business
Mercy Child Advocacy Center, which opened in 2003, employs a small team of abuse experts and serves about 500 children a year. Most are victims of sexual abuse. Referrals primarily are from Hot Springs and surrounding Garland County, though the center also serves other counties with no advocacy center of their own. Newly referred children receive comprehensive medical care and lab work; the center's doctors and nurses are experts in abuse and sexual assault.
Center employees also work with families, connecting them with social services. Though the center is not affiliated with law enforcement, employees sometimes have to explain to parents the legal consequences of not doing the right thing.
"This is serious business," said McCutcheon. "We lay it out for them — 'You can choose to believe your child and make sure your child is safe. And you need therapy for yourself; and your child needs therapy.' And they're given the other road. They can go to jail for failure to protect, their kids can be taken from them. And you know what, we see that. It can be really sad when they choose the wrong road."
ChildFirst
A crucial part of the process, both psychologically and legally, is the forensic interview. Specialist Tracey Childress is trained in the leading national protocol, "ChildFirst." Childress likes to stress she does not interview children; she interviews a child.
"I work with one child at a time," said Childress, who interviews 35 to 50 children every month. "Each child is different."
Childress must simultaneously assess a child's cognitive and developmental status while building a trusting rapport. She then asks the child to identify his or her body parts so they share a common vocabulary. Next, she asks the child about touches the child likes, such as high fives, and touches the child doesn't like. At this point, a child may start talking about abuse. That's when Childress will gather details of the abuse focusing on the sensory aspects of the experience.
"I ask questions about how it felt, what it tasted like, how it looked," said Childress. "Law enforcement or a doctor or a social worker may not think of asking those sensory questions because they aren't always testifying in court. But I ask them so that child will be credible in court and people will know they had an experience."
Truth telling
Law enforcement officers watch the interview from an observation room;
Childress also records the meeting. Before the 2004 Supreme Court ruling Crawford v. Washington, such interviews were admissible in court. Now, however, a child victim must appear in court to be cross-examined.
"It's very hard for our little children to articulate what has happened," said Childress. "These children are not as equipped as the person accused, and they have to be the one to talk about their body and what was done to it."
Childress serves as backup, an expert witness who can explain why a child delayed disclosing the abuse or did not include key details in every interview. Just hours before talking to Catholic Health World, Childress interviewed two children who waited to come forward to report abuse. One girl was afraid to send her father to jail; another was threatened by her attacker.
"The prosecutor will turn to me to help educate the jury," said Childress. "Sometimes the first time an act occurs, they don't understand what's taking place, and then it keeps happening, and they feel so much guilt because they feel like they allowed it. Shame, threats, coercion — there are so many reasons."
In response, defense attorneys always ask the same question — Don't all children lie?
"I respond, 'Everybody lies,'" said Childress. "But children are not sophisticated liars. They lie to get out of trouble, not to get into trouble. The biggest misconception is the children are making this up, and what I try to do is to explain that this child didn't just say, 'Someone hurt me.' They gave the specifics of how it felt. They wouldn't be able to give the dynamics if they didn't have an experience to attach it to."
Sensitizing law enforcers
The result of the center's efforts has been tough prosecution of the area's offenders. Now McCutcheon and Childress are taking their message statewide, training police, prosecutors and social workers about proper interview techniques and dispelling the persistent myths of sexual abuse.
Still, Childress has gotten push back from some investigators. Though she has developed a strong relationship with local prosecutors, she has met police officers and prosecutors in other counties who dismiss the "ChildFirst" protocol.
"I hear, 'You know, Tracey, I've interviewed kids for 20 years.' And then they walk up to a kid and say, 'Tell me what happened,'" said Childress. "Well there is a gun on the hip of that officer, and the child has been told by the offender, 'If you ever speak out, I'm going to have a cop take you to jail.' I still find even within centers there are still people who do not understand the holistic approach" to victim advocacy.
McCutcheon hopes to help fill in those care gaps across the state. McCutcheon said the center's mission is to represent the children society so desperately wants to protect, but still fails to understand.
"It's a special calling," said McCutcheon. "When I speak to other professionals, I say, 'Do not harden, do not go numb. You need to keep your passion.' For me, it is the hope that is provided here. To be able to restore their childhood, their innocence — because that can happen — and return them to whom God created them to be, is what keeps me going."
Chesterfield, Mo.-based Mercy health system is in the process of selling Mercy Hospital Hot Springs to the for-profit Capella Healthcare Inc., but Mercy will continue to operate the child advocacy center after the sale, according to Mercy Hospital Hot Springs spokesman Jeffrey Slatton.
Copyright © 2012 by the Catholic Health Association of the United States
For reprint permission, contact Donna Troy or call (314) 253-3450.