OVC Provider Forum Transcript

CACs and SARTs Partnering for Sexual Violence Victims
Sally Laskey, Chris Newlin  -  2014/4/15
How can sexual assault - community based advocates work in collaboration with CAC's system based advocates on cases? How can we come to an understanding of our roles and how they complement each other by sharing resources is in the best interest of the victim(s) served vs. being territorial? What is the barrier to SARTS and MDTs working together? Are any of these issues listed above addressed in policy or statues? What level of confidentially can the Family Advocate provide in a CAC vs. The SAP Advocate having confidential communication by law. (In Texas) The system can be so scary and in addition to the crime, life altering for victims. Why does it seem SAPs are not welcomed or encouraged to work with the CAC's to meet the needs of the victims?
1.  Sally Laskey
 Policy Part 2: Research is illuminating what many of us who wear multiple hats in our community have felt-some communities couldnít sustain more than one coordinating groups/councils/taskforce on a similar topic without diminished the effectiveness of one of the groups. (See Campbell , Greeson, Bybee, and Fehler-Cabral (2012)). In some communities where there has been significant disconnect between CACís and SARTís it have been adolescent victims that have fallen through the cracks.
2.  Sally Laskey
 In regards to policy and statues: It has been extremely helpful to have various federal and state agencies mandate collaboration and MOUís for multidisciplinary teams. This has often made sure that all the key disciplines are at the table and services are more coordinated for victims. In some communities, new entities are created without community assessment or planning and many different multidisciplinary groups are formed often with similar missions or target populations. Wolff (2001) talks about communities becoming ďover-coalitionedĒ and that leading to challenges with coordination and burnout. We need a new way to think about sustainability and SA specific services, because it is survivors that are suffering when we are not able to truly collaborate.
3.  Sally Laskey
 Confidentiality Part 2: We know that having positive and helpful responses to trauma is critical to healing for survivors of sexual assault. (See podcast with Dr. Ullman: Talking About Sexual Assault http://www.nsvrc.org/podcasts/nsvrc-xchange-forum-podcasts/xchange-podcast-dr-sarah-e-ullman )
4.  Sally Laskey
 Confidentiality Part 1: The problem of sexual violence is so complex that we need as many support people as we can find. The needs of sexual assault survivors are vast and span health, legal, safety, financial, educational, psychological and spiritual needs. One critical note for more engagement between CAC system based advocates and community based advocates is that survivors can get in-depth information about the system response in a timely manner from system based advocates and community based can offer long term support for survivors and their families.
5.  Sally Laskey
 Barriers to Collaboration: For the SART Toolkit we gathered some information on typical points of conflict for multidisciplinary teams and some different approaches to those conflicts. http://ovc.ncjrs.gov/sartkit/develop/meeting-conflict.html Working to end sexual violence is ultimately about social change. Change work comes with conflicts, but if we can move through these points of conflict in order to meet the needs of survivors in our communities we will be more successful. What are survivors and their families asking for in your community? Are there ways that you can jointly try to address those needs? As we identify areas where we can come together and appreciate the different skill sets of the professionals in our community we can remove barriers to collaboration.
6.  Sally Laskey
 I think that you point out the importance of understanding roles community based and system based advocates. Community based advocates often have legislated confidentiality and system based advocates do not. There is a great deal of benefit to having both types of advocates working with and supporting a survivor of sexual violence. For more on role differences see http://ovc.ncjrs.gov/sartkit/develop/team-advocate.html
7.  Chris Newlin
 Fifth question - This should not be an issue if both are part of the MDT which should allow them to communicate freely when both are involved in a case. However, if this is not allowed per state statute, then it would be an important legislative priority in the following year. It sounds like additional dialogue is needed to coordinate services if both are actually involved with the case.
8.  Chris Newlin
 Fourth question - Some states do require coordination within the MDT for child victims, but I am not aware of any state statutes related to collaboration between the SARTs and MDTs.
9.  Chris Newlin
 Third question - One obvious barrier is the age of those victims being served. However, it is most helpful to view sexual assault across the lifespan and how the MDT and SART can help provide this continuum of service. In most rural and many cities, the individuals working these cases have responsibilities across the entire lifespan, so it can be an easier to coordinate services. Collaborating in a larger city is balanced with the breadth of services available and necessary for appropriate service delivery. One barrier which is not always well addressed is the co-occurrence of sexual assault involving child victims with sexual assault involving adult victims. Many SARTs and MDTs donít necessarily communicate about this level of interface as might be helpful to protect citizens.
10.  Chris Newlin
 Second question - This is precisely the reason why there should be open dialogue between the multiple organizations who may be serving the child/family, to assure there is a common understanding of both a philosophical and operational approach. A victim-oriented approach necessitates that all organizations lower their proprietary interests and always prioritize the needs of the victim.
11.  Chris Newlin
 First question - If both organizations are working with a particular child/incident, it is imperative for them to communicate with one another to assure a continuity of service. This coordinated response should be addressed in the Interagency Agreement which is co-developed and signed by the various agencies involved in the MDT.
12.  Sally Laskey
 Thank you for your question. There are many ways that system based and community based advocates can collaborate to meet survivors needs. I appreciate that you are putting the focus on victim needs and how overwhelming our systems can be. If we take time to develop a trauma informed approach, our systems will be more accessible and our collaboration will improve. The NSVRC conducted interviews with communities across the country that have successful collaborations between CACís and Rape Crisis Centers that speak to some of the challenges you mentioned and how they overcame them. We posted a recent blog on the topic that might be interesting. http://www.nsvrc.org/blogs/feminism/best-practices-collaborating-your-local-child-advocacy-center
I live in a rural county, it would be very beneficial to our adult rape victims if we could use the CAC facility for forensic rape exams since it is located in the center of our county and a safer, more confidential setting. I am not sure if this violates CAC standards or how this would work for billing/VCAP?
1.  Sally Laskey
 If you have a few minutes you might want to listen to the NSVRC Just Rural Podcast series on collaborations between CACís and Rape Crisis Centers for some tips for communities that have developed strong collaborations. Here are some highlights from a recent blog post. http://www.nsvrc.org/blogs/feminism/best-practices-collaborating-your-local-child-advocacy-center
2.  Chris Newlin
 Provided this does not interfere with the operations of the CAC, this might be a great collaboration between agencies with similar missions. It should not violate any CAC standards, and if there was a concern this may be the case, a solution could likely be identified. You would have to check with VCAP in your state regarding the billing procedures and if this would be allowed. They may actually appreciate the increased level of collaboration between the two organizations.
3.  Sally Laskey
 The NSVRC does a lot of work with rural communities. It makes sense that you would want to have a more centralized location for services. If you have a collaborative relationship with the CAC you might be able to work out how to create space that would be accessible for adults. Most often CACís are set up with a child in mind so I imagine that there would need to be adjustments to the exam setting or an additional setting set up. It might be beneficial to meet with all collaborative partners to talk about best approaches and available options together.
Our agency is in the process of rebuilding our SART. We have come up with new guidelines but we are having trouble with participation. I have attended a national training and understand how a SART is intended to work but I need help explaining that to law enforcement and district attorneys. Any information you can give is greatly appreciated.
1.  Sally Laskey
 I would invite you to contact the NSVRC at 877-739-3895 or resources@nsvrc.org to brainstorm possible approaches to getting your core SART members on board.
2.  Heather Hodge
 We do not have support from the DA
3.  Sally Laskey
 I have found that using the structure of a SART as a grounding place to share innovative practices and emerging science is often a motivation for participating. Many SARTís are gathering around tables and having lots of training on the Neurobiology of Sexual Assault. Bringing people together and offering training such as NIJ's seminar series recordings is a low cost and high impact option. Check out Dr. Campbellís seminar of Neurobiology of Sexual Assault as an option. http://www.nij.gov/events/Pages/research-real-world.aspx
4.  Sally Laskey
 Rebuilding is often a challenging process. There is no one way that a SART operates since they are all community and resource specific. I have found that what helps with motivation is having a clear understanding of what each team member can give and can get from SART participation. If you are in the position of rebuilding, you can also take the opportunity to address any unmet needs that may have existed in the previous rendition of the SART. If you know what each team member values, you can often find a way to engage them. Additionally, I think it is important to have leadership at the table to be setting the standards for SART participation. Do you have a champion in the DAís office?
5.  Chris Newlin
 Sally is probably the best resource for this inquiry.
I am curious, how many MDTs operate a combined CAC/SART? We are one.
1.  Diane Olmstead
 The CAC sees around 240 cases per year and the SART approximately 100. Our county population is about 200,000. We have an umbrella organization that houses both the CAC/SART and collaborates with about 50 partners currently.
2.  Sally Laskey
 We are learning of more and more communities that are collaborating or combining teams, but I don't have national numbers available. Perhaps the NSVRC can reach out to some research partners about this question. The latest national survey we did with SART's was in 2009. http://www.nsvrc.org/publications/national-sexual-assault-response-team-survey-report-2009
3.  Chris Newlin
 This is a great question, and I am not sure that anyone has actually tracked this. I am assuming you are from a smaller jurisdiction which does not have the high case number demands and allows for this level of collaboration within a single context meeting.
What are the biggest challenges that SARTs face in working with CACs?
1.  Sally Laskey
 For some communities that have setting up a multi-county or regional SART I have seen some level of case review happening. It is really important to have clear guidelines, goals and processes for when and why case reviews happen. There are tools available in the SART Toolkit to support these conversations. http://ovc.ncjrs.gov/sartkit/develop/meeting-case.html
2.  leigh
 Do other counties/jurisdictions combine their SART and MDT case review meetings? What do you recommend for rural jurisdictions?
3.  Diane Olmstead
 I think it is SART not having required standards as the CAC does. That leaves a great deal of room for discussion of certain guidelines. This is not a bad thing because it fosters sharing varied perspectives. It demands oversight, documentation, research, and extended communication. As a result, our Team really wants to do case by case consideration. That could become a grueling process as we see more and more cases.
4.  Chris Newlin
 I think there is different levels of collaboration across the US in regards to the challenges. In some communities SARTs and MDTs work closely together. In others, they have not achieved the level of collaboration that is truly beneficial for clients to be served. Some challenges which have been seen include: Confidentiality concerns limiting true collaboration, personality conflicts between agency leadership and/or staff, clearly identified agreements on which clients will be served by SART and which will be served by MDT if they are not operating together, issues related to billing for services can cause ethical dilemmas for organizations that depend on reimbursement for survival and this business side must not interfere with what is best for the client.
5.  Sally Laskey
 My experience in providing technical assistance in this area has been focused on issues with clear roles for all members that includes understanding the value of each team member.
How do you address the issue of a disclosure happening in an exam that did not occur in the forensic interview?
1.  Sally Laskey
 I agree with Mr. Newlin that this is a fairly common occurance and that having protocols in place are key. Disclosure for most victims of sexual violence is a process and we are getting a lot better about allowing and supporting survivors to disclose how and when it feels safe to them. We also have a lot of tools to explain to juries why a survivor might disclose different things at different times.
2.  Diane Olmstead
 For the CAC, the examiner documents the disclosure and shares the information with CPS and police either directly or through the CAC Coordnator or Family Liaison, which ever is more expedient. For the SART, an advocate is in attendance at the exam.
3.  Chris Newlin
 This is a common concern, and again goes back to the importance of having a clearly defined Interagency Agreement. In most cases, a forensic interview is done prior to the medical exam. This can occur even in cases where the alleged abuse occurred within 72 hours. The disclosure in a medical exam may be explained in the context of the medical hearsay exception. It is good practice to make sure medical providers have some training in forensic interviewing so they use appropriate communication methods when communicating with clients. However, this should not necessarily preclude the use of forensic interviewers.
I am the victim advocate in a rural county in upstate New York. I wanted to know if other CAC victim advocates are allowed to transport victims to appointments, court, etc.
1.  nicole Davoli
 Thank you for this information. We do not have alot of public transportation in this county and there are no cab services either. I would like to learn more information about your program and how you are able to transport. in my county, victims have to get medicals that are 45 minutes away and this is a huge barrier for us. CPS workers have to take them and it would help out so much if I could transport the victims with their non-offending caregivers. Do you have special insurance through your agency? My director is supportive of this but is unsure how it could work as far as car insurance goes in the event something happens.
2.  Marybeth
 I am a victim advocate at a CAC further downstate. We do transport as necessary.
3.  Sally Laskey
 This is a great place to potentially engage the local sexual assault center/rape crisis center in your community. I am aware of many communities in which community based advocates have insurance, training and resources to assist with transportation. I have also worked with prosecution based victim witness advocates that also provided transportation services.
4.  Diane Olmstead
 Never. Only DSS and police transport.
5.  Chris Newlin
 This can be a difficult issue as there may be significant liability concerns associated with this practice. However, we have some clients who may then be prevented from accessing services due to a lack of transportation. Each community must identify innovative solutions to respond to transportation needs. Some programs provide gas cards, while others utilize public transportation passes. However, these may not be options of one does not have a car or public transportation. Identifying a non-partisan group that can assist with transportation (could be a mission of a faith group) may be one innovative approach.
Has anyone used, or heard of using, CASA volunteers for victims of sex trafficking?
1.  Lucy Bloom
 Thank you. I appreciate the feedack on the need for training and the calaber of volunteer we would be looking at. There does seem to be a need for volunteers who could assist with heping the youth understand all of the processes and helping them get to and from appointments. Also, a need for consistent support. Which, if an advocate committed to a youth victim for 12-18 months, that would facilitate serving several of these needs. In Kansas, we bring victims of trafficking under our CINC provisions. This may possibly help facilitate supporting advocacy and the victim centered approach in a greater way.
2.  Sally Laskey
 I'm also not familiar with the use of CASA volunteers in this situation. This technical assistance guide provides information about the prevalence of sexual violence throughout various forms of human trafficking. The content of this guide is intended to support community-based advocates working in their outreach and service provision to trafficking victims. http://www.nsvrc.org/publications/nsvrc-publications-guides/human-trafficking-guide-victim-advocates OVC has also done a lot of work in this area that you might want to look into. http://www.ovc.gov/news/human_trafficking.html
3.  Chris Newlin
 This may be a bit outside the scope of this web forum, but I am not aware of this practice being utilized. The needs of CSEC victims may be beyond the scope of a volunteer CASA unless this CASA is exceptionally trained and supported by CASA staff.
We have a rapid response team comprised of licensed staff who meet law enforcement when a child victim of trafficking is brought into police protective custody. The RRT staff member primarily provides a support to the victim and seeks to assist in recommendation for immediate placement. The MDT approach is key to sharing information and not overtaxing the child with multiple interviews. What methods of information sharing have you seen work best in situations where the needs of child victims of CSEC are being addressed.
1.  Lucy Bloom
 With our EMCU team, each victim does receive forensic exam/interview. Maybe not immediately, but within 48 hours typically. Our primary EMCU is located in an urban area. In our rural areas, it has been a challenge to come up with a solution to provide the same medical support. It has been discussed to partner with the CACs to provide a SANE-SART exam.
2.  Sally Laskey
 Having trained individuals that can provide confidential support to child victims is really important. I appreciate that your team is thinking about lessening the burden on the child, but equal attention should be given to providing the child with a safe and confidential space to focus on healing.
3.  Chris Newlin
 This situation requires additional expertise which is not always involved within the MDT. An initial issue is often one of appropriate placement - where can we place the child right away? A Detention Center is not an optimal choice, but oftentimes, a foster home is inadequate; and the child's nuclear home may not be appropriate. Collecting all available information regarding the child, including past law enforcement and CPS involvement is essential. Also, a comprehensive medical exam is indicated to assure a child's overall health is being considered. Traditional forensic interviewing may not work well with these cases either.
What information is helpful to be shared between each groups? What should SART teams know that is helpful for CACs and vice versa.
1.  Sally Laskey
 I think that victim service professionals can provide insight into community needs and what is working for sexual assault survivors if regular communication is happening outside of crisis. I think that this can be done while also protecting confidentiality of victims. More collaboration with SARTís and CACís will help us to understand and address polyvictimization issues. See National Childrenís Advocacy Center collection of resources http://www.nationalcac.org/calio-library/polyvictimization.html and Building Cultures of Care: Guide for sexual assault service programs http://www.nsvrc.org/publications/nsvrc-publications-guides/building-cultures-care-guide-sexual-assault-services-programs
2.  Diane Olmstead
 I think the binding factors stem from case review. While professionals may vary in response from child to adult, according to standards, the review process should be handled in the same manor: did we do everything we could for this victim; what services are lacking; how can we improve? etc.
3.  Chris Newlin
 It is most beneficial if there is a strong working relationship between the leaders of the SART and MDT. Engaging in ongoing dialogue about the types of cases being seen and mutually beneficial training opportunities can be a great place to start. Additionally, it can be very helpful for both to fully understand the work of their counterparts which will have overlap at times. I have found that it is often helpful to also have philosophical discussions on how both programs view the issue of sexual assault, child sexual abuse, domestic violence, poly-victimization, and many other topics to assure there is open dialogue and understanding on these topics.
My community is in the process of developing a CAC. We have a strong SART and Rape Crisis Center. What is your suggestions for SART and Rape Crisis Center to be involved in this process from the beginning?
1.  Chris Newlin
 This really depends on the quality of working relationship between the CAC and SART. Having a strong SART is a positive indicator for the likelihood of success as both approaches are victim-centered models. There should be open dialogue about how these two organizations will work together, including how to differentiate where and how clients will be referred to each. These should follow mutually agreed upon guidelines and not be based on relationships between professionals involved in an individual case.
2.  Diane Olmstead
 A small committee of our SART Administrative Team meet weekly for a number of months with representation from each discipline. The hardest part was reading through and discussing each of the necessary standards outlined by NCA. The Coordinator's role was key.
3.  Sally Laskey
 I would highly recommend that you all come together to talk about goals and needs in the community and how you can coordinate efforts. I think that SART's can assist with rapid response issues and that rape crisis centers provide tremendous opportunities for holistic healing for survivors and their families that would be supports for the CAC.
Is there anything being done or can be done from the CAC/SART partnership for prevention?
1.  Sally Laskey
 The focus of Sexual Assault Awareness Month is on youth and prevention. Check out our resources and let us know if there are additional tools that would help you as you explore more CAC/SART collaboration in this area. http://www.nsvrc.org/saam
2.  Diane Olmstead
 Our SART/CAC created an Education and Outreach Task Force that asks our partner/members to go out and share prevention trainings they've received with the community at large. We cover alot of ground that way and share greatly needed resources. Green Dot was a great example.
3.  Chris Newlin
 The National Children's Advocacy Center has done surveys over the past several years regarding child abuse prevention activities done in CACs. Deborah Callins from the NCAC is a great contact for this as we have also written a book chapter related to this. Many CACs are involved in child abuse prevention activities despite having very limited (and declining) funding for these efforts. Also, I know many Sexual Assault Centers are also involved in prevention efforts, and sometimes these efforts can be interwoven. We just did a joint press conference with the State of Alabama Attorney General during Crime Victims Rights Week, for example.
4.  Sally Laskey
 Absolutely! I think this is a great deal of opportunity in this area. I think central to this would be a connection of the Rape Crisis Center in the community. While the capacity of each program is somewhat different, they are likely to have prevention programming already in place. We have found in our assessment work with SART's that engaging in prevention work in the community has been a key to their sustainability efforts. We are encouraging SART's to engage in Sexual Assault Awareness Month and prevention work throughout the year.
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