Elsevier

Aggression and Violent Behavior

Volume 65, July–August 2022, 101638
Aggression and Violent Behavior

Financing mental health services at Child Advocacy Centers for victims of child sexual abuse and their families

https://doi.org/10.1016/j.avb.2021.101638Get rights and content

Highlights

  • CACs are a common entry point for children after disclosure of child sexual abuse.

  • Existing funding mechanisms do not meet the mental health needs of this population.

  • Complexities and requirements of third-party billing are a barrier to services.

  • Community capacity for evidence-based trauma-informed services is limited.

  • CACs can increase access through innovative policy, research, and advocacy.

Abstract

Child sexual abuse (CSA) is a significant public health concern and is associated with a multitude of negative health outcomes. A substantial body of research has shown that experiences of CSA increase risk for short-term and long-term negative sequelae across psychological, behavioral, physical, and biological domains. Mental health treatments have been effective at decreasing children's mental health symptomology after CSA and preventing future negative outcomes. Child Advocacy Centers (CACs) are a common entry point for children following disclosure of CSA and are intended to streamline services, promote collaboration, and increase accessibility of mental health services. CACs rely on the blending and braiding of multiple funding sources to provide mental health services. Yet, traditional funding mechanisms are insufficient to meet the mental health needs of this population. Specific barriers related to the current funding system and the community context of mental health service provision are discussed. The CAC model provides a unique opportunity to increase access to mental health services through innovative funding mechanisms. Recommendations for strengthening the CAC model through policy research and advocacy are provided.

Introduction

Child sexual abuse (CSA) is a significant public health concern affecting approximately 25% of girls and between 5 and 16% of boys (Finkelhor et al., 2014; Friedenberg et al., 2013; Sedlak et al., 2010). Children who have experienced CSA are at increased risk for negative outcomes, including psychological distress, low self-esteem, externalizing behavior problems, delinquent behavior, and risky health behaviors (Cummings et al., 2012; Kendall-Tackett et al., 1993; Maniglio, 2009; Putnam, 2003; Tyler, 2002). Mental health services are critical in ameliorating and preventing these negative sequelae. Child Advocacy Centers (CACs) provide a streamlined entry point for children following disclosure of CSA and increase accessibility of mental health services (National Children's Alliance [NCA], 2019b; Newman et al., 2005). Yet, current funding is inadequate to meet the need of all children and families who present to CACs. This paper begins with a review of the literature on CSA and mental health sequelae and the CAC model. We then provide an overview of current policy and funding for mental health services at CACs and highlight the challenges associated with traditional funding mechanisms. Finally, we provide recommendations for strengthening the provision and accessibility of mental health services in the CAC model through policy, research, and advocacy.

Section snippets

Child sexual abuse

CSA is prevalent in the United States and is associated with a multitude of negative health outcomes. One surveillance study of Adverse Childhood Experiences (ACEs) with American adults across 23 states found that 11.6% reported having experienced CSA, representing approximately 16% of females and 7% of males in the sample (Merrick et al., 2018). National estimates relying on court substantiated reports found that approximately 9% of children experienced CSA in 2019 (HHS, 2021). Of note,

The Child Advocacy Center (CAC) model

Given the commonality of adverse mental health outcomes for children who experience abuse and neglect, access to mental health services for children and caregivers is crucial. Following disclosure of CSA, children are often referred to a CAC for follow-up investigation and treatment services. CACs are increasingly being utilized as streamlined entry points into the child welfare system for children following experiences of abuse and neglect. CACs were born in an effort to prevent the

Funding mental health services for victims of CSA

According to the NCA, CACs receive funding from various sources, a combination of federal grants and private funding sources (NCA, 2019b). Most CACs rely on public funding and private donations as their primary sources of funding. Overall, 68% of CAC funding is from federal, state, and local dollars, with the remaining funding largely coming from philanthropy and other private sources (NCA, 2016b). The Victims of Child Abuse Act (VOCAA) of 1990 allows the NCA to work with the Office of Juvenile

CAC model

NCA (2017a) provided recommendations for efforts within the CAC system to improve the funding landscape, although these recommendations were broadly focused and not specific to mental health. Some relevant recommendations include a focus on accessing and utilizing VOCA and VOCAA funds, capacity-building to develop sustainable funding models, and the expansion of infrastructure to enable third-party billing for services. NCA and federal funders could consider enhancing existing technical

Conclusion

Access to and provision of mental health services for children who experience CSA and.

their families is critical to ameliorate the negative outcomes associated with CSA, prevent revictimization, and promote family resilience. CACs are a common coordinated entry point through which children are referred to mental health services following disclosure of CSA and play a substantial role in this linkage. CACs currently rely on an array of federal, state, and private funds to provide mental health

Declaration of competing interest

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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