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