‘The John Van Brakle Child Advocacy Center ‘Multidisciplinary Team Protocol ‘The purpose of this protocol i to define the collaborative response among law ‘enforcement, child protection, prosecution, medical, mental health and victim advocacy professionals from the John Van Brakle Child Advocacy Centerin a clear and concise manner. The protocol aims to clarify the roles of each discipline, coordinate the activities of each agency, reduce duplication of effort and focus activities on the needs of the child, Asa procedural guide, the protocol will be used by the CAC's staff and partners to assist in intake, coordination, investigation, treatment and follow-up procedures and with new-hire training. ‘The Mission ofthe John Van Brakle Child Advocacy Center (CAC) is to provide ‘coordinated evidence-based response to suspected child abuse by bringing together a multidiseiplinary team to offer services in one location, ensuring a trauma-focused collaborative approach for each child and family. CAC GOALS AND OBJECTIVES ‘+ Minimize trauma to child vietims of suspected child abuse or witness to violence; + Coordinate a collaborative response to cases of child abuse; + Help children heal from their trauma; ‘+ Provide continuing training and education for agency personnel and other professionals and volunteers inthe community who work with abused ehildren; and, “+ Serveas a source of information and education for the community on {sgues surrounding abused children, NON-DESCRIMINATION ‘The CAC does not disriminate against anyone (professionals, children, families ‘or suspects) based on race, gender, age, sexual orientation, religion, disability or national origin. OPERATIONAL GUIDELINES ‘The CAC primarily serves victims of sexual or physical abuse under the age of 18 in Lehigh County, The CAC also provides interviewing services and medical evaluations for other counties. Each member agency shall assume responsibilty for referring cases in which they have involvement. All agencies that sign the ACs Multiiseiplinary Team Protocol agree to abide by the protocols outlined in this agreement. Agencies from other counties who request the services of the CAC must also agree tothe following procedures described inthis working protocel. ‘MULTIDISCIPLINARY TEAM Led by the CAC, the purpose of the Multdiscipinary Team (MDT) is to provide a collaborative coordinated response to the investigation, treatment, and possible legal issues for cases of alleged child abuse or witness to abuse. 1 October 2022‘The Multidisciplinary Team (MDT) consists oft Lehigh Valley Hospital Department of Child Protection Medicine Lehigh County District Attorney's Office Lehigh County Special Victims Unit Detectives Allentown Police Department Lehigh County Office of Children & Youth Services Forensic Interviewer Mental Health Professionals Family Advocates, CAC stat Other peripheral members will participate as necessary to augment the team’s mission on a case-by-case bass. Peripheral members will not be required to sign this protocol agreement, but will till abide by the waitten procedures and confidentiality policy. Each ofthese agencies has signed an interagency memorandum of understanding ‘here they have agreed to appoint representatives to actively serve on the MDT. MDT GOALS AND OBJECTIVES ‘Achieve and maintain multidisciplinary cooperation and coordination in the case management and tracking of child abuse cases; ‘+ Ensure immediate protection and safety of the child victim; ‘+ Lessen or prevent trauma to the child by reducing to a minimum the ‘number of interviews to which an abused child is subjected; ‘+ Enhance communication, coordination and collaboration among the agencies responsible for dealing with child abuse and neglect cases; ‘+ Provide for a multidiseiplinary ease conference and ease management approach whichis focused first on the suspected child victim's needs for ‘are, second on the law enforcement, prosecution and child protection proceedings involved, and third on the family members who are supportive ofthe child and whose interests ae consistent with the best interest of the child; + Obtain probative, admissible evidence for both child protection proceedings and eriminal prosecution; + Provide extensive initial case screening, assessment, and validation procedures in order to exonerate the accused or proceed with appropriate child protection and/or criminal actions; + Improve coordination and tracking of the investigative, prosecutorial and + Provide victims and families wth appropriate services and/or referrals. Conflict Resolution Ifa MDT member has a conflict with another MDT member, itis recommended that the two meet and discuss and resolve the issue. If that is not possible, itis, recommended that the immediate supervisor be informed of the conflict and works to resolve the issue. Ifthat measure is unsuccessful, then the supervisor's immediate leadership should be consulted forthe resolution of the issue. 2 October 2022Documentation should be performed in accordance with the policy ofeach agency. Due to the large numberof interagency partners, every effort has been made during the development of this document to maintain a cooperative atmosphere. ‘None of the recommended procedures and protocols contained herein are intended nor permitted to conflict or impede compliance with the internal Policies and provedures of any partner agency Survey of Services MDT partners wil be given the opportunity to provide suggestions, feedback and insight through regular department head meetings and NCA Outcomes “Measurement System (OMS). Families served bythe CAC wil also be provided surveys requesting feedback and suggestions to further enhance the services provided Record Keeping ‘Bach agency wil maintain records according to its ageney’s current requirements and practices. + Laweenforcement, prosecution and OCYS will provide the CAC with additional data to ensure thatthe CAC is conducting 75% ofthe forensic interviews that moet the CAC case acceptance criteria. + The CAC will keep a record ofall MDT attendees, confidentiality agreements and MDT minutes that note the agency action items for each case. All meting notes and signed confidential agreements willbe on file inthe CAC office and canbe viewed by participating team members. ‘+ The Forensic Interviewer wil enter pertinent information into the CAC's database and provide aggregate reports tothe MDT on a regular basis + Forensic interview records are considered evidentiary and should not be shared with family members or outside agencas/individuls without a ‘court order or subpoena. Deuils on the maintenance and storage of Forensi interview audio and video recordings canbe found in the Forensi Interview protocol Confidentiality All information collected on clients ofthe CAC is to be considered sensitive and private. Members of the MDT, including CAC staf, will maintain strict confidentiality of client information and records a all times, as outlined in the ‘MDT protocol and procedures to follow. All MDT members and CAC staff sign a confidentiality agreement at each MDT ‘meeting. In the event meetings ae held virtually, prtiipants will sign using the chat feature. Signed agreements are kepton file atthe CAC's office. Case Review agendas, fllow up and recommendation emails ae sent using a secure network. 3 October 2022Allnon-essential meeting materials that contain personally identifiable case information are to be left atthe CAC and shredded immediately following the MDT meeting Separation of Victims and Offenders ‘The CAC's mission is to provide a safe environment fo children. Under no circumstances are alleged perpetrators allowed on the CAC premises. Additionally, no services may be provided by the CAC to alleged perpetrators. If ‘any known or alleged perpetrators enter the CAC, including those who have accompanied a child to the center, they will be asked to leave the premises mediately by staf and/or law enforcement personnel. Any required meetings ‘between law enforoement or CPS with alleged perpetrators should oceur offsite. Exceptions to this policy may be made only ifa child, who isan alloged offender, {is being interviewed as a potential victim. In these cases the interviews may ‘occur, but every effort willbe made to schedule these interviews at times when no ‘other children are present. In cases when this is not an option, particulary in the ‘ase of siblings, supervision ofthe children wall be provided by the CAC staff. CAC staff will notify aw enforcement and/or OCYS immediately ia child makes disclosure during a forensic interview, medical evaluation or therapy session ‘with implicates a person whois on the CAC’s premises atthe time. Cultural Competency ‘Tocffectively meet clients’ needs, the CAC and MDT are committed to understanding each client's worldviews, adapting practices as needed, and offering assistance in a manner in which it can be utilized. The CAC's intake process gathers information from referral sourees and clients to ascertain cultural, linguistie, and physical accessibility needs throughout the investigation, intervention and ease management processes. Language access sorvices are available to all elients and families, Clients and/or family members who are non-English speakers or deaf or hard of hearing wil be noted on the referral form. After the appointment is scheduled, the appropriate language access support will be arranged by the CAC (either a live or video interpreter). Case Review [MDT case review isthe formal process that provides a forum for reviewing cases \with input from all MDT partner agency representatives which enables the MDT tomonitor and assess its independent and collective effectiveness so as to ensure the safety and well-being of children and families. The process encourages ‘mutual accountability and helps to assure that children’s needs are met. sensitively, effectively and ina timely manner. In aocordance with the National (Children’s Alliance standards, every CAC must perform and document MDT Case ‘Review at least once per month. Case Review is intended to plan and monitor ceurrent cases and isnot intended asa retrospective case study. Emergency Case Conferences willbe scheduled when necessary.MDT Case Review serves multiple purposes including 4 October 2022Experience and expertise of MDT members is shared and discussed; Collaborative efforts ae fostered Formal and informal communications are promoted; Protocols and procedures are reviewed; and, Informed, collective decisions are made. Case Review also accomplishes the following Review interview outcomes; Discuss, plan and monitor the progress of an investigation; Review medical evaluations; Discuss child protection and other safety issues; Provide input for prosecution and sentencing decisions; Discuss emotional support and trestment needs ofthe child and family ‘members as well as strategies for meeting those needs; + Assess the family’s reactions and response to the childs disclosure and involvement in the eriminal justice and/or child protection systems, ‘+ Review criminal and dependency case updates, ongoing involvement of the child and family, and disposition; ‘+ Make provisions fr court education and support; ‘+ Discuss ongoing cultural and special needs issues relevant to the case; and, ‘+ Ensure tha all children and families are afforded the legal rights and comprehensive services to which they are entitled, AILMDT partners will have an appropriate representative participating at Case Review whenever possible, espetally when that agen has cases being reviewed. Case Review is held on a monthly basis andi coordinated and led by the CAC's MDT Coordinator who i a tained falitator. The facilitator wil seek input on Case Review seletions from all MDT members two weeks prior to the scheduled ieeting. Any MDT member may suggest a cas for review. The fcltator will ereate and send a final agenda for MDT Case Review including the eases to be reviewed and required attendees at east days in advance ofthe meeting Meetings are held via Webex or in-person at Lehigh Valley Hospta-a7th Street. ‘The CAC's MDT Coordinator serves as the MDT facilitator and ensures: ‘+ Reminders and agendas for meetings are sent ina timely manner; ‘+ Confidentiality statements are signed; ‘+ Case Review meetings are effectively facilitated; and, + Follow-up recommendations are summarized and communicated to the MDT. Case Criteria Any case of sexual abuse or suspected sexual abuse as defined below that involves a child between three and eighteen years of age and is under investigation by one of the MDT organizations is considered a CAC case. The determination of how ‘young a child is seen is made on a case by case basis and may be influenced by {xtenating ereumstances such as eommuncaton skis and/or developmental clays. 5 October 2022For purposes of referral, cases of suspected sexual abuse should be defined as one (or more ofthe following: + Disclosure of abuse, and/or ‘+ Witness of abuse by an adult or child, and/or ‘+ Exposure to a high-risk offender (i. adult in possession of child pornography, sibling/ household contact of child victim) ‘Cases that should also be referred but are not included in the official case definition include but are not limited to: + All cases of serious physica abuse meeting the definition below and allegedly committed by a parent, relative, guardian, or other person responsible forthe care ofa cil. ‘© For purposes of referral ll cases of serious physical abuse shall be defined as: “Any injury to @ non-mobile infant + Any injury ina child that is inconsistent with history provided or unaccounted for play/actvity typical for Aevelopmenta level ofthe child Patterned injuries to skin + TEN-4-FACESp: Bruising onthe torso (chest, abdomen, back, buttocks, genitourinary area), ear, neck, infant who i 4.99 months ot younger, frenulum, angle ofthe jv, fleshy part of the cheeks, eyelid, subconjunetivae, patterned bruising (bite loop, and slap, squeeze, grab, multilinear) Injures of difering ages Diselosure/witnessed event of injury/potential injury ‘+ Siblings of vitim child or other children in the same household where the abuse occurred + Cases of child maltreatment fatalities with surviving siblings may be referred tothe CAC. + Other eases not mecting the above definitions may be referred tothe team for investigation and review by a MDT participating agency. Possible referrals may include negleet/abandonment, kidnapping, child exploitation, child witnesses to injury or violent crime, including domestic violence or homicide. Case Tracking ‘The CAC tracks cases through a secure database in accordance with National CiidensAliance (NCA) guidlines. At minimum, the allowing dats Demographic information about the child and family Demographic information about the alleged offender ‘Type(s) of abuse Relationship of alleged offender to child MDT involvement and outcomes (Charges filed and case disposition in criminal court Child protection outcomes 6 October 2022‘+ Status/follow-through of medical and mental health referrals ‘+ Percentage of referrals for each agency made to the CAC meeting Case ‘Acceptance criteria [MDT partners wil provide ther data for ackingin a imely fashion and in Accordance with NCA requirements, Data recorded ina pswor’-potected State: Te Forensic ntervewer primary responsi electing and entering data and running agrepate monthly feprt forall NDT partners ‘including law enforcement, OCYS advocates the mental health coordinator and prosecution. The CAC wes the NCA Outcomes Mensurement System (OMS) to Cvelate client sere deiey racking datas sviabe sare upon ‘request by MDT agencies. This data is also shared with MDT partners on monly basi Investigations and Assessments Investigatio ‘+ Whenever possible all investigations will be join investigations, including, all members of the multidieiplinary team. + The Lead Police Investigator will direct al joint investigations. ‘+ Allinteractions with potential witnesses must be at the direction and/or With the consent ofthe Lead Police Investigator. ‘+ When OCYS has mandatory deadline to mee, all potential interactions \with any potential witness shall be communicated to the Lead Police Tnuvetigntar prior to netnal contact with anid potential witness + Noone may release any information toa suspect, except as is required by law. Such release shall only disclose the minimal amount of information required by law. Such release shall be shown to the Lead Police Investigator prior to disclosure to said suspect ‘+ Allinformation recovered during the course ofthe investigation will be ‘shared among team members. ‘+ The Lead Police Investigator shall interview the person reporting the suspected abuse in order to obtain as much background information as possible prior to making contact with the victim, the victim's family or suspect. + allehi terviews will be conducted by the CAC’s Forensic Interviewer. interviews shall be recorded per the Forensic Interviewing Protocol. Interview of the Family ‘+ The investigating team should interview the non-offending earetaker in person as part ofthe investigation, ‘+ Inintea-familial situations, CPS shall assess the non-offending parent's ‘capacity to believe, protect, and support the child throughout the investigation, Where there are siblings or other children in the home who ‘may have had contact with the alleged offender or who might have 7 October 2022,additional information, each should be interviewed in accordance withthe Forensic Interviewing Protocol, ‘Intensow of the Alleged Oender/Perpetitor Initial contact with the suspect should occur as soon as possible. + No team member may initiate contact with the suspect without the foreknowledge of the Lead Police Investigator. + Under no circumstance, wll any known alleged offender be permitted at the CAC. + Interviews of the suspect shall be done atthe direetion of the Lead Police Investigator + Joint interviews ofthe suspect will be conducted atthe dieetion of the Lead Police Investigator on a case by ease basis. ‘+ Itis understood that CPS may contact the alleged perpetrator immediately toascertain the safety of children. However, CPS shal contact and inform the Lead Police Investigator prior to contacting the suspect ‘+ The suspect's statement shall be writen, audio reeorded, oF video recorded, Medical Assessment and Examination * tis recommended that a physician with expertise in child maltreatment perform a medical examination in cases of suspected child maltreatment. + The law enforcement investigator will ensure that all pertinent evidence, medical reports, and written statements are collected. + See updated medical protocols based on eurrent evidence-based medicine. Case Decision-Making Desisions regarding Criminal Prosecution Decisions regarding ChildLine Referrals ‘+ OCYS makes the final decision regarding ChildLine referrals. Decision sgning an uminnt Rsk Assesment is responsible for assuring the safety ofthe child victim, as well as ter ten wh ey come econ ithe lege pores 8 October 2022‘sisions. on Custody of Chikren OCYS, medieal personnel, of law enforcement may take custody ofa child ‘+ Since the primary function of OCYS is the safety and welfare of children, it is preferred that OCYS take custody of children pursuant toa court order. However, medical personnel or law enforcement may take custody of ‘child under the following specifie circumstance: ‘physician examining a child may take custody of the child for 24 hours, itis immediately necessary to protect the child. + Law enforcement may take custody of a child ifa child is suffering from illnes or injury or is in imminent danger from his surroundings. Before fling the Investigation Outcome Report, the CPS worker will contact the jurisdictional aw enforeement investigator to advise him/her of the proposed disposition. ‘+ On the completion of the law enforcement investigation by arrest or the placing ofa case in the inactive status, the aw enforcement investigator ‘will notify the CPS worker ofthe disposition. + The Distriet Attorney shall notify the CAC on the final disposition ofthe prosecution. + The final authority to determine whether or not to initiate formal riminal actions remains with the District Attorney and the final authority to {determine disposition of the Investigation Outcome Report remains with ocvs' Case Resolution ‘Victim Jnformation and Suppart Case status updates and the outcome ofthe investigation are provided to the ition when appropriate and to non-afendingearegivers. + The investigative tam will identify a support system forthe cid vitim +The cid viet is provided ongoing emotional support and referral for treatment when nebded ‘+The non-offending caregiver receives support and education regarding child maltreatment and system intervention + Tho family is encouraged to seek out and fllow through on treatment for the child vitim. + The non-offending caregiver is educated about the special dynamics of child maltreatment to assist him/her in understanding what has ‘transpired and in supporting the child vietim. Court 2 : feneewrn ° October 2022Alleged child vietims of abuse willbe interviewed at the CAC unless specific circumstances require otherwise. The goals of the interview are to collect information that will either corroborate or refute allegations or suspicions of maltreatment, and to determine the identities and behaviors of al persons involved. An interview may be conducted with a child when there are concerns that he/she has been a viet of physial or sexual abuse or when a child has been a witness to a violent or abusive act perpetrated on another victim. ‘The interviewor should adopt a hypotheses-testing approach and maintain objectivity throughout the conversation, rensic Interviews are conducted by one ofthe following: ‘+ Fovencte Interview Specialist who has completed specialized training in conducting forensic interviews of 32 or more hours fom an NCA- approved training, who maintains ongoing education in the field of child maltreatment/forensic interviewing with st a minimum of 8 hours every thwo years and attendance of statewide or regional peer reviews at least tbeice «year at which the Forensie Interviewer participates in all four required elements of the structured pesr review process. + Specially trained Children and Youth workers, Law Enforeement officers/detectves/ criminal investigators, and/or Child Advocacy Center staff if the Forensic Interviewer is unavailable, CAC staf wll monitor the forensic interview. Witnessing forensic interviews will take place in the CAC observation room. Th some cases, the forensie interviewer may facilitate remote observation by MDT members who cannot be present on: site. This observation oceurs in realtime and allows for communication with team members throughout the process Partners viewing the forensie interview may include: + CACstat? CAClinical interns OC¥S Case Workers Law Enforeement officers/Aetectives/cviminal inv ‘Medical personnel 0 October 2022‘The Forensic Interviewer will complete a child forensic interview after a CAC referral requesting a forensic interview is received for a case that meets the case ‘acceptance criteria set forth in the CAC protocol. The forensic interview will be scheduled by the CAC staf who wil coordinate the team member's and family’s availability ‘Mult-session forensic interviews wil be completed on a case-by-case basis when determined by the MDT to be in the best interest ofthe child. Multi-session, forensic interviews will be conducted following protocals that have been csiablished by NCA-approved trainings by a forensic interviewer who has ‘completed said trainings. ‘The Forensic Interviewer will complete child forensic interviews for cases that ‘meet the following requirements: ‘+ The child that is being referred lives in Lehigh County and it would best serve the family to come tothe CAC. + The interview is requested and approved by the appropriate investigating agencies from the county/state that needs the interview. + The appropriate MDT members from the requesting county/state attend the interview or make arrangements for another member to observe the interview in their place. ‘Authorization wil be obtained from a parent or guardian to conduct and record the forensic interview. Ia parent or guardian is unavalabe to sgn the form, authorization may be obtained over the phone or by any other electronic means. ‘There willbe a parent/child orientation tothe video equipment, interview room and proces pio othe interview beginning. labor 22 Coos [Representatives from the fll MDT (CPS, law enforcement, prosecution, CAC personnel, victim advocacy, mental health and medical) are routinely present to share information in advance of the forensic interview and after its completion during pre-and post-meetings in an efort to avold unnecessary duplication of questioning, Ata minimum, CPS and law enforcement personnel ae present and ‘observe all interviews and facilitate information-sharing prior to and following ‘the interview. If the child is scheduled to reesive a medical exam, the medical, provider will make every effort to observe the interview as well. Information to be discussed includes but isnot limited to: re-Interviews Information regarding the child and their family ‘+ Information regarding the alleged offense(s) and the investigation ‘+ Special considerations regarding the child i. special needs, medical or ‘mental health diagnosis, medications, primary language, prior contact, ‘with the system, developmental level ‘+ Information regarding the child's culture and how the child identifies + Existence of any evidence u October 2022+ Inthe event that there is evidence the MDT wil discuss what the advantages/ disadvantages would be fr introducing it into the interview ‘and will make a joint decision on whether or not to do so cuss the results ofthe interview + Discuss needs for services such as counseling, exams and other community referrals ‘The Forensic Interviewer wil follow the structure of « NCA-approved protocol, such asthe National Children's Advocacy Canter Forensic Interview Structure ‘The Forensic Interviewer wil adhere to the following: + Alternating open-ended with closed-ended questioning of a non-leading and non- or minimally-suggestive nature + Closed-ended (directive directed) questions are appropriate to ect responses clarify responses, o seateh for farther abuse once the child has completed his or her disclosure in response to open-ended questioning + During a breakin the forensic interview, the Forensic Interviewer wil consult with the partners monitoring the interview to ensure that all appropriate areas of questioning were covered + Leading questions wil not be asked Only the Forensic Interviewer and the child wil be in the interview room during the interview. Exceptions to this will be made if there isa need for an interpreter. In such cases the interpreter wil bo in the interview room with the Forensi Interviewer and the child. Family members and friends are not permitted into the interview room or observation room, ‘The use of interview aids in the forensic interview willbe disoussed on a case-by- case basis with the MDT. Ifitis deemed necessary and appropriate to use a type of aid (for example, crayons and paper) the Forensic Interviewer will arrange to hhave these aids inthe room ahead of time. ‘The forensic interviow will be audio and video recorded, The Forensic Interviewer will state the date, time, name and date of birth of the child being interviewed and names of all observers and their roles on the recording prior to bringing the child into the interview room, * Audio/Video recordings will be labeled and stored in accordance with the ‘Maintenance & Storage Policy ineluded inthis protocol, + The Forensic Interviewer will keep a written log of ll interviews completed which will include the name of child, name of observers and zname of individual completing the interview. Except in exceptional circumstances, all forensic interviews shall be conducted at the CAC. Every attempt shall be made to video and audio record any forensic interview not conducted atthe CAC. In circumstances where it does not appear a child victim will disclose during the interview, the Forensic Interviewer may terminate the interview at any time. 2 October 2022,‘Members of the MDT will rview the circumstances on a case-by-case basis to determine ifa second or subsequent interview should be requested. Ifthe Forensic Interviewer believes that a second or subsequent interview is ‘worthwhile then it wil be scheduled. Circumstances include but are not limited tot child refusing to come into the interview room, child shutting down when {Bringa disclosure; or, child being unwilng to dscuss the reason for being Qutside Agencies ‘Asa courtesy, the CAC makes its facilities available to trained and qualified personnel from state and/or federal agencies who may request to conduct, forensic interviews. + The CAC requests that visiting law enforcement personnel conducting interviews at the CAC should do so in plain clothes and with their weapons ‘concealed. + Because this i a courtesy, linkage agreements will not be kept with these agencies. eee ‘fa child makes a secondary disclosure at the CAC, a new report will be made to ‘the appropriate agency, ‘Who May View the Forensic Interview. ‘+ Representatives of agencies (law enforcement, OCYS, District Attorney, AC) who are investigating or who may investigate the incident lading to interview. ‘+ Others with legitimate therapeutic objectives (e.g. those providing psychological care) may observe, if approved by the Supervisor of the Special Offense Unit from the Distriet Attorney's Office. All viewing the interview must first know and agree that they will be subjet to subpoena, ‘with respect tothe interview. If thisis not acceptable, they wil not be permitted to view the interview. + Those in training to serve in agencies which investigate child abuse, as approved by the MDT. + Those training in professions providing medical or psychological care for abused children (medical students, residents, those earning graduate and post-graduate degrees), as approved by the CAC, and by the MDT. ‘Who May Not View the Forensic Interview ‘Members and friends of the family. In exceptional circumstances, a ‘member ofthe family may be permitted to be present in the interview room fora short time, until the child becomes engaged in the interview, at the judgment of the Forensic Interviewer. If family member is permitted to be present in the interview room, he or she wil tll the child that he or shes leaving the interview room, and will leave, a the request of the interviewer. Once requested to leave, the family member is not permitted to view the remainder of the interview. Ifthe family member does not leave when requested, the interview will be terminated, 3B October 2022‘+ Attomeys representing the child, family, or other partis involved in legal actions pertaining to the reason for the child's evaluation. ‘+ Others not from an authorized agency, not in traning, and without legitimate therapeutic objectives. 0 ing ‘+ Audio/Video recordings wll be labeled with the sequential number ofthe ‘recording followed by the year ofthe reeording, the child's name and date of birth, the date the of the interview and ifit isan original ora copy. ‘+ The audio/video recordings shall be stored in an area that shall be locked at the CAC. The Supervisor of the Special Offense Unit ofthe District “Attorney's Office, the Child Abuse Investigator for the District Attorney's Office, the Executive Director of the CAC and the Forensic Interviewer at the CAC shall be the only people with keys to the storage unit for the audio/video recordings. ‘+ Audio/video recordings wil be stored in sequential order by year. ‘Upon conclusion ofthe interview ofthe child the audio/video reco shall immediately become the property of ‘0. The Lehigh County District Attorney's office. Such recordings shall be released to an Assistant District Attorney on site, or toa person assigned the responsibility to receive the recordings on behalf ofthe District Attorney's office (The Child Abuse Investigator from the Lehigh County District Attorneys Office) © Lehigh County Office of Children and Youth Services (OCYS) conducting the investigation, if the Lehigh County District ‘Attorney's office isnot involved. Such recordings shall be released ‘to OCYS personnel onsite, or to a person assigned the responsibility to receve the recordings on behalf of OCYS. © CAG, ifneither the District Attorney's office nor OCYS is involved at the time ofthe interview. © Ifthe recordings are in the possession ofthe CAC, and a police ‘agency and/or the Lehigh County District Attorneys office subsequently becomes involved, the recording shall become ‘property ofthe District Attorney's offic, © Ifthe recordings are in the possession ofthe CAC, and OCYS, ‘subsequently becomes involved, but the Lehigh County District ‘Attorney's offce does not become involved the recording shall ‘become the property of OCYS, Ifthe interview was completed asa courtesy for another ‘county/state, the recording will be released to the appropriate law enforcement or OCYS agency for that county/state. ‘+ Upon conclusion ofthe interview of the child the Forensic Interviewer will produce two original audio/video recording DVDs. One will be stored in October 2022,the locked storage unit; the second will be provided to the individual representing the agency of whieh itis the property. Law Enforcement Children and Youth Services Children and Youth Services is guided by legal mandates to investigate child albuse in keeping with the Child Protective Services Act, to protect children from abuse and neglect, to preserve the family, if possible, and offer services for rehabilitation when needed, ‘+ The Child Protective Service (CIS) Units of the Lehigh County Uffice of Children and Youth Services (LCOCYS) are responsible for investigeting reports received involving suspected child maltreatment that is alleged to hhave occurred in Lehigh County. ‘+ Pursuant tothe Child Protective Services Law, Title 28, Chapter 63 (CPST) LCOCYS will routinely report to the appropriate law enforcement agency and Distriet Attorney all referrals of suspected child maltreatment received by LOCYS which involve possible criminal offense. ‘+ Each CPS Unit is responsible for collecting and preserving, information related to the investigation that may needed to initiate and support ongoing court aetion in Juvenile Court. CPS will provide such information to the District Attorney which may be used to prepare petitions and other court documents in Criminal court + Each CPS investigation concludes witha status determination based on the evidence gathered and an investigation report is electronically flea with Pennsylvania's ChildLine + The CPS Units are responsible for decision-making throughout the investigation as to whether the child i in need of protection and/or services within the guidelines established in the Juvenile Act, 42 PA CS. See 630: and CPSL. During each investigation, CPS is responsible for assessing safety and risk factors foreach child in the family and developing and supporting case plans to address those factors as identified, 5 october 2022‘+ CPS caseworkers will participate in Case Review team meetings when theit cases are scheduled for review or assign a representative to share those updates, District Attorney Medical Services ‘ team of specially-trained Child Protection Medicine physicians from Lehigh Valley Health Network conduct medieal exams on-site at the CAC in designated «cases of suspected child maltreatment. The Chief of Child Protection Medicine, = board-certified child abuse pediatrician, reviews all findings deemed abnormal Eveu in cases where no medical findings could result from abuse, examination is provided forthe ehild for reassurance reasons, Who Ressives a Medical Exam All children being evalusted the CAC willbe offered s medical evaluation and will be eon by a medical provider at the time of the initial visit. On the rare ‘occurrence when a medial provider is not available, the child will be rescheduled fora medical evaluation 6 (etober 2022‘Medical cae is provided to all children regardless of ability to pay. No child will ‘be denied media care beau oflck of medi insurance or third party souree of payment. When the child has medical insurance, the insurer is billed for ‘the medical evaluation unless the accompanying caregiver declines or such billing is contra-indiceted, Caregivers and children never receive a bill for medical, or any CAC services. ‘The purposes of a medical evaluation include: + Ensure the health, safety and well-being ofthe child + Evaluate each child and diggnose and treat medical conditions which may be the result of abuse + Evaluate, document, diagnose and address medical conditions resulting from abuse and to arrange appropriate follow up as required by the primary care physician andjor specialist ‘+ Differentiate medical findings which may mimic findings of abuse but ‘Which may be explained by other medical conditions ‘+ Document, diagnose and address medical conditions unrelated to abuse ‘+ Assess the child for any developmental, emotional or behavioral problems needing further evaluation and treatment and make referrals as necessary + Reassure and educate the child/earegiver + When appropriate, refer for counseling or mental health evaluations to address trauma related to abuse or assault + Communicate results ofthe medical evaluation to the child (when appropriate forthe child's aye) to Une child's accompanying caregiver, and Fy team members ‘+ Review past medical records, when indicated, for medical information related to possible abuse or neglect Me Pro Medical evaluations are available at the CAC from 8:30-5:00 pm Monday through Friday. Referrals for emergency evaluations after hours are made to the Children’s Emergency Room at Cedar Crest. Children may subsequently be referred to the CAC for follow-up medical evaluation and forensic interview. ‘A medical provider meets with non-offending guardian(s) or caretaker(s) ofthe child while the child is undergoing his/her forensic interview. Past medical history, social history, behavioral risk factors, and the guardian's understanding ‘of the reason for the evaluation are reviewed. When appropriate forthe child's ‘age and developmental level, the medical history is algo reviewed with the child, along with a personal health history tthe conclusion of the forensic interview, the medical provider meets with the interviewer and with all members ofthe investigative team who are present. Information from the forensie interview is discussed briefly, as well as background information. 0 October 2022Medical examinations are performed by a CAC medical provider. The child may ‘choose to be accompanied by a non-offending caregiver, or by the family advocate. There will always be a medical assistant or a second hospital personnel in the examination room with the child and medical provider. Documentation of medical evaluation is recorded inthe medical record, and by typed reports. Verbal reports are given to investigators when present. The ‘medical providers are availabe to speak with investigators by telephone and at ‘CAC Case Conferences for information/ clarification as needed. Written reports are sent to investigators using an enerypted e-mail and with proper signet releases and as allowed by law. ‘The medical providers adhere to the following guidelines: ‘+ Adecision is made by the medical provider based on all information ble as to whether a physical examination would be in the best sts of the child, ‘+ Anexamination is offered forall children even if there are no disclosures, or disclosures are not expected to leave medical findings, for reassurance purposes ofthe child or guardian, ‘+ Nochild is examined against the will ofthe child, and no child is held down for an examination. + Ifthereis a potential if threatening situation which mandates immediate examination ofa child, all efforts are made to reassure a child as to the painlessness of examination, ‘+ Inthe rare situation of vaginal bleeding or other need for emergent ‘examination inthe face of an unwilling child, the child wil be referred to the Children's Emergency Room at Lehigh Valley Hospital - Cedar Crest for assessment and examination under anesthes ‘+ In non-urgent situations where medical evaluation is indicated but the child is unvalling, a follow-up examination may be scheduled forthe child. Interim counseling or pay therapy is encouraged, Medical providers are active members ofthe MDT who: ‘+ Ate privy to all information gathered at every step of the process. Prior to the medical exam, the child's incident report, forensic interview report and any other relevant medical history information are shared with the CAs ‘medical provider performing the exam. ‘+ When possible, attend the forensic interview to avoid duplicative ‘questioning of the child. If the medical provider eannot attend the forensic interview, they will consult with the forensic interviewer prior to the exam, + Attend MDT meetings on a regular basi, discussing individual medical ‘evaluations with the team, participating in Case Review discussions, ‘making referrals to other providers as needed and tracking medical, developments and outcomes, + Take an active role in educating the CAC’ staff and MDT with regard to the nature and purpose of the medical evaluation, ‘Assist other team members in educating clients and their families about the medical evaluation 8 October 2022+ Anogenital examinations for suspected cases of sexual abuse are photo documented unless refused by the child or guardian, ‘+ The photo documentation is secured in a protected hospital network drive. ‘+ Description ofthe examination is included in the physical examination Portion of the consultation report. ‘+ In the majority of ehildren, photo documentation ofthe anogenital ‘examination is done, even inthe absence of abnormal findings, to allow for peer review, second opinions, and to help avoid the need for repeat examination. ‘+ Collection of Sexual Assault Kitis dane when there has been sexual contact within 72 hours and the child has not showered, bathed, or gone swimming. + These kits and any clothing are managed by the medical provider to ‘antin chain of uscd, unt given to the appropriate lw enforcement + Only State of Pennsylvania authorized Sexual Assault Kits are utilized. Instructions are followed including appropriate labeling and storage as ‘mandated by Pennsylvania state instructions and guidelines Phy or Neglect ‘+ Injuries which are suspected to have resulted from of physical abuse or neglect are photo documented and unaltered copies of these images ere provided to investigators. ‘+ Digital photos are taken using w handheld camera ‘+ Law enforcement and OCYS, as requested, will be sent photos securely via email ‘+ Pennsylvania's Child Protective Services Law states that consent is not required when photographs are taken because of suspicion of abuse. ‘Emergent Appointments ‘+ Acute sexual assault (© If itis determined that the alleged sexual abuse occurred within 72 hours and itis after normal business hours, the child should be referred to the Children's Emergency Room at Cedar Crest for examination by a SANE professional (Sexual Assault Nurse Examiner) Ifthe child is experiencing genital, rectal pain or bleeding or severe discharge, or other bodily injury that may be the result of sexual assault or abuse, and the CAC cannot accommodate this emergent appointment, the child should be referred to the Children's Emergency Room at Cedar Crest. + Acute physical injuries: © All children less than 3 years of age with any acute injury should be referred to the CAC of, after hours, to the Children's Emergency Room at Cedar Crest. 9 ctwber 2022(© All children less than g years of age with fractures or head injury should be referred to the Children's Emergency Room at Cedar Crest with notification ofthe CAC Medical Provider(s). (© Children over the age of 3 with isolated cutaneous injury may be seen at the CAC. If an emergent appointment is requested by investigators and the CAC cannot accommodate the child, a referral should be made to the Children's Emergeney Room at Cedar Crest. ‘Medical Provider Qualifications: ‘+ The medical team is comprised of specally-rained physicians and nurse practitioners. + The medical director is board-cligible or board-certified inthe sub- specialty of Child Abuse and Neglect as defined by the American Board of Pediatrics, ‘+ This physician engages in training opportunities and peer review to ‘maintain and enhance lineal skills, and supervises the nurse practitioners. ‘+ Nurse practitioners have pediatric experience and have completed medical ‘taining course(s) offered through the NCA. ‘+ Nurse practitioners function independently and in accordance with rules and regulations ofthe respective State Boards of Nursing or Medicine. All, ‘mid-level providers are full supported by the physician(s) and have telephonic access for consultative purposes as necessary. ‘+ New providers willbe required to complete the Midwest Regional Child Aadvoeaey Center's Care Mestieal Trainings within ane yoar of hire irector, and are reviewed again during peer review sessions. Medical providers are required to participate in ongoing continuing education including, butnot limited to: ‘+ Medical peer review via teleconference through the Midwest Regional (Chik Advocacy Center or in-person, quartely per review at a esignated location, ‘+ CEU/CME credits in ongoing education in the fields of physical and sexual ‘abuse to exceed the minimum of 3 hours every 2 years. The following ‘describe the opportunities for continuing education and peer review’ °° Informal or formal consultation with network of child abuse specialists at Children’s Hospitals when needed. jon at child abuse conferences and tr © Routine review of journals including Child Maltreatment, Child ‘Abuse and Neglect, and APSAC Advisor. ing opportunities ‘on medical issues to members ofthe multiisciplinary team during a child's evaluation and at Case Reviews. 20 October 2022+ Provide education to community members, residents, and community physicians on medical aspects of child abuse, + Actasa consultant to investigators on medical aspects of child abuse nd neglect. + Provide telephonic consultation to primary eare physicians and other ‘medical providers. ‘+ Examine children referred by a medical provider for a second opinion of possible medical finding. ‘Testify in court wien subpoenaed. i Strict confidentiality of all records containing a patient's name and protected health information is to be maintained in accordance with Lehigh Valley Health Network policies. ‘+ Written or verbal authorization will be obtained from the parent or legal {guardian to release information to agencies involved in the investigation, evaluation and treatment of their child seen at the CAC. ‘+ Written or verbal information may be disclosed without parent/guardian authorizations to Children and Youth Services, if Children and Youth Services has an open investigation pertaining tothe child under the C Protective Services Law, Chapter 63 ~ Title 23 § 6313 (PA CPSL). ‘+ Written or verbal authorization is requested from the parent or legal guardian to allow release of information to the child's primary medical provider + The wulliotization orm used at the CAC includes the dated signature of te patient or guardian and of a witness. The authorization form expires one year from the date of the authorization and is so indicated on the form. ‘The authorization form informs persons giving authorizations thet the authorizations may be revoked by their written request. ‘+ Medical information to the multidisciplinary team members may be faxed (or emailed. Emails will be encrypted before sending. ‘+The person releasing medical information must document, by written note entered chronologically in_the progress notes of the patient's medical record, the date and time of disclosure of the information, the information disclosed, to whom it was disclosed, the method of affirming the identity of the petson to whom the information was disclosed and the method by ‘hich the information was transmitted andor received. ‘Mental Health Services ‘Mental health services ae intended to help child victims and non-offending family/caregivers cope wit trauma-related symptoms. These services are provided without regard to their ability to pay. li ‘The mental health coordi aster’s-prepared, licensed mental health professional trained in evidence-based modalities including but not limited to Trauma-Focused Cognitive Behavioral Therapy and can provide individual and family therapy. a October 2022‘+ The mental heslth coordinator participates in regular supervision with senior mental health professionals at Lehigh Valley Health Network. ‘Erocess for Providing Mental Health Services Information on mental health service options forthe child vitims(s) and ‘non-offending caregivers is provided to all families involved in an open child maltreatment investigation, ‘+ Areferral by any MDT member can be made to the CAC for mental health Services even in cases wherea child is not initially seen at the CAC. ‘+ The mental health coordinator provides assessment and treatment services in-person and via telchealth ‘+ Referrals may be assigned to local mental health professionals with whom. there are signed linkage agreements with the CAC. + Information relevant tothe protection of a child will be shared with the [MDT with respect given to the professional's responsibility to protect lent confidentiality. ‘+ The mental health coordinator will participate in MDT Case Review and advocate for the mental health needs ofthe alleged child vietim and their rnon-offending care givers ‘+ The mental health coordinator will offer expertise to the MDT regarding ‘mental health and effects of trauma that may be helpful to the child ‘maltreatment investigation. + To protect the welfare of the child, as well asthe confidentiality of information, forensic interview records are kept separately from therapeutic intervention records. + CAC mental health professionals are not permitted to disclose confidential information, such as treatment details, to investigators or other MDT ‘members except in the case of additional allegations disclosed during ‘weatment Family Advocacy ‘Thecompler proms of hld maltreatment ypially require more than aes, ‘mei and ental heath response Specisd vm sept snd edveaeh serve ae desigied oredue ana olden, improve outomes of Snvegtone a prosecutions and prvie cel support and intervetion othe non-fending patentee. Fun avocay illbe Provided byte Ful Advocate tnd other member of the CAC tam who kav Parcpated in egired Neon Glens Allance ining and the requ 8 ours of contning dcnton every wo yeas. Advocacy services are offered to all CAC clients and are available at al stages of investigation, prosecution and treatment. These evies include but are not sited ts ‘+ Conducting crisis assessment and intervention, rsk assessment and safety planning. 2 October 20224+ Assessing the individual needs, cultural considerations for child/family and ensuring those noods are addressed *+ Providing education regarding provision of and access to victim's rights and erimevitin's compensation + Assisting clients in procuring concrete services (housing, protective orders, dems vlencentervento, od teanepoation pbc aman, ate) + Referring clients for trauma focused, evidence-based mental health ‘treatment, ifnot available at the CAC. + Providing transportation assistance ss necessary to interviews, treatment, and other caseelated meetings. + Participating in MDT Case Review to: communicate and discuss the "unique needs ofthe child and family and the associated support servies planning and ensure the seamless coordination of services. + Updating the family onthe cas tats, continuances, dispositions, sentencing, et. + Coordinating case management services with ll individuals providing vietim advocaey services. nal Family Advocate responsibilities include * Being present atthe pre-meeting before the forensic interview to discuss and share information with the investigator and forensic interviewer. * Conducting the pre-interview session with the caregiver to collect information about the family, the alleged abuse and any other related information that might be relevant to the interview such ay developinenil ‘or medical needs, special needs, language barriers, and/or cultural issues that might impact the interview with the hild ‘+ Meeting with the caregiver postinterview to conduct a needs assessment, and educate about available mental health service, vietim compensation information, referals for follow-up services, and/or any other appropriate materials ‘+ Provide information as needed about community resources available to help with basic needs including food, rent, clothing, housing, utilities and transportation. * Conducting foliow-upe with families to check on ther status, offer support and/or additional referrals at all stages of involvement with the CAC. + Ensuring that all services are provided in a cultually-competent manner Snauding assuring that language acess Services are provide as needed to ents. ‘+ Providing the victim witness with a better understanding ofthe justice process and his/her role ‘+ Keeping team members informed of the family dynamics and the child and {family’s attitude toward prosecution. John Van Brakle Child Advocacy Center (CAC) ‘The CAC i responsible for providing an avenue to lessen the emotional trauma to children by coordinating multdiseiplinary investigation, assessment, prosecution 2 October 2022‘and treatment of child abuse. The CACS role is inclusive ofthe following: Data and Information Sharing 1. CAC will tack client demographics such as age, sex, victimization race and ease outcomes. 2, The CAC will maintain a case-tracking database to assist in the effective partnering and sharing of information. Mukacpinary Team ‘CAC will take the lead in gathering information needed from the Assistant District Attomey, Child Protective Services, and Law Enforcement to determine ifa case should be scheduled for a MDT Case Review. 2, CAC will comple alist of cases to be reviewed at each MDT meeting and participate in and facilitate the meetings. 3. CAC will document and use the information gathered. Forensic Interviews 1. The CAC il schedule all forensic interviews and will provide space and ‘equipment for forensic interviews. 2, During intake the CAC staf will meet and discuss family issues and needs with the parent/guardian and will provide the child and family a tour the facility. 3. The CAC will have the family sign appropriate paperwork. ‘4 Upon completion ofthe interview CAC will falitate the post-interview ‘meeting with CPS, and Law Enforcement. ED October 2022John Van Brakle Child Advocacy Canter Protocol Signature Page ‘We, the undersigned, do hereby acknowledge that we have reosived a copy and seta appr nano prt mero te san Van ect sera and pysial cbueonen Dated this 14 day of Dewabrr20 22 Aba ‘Aanaafotrator, LVH-a7th Street Compas and Program Diecor Yor School-Based Health andthe Guid Advocacy Center aly Haas Nato Ct Off rototon Nokian (~~ FR, emo oF forsee ‘esta Falls Dp fl 2, Cte Of of Cask Yh Banas as (Ouober 2002