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HomeMy WebLinkAboutContract 61052CSC No. 61052 t children's advocacy center FOR NORTH TEXAS MULTIDISCIPLINARY TEAM WORKING PROTOCOL FOR DENTON COUNTY January 2024 OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX I. Mission Statement The mission of the Children's Advocacy Center for North Texas is to empower child abuse victims, their families, and the community through education, healing, and justice. II. Goals and Objectives The goal of the Children's Advocacy Center for North Texas is to develop a cooperative team approach to investigating child abuse through interagency communication and collaboration. Further, through the Advocacy Center's team approach, we develop, maintain, and support an environment that emphasizes the best interests of children and families and supports investigative services. Children's Advocacy Center for North Texas (CACNT) will assess victims of child abuse and their families to determine their need for services relating to the investigation of child abuse and provide or refer for such services. The Advocacy Center provides trauma -informed, evidence -based mental health and victim services designed to reduce or mitigate trauma symptoms of the child and promote healing for the child and the child's safe caregivers. Children's Advocacy Center for North Texas's multidisciplinary team (MDT) is a group of professionals who represent various disciplines and work collaboratively from the point of a child abuse investigative report to ensure the most effective coordinated response possible for every child. While the Advocacy Center provides a facility at which our MDT can meet, the goal is a systemic response ensuring interagency collaboration with a focus of reducing trauma to children and families, improving services, and preserving and respecting the rights and obligations of each partner agency to pursue their respective mandates. The coordinated response of the MDT ensures we are reducing —to the greatest extent possible —the number of interviews required of a child victim and minimizing the negative impact of the investigation on the child and family. Through interagency collaboration and the Advocacy Center's coordination of the team, Children's Advocacy Center for North Texas's MDT facilitates the efficient and appropriate disposition of a case both criminally and civilly. III. Multidisciplinary Team A. Participating Agencies 1. MDT Partners Child Abuse Team Children's Advocacy Center for North Texas's Partner Agencies include the Texas Department of Family and Protectives Services (DFPS), all law enforcement agencies in Denton County, the Denton County District Attorney's Office, Denton County Juvenile Probation Department and medical providers and professionals. All members of the Advocacy Center's staff are members of the multidisciplinary team. 2. MDT Partners Child Sex Trafficking Team Includes all partners from the Child Abuse Team, the Care Coordinator (CC) at Children's Advocacy Center for North Texas, and all Commercially Sexually Exploited Youth (CSEY) agencies servicing Denton County. 2 B. Roles and Responsibilities 1. MDT Partners Child Abuse Team i. Law Enforcement: The appropriate law enforcement agency investigates and determines whether a crime has been committed and to present information to the proper authorities for prosecution. Law enforcement partners agree to: a. Work collaboratively with DPFS on joint investigations. b. Refer cases to Children's Advocacy Center for North Texas that meet specified criteria (defined in Section IV below). c. Routinely share information among team members and provide information about case status as needed and as allowed by law. d. Observe forensic interviews related to their assigned investigation. e. Make every effort to interview the suspect/perpetrator prior to filing the case with the District Attorney's Office. f. Be an active participant in case review meetings. g. Provide constructive feedback and education regarding criminal investigations. h. Attend New Team Member Orientation regarding CACNT services, the multidisciplinary investigative process, and other relevant cross -discipline trainings. i. Participate in Advocacy Center activities including ongoing education, community education efforts and team building programs. ii. Texas Department of Family and Protective Services: DFPS is responsible for the protection of children, older adults, and adults with disabilities. DFPS is mandated to take civil action necessary to protect children from abuse and neglect. DFPS partners, including Agents of the State, agree to: a. Work collaboratively with law enforcement on joint investigations. b. Refer cases to Children's Advocacy Center for North Texas that meet specified criteria (defined in Section IV below), when appropriate. c. Routinely share information among team members and provide information about case status as needed and as allowed by law. d. Observe forensic interviews related to their assigned investigation. e. Be an active participant in case review meetings. f. Provide constructive feedback and education regarding civil investigations and child safety. g. Attend New Team Member Orientation regarding CACNT services, the multidisciplinary investigative process, and other relevant cross -discipline trainings. h. Participate in Advocacy Center activities including ongoing education, community education efforts, and team building programs. iii. Denton County District Attorney's Office (DA): The DA's Office is responsible for assessing the criminal aspects of a case in accordance with their prosecutorial role. A District Attorney prosecutor may request that a law enforcement agency file a case for review and/or prosecution. District Attorney partners agree to: 3 a. Routinely share information among team members and provide information about case status as needed and as allowed by law. b. Attend New Team Member Orientation regarding CACNT services, the multidisciplinary investigative process, and other relevant cross -discipline trainings. c. Be an active participant in case review meetings. d. Provide constructive feedback and education in line with current case law. e. Assist with ongoing training in the field of criminal investigation and prosecution. f. Participate in Advocacy Center activities including ongoing education, community education efforts and team building programs. iv. Denton County Juvenile Probation: Juvenile Probation is responsible for assisting in and referring any child abuse victims in the juvenile system to Children's Advocacy Center for North Texas and providing the multidisciplinary team with any pertinent information on any cases in thejuvenile system. The probation department also solicits information from the multidisciplinary team to assist in making recommendations or treatment decisions during case dispositions where a juvenile committed the alleged offense. Juvenile Probation partners agree to: a. Routinely share information among team members and provide information about case status as needed and as allowed by law. b. Attend New Team Member Orientation regarding CACNT services, the multidisciplinary investigative process, and other relevant cross -discipline trainings. c. Be an active participant in case review meetings, as available. d. Provide constructive feedback and education regarding the juvenile justice system. e. Participate in Advocacy Center activities including ongoing education, community education efforts, and team building programs. v. Medical Team: The medical team is comprised of highly trained professionals who specialize in conducting medical -forensic examinations of victims of sexual assault and victims of serious physical abuse. Partnering agencies include Children's Health - Referral and Evaluation of Abused Children (REACH) team, Child Advocacy Resource and Evaluation (CARE) Team, Texas Health Resources Denton SANE Team, and Children's Advocacy Center for North Texas medical providers. The role of the medical professional is to provide medical treatment and diagnosis to any child subject to allegations of child abuse and in need of medical evaluation. These specialists also provide medical information, recommendations, and consultations regarding the needs of the child. This includes medical examination for concerns regarding physical abuse, sexual abuse, and/or medical or physical neglect. a. Routinely share information among team members and provide information about case status as needed and as allowed by law. 4 b. Attend New Team Member Orientation regarding CACNT services, the multidisciplinary investigative process, and other relevant cross -disciplinary trainings. c. W en clients present to medical first, work to ensure that clients get appropriate follow-up services, and get connected to the multi -disciplinary process. d. Be an active participant in case review meetings, as available. e. Provide constructive feedback and education regarding medical forensics. f. Participate in Advocacy Center activities including ongoing education, community education efforts and team building programs. g. Be available to aid in the criminal justice process by being available for court testimony regarding medical issues. vi. Children's Advocacy Center for North Texas Staff: Advocacy Center staff are responsible for the general operation and maintenance of the facility. All members of the Advocacy Center staff are members of the multidisciplinary team. a. Partner Relations staff agree to facilitate and coordinate joint investigations by partner agencies, including the review of DFPS reports and create a warm and welcoming environment for partners. b. Client Services staff agree to provide victim advocacy services and assist partner agencies with forensic interviews in a neutral and supportive manner. c. Clinical staff agree to provide trauma informed mental health services to victims and family members and provide input and recommendations to the MDT regarding the emotional needs and well-being of child victims. d. Medical staff agree to provide trauma informed medical services to victims and family members, ensuring the medical evaluations assess the victim for any medical, developmental, emotional, or behavioral problems needing further evaluation and treatment and, in coordination with the MDT, make referrals, as necessary. 2. MDT Partners Child Sex Trafficking Team Includes all partner roles and responsibilities from the Child Abuse Team and the following: i. Care Coordinator (CC) The Children's Advocacy Center for North Texas serves as the CST Care Coordinator. The Advocacy Center coordinates with all participating agencies and service providers to ensure a strong, cohesive and collaborative approach to all victims of CST from identification through the investigation process until case has been discharged from the Care Coordination Team. The Care Coordinator will also ensure resources are identified and utilized when needed and critical relationships are cultivated and maintained amongst the CST Care Coordination Team and community agencies. ii. Commercially Sexually Exploited Youth (CSEY) Advocate Agency The role of the CSEY Advocate Agency is to provide advocates for victims throughout the process of crisis response, crisis intervention, crisis management, and long-term care management. Advocates are responsible for personal contact and rapport with the victim from initial contact. Advocates manage coordination of services from the victim's side, 5 ensuring that the victim is well heard and well served by other CST service providers. Advocacy services are provided in support of needs of law enforcement/first responders and service providers with prior relationships with victims. Each of the above -mentioned participating agencies has specific responsibilities regarding the investigation, prosecution, medical and therapeutic treatment in cases of child abuse, child sex trafficking (CST), and child fatality investigations. Together, we commit to the multidisciplinary team approach through the Children's Advocacy Center for North Texas and acknowledge it will serve to enhance the individual efforts of each agency and will unify our community in the daily work of ensuring the protection of the children of Denton County. IV. Case Criteria A. Texas Department of Family and Protective Services (DFPS) and Denton County law enforcement agencies will refer the following cases to Children's Advocacy Center for North Texas for services, when appropriate: 1. Child victims of allegations of a sex crime, including sex trafficking, child pornography, and online child exploitation 2. Adult victims of allegations of a sex crime, including sex trafficking, child pornography, and online child exploitation, when the adult has developmental delays that impair communication. 3. A suspect admits to sexual abuse of a child or an adult with developmental disabilities. 4. Child victims of allegations of severe child physical abuse as determined by the investigative agencies. 5. Children who have witnessed violent crimes as determined by the investigative agencies, sexual abuse, or severe physical abuse. 6. Child fatalities: The Advocacy Center can provide case coordination, special case reviews and/or services for the family, including surviving siblings. 7. A child under 18 years of age who comes into contact with Law Enforcement or DFPS, under circumstances that may be indicative of child abuse, child sex trafficking, and/or exploitation. B. CST High Risk Youth (HRY) 1. Children contacted by anyone in circumstances that would give a prudent person reasonable suspicion the child is being encouraged or compelled to engage in sexual conduct. 2. Children who are reported missing or runaway to law enforcement and other professionals, more than four (4) times in a 12-month period. 3. Children who are 12 years of age or younger and are missing or runaway. 4. Children who have been a runaway and missing for over (30) consecutive days. 5. Children with two (2) or more separate incidences of sexual abuse and/or exploitation in a 12- month period. 6. Children screened using a validated commercial sexual exploitation tool and scored within a range of clear concern for commercial sexual exploitation upon completion of a forensic interview. 7. Children in DFPS conservatorship, who are missing, or are on runaway status. 8. Missing or runaway children under 18 years old suffering from any mental or physical disabilities. X Children's Advocacy Center for North Texas may provide services to children in cases not meeting the above criteria when the referring agency sees a need for a multidisciplinary approach. Children's Advocacy Center for North Texas primarily serves child victims, ages 0-18 and appropriate family members in Denton County. This includes cases in which the child is: 1) a resident of Denton County and/or 2) the offense is alleged to have occurred in Denton County. As a courtesy service, the Advocacy Center will serve clients from, and work with, multidisciplinary teams from other counties upon request. 3) Under special circumstances, the Advocacy Center may provide services to primary victims over the age of 18, including adults that have developmental delays functioning at a mental age younger than 18. Texas Family Code (264.4061) states a DFPS referral made by a professional alleging any of the criteria above will be referred to Children's Advocacy Center for North Texas and the Advocacy Center must respond. It further states any interview of a child conducted as part of the investigation must be a forensic interview conducted in accordance with this working protocol unless a forensic interview is not appropriate based on the child's age and development. However, the forensic interview is not the only point of entry for children or families to receive services. Sensitive Cases: Situations involving direct team members, CACNT staff, and/or their immediate family members as alleged victims or offenders, will be considered sensitive. At the discretion of the Director of Partner Relations or designee, forensic interviews and counseling services for these sensitive cases may take place off -site. Confidentiality will be maintained, and these sensitive cases will not be reviewed in the case review meetings. Any sensitive cases needing a case review will be scheduled as a special case review. V. Case Coordination Services A. Multidisciplinary Team Coordination The MDT's collaborative response begins with case initiation and continues through the investigation, service provision, and prosecution or appropriate disposition of the case by the Multidisciplinary Team. Children's Advocacy Center for North Texas provides Multidisciplinary Team Coordinators and Director/Assistant Director of Partner Relations to strengthen and sustain the MDT with coordination and collaboration between partners to ensure timely access to services for victims and their non - offending family members. A primary tool used by the Advocacy Center to facilitate a coordinated approach to cases are the intake reports generated by the Department of Family and Protective Services (DFPS). DFPS reports are delivered to CACNT via case -tracking system, Apricot 360. Children's Advocacy Center for North Texas's role in reviewing DFPS reports is to identify which reports meet accepted criteria (defined in Section IV of these protocols) and facilitate Advocacy Center/MDT services related to case investigation, assessment, and intervention. Services provided by Children's Advocacy Center for North Texas may include: 1. Forensic interviews 2. Victim support and advocacy 3. Medical evaluations 4. Mental health services 5. MDT case review 6. Case coordination 7 MDT Coordinators review DFPS reports and initiate a response by the MDT within 72 hours (on average), when appropriate. The MDT's response is documented in Children's Advocacy Center for North Texas's case -tracking system. MDT responses include referring the case for any of the services listed above or determining through a coordinated approach that CACNT services are not needed. Children's Advocacy Center for North Texas's access to DFPS reports shall not be construed to change, reduce, or expand the authority or jurisdiction of Children's Advocacy Center for North Texas or any MDT partner as it relates to initiating and conducting investigations, assessments and/or interventions. Cases can also be directly referred to Children's Advocacy Center for North Texas by DFPS and/or law enforcement. The process for how these referrals is handled is based on the service for which they are referred and is identified in the sections that follow. After hours case consultation may be initiated by contacting CACNT on -call number, 469-293-2128. After-hours Care Coordination An after-hours Rapid Response can be initiated at the request of DFPS and/or law enforcement only during an active recovery. To request a Rapid Response, a team member must call the on -call phone number, 469-293-2128, and request to be connected to the Care Coordinator. A Rapid Response is limited to cases where an active child sex trafficking recovery is in progress. MDT Coordinators/Facilitators must complete a minimum of 8 hours of instruction relevant to child abuse investigation, intervention, and multidisciplinary teams. After completion of initial 8 hours of instruction, MDT Coordinator/Facilitator must complete 8 hours of continuing education everytwo years in the field of child maltreatment and/or facilitation. B. Case Review Meetings The Texas Family Code Section 264.406 mandates that Children's Advocacy Center Multidisciplinary Teams meet at regularly scheduled intervals to review child abuse cases and coordinate the actions of the entities involved in the investigation and prosecution of the cases and the delivery of services to the child abuse victims and the victims' families. Insight from each MDT representative provides the environment for a coordinated, comprehensive, compassionate, and professional response. Therefore, the result and ultimate purpose of case review is to make informed case decisions based on information shared and professional expertise from across all disciplines, ensuring team members have a chance to adequately address their specific case interventions, questions, and concerns with a focus on successful outcomes for the child, family, and criminal/civil case. 1. Criteria for Case Review i. Sexual Abuse a. Outcries of sexual abuse involving victims 14- years -old and younger b. Outcries of sexual abuse cases with unknown perpetrators c. Cases involving online exploitation or child pornography d. A suspect admits to sexual abuse ii. Physical Abuse All Felony -level physical abuse cases including, but not limited to: a. Serious bodily injury K b. Victim is not mobile and unexplained injuries occur c. Children under 12 months of age with unexplained or non -accidental fractures or other physical injuries to the head or torso iii. Any team member can refer a case for case review by asking a Partner Relations staff member to add the case to the agenda. Children's Advocacy Center for North Texas conducts case review meetings regularly, at least once per week, unless circumstances dictate otherwise. Case Review meetings will be conducted at Children's Advocacy Center for North Texas facilities. The Director of Partner Relations or designee will facilitate meetings. Partner Relations staff will ensure involved agency representatives are notified of scheduled case review meetings. Notification comes by email and will include the agenda, date, time, and location of the case review meeting. Individual case review notes and case dispositions will be documented in Children's Advocacy Center for North Texas's case -tracking system. The case review sign -in sheet will be retained on file (paper or electronic) for a minimum of 2 years. Advocacy Center Forensic Interviewers, Family Advocates, Clinical Supervisors, and Partner Relations staff review cases that were referred for services in the weeks prior. The decision to add a case to the case review agenda is based on case review criteria (listed above), the needs of the investigation and the needs of the family, Denton County jurisdiction, complexity of the case and referrals that need to be made. Attendees at case review should include: partner agency representatives assigned to cases on the agenda (the "Assigned Team" on each case); law enforcement, DFPS, District Attorney's Office representative (adult and juvenile prosecution), Juvenile Probation Court Liaison, Advocacy Center staff, and Medical Providers. Attendees may participate in person or via a HIPAA compliant virtual platform. A calendar invite containing the date, time, location, and information to join virtually will be emailed to team members by Partner Relations staff. Team members with cases on the agenda will make a good faith effort to attend case review. Assigned Team members unable to attend should communicate to the MDT a status update so other members of the MDT can continue their services to the child, family, or investigation in a timely fashion. Non -partner agencies involved in child abuse investigations, assessment, and/or service provision requesting to have a case reviewed should contact the CACNT Director of Partner Relations or designee at least three working days in advance. Non -partner agencies should only be present in the case review during their individual case which will be reviewed at the beginning of the case review schedule. Audio or video recording of case review meetings is strictly prohibited. 2. Subsequent Case Reviews: Cases will be reviewed following initial case on an "as needed" basis or upon request of Team member(s). Cases that have not had initial case review will be kept on the case review schedule for subsequent meetings. 3. Special Case Reviews: i. A special case review will be scheduled outside of the weekly planned meeting time ii. Only involved parties will be invited and included in the case review iii. Special Case Reviews will be requested for the following case types: a. High -Profile cases (involving cases that include teachers, politicians, or cases in 01 which the media will be involved) b. Cases involving specialized medical team c. Child fatality cases d. Cases involving Commercial Sex Trafficking victims e. Sensitive cases f. Cases not meeting the above criteria may be requested for a special case review meeting by any MDT member by contacting an MDT Coordinator. 4. Team members are responsible for follow-up actions recommended during case review. VI. Case Tracking Case tracking is a systematic method of collecting data on each case served by Children's Advocacy Center for North Texas. Case tracking provides a mechanism for monitoring case progression throughout a multidisciplinary interagency response. Case information is tracked from case identification through the final DFPS, Law Enforcement, and/or Prosecution disposition of the case. A. Apricot 360 Children's Advocacy Center for North Texas uses an online case -tracking system called Apricot 360. Cases that meet the MDT criteria are tracked in Apricot 360 but are not considered clients of the Advocacy Center until they are officially referred by a member of the MDT. Basic demographic information is collected on all clients at the time of intake. Apricot 360 is also used to document services provided (internal and external), regular case review meetings, and case dispositions. Team members can request information on case status and demographics of families documented in Apricot 360 by contacting any staff member of the Advocacy Center. Deidentified aggregate data that does not identify individual clients collected in Apricot 360 can be requested by any partner agency to assist in assembling local, regional, statewide, and national statistics that are useful for advocacy, research, and legislative purposes in the field of child maltreatment. Children's Advocacy Center for North Texas provides statistical information obtained through case tracking to Children's Advocacy Centers of Texas, National Children's Alliance, the Office of the Attorney General and other local, state, or federal funders or accrediting bodies. VII. Conflict Resolution Conflicts between team members are bound to arise from time to time. When handled appropriately, the resolution of the conflict can be a growth experience for all parties involved. One of the goals of Children's Advocacy Center for North Texas is to develop and nurture healthy partnerships between agencies. The skills we teach our clients, such as setting boundaries, clarifying roles, and stating clear expectations can also be applied to work relationships. Any differences between team members conducting joint investigation of a specific case in which questions arise regarding the best interest of the child, jurisdiction, or compliance with protocols shall be addressed as follows: A. Involved team members will attempt to resolve the difference through discussion and the sharing of information. 10 B. Case may be referred to a "team conference" involving both parties and all team members possessing direct knowledge of the case. The conference may also include Advocacy Center staff providing services, prosecutor, and/or CACNT's Director of Partner Relations. C. A second team conference can be held with appropriate supervisors involved, if necessary. D. Decisions regarding complaints/concerns by partner agencies about joint investigative procedures, as mandated by law, lie with each individual agency. Vill. Confidentiality All state and federal confidentiality laws will be followed in connection with this agreement, including Texas Family Code §264.408. All agencies/organizations participating in the MDT will immediately share pertinent case information with the appropriate agency within 2 business days, in person, via encrypted email and/or phone call. MDT members and Advocacy Center staff will make every effort to discuss cases privately; where others not directly associated with the case may overhear them. Separate areas are designated for such private conversations with caregivers/family members so that individuals may discuss aspects of their case in confidence. Confidential information shared with CACNT remains the property of the agency that shared the information with the Advocacy Center. IV. Client Services A. Forensic Interviews Texas Family Code (264.4061) states a DFPS referral made by a professional alleging any of the criteria below will be referred to Children's Advocacy Center for North Texas and the Advocacy Center must respond. It further states any interview of a child conducted as part of the investigation must be a forensic interview conducted in accordance with this working protocol unless a forensic interview is not appropriate based on the child's age and development. The purpose of a forensic interview is to obtain information from a child about abuse allegations that will support accurate and fair decision -making by the MDT within the criminal justice, child protection, and service delivery systems. Forensic interviews are conducted with children who are alleged victims or witnesses to abuse or violence. Forensic interviews are conducted in a manner that is developmentally and culturally sensitive, unbiased, fact-finding, and legally sound. When a child is unable or unwilling to provide information regarding any concern about abuse, other interventions to assess the child's experience and safety are required. The Advocacy Center/MDT must adhere to research -based forensic interview guidelines that create an interview environment that enhances free recall, minimizes interviewer influence, and gathers information needed by all the MDT members to avoid duplication of the interview process. The Forensic Interviewer is responsible for ensuring that the interview is conducted in a manner that is victim -focused and neutral to the investigation, while also remaining non -therapeutic in scope; if the child needs mental health treatment, Advocacy Center staff will ensure a referral is made to Clinical Services. 1. Texas Department of Family and Protective Services (DFPS) and Denton County law enforcement agencies (undersigned below) will refer the following cases to Children's Advocacy Center for North Texas for forensic interview services, when appropriate: 11 i. Child victims of allegations of a sex crime, including sex trafficking, child pornography, and online child exploitation ii. Adult victims of allegations of a sex crime, including sex trafficking, child pornography, and online child exploitation, when the adult has developmental delays that impair communication iii. Suspect admits to sexual abuse of a child or an adult with developmental disabilities iv. Child victims of allegations of severe child physical abuse as determined by the investigative agencies v. Children who have witnessed violent crimes as determined by the investigative agencies, sexual abuse, or severe physical abuse vi. Child survivors from the household of a child fatality Children's Advocacy Center for North Texas may provide Forensic Interview services to children in cases involving other types of child victimization when the referring agency sees a need for a multidisciplinary approach. Children's Advocacy Center for North Texas primarily provides Forensic Interview services to verbal child victims and witnesses, ages 2-18, in Denton County. This includes cases in which the child is: 1) a resident of Denton County and/or 2) the offense is alleged to have occurred in Denton County. As a courtesy service, Children's Advocacy Center for North Texas will interview children, and work with multidisciplinary teams, from other counties upon request. All efforts will be made to communicate with the child in the language spoken in their home; interpreters will be secured for the interview/observation rooms, when necessary. If the child communicates non -verbally, all efforts will be made to secure an interpreter or familiarize the interviewer with the child's communication device. 3) Under special circumstances, the Center may provide Forensic Interview services to primary victims over the age of 18, including adults who have developmental delays functioning at a mental age younger than 18. 2. Criteria for choosing an appropriately trained interviewer (for a specific case): i. All Forensic Interviewers must complete CACTX Forensic Interviewing Block 1, or a comparable nationally accredited training, before conducting forensic interviews. If applicable, Forensic Interviewers must complete the remaining training Blocks within their first year of employment. Forensic Interviewers must also attend, at a minimum, 15 hours of advanced training in conducting forensic interviews of Commercially Sexually Exploited Youth. ii. Upon completion of core curriculum or nationally recognized forensic interview training, individuals who conduct forensic interviews must demonstrate participation in ongoing education in the field of child maltreatment and/or forensic interviewing for a minimum of 8 contact hours every two years. CACNT provides ongoing development of forensic interview skills by conducting in-house peer review. Additionally, Forensic Interviewers will meet the CAM statewide peer review requirement. iii. The Forensic Interview Supervisor, or designee, will assign Interviewers to specific cases. The assignor will take into consideration: allegation type(s) and complexity, age of child, native language/method of communication of child, experience and training level of Interviewer, language(s) spoken by Interviewer, and any other impacting factors specific 12 to the case. The assignor will ensure that the selected Interviewer is the most appropriately trained interviewer for the case, based on the information known. B. Forensic Interview Process 1. The referring agency will initiate a joint investigation and/or request a forensic interview at the Center. The Assigned Team should screen the family prior to scheduling a forensic interview for any potential language barrier and work with Children's Advocacy Center for North Texas to find interpreters, if needed. At least one representative from the Assigned Team MUST be present for the entire duration of the forensic interview. A forensic interview will not be conducted unless reasonable efforts have been made to notify assigned investigators. 2. Joint DFPS/law enforcement investigations i. Upon receipt by DFPS of a referral, DFPS will contact the appropriate law enforcement investigator. ii. If the referral to DFPS was made by a professional and alleges sexual abuse of a child, or is a case that meets CACNT criteria, DFPS will contact the Advocacy Center to jointly determine whether an MDT response is appropriate. The MDT response may include a forensic interview. iii. The DFPS investigator and law enforcement investigator will coordinate the logistics of the forensic interview together. iv. The assigned DFPS investigator or law enforcement investigator will schedule the interview with CACNT Client Services or Partner Relations. v. The Forensic Interview Supervisor or designee will assign the interview to any of the trained forensic interviewers. 3. Law enforcement only interviews (cases not involving a DFPS investigation) i. Law enforcement agencies requesting an interview will directly contact Children's Advocacy Center for North Texas's Client Services or Partner Relation's Department. ii. The Forensic Interview Supervisor or designee will assign the interview to any of the trained forensic interviewers. iii. Advocacy Center staff may discuss the case with DFPS staff to determine whether DFPS has, or should have, a role in the investigation. 4. After-hours Interviews i. Interviews may be conducted after-hours at the request of DFPS and/or law enforcement. To request an interview outside of the normal workday, a team member must call the on - call phone number, 469-293-2128. After-hours interviews are limited to cases where the child and/or the community at large are in immediate danger (i.e.: child witnesses to a homicide, abduction, aggravated assault, etc.). Under most circumstances, a sexual abuse case does not warrant an after-hours interview; however, obtaining an acute sexual assault exam is highly encouraged. The decision to conduct an after-hours interview is made collaboratively with the Assigned Team and the on -call Client Services Staff. If the decision is made to conduct the interview, at a minimum, two CACNT will respond, to include a forensic interviewer, family advocate, and mental health professional. All after - hour medical services must follow the Center's medical protocols found within this 13 document. All after -hour calls not meeting the above criteria will be scheduled during the call, for services the next available business day. 5. Mobile Forensic Interviews i. If a child needs to be interviewed offsite, coordination between CACNT and the Assigned Team will occur to meet this need. Mobile interviews are discussed on a case -by -case basis. 6. Tele-forensic Interviews i. Tele-forensic interviews are only for use as an alternative to in -person forensic interviews in extenuating circumstances and will be discussed between the CACNT and MDT partners upon request. Tele-forensic interviews will be conducted using a HIPAA compliant platform, Zoom. MDT investigative partners will observe the interview via Zoom with cameras off and microphones muted. MDT partners will communicate with the Forensic Interviewer confidentially using a breakout room that is separate from the child being interviewed. 7. Interviews of adults i. The Director of Client Services or designee will determine what special circumstances allow for the interview of an adult with disabilities. Determination will depend largely on the individual's ability to communicate and participate in the forensic interview process and the suitability of the case circumstances to our protocols. 8. Interviews in Spanish i. Special care will be taken to use a Spanish-speaking interviewer when the child speaks Spanish in the home or prefers to speak Spanish during the forensic interview. All efforts will be taken to secure an interpreter for the observation room, should one be necessary. Any interpreter who is not a staff/MDT member will sign the Confidentiality and Guidelines for Interpreters Form, which includes their current contact information. The form will be uploaded into the case -tracking system, and a copy will be provided to the Assigned Team. The District Attorney's Office may request a written English transcription of the Spanish forensic interview for trial purposes. The District Attorney's Office should request the transcription from the Forensic Interviewer and allow at least two weeks for the completion of request. 9. Interviews in other languages i. Special care will be taken to use an interpreter when the child speaks a language, other than English or Spanish in the home or prefers to speak that language during the forensic interview. Coordination of an interpreter, including American Sign Language interpreter, can be difficult for interviews requiring a language other than spoken English or Spanish, and time to coordinate an appropriate interpreter will need to be allowed. For these cases, an interpreter will join the interviewer in the interview room. Interpreter will sign the Confidentiality and Guidelines for Interpreters Form, which includes their current contact information. The form will be uploaded into the case -tracking system and a copy will be provided to the Assigned Team. 10. Multi -session Forensic Interview (MSFI) i. A multi -session forensic interview is one forensic interview over multiple sessions and may be requested by the Assigned Team. Multi -session forensic interviews will only be 14 completed with unanimous Assigned Team (present for interview) approval and must be done by forensic interviewers trained in MSFIs. Considerations for a MSFI include, but are not limited to pre-school aged children, children from culturally diverse backgrounds, children with disabilities, children who have suffered extreme trauma including chronic abuse, and children who are victims of human trafficking or multiple suspects. Special considerations are taken when scheduling a MSFI, including the timing and space between sessions, the safety and development of the child, and the needs of the Assigned Team. A member of the Assigned Team must be present for the duration of each session, and each session will be completed by the same forensic interviewer, unless changing interviewers is best for the child or the forensic interview process. 11. Subsequent Forensic Interview i. A subsequent forensic interview is defined as an interview of a child after the completion of a forensic interview. These interviews must be requested by the Assigned Team and will be completed by the initial forensic interviewer unless changing interviewers is best for the child or the forensic interview process. Subsequent forensic interviews are best for addressing new allegations in the same case and/or recant or reaffirmation interviews. The Assigned Team is required to consult with the DA Prosecutor prior to scheduling a subsequent forensic interview. 12. Sharing of information i. Referring agencies will ensure that information necessary for Children's Advocacy Center for North Texas documentation is provided to Center staff as necessary to provide services. This information will be kept and maintained by Children's Advocacy Center for North Texas electronically, indefinitely. Confidential information shared with Children's Advocacy Center for North Texas remains the property of the agency that shared the information with the Advocacy Center. The investigative team will share pertinent information with the forensic interviewer prior to the forensic interview; this includes the name, age, language, and address of all parties involved, the allegations in the case, and any known facts that may influence the interview (i.e., disabilities the child may have, etc.). 13. Notifying families i. Referring agencies will notify victim, non -offending family members, witnesses, or other individuals relevant to investigation of scheduled interview at CACNT. 14. Observation of interviews i. To protect the integrity of the forensic interview and to maintain neutrality, no one outside of the MDT or assigned investigative team will be allowed to observe a forensic interview unless they are deemed appropriate and approved unanimously by the assigned investigative team. In no way should members outside of the MDT (see section III) observe live interviews. Should non -multidisciplinary team members need to observe an interview, they can request to view the recording from the referring agency. ii. Adults accompanying the child being interviewed are not allowed in the observation room. iii. In cases of non-English speaking children, interpreters will be allowed in the observation room. 1s iv. While interviews are being conducted, MDT partners communicate with the forensic interviewer through the light indicator which prompts the forensic interviewer to step out of the interview room to consult with MDT partners before resuming the interview. 15. Interview Room i. Only trained forensic interviewers, interpreters (when needed), and the child being interviewed are allowed in the interview room during the forensic interview. Only under special circumstances, and with the approval of the Assigned Team, may the adult accompanying the child escort the child to the interview room, wait for the child outside the interview room, or be in the interview room with the child. The forensic interviewer and the Assigned Team will determine what is in the best interest of the child and the criminal/civil case. 16. Pre -Interview Preparation i. Prior to the forensic interview, investigators will brief the interviewer and advocate with pertinent information. The forensic interviewer will gather minimal information about the case from the Assigned Team including, but not limited to: a. the name, age, initial outcry of the child and any known factors that may impact the forensic interview process b. the name, age, and relationship of the alleged perpetrator c. basic investigative information related to the case ii. Investigators will provide interviewer with any evidence to be presented during interview. Investigators may or may not choose to greet the family before the forensic interview. 17. Forensic Interview Structure i. The forensic interview will follow a semi -structured protocol, according to interviewer's training and Children's Advocacy Center for North Texas protocols. ii. At the interviewer's discretion, anatomical drawings or dolls may be used to clarify body parts/positions, if child is unable to verbally clarify. iii. Before the interview is concluded, the interviewer will leave the interview room (unless unable to) and meet with Assigned Team to ensure necessary information is gathered. iv. All forensic interviewers will conduct a global screening for domestic violence, drugs, alcohol, physical abuse, sexual abuse and exposure/production of pornography regardless of allegations of current investigation to ensure child safety. 18. Post -Interview i. The Assigned Team has the opportunity to meet with non -offending family members or caregivers present at CACNT after the forensic interview. Afterward, it is strongly encouraged the team members/Center staff share information and collaborate on decisions to be made regarding the safety of the child/family and the next steps of the investigation. The Assigned Team or CACNT staff are also encouraged to ask Children's Advocacy Center for North Texas's clinical staff to meet with the family if the child is in crisis. 19. Introduction of Evidence i. The introduction of evidence can be utilized during a forensic interview on a case -by -case basis. Copies of evidence will be brought to the CACNT ready for presentation by the investigative MDT partner(s). Evidence is owned by the MDT partners and is not retained 16 by CACNT. Discussion of the use of evidence will occur between the investigative MDT partners and the forensic interviewer prior to the forensic interview being conducted. Only forensic interviewers who have advanced training in the introduction of evidence can use evidence during the forensic interview of a child. Types of evidence that may be introduced include, but are not limited to, photo/internet images, text messages, journals, and drawings. Images containing child sexual exploitation imagery will be sanitized prior to presentation to the child during the forensic interview. 20. Use of Interview Aids i. Forensic interview aids (i.e. anatomical drawings, anatomical dolls) will be used when deemed appropriate by the Forensic Interviewer and MDT, in order to gain further clarification of a child's statement or a report of abuse. 21. Recording and/or Documentation of the Interview L The forensic interview will be video and audio recorded; the assigned Forensic Interviewer is responsible for ensuring the starting/stopping of the recording equipment, as well as, ensuring that the investigating agencies receive a copy of the interview and interview work products. The assigned interviewer is responsible for documenting the interview service and narrative in client tracking database. C. Victim Support and Advocacy Non —offending caregivers of alleged child abuse victims need assistance with navigating the MDT response and being connected to services to begin their healing process. CACNT understands the importance of victim -centered advocacy and provides services to ensure a consistent and comprehensive network of support for victims of abuse and their non -offending family members. Coordinated, comprehensive family advocacy services encourage client access to, and participation in the investigation, medical and therapeutic treatment, prosecution and other support services for children and families. Children's Advocacy Center for North Texas Family Advocacy Program provides crisis intervention, support, and education to families throughout all phases of the MDT response including the investigation, treatment services, prosecution procedures. The goal of these services is to provide stability, promote safety, reduce trauma, and link families to support services. All CACNT Family Advocates must complete a minimum of 24 hours of specialized core victim advocacy training. After completion of core training, family advocates will complete continuing education in the field of victim advocacy and child maltreatment at a minimum of 8 hours every two years. Family Advocates also participate in internal peer review a minimum of twice per year. Family Advocates who work with commercially sexually exploited youth also complete an additional 15 hours of training specializing in working with CSEY. Family Advocates are assigned at two points of entry at CACNT. A Family Advocate will be assigned to every new case beginning at the forensic interview and to cases that are referred for therapy and advocacy only services. Family advocacy services will be provided by the Family Advocates, Family Advocacy Supervisor, or by interns under the supervision of LMSW credentialed staff. MDT members or other CAC's can refer families in need of support by calling the Clinical Intake Specialists and completing a JotForm. 17 1. Delivery of Family Advocacy Services: Family Advocates will meet with the client's caregiver during the initial FI appointment. During this time, the Advocate will conduct a family needs assessment, provide information/education, and provide crisis counseling and stabilization services, in addition to other services. A Family Action Plan with identified and attainable goals will be created by the Family Advocate and discussed with the family. Follow-up meetings will be scheduled for all clients and ongoing case management will be conducted by the Family Advocate based on the goals created and the services needed that have been identified on the Family Action Plan. Follow-up appointments will take place at Children's Advocacy Center for North Texas, virtually via Zoom, over the phone, or an alternate location (if necessary). After the initial appointment, frequency of follow-up and services provided will vary depending on the family's unique situation and needs. In general, a Family Advocate will follow-up with the family within one week of the initial appointment. Continued consistent follow up with families will occur until all identified goals on the family action plan are attained, generally throughout the course of the investigation and/or legal proceedings. 2. Services provided by the Victim Support and Advocacy Program include: i. Crisis assessment and intervention, risk assessment and safety planning, and ongoing family engagement in order to support children and family members at all stages of involvement at CACNT ii. Assessment of individual needs, cultural considerations for child/family and help to ensure those needs are being addressed in concert with the MDT and other service providers; child /family's response to participating in the investigation, prosecution, treatment and support services including communication with MDT regarding factors impacting engagement. iii. Presence at the CAC during the forensic interview in order to participate in information sharing with other MDT members, inform and support the family regarding the coordinated, multidisciplinary response, and assess needs of children and non -offending caregivers iv. Provision of education and assistance in ensuring access to victim's rights and crime victim's compensation v. Assistance in procuring concrete services (housing, protective orders, domestic violence intervention, food, transportation, public assistance, civil legal services, etc.) vi. Provision of referrals for trauma -focused, evidence -supported mental health and specialized medical treatment, whether provided at the CAC or at offsite community providers vii. Facilitating access to transportation to interviews, court, treatment, and other case - related meetings viii. Engagement with the child and family to help them understand their own unique situation regarding: investigation/ prosecution process, crime victims rights, child abuse dynamics and/or child trauma ix. Participation in case review to communicate and discuss the unique needs of the child and family and associated services planning; and help ensure the coordination of identified services and that the child and family's concerns are heard and addressed 18 x. Provision of case status updates to the family, including investigations, court date, continuances, dispositions, sentencing and inmate status notification (including offender release from custody) xi. Provision of court education and support, including court orientation and accompaniment xii. Completion of the Commercial Sexual Exploitation — Identification Tool (CSE-IT) The CSE-IT is used as a universal screening tool on all clients ages 10 and up with parental notification. 3. Coordinated Case Management of Victim Advocacy Services between CACNT and offsite Advocacy Agencies: The delivery of coordinated case management occurs with victim advocates offsite who share cases with CACNT family advocates. CSEY Advocates working with CSEY/HRY have linkage agreements with the CACNT as well as ROI's that are signed for consistent coordinated collaboration of shared clients. Court Victim Advocates through the prosecution's office are MDT partners and have signed MOU's in place to collaborate with CACNT Family Advocates when cases are shared between both agencies to ensure timely and seamless deliver of advocacy services to clients. For teaching, supervision and consultation purposes, advocacy sessions at the CACNT may be video recorded. Family Advocates may view recorded sessions at CACNT for training and quality assurance during individual supervisions and group peer reviews. After these recordings are viewed, they will be destroyed and are not maintained as part of the client's record. VII. Medical Evaluations and Treatment All children who are suspected victims of child abuse should be assessed to determine the need for a medical evaluation. Medical evaluations are a critical piece for the overall well-being of a child, medical diagnosis, therapeutic healing, and criminal justice response to the suspected sexual and physical abuse of children, as well as in cases of neglect. A medical evaluation will assess the child's emotional and physical health, while also providing potential forensic findings that will aid the investigation in concerns of abuse. A medical evaluation holds an important place in the multidisciplinary assessment of child abuse. Obtaining an accurate history is essential in making the medical diagnosis and determining appropriate treatment of abuse. Physicians, nurse practitioners, physician associates, and nurses may all engage in the medical evaluation of child abuse. A. Purposes of a medical evaluation in suspected child abuse include: 1. Help ensure the health, safety, and well-being of the child 2. Diagnose, document, and address medical conditions that resulted or could have resulted from abuse 3. Provides a history that may aid in future medical diagnosis and treatment. 4. Differentiate medical findings that are indicative of abuse from those which may be explained by other medical conditions 5. Diagnose, document, and address medical conditions unrelated to abuse 6. Document the overall appearance of the child 7. Assess the child for any developmental, emotional, or behavioral problems needing further evaluation and treatment and, in coordination with the MDT, and make referrals as necessary 19 8. Reassure and educate the child and non -offending caregiver/family members The role of the medical professional is to provide medical treatment and diagnosis to any child subject to allegations of child abuse and in need of medical evaluation. These specialists also provide medical information, recommendations, and consultations regarding the needs of the child. This includes medical examination for concerns regarding physical abuse, sexual abuse, and/or medical or physical neglect. These specialists can include child abuse pediatricians, nurse practitioners, physician associates, emergency physicians trained in evaluation of sexual assault, and certified Sexual Assault Nurse Examiners (SANE). All providers must meet and maintain the educational requirements set forth by the Office of the Texas Attorney General, including at least eight (8) contact hours of continuing education in the field of child abuse every two years. All medical care is documented in a patient's health record. All State and Federal confidentiality laws will be followed in connection with this agreement. It is preferable for the forensic interview to occur prior to exam, but if medical needs of the patient or forensic collection precede the necessity of the interview, then he/she may be seen for the medical evaluation first. Coordination with law enforcement, medical provider, and the interviewer is recommended. B. Criteria for Acute Medical Evaluations A victim/child who has made an outcry, or circumstantial evidence suggests the conclusion that the child is a victim of sexual abuse, and the incident or contact occurred within 120 hours involving at a minimum one of the following: 1. skin or oral contact of the genitals, anus, or breasts 2. exchange of bodily fluids 3. penetration of sex organ or anus 4. complaints of physical trauma 5. a forensic evidence collection kit is requested by law enforcement. 6. a victim appears to be under the influence of substances. 7. a child with physical injuries that require immediate medical attention. 8. forensic evidence collection may be obtained outside of the timeframe on a case -by -case basis. C. Criteria for Non -Acute Medical Evaluations A victim/child who has made an outcry, or circumstantial evidence suggests the conclusion that the child is a victim of sexual abuse, and the incident or contact occurred over 120 hours, involving at a minimum one of the following: 1. skin or oral contact of the genitals, anus, or breasts 2. exchange of bodily fluids 3. penetration of sex organ or anus 4. complaints of physical trauma 5. a victim/child with current injuries that do not require immediate medical attention. 6. reports of trauma from other medical centers with uncertain assessments regarding abuse, or where further information is needed (example: indicated skeletal survey in child < 2 years). 7. a victim/child in which circumstantial evidence suggests the conclusion that he/she is the victim of medical abuse (failure to thrive, fictitious disorder by proxy, etc.). 20 Any case not meeting specific criteria listed above may be reviewed on a case -by -case basis with a medical provider to determine if there is a need for medical evaluation and/or additional medical testing. D. Sexual Abuse 1. Children's Advocacy Center for North Texas i. Acute/Emergent Evaluation: If less than 120 hours since reported incident or contact and a sexual assault exam is needed: a. During the hours of 8AM-4PM Monday -Friday, call Children's Advocacy Center for North Texas at 972-317-2818 to coordinate scheduling of an acute evaluation. b. Please ask to speak with someone from the medical staff to determine if victim is medically appropriate for on -site evaluation, if there is a provider available to perform an evaluation, time, and location in which the evaluation will take place. c. If an emergent evaluation is necessary after hours, on the weekend, or if an appointment is not available at the Advocacy Center, call Texas Health Resources (THR-Presbyterian Denton) Denton Emergency Department charge nurse at 940- 898-7059 to facilitate the coordination of exam to be done by the THR SANE Team. d. Any victim with emergent medical needs will need to be evaluated for medical clearance prior to any sexual assault exam. ii. Non -Acute Evaluations: (greater than 120 hours since reported incident or contact) a. Call Children's Advocacy Center for North Texas at 972-317-2818 during the hours of 8AM-4PM Monday -Friday to request scheduling of an appointment or the Family Advocate can schedule an appointment when he/she is with the family at time of the forensic interview. b. Non -Acute Evaluations will take place at either the Lewisville or Denton locations. C. If an emergent medical need presents during any medical evaluation, the patient will be transferred to the local hospital emergency department for medical clearance prior to completion of exam. iii. Follow-up Medical Care a. Acute and non -acute evaluations that include Sexually Transmitted Infections (STI) lab testing, shall be contacted with lab results by a CACNT medical provider. If STI testing was not completed at the time of the exam, CACNT medical provider will contact patient/caregiver to offer a follow-up visit for STI testing. b. In the event lab results are positive, medications will be offered, and a test -of -cure appointment will be arranged for 3 weeks. 2. Cook Children's Hospital Acute and non -acute medical evaluations may be conducted at Cook Children's Hospital CARE Team by calling 682-855-3953. 3. Children's Health (Dallas/Plano) i. For acute medical evaluations requiring evidence collection: a. During REACH Clinic hours (M-F, 9a-5p), call the clinic at 214-456-6919 to determine if evaluation can be done there. 21 b. Outside of REACH Clinic hours, contact The Turning Point's 24-hour hotline 1-800- 886-7273: Please have Police Department contact information, sexual assault case number, child's name, age, and clothing size available to give to The Turning Point nurse/advocate. ii. For non -acute medical evaluations, a referral is sent to the outpatient Referral and Evaluation of At -Risk Children (REACH) clinic. E. Physical Abuse/Neglect 1. Children's Advocacy Center for North Texas For any non -emergent concerns of abuse or neglect, or if an incident does not meet criteria for a sexual assault exam, a head -to -toe physical assessment may be completed at the Advocacy Center. You may call 972-317-2818 to schedule or discuss the case with medical staff. ii. You may also consult with a medical provider regarding any further concerns or questions that you may have related to abuse or neglect, or if uncertain whether a medical evaluation for a child/victim is warranted. iii. Results of the medical evaluation will be shared with the requesting partner agency. If further follow-up is warranted, patient will be referred to Children's Heath REACH Clinic or Cook Children's CARE Team. If no follow-up care is required, a recommendation to DFPS for FACN may be made. iv. If an emergent medical need presents during any medical evaluation, the patient will be transferred to Children's Health or Cook Children's Emergency Department. 2. Cook Children's CARE Team i. For incidents of physical abuse that occur during working hours, the referring agency will contact the CARE Team at Cook Children's by calling 682-855-3953. The medical provider will determine if the child should be seen in the CARE Team Clinic or the Emergency Department. After 4:30PM Monday -Friday and on weekends, these patients should go through the Emergency Department. ii. Injuries that should be referred for evaluation/consultation: a. Age 0-6 months: 1. Any mark or injury, including skin abrasions, scratches, or bruising b. Age 6 months and older: 1. Bruises, lacerations, or burns to protected, fleshy, or flexor surfaces — for example: inner thighs, abdomen, neck, face, ear, genitalia 2. Bruises, lacerations, or burns showing an object pattern —for example: belt loop, cigarette burn, curling iron 3. Oral injuries, especially lacerations under the tongue or to the roof of the mouth 4. Fractures, especially metaphyseal fractures, rib fractures, spiral fractures of the humerus or femur, scapula fractures 5. Head trauma c. Age 0-12: exposed to illicit drugs d. Concerns for neglect: Call to request a case review 22 e. At risk: Siblings (2 and under) of children requiring hospitalization for maltreatment require a referral/consultation to the clinic. Evaluations of older siblings by non -medical personnel will be reported back to the CARE Team. f. Concerns regarding Medical Child Abuse g. In an emergency, call 911 h. For any other concerns, please call for assistance. 3. Children's Health (Dallas/Plano) i. For non -acute physical abuse medical evaluations, a referral must be made by DFPS or law enforcement and is sent to the outpatient Referral and Evaluation of At -Risk Children (REACH) clinic. The REACH Clinic is located at Children's Medical Center Dallas and Plano. Dallas is open Monday -Friday from 9:00AM-5:0013M. Plano is open Monday and Thursday from 9:OOAM-5:OOPM with expanding hours as need arises. If a child needs to be seen urgently, contact REACH Clinic at 214-456-6919. ii. After clinical hours and on weekends for emergency cases, patients should go through the Emergency Department. 4. Forensic Assessment Care Network (FACN): When documents and photographs are present and a medical consult is requested, DFPS will make the referral to FACN. DFPS uploads the documents and/or photographs into the FACN and they are reviewed by a child abuse pediatrician. A response is provided back to the DFPS worker within seven calendar days for routine cases or three calendar days for emergencies. When children/victims of suspected abuse are initially treated by a non -MDT medical provider who does not specialize in child abuse and who does not meet the training requirements outlined in the Texas Standards, these cases will be reviewed by one of the medical providers at the Advocacy Center to assess the need for additional medical evaluation and/or follow-up care. The medical staff will review all previous medical records, when available, to prevent duplicated examination and/or testing. F. Medical Chart and Peer Review 1. A child abuse medical specialist or medical director for the Advocacy Center will review 100% of all abnormal exams/evaluations performed by the Center and any other charts requested by medical staff for review. The medical director will also be available to the medical/nursing staff for consultation and any concerns related to any case or victim. 2. All medical providers providing care at the Center, or any partner agencies, are required to regularly take part in peer and chart review within the organization and with other providers providing care to sexual assault and child abuse victims. G. Medical Documentation Records 1. All medical records for completed on -site medical evaluations at the Children's Advocacy Center for North Texas will be custody of and maintained by the Forensic Nursing Program Director (or designee). All medical records are considered legal documents. Medical Records will be stored at the facility in which the medical evaluation was conducted (Lewisville or Denton) or maintained in an electronic medical record at the facility where the medical evaluation was completed. The medical history and physical examination findings will be carefully and thoroughly documented. The record of the medical evaluation shall be kept in accordance with the Record Retention Policy. HIPAA Confidentiality and Privacy rules apply to all institutions involved in medical care. 23 Information from the medical evaluation shall be shared with the MDT in a routine and timely manner. All images taken during medical evaluations will be secured separately from the documented medical record. Physical abuse photos will be provided upon request to the investigating law enforcement agency and/or the District Attorney's Office along with the written medical evaluation. Photos containing breasts and/or genitalia will only be made available upon a written request from the District Attorney's Office or investigating law enforcement agency to the Forensic Nurse Medical Director. 2. For off -site MDT medical providers, medical records are documented per hospital/facility standards. This includes, but is not limited to medical history, test performed and results, physical examination findings, and photographic documentation. These records are property of and stored at the facility in which the medical evaluation was conducted. Investigating law enforcement agencies must contact off -site provider for photo documentation. Vill. Mental Health Exposure to child abuse or violence can create trauma symptoms for children. Many traumatized children will suffer ongoing or long-term adverse social, emotional, and developmental outcomes that may affect them throughout their lifetimes without effective therapeutic intervention. All mental health services are available and accessible to all CAC clients without cost. A. The following cases should be referred to Children's Advocacy Center for North Texas for Mental Health services, when appropriate: 1. Child victims of allegations of a sex crime, including sex trafficking, child pornography, and online child exploitation. 2. Adult victims of allegations of a sex crime, including sex trafficking, child pornography, and online child exploitation, when the adult has developmental delays that impair communication. 3. Suspect admits to sexual abuse of a child or an adult with developmental disabilities. 4. Child victims of allegations of severe child physical abuse as determined by the investigative agencies. 5. Children who have witnessed violent crimes as determined by the investigative agencies, sexual abuse, or severe physical abuse 6. Child survivors from the household of a child fatality Children's Advocacy Center for North Texas provides trauma -informed, evidence -based therapy, such as Trauma -Focused Cognitive Behavioral Therapy (TF-CBT), Eye Movement Desensitization and Reprocessing (EMDR), and Child and Family Traumatic Stress Intervention (CFTSI), for child and adolescent victims of abuse and non -offending family members. Specialized approaches such as Alternatives for Families -Cognitive Behavioral Therapy (AF-CBT) or Problematic Sexual Behavior -Cognitive Behavioral Therapy (PSB-CBT) respond to specific victim populations, improve skills, or reduce harm in the home. Clinical services provided by Children's Advocacy Center for North Texas include crisis counseling, individual therapy, group therapy, play therapy, family therapy, consultation with the MDT, clinical assessments, referral to community agencies, court support services, and disaster responses in events involving children. Children's Advocacy Center for North Texas uses trauma -specific assessments of traumatic events and abuse -related trauma symptoms to determine the need for treatment. 24 Non -offending caregivers/family members are often the key to a child's recovery and ongoing protection. Non -offending caregivers may benefit from counseling and support to address the emotional impact of the abuse allegations, reduce or eliminate the risk of future abuse, and address issues that the allegation may trigger. Non -offending caregivers are involved in the child's treatment throughout services will receive the support throughout the child's treatment. Children's Advocacy Center for North Texas reserves the right to determine which clients will be treated in- house and which clients will be referred to other external resources. Mental Health services may be requested via Children's Advocacy Center for North Texas's client case -tracking system or by submitting a Therapy Referral form. The Therapy Referral form can be emailed by request. Outside referrals will be accepted in cases that have an active or previous law enforcement and/or child protective service agency report who meet the set requirements of Children's Advocacy Center for North Texas mental health services criteria. B. CACNT mental health providers actively attend and participate in MDT case review and case management. 1. The Director of Clinical Services or designee will serve as clinical consultant to the MDT on issues relevant to child trauma and evidence -based treatment and assessment. 2. Children's Advocacy Center for North Texas mental health department will make a determination of appropriateness for services on a case -by -case basis according to need, availability of treatment staff, and space resources. 3. CACNT mental health providers will share information with MDT while protecting the clients' right to confidentiality and the mental health professional's legal and ethical requirements, including maintaining clear boundaries between the forensic interview and other investigative processes and mental health treatment. 4. Mental health professionals at the Advocacy Center can monitor and share with the MDT the child's and caregiver's engagement and completion of treatment. C. Mental health services at Children's Advocacy Center for North Texas are protected health information. With authorized parental consent, team members can request that the following information be shared with the MDT members when it is in the best interest of the child: participation in therapy, treatment progress, and/or any information pertinent to the investigation. Advocacy Center therapists reserve the right to obtain consent from the client or legal guardian prior to sharing additional requested information. It is important to note mental health services are to treat the symptoms of trauma and not to gather further detail about the alleged offense. While important details of the offense may arise during counseling services, it is not the primary goal of the Advocacy Center's mental health treatment. A child and/or family should not be referred for counseling services for the sole purpose of gathering more information. 1. The following are possible situations that may limit confidentiality: i. For purposes of supervision or consultation ii. Concerns that a client is a danger to himself/herself or someone else iii. The disclosure of abuse, neglect, or exploitation of a child, elderly, or disabled person iv. The disclosure of sexual misconduct or unethical behavior of another mental health professional 25 v. Ordered by the court to disclose information vi. The client directs the release of information vii. Otherwise required by law to disclose information D. For teaching, supervision, and consultation purposes, therapy sessions at the Children's Advocacy Center for North Texas may be video/audio recorded. Therapists may view recorded sessions at Children's Advocacy Center for North Texas or in the mental health providers formal graduate program required class. Once these recordings are viewed, they will be destroyed and are not maintained as part of the client's record. Audio/Video recordings may be recorded for programming, training, and consultation purposes and shared via secure link to a Training and Technical Assistant site. E. Mental health services are provided by professionals with training in, and who deliver evidenced - supported, mental health treatment specific to child abuse and/or child trauma. All mental health providers, whether providing services on -site or through linkage agreements with outside individuals and agencies, must meet at least one of the following education/license and training requirements: 1. A student currently enrolled in an accredited graduate or doctoral program in a mental health related field 2. A minimum of a master's degree in a mental health field and a license to practice If not licensed to practice independently, a requirement to attend supervision with a licensed mental health professional on a consistent basis and in accordance with the rules of the licensee's discipline. IX. Record Retention and Children's Advocacy Center for North Texas Response to Subpoenas A. All Children's Advocacy Center for North Texas records are strictly confidential, kept in a secure manner and will be shared only in accordance with the Texas Family Code 264.408. All Advocacy Center records may be accessed only by the service provider or appropriate custodian of record or designee. 1. All Children's Advocacy Center for North Texas records (advocacy notes, intake, clinical notes, FI narrative) are password protected and kept in secure online web -based platforms. The data is stored in a secure, HIPAA compliant database. 2. All Children's Advocacy Center for North Texas records, regardless of format, are subject to the maintenance, retention, destruction, and release policies. B. Custodian of Records 1. In order to maintain the highest level of professional ethics and client confidentiality, Children's Advocacy Center for North Texas designates the Director of Clinical Services, or designee, as the custodian of all records maintained in Apricot 360 and will respond to all subpoenas or requests for clinical, client services, or case coordination records. The Forensic Nursing Program Director, or designee, is the custodian of records for all on -site medical records. Children's Advocacy Center for North Texas designates the Chief Financial Officer as the custodian of record for all staff human resource records. 26 C. Record Maintenance 1. Children's Advocacy Center for North Texas Electronic Client File: Children's Advocacy Center for North Texas uses an online case -tracking system called Apricot 360. Apricot 360 is an electronic web -based database that tracks intake information, demographic information, service information and the protected health records of the client. This database includes records of case tracking, case disposition, case coordination, forensic interview narrative and services, victim advocacy services, medical services, and mental health records. 2. Initial client information is gathered through the client intake form, the DFPS report, or a police report. The client intake form gathers contact information, victim and family member names and dates of birth, disabilities, and identifying information for client and family members. 3. The client intake form is scanned and attached to the electronic client file. All subsequent Advocacy Center services will be recorded in the electronic file. 4. Any client record deemed "Case Sensitive" by the Children's Advocacy Center for North Texas Director of Partner Relations or designee will be restricted to only CACNT staff involved in service provision. 5. All abuse and neglect reports provided by DFPS to CACNT are the property of DFPS and not the Advocacy Center. Because these intake reports are legally the property of DFPS and CACNT receives only a copy of the intake report that DFPS sends to the appropriate law enforcement agency, CACNT will follow its own organizational Records Retention Policy as it relates to client and case file information when determining how and when intake reports will be retained or destroyed. CACNT multidisciplinary partner agencies, including but not limited to DFPS, law enforcement, and prosecution agencies, shall have access to the Advocacy Center's Records Retention Policy to ensure they are informed of CACNT's practice as it relates to the retention and destruction of intake reports. 6. Partner agency reports will not be maintained as part of the electronic client file. 7. Therapy Records: The therapy intake form, informed consent, release of information, and assessment tools will be maintained in the electronic client file. When appropriate, outside mental health discharge documents, copies of custody or guardianship documents will be attached to the electronic client file. 8. Family Advocacy Records: The Family Advocacy referral form, intake form, and needs assessment are all attached to the electronic client file. 9. Forensic Interview Records: The forensic interview service will be documented in the electronic client file; a narrative of the interview will be completed as part of this service. Documents created or utilized during the interview will be given to the investigating agency; copies of any documents created or utilized during the forensic interview will not be attached in the electronic client file. The originals of anatomical drawings or other evidentiary documents created or utilized during the interview will be maintained by law enforcement/investigating agency. If transcriptions of the interview are completed, they will be attached in the file. i. Forensic interview video records are kept electronically on VidaNyx, a secure, HIPAA compliant, cloud -based server that is password protected. ii. In accordance with the Texas Family Code, a recorded interview of a child made at Children's Advocacy Center for North Texas is the property of the prosecuting attorney involved in the criminal prosecution of the case involving the child. If no criminal 27 prosecution occurs, the interview recording is the property of the attorney involved in representing the Department in a civil action alleging child abuse or neglect. If the matter involving the child is not prosecuted, the recording is the property of the Department if the matter is an investigation by the Department of abuse or neglect. If the Department is not investigating or has not investigated the matter, the recording is the property of the agency that referred the matter to the Center. iii. Following the interview, copies of the interview recording will be provided to the referring party(ies). Children's Advocacy Center for North Texas will retain the original forensic interview recording as the designated custodian of records for the Denton County District Attorney's Office. Any requests for forensic interview recordings pertaining to a pending civil or criminal case will be directed to the District Attorney's Office. Requests for forensic interview recordings pertaining to cases not involving civil or criminal prosecution will be referred to the Texas Department of Family and Protective Services. All other requests will be referred to the appropriate law enforcement agency. 10. Medical Records: i. Medical evaluation records are maintained in a separate unique medical database platform called FeMR. This web -based platform is HIPAA compliant and password protected. Records documented in FeMR may include informed consent, medical and abuse history, photo documentation, lab orders/results, medications given, body diagrams, and discharge instructions. ii. Record of whether a medical evaluation has been completed, including FACN consultations, will be recorded in the client database, Apricot 360, to ensure services referred have been completed and for tracking purposes. Communication with family members by any medical staff may also be documented in Apricot 360. D. Children's Advocacy Center for North Texas staff have varying levels of access to the Center database files: 1. Staff and Supervisors: May enter information in the database and edit service notes. Only Mental Health Providers and Site Administrators have access to view mental health session notes. 2. Site Administrator: Access to read, create, and edit all areas of the client database. E. Record Retention: 1. Client and Clinical electronic records will be maintained indefinitely in Children's Advocacy Center For North Texas's database. 2. Medical records for completed on -site medical evaluations will be custody of, and maintained by, the Forensic Nursing Program Director (or designee). Medical records will be maintained in an electronic medical record indefinitely. Any physical records will be housed at the location where the exam was conducted. 3. Forensic Interview records will be archived indefinitely at the Children's Advocacy Center for North Texas, via VidaNyx. F. Record Destruction: 1. When disposing of Children's Advocacy Center for North Texas documents containing client information, these documents will be shredded and/or destroyed to maintain client confidentiality. 28 2. Records will only be disposed of or redacted by court order. G. Record/Information Release: 1. Parents requesting records pertaining to their child must submit a request in writing to the Custodian of Records. However, in accordance with The Health and Safety Code 611.0045, the Custodian of Records will determine if the records may be released, based on the physical, mental, or emotional health of the child. The steps outlined in THSC 611.0045 will be followed. 2. Under limited circumstances, parents may request to the view a copy of the forensic interview. This request must be approved by the District Attorney's Office. The viewing must be monitored by law enforcement or DFPS. Copies of the forensic interview will not be released directly to a parent. Audio or video recording is strictly prohibited during the viewing of a forensic interview. 3. Members of the MDT that are involved in the case, including DFPS, investigating law enforcement agency, and the District Attorney's Office may request records, except for therapy records, without a subpoena. Therapy session records require a court order; however general information regarding the client's progress in therapy may be shared with the multi -disciplinary team without a court order. 4. Other than the above -mentioned, records will be released by subpoena or court order only. All records may be released only by the appropriate custodian of record or designee. H. Subpoenas for Criminal Proceedings: 1. Subpoena Duces Tecum: Ordering the appearance of an individual and/or presentation of documents. i. Records will be released by subpoena or court order only. The designated custodian of record will respond to all subpoenas. If records are requested by anyone other than the District Attorney's Office, the Center's legal representative, prosecutor, or private counsel, will be contacted prior to release of record. ii. Children's Advocacy Center for North Texas follows the Texas Family Code 264.408(d, d- 1, e): A video recording of an interview of a child that is made by a center is the property of the prosecuting attorney involved in the criminal prosecution of the case involving the child. If no criminal prosecution occurs, the video recording is the property of the attorney involved in representing the department in a civil action alleging child abuse or neglect. If the matter involving the child is not prosecuted, the video recording is the property of the department if the matter is an investigation by the Department of abuse or neglect. If the Department is not investigating or has not investigated the matter, the video recording is the property of the agency that referred the matter to the center. iii. A video recording of an interview described by Subsection (d) is subject to production under Article 39.14, Code of Criminal Procedure, and Rule 615, Texas Rules of Evidence . A court may deny any request by a defendant to copy, photograph, duplicate, or otherwise reproduce a video recording of an interview described by Subsection (d), provided that the prosecuting attorney makes the video recording reasonably available to the defendant in the same manner as property or material may be made available to defendants, attorneys, and expert witnesses under Article 39.15(d), Code of Criminal Procedure. In the event the Court permits providing a copy of said video to the Defense, a protective order concerning said video recording shall be included. 29 iv. The Department shall be allowed access to the video recordings of forensic interviews of the child. 2. Standard Subpoena: Ordering the appearance of an individual. i. Contact will be made to/by the subpoenaed party to discuss testimony and fee schedule. Subpoena for Civil Proceedings: 1. Standard Subpoena: Records will be released by subpoena or court order only. The designated custodian of record will respond to all subpoenas. The Center's legal representative will be contacted before release of record. Criminal proceedings may take precedent over civil proceedings therefore, in addition to the Center's legal representative, the criminal prosecutor will be notified before release of record. 2. Subpoena Duces Tecum: Contact will be made to/by the subpoenaed party to discuss testimony and fee schedule. 3. Multidisciplinary Partners may serve Subpoenas requesting records or appearance of CACNT staff via encrypted email. J. Fees for Release of Records or Testimony: 1. Fees are waived when requested by the following District Attorney's Office: Collin, Dallas, Denton, Grayson, Jack, Parker, Rockwall, Wise & Tarrant (DFW area). X. Diversity, Equity and Access A. Children's Advocacy Center for North Texas provides culturally responsive services for all CACNT clients throughout a case. 1. CACNT services are accessible and tailored to meet the various individualized and unique needs of children and families regarding culture, development and special needs throughout the investigation, intervention, and case management process. 2. Provisions are made for non-English speaking and deaf clients throughout the investigation and all core services through, but not limited to, Translation and Interpretation Network, and/or American Sign Language Interpreter. i. Any interpreter who is not a staff/MDT member will sign the Confidentiality and Guidelines for Interpreters Form, which includes their current contact information. The form will be uploaded into the case -tracking system, and a copy will be provided to the Assigned Team. XI. Client Safety and Protection Children's Advocacy Center for North Texas staff and MDT partners will ensure that alleged offenders are separate from alleged victims. Agency partners shall notify Advocacy Center staff that alleged offenders will be on site to ensure appropriate supervision and security measures are in place. Any individual who would compromise the safety and security of persons is not allowed in the facility. Should any person's behavior escalate to indicate they might compromise the safety and security of themselves or others, Center staff and/or MDT members will work to remove them safely from the facility and/or local law enforcement will be notified. Psychological safety of children is important and Advocacy Center staff/interns 30 and MDT members will ensure every effort is made to protect children from exposure to events that may create trauma triggers within the facility. Children with Problematic Sexual Behavior (PSB) will be supervised by Children's Advocacy Center for North Texas staff/interns while in the building. Advocacy Center staff and the MDT agree that the development, maintenance, and support of a neutral, child friendly environment that emphasizes the best interest of children and that provides investigative and rehabilitative services to the child and non -offending caregivers/family members is of utmost importance. All Children's Advocacy Center for North Texas staff therapists and Clinical interns will schedule and identify all appointments serving youth with PSB on the internal calendar as "Client Name - PSB" so that staff, interns, and volunteers may plan and coordinate supervision. Staff Therapists/Clinical Interns will notify front desk Family Engagement Specialist of all scheduled appointments for youth with PSB. If the Family Engagement Specialists is not available, Staff Therapist/Clinical Intern will notify lead therapist for that evening. The lead therapist will be responsible for coordinating supervision for the appointment. Family Engagement Specialists will provide direct supervision and external control of the PSB clients while PSB clients are waiting for their scheduled appointment with Staff Therapist/Clinical Intern. Any child alleged to have engaged in an inappropriate sexual behavior will not be left alone without proper supervision in the lobby area. A. Supervision of School -Aged Children 1. The Staff Therapists/Clinical Interns will directly supervise all PSB clients during group therapy sessions. 2. One or more Staff Therapists/Clinical Interns will be in the hallways as PSB clients are entering the therapy area and will direct them to the appropriate group therapy room. 3. All PSB clients will be escorted to the bathroom one at a time by Staff Therapist/Clinical Intern. The Staff Therapist/Clinical Intern will ensure that no other child is in the bathroom prior to the PSB client entering the bathroom. The Staff Therapist/Clinical Intern will wait in the hallway by the bathroom door to ensure that no other children enter the bathroom. 4. All PSB clients needing childcare services will be reported to Family Engagement Specialist privately and/or through an Activity Center Request Form. Family Engagement Specialist will arrange, if possible, for PSB client to receive childcare separate from other children. Staff Therapist/Clinical Intern will identify appropriate therapy room for childcare to be provided to PSB client. XII. Review, Revisions and Re -Execution of Working Protocols A. This Children's Advocacy Center for North Texas Protocol Agreement shall be modified as determined by Children's Advocacy Center for North Texas's Chief Executive Officer upon the review and recommendation of Children's Advocacy Center for North Texas's MDT Leadership Team comprised of multidisciplinary team members. Children's Advocacy Center for North Texas's MDT Leadership Team may review and change the protocols due to: 1. conforming to existing or new statutes, rules, regulations, or departmental policies which may conflict with any provisions of the working protocols 2. better meeting the needs of families and children in the provision of child abuse related services 31 3. improving the procedures set forth in this working protocol 4. adding or deleting agencies as parties to the working protocol agreements 5. on a change of a signatory of a participating agency 6. on a significant change to the memorandum of understanding (MOU) 7. other purposes as the parties may agree. B. Children's Advocacy Center for North Texas's MDT Leadership Team will review, revise, modify, and re - execute the working protocols at a minimum every three years or upon significant changes to the document. C. Any party seeking to terminate the Agreement mustgive thirty (30) days written notice, submitted to all parties (signatories). Signatories of this Agreement will include the following agencies: 1. Texas Department of Family and Protective Services 2. Denton County District Attorney's Office 3. Law enforcement agencies in Denton County 4. Cook Children's Hospital CARE Team 5. Texas Health Resources SANE Team 6. Children's Health 7. Denton County Juvenile Probation 8. Children's Advocacy Center for North Texas 9. any other agency/organization that will house personnel at the Center or plans to follow the procedures set by this Agreement. This agreement shall become effective upon signature of the parties listed below: t. �AAJ Alk KristeA Howell Date Chief Executive Officer Children's Advocacy Center for North Texas [SIGNATURE PAGE FOLLOWS] 32 ACCEPTED AND AGREED: CITY OF FORT WORTH By: William Johnson( r6,202412:15 CST) Name: William Johnson Title: Assistant City Manager Date: Mar6,2024 APPROVAL RECOMMENDED fBy: RobertAar6,202411:52CST) Name: Robert A. Alldredge, Jr. Title: Executive Assistant Chief CONTRACT COMPLIANCE MANAGER: By signing I acknowledge that I am the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting requirements. By: X94A� �J� Name: Loraine Coleman Title: Administrative Services Manager APPROVED AS TO FORM AND LEGALITY: pdg4UUn�� ATTEST: 0 000Rr�aa p �a°° °°oo�dd By: o c~ia '=c Name: Andrea Philips a� o °o* �° Title: Assistant City Attorney nezp5aaa� BY: CONTRACT AUTHORIZATION: Name: Jannette Goodall M&C: (None Required) Title: City Secretary Date Approved: Form 1295 Certification No.: N/A OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX