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10.1177/1524838005277440TRAUMA, VIOLENCE, & ABUSE / July 2005Jones et al. / CRIMINALINVESTIGATIONS OF CHILD ABUSE
CRIMINAL INVESTIGATIONS OF CHILD ABUSE
The Research Behind “Best Practices”
LISA M. JONES
THEODORE P. CROSS
WENDY A. WALSH
MONIQUE SIMONE
University of New Hampshire
This article reviews the research relevant to seven practices considered by many to
be among the most progressive approaches to criminal child abuse investigations:
multidisciplinary team investigations, trained child forensic interviewers, video-
taped interviews, specialized forensic medical examiners, victim advocacy pro-
grams, improved access to mental health treatment for victims, and Children’s
Advocacy Centers (CACs). The review finds that despite the popularity of these
practices, little outcome research is currently available documenting their success.
However, preliminary research supports many of these practices or has influenced
their development. Knowledge of this research can assist investigators and policy
makers who want to improve the response to victims, understand the effectiveness
of particular programs, or identify where assumptions about effectiveness are not
empirically supported.
Key words: child abuse, investigations, criminal justice
SOON AFTER THE WIDESPREAD ACKNOW-
LEDGMENT of child sexual abuse in the 1970s
and 1980s came the realization that traditional
investigation methods risked traumatizing vic-
tims further (see, e.g., Whitcomb, 1992). Many
professionals did not know how to conduct ef-
fective and child-sensitive forensic interviews
and medical examinations, and uncoordinated
investigations could lead victims to have to “tell
their story” about the abuse repeatedly. There
was a paucity of support and treatment services
for victims and their families. Problems with the
investigation could make the inherent difficulty
of prosecuting child sexual abuse even harder.
Many jurisdictions in the United States have
implemented reforms designed to reduce the
stress on victims and improve the effectiveness
of criminal justice investigations of child abuse.
This article reviews research related to seven re-
forms considered “best practice” for child abuse
investigations (Lanning, 2002; Pence & Wilson,
1994a, 1994b; U.S. Department of Justice, 1999;
Winterfeld & Sakagawa, 2003): multidisciplin-
ary team investigations, trained child forensic
interviewers, videotaped child interviews, spe-
cialized medical forensic exams, victim advo-
cacy and support programs, improved access to
mental health treatment for victims, and Chil-
254
TRAUMA, VIOLENCE, & ABUSE, Vol. 6, No. 3, July 2005 254-268
DOI: 10.1177/1524838005277440
© 2005 Sage Publications
Jones et al. / CRIMINAL INVESTIGATIONS OF CHILD ABUSE 255
dren’s Advocacy Centers (CACs). We use the
term best practice loosely to refer to procedures
for improving child abuse investigations en-
dorsed by a substantial number of policy mak-
ers and professionals. Strong professional en-
dorsement, however, does not necessarily mean
that outcome research has established a pro-
gram’s efficacy. In some cases, research is avail-
able but preliminary. In other cases, judgment
about a practice may be based on the accrual of
practitioner reports of its success. Like many so-
cial interventions, the innovations reviewed
here were implemented primarily in response
to identified needs and much less so to research
evidence.
Bursts of innovative program development
are encouraging, but child abuse professionals
now need to educate themselves on the research
behind these developments. Given tight re-
sources for children’s services, funders are more
frequently requesting evidence for the efficacy
of proposed programs. More important, the
child abuse professional field is becoming ma-
ture, and these reforms are increasingly being
implemented in the United States and in other
nations as well. Now it is time to look carefully
at the research to assess whether these new ap-
proaches solve the problems they were de-
signed to fix and for clues on how they can be
further refined to improve the response to
children, families, and communities.
MULTIDISCIPLINARY TEAM (MDT)
INVESTIGATIONS
Given the number of professionals involved
in child abuse investigations, there have been
increasing efforts to coordinate investigator ac-
tivities, particularly those of law enforcement
and child protective services (CPS). Virtually
nonexistent 25 years ago, hundreds of multi-
disciplinary teams (MDTs) are in use across the
country (Kolbo & Strong, 1997). As of 1999, 36
states had legislation requiring MDTs on cases
of child abuse (U.S. Department of Health and
Human Services, 1999), and as of 2002, 50 states
had legislation requiring cross-referral of these
cases among profes-
sional agencies (U.S.
Department of
Health and Human
Services, 2002). How-
ever, in practice, the
nature and purpose
of interagency collab-
oration varies
widely. Models range
from minimal cross-
referral protocols
with infrequent col-
KEY POINTS OF THE RESEARCH REVIEW
•Many innovative child abuse investigation meth-
ods are being recommended as “best practice,”
but the level of research support for these prac-
tices varies widely.
•Although mostly preliminary, research suggests
the value of many investigation reforms.
•Multidisciplinary teams (MDTs) can improve
investigation quality and case outcomes. Re-
search is mixed on whether MDTs are effective
at minimizing the number of interviews chil-
dren experience.
•Trained child forensic interviewers are taught
research-based methods for improving inves-
tigations; these skills have decreased inter-
view errors in laboratory settings. Training
appears to be effective when highly structured
protocols are used and regular supervision is
provided.
•Videotaping child interviews is more accurate
than verbatim notes, and the majority of chil-
dren report no problems with videotaping.
•Specialized medical forensic examiners pro-
vide higher-quality examinations and more
consistent decision making in cases of sexual
abuse. Increased preparation for the exam can
reduce stress for children and their caregivers.
•Victim advocacy and support programs are
needed; victims and families find the investi-
gation and prosecution process stressful. One
study found a court preparation program ef-
fective in improving outcomes for children.
•Mental health treatment can reduce abuse-
related emotional difficulties for children and
nonoffending caregivers. Research is needed
on increasing victim access to empirically sup-
ported treatments.
•Children’s Advocacy Centers (CACs) may im-
prove communication among professionals
and outcomes such as substantiation and
prosecution rates, but findings are mixed and
more outcome research is needed.
Given the number of
professionals
involved in child
abuse investigations,
there have been
increasing efforts to
coordinate
investigator activities,
particularly those of
law enforcement and
child protective
services (CPS).
laboration to integrated teams that work closely
together on investigations.
One goal of MDT investigations is to elimi-
nate the need for multiple, duplicative inter-
views and thereby reduce children’s distress re-
lated to repeatedly “telling their story” of abuse.
For example, many MDTs conduct joint forensic
interviews in which one interviewer talks to the
child while other investigators watch via a one-
way mirror or closed-circuit TV, occasionally
advising the interviewer on which questions to
ask. Concern about the impact of repetitive in-
terviews on children may be warranted. Two
small studies (Berliner & Conte, 1995; Tedesco &
Schnell, 1987) found that the greater the number
of interviewers children reported, the more
likely the child was to perceive the investigation
experience as harmful. Another found a signifi-
cant correlation between the number of inter-
views and the level of trauma symptoms experi-
enced by children, even after controlling for
several potential confounding variables (Henry,
1997). Fewer interviews may also improve the
quality of children’s testimony, increasing the
strength of the case. Laboratory research has
found that repeated questioning of a young
child witness increases the likelihood of inaccu-
rate or false details (Bruck, Ceci, & Hembrooke,
1998).
Although there may be some support for the
goal of reducing interview redundancy for chil-
dren, research is mixed on whether MDTs ac-
complish this goal. Two studies found that
MDTs reduced the number of interviews per
child in their child abuse investigation pro-
grams (California Attorney General’s Office,
1994; Jaudes & Martone, 1992). Another study
(Henry, 1997) found that children from a com-
munity with greater investigator coordination
were interviewed fewer times on average than
those from a community with a less coordinated
system. However, two evaluation studies found
no differences in the number of interviews be-
tween cases seen by an MDT in a CAC and non-
MDT cases (Hicks, Stolfi, Ormond, & Pascoe,
2003; Steele, Norris, & Komula, 1994). These
evaluations are described more below, but the
lack of findings might be partially explained by
implementation problems.
MDT investigations are thought to improve
investigations in other ways as well. Interagency
communication on cases should be greater for
MDTs, which could in turn improve child safety
by keeping cases from “falling through the
cracks.” Shared information could also reduce
gaps in evidence collected by different investiga-
tors. In addition, increased communication be-
tween law enforcement, CPS, and other profes-
sionals is designed to reduce the degree to
which multiple investigations interfere with
each other (Lanning, 2002; Myers, 1998; Pence &
Wilson, 1994a).
Research indicates that the impact of MDTs
on investigation process and case outcomes
may be significant. Respondents to a survey of
professionals for the California Attorney Gen-
eral’s Office (1994, pp. 84-85) felt that the team
approach to decision making led to more effec-
tive and efficient decisions and “quicker resolu-
tion[s].” A study of daycare sexual abuse inves-
tigations (Finkelhor & Williams, 1988) found
professional satisfaction levels higher for MDT
investigations compared with traditional inves-
tigations. This study also found that team inves-
tigations had fewer “weaknesses” than tradi-
tional investigations, as rated by investigators
(such as problems with parental cooperation
and weak interviewer skills), and resulted in
higher conviction rates and more frequent sus-
pension of day care licenses. Two additional
studies also found that MDTs improved case
outcomes. Jaudes and Martone (1992) found
that joint investigations increased the likeli-
hood that police and prosecutors would iden-
tify and charge perpetrators and that CPS
would substantiate allegations. Tjaden and
Anhalt (1994) also found that greater coordina-
tion within a community was positively related
to a number of case outcomes, such as victim
corroboration, perpetrator confession, criminal
charges, and conviction rate. However, this
study did not control for preexisting differences
between cases that received independent
versus joint investigations, and no differences
in outcomes were found between more
coordinated and less coordinated communities.
Proponents of MDT investigations claim that
reducing the number of victim interviews is one
of the primary benefits of coordination. Re-
256 TRAUMA, VIOLENCE, & ABUSE / July 2005
search may yet show that MDTs can provide
this benefit, but the current mix of findings indi-
cates that this question needs to be better ex-
plored.Theremaybecertainmodelsof
multidisciplinary coordination that have more
success in reducing interviews. Differences in
the quality of the collaboration may also explain
some of the varied findings. In addition, re-
searchers might need to identify more sensitive
measures of interview redundancy than the
number of interviews per se. For example, the
number of times children must repeat them-
selves when speaking to different investigators
might serve as a better measure. Meanwhile, an
encouraging number of studies suggest that
MDTs can improve overall investigation qual-
ity, an outcome with an arguably greater impact
on the well-being and safety of children. Practi-
tioners and policy makers can look to this
research as offering support for the effective-
ness of multidisciplinary teamwork.
TRAINED CHILD FORENSIC INTERVIEWERS
There has been increasing recognition of the
skill and sensitivity required to conduct effec-
tive and humane forensic interviews of alleged
child victims. Poor interviewing can alienate
and distress children, lead to inaccurate assess-
ments about allegations, and create opportuni-
ties for defense attorneys to attack interviews as
suggestive and misleading (Wood & Garven,
2000). A number of training programs have
been developed to increase interviewer skills
(see, e.g., the programs cited below). Special-
ized interviewers are employed in many juris-
dictions for their abilities to work with children
and their training in child forensic interviewing.
It is very likely, however, that many police and
child protective investigators who interview
children still lack this training.
Extensive research has identified several
common interviewing mistakes that affect chil-
dren’s openness and accuracy and the amount
of useful detail they provide (see Wood &
Garven, 2000). A number of studies demon-
strate that suggestive interviewing can lead
some, primarily younger, children to make mis-
leading or false statements inadvertently (see
Ceci & Bruck, 1993; Poole & Lamb, 1998). Rein-
forcing children for certain answers (e.g.,
implying that the child can demonstrate help-
fulness by disclosing abuse) can increase false
reports. Interviewers who tell children what
others believe about the allegations can influ-
ence children to make false statements out of a
sense of compliance. Insensitive interviewers
can distress already traumatized children and
lead them to “close up” to interviewers. Poor
interview questions can lead children to
disclose too little information.
Considerable research supports specific
methods for conducting interviews. Being in-
terviewed in a warm, supportive way, with at-
tention to building rapport at the beginning of
the interview, leads children to provide more
accurate, more detailed reports (Carter, Bot-
toms, & Levine, 1996; Goodman, Bottoms,
Schwartz-Kenney, & Rudy, 1991). Children’s
positive associations with the investigation in-
crease when they feel the interviewer has been
emotionally supportive (Berliner & Conte, 1995;
Henry, 1997; Tedesco & Schnell, 1987). Open-
ended questions that ask children to tell what
happened from beginning to end produce lon-
ger responses with more detail than focused
questions (Hershkowitz, Lamb, Sternberg, &
Esplin, 1997; Lamb et al., 1996; Sternberg et al.,
1997). Age-appropriate language increases the
accuracy and credibility of children’s responses
(Perry, McAuliff, Tam, & Claycomb, 1995;
Saywitz, Jaenicke, & Camparo, 1990).
Leading training programs all teach inter-
viewing methods that are based on or influ-
enced by this research. These include the
CornerHouse Forensic Interview (www.
cornerhousemn.org), the American Prosecutor
Research Institute’s Finding Words course
(www.ndaa.org/apri/), Forensic Interviewing
of Children Training at the National Children’s
Advocacy Center Academy (http://www.
nationalcac.org/academy/forensic_children.
html), and the Forensic Interview Clinics of the
American Professional Society on the Abuse of
Children (www.apsac.org). Michael Lamb and
colleagues at The National Institute for Chil-
dren’s Health and Development (NICHD) have
developed an entire interview protocol based on
their interviewing research (Orbach et al., 2000).
These methods train interviewers to develop
Jones et al. / CRIMINAL INVESTIGATIONS OF CHILD ABUSE 257
rapport with children, use age-appropriate lan-
guage, and eliminate pressures and reinforce-
ments that would lead children to respond in
misleading ways.
However, training interviewers to improve
their interviewing is not easy or straightfor-
ward. Research has found that training pro-
grams increase attendees’ knowledge but have
only limited success improving interviewing
skills (Memon, Bull, & Smith, 1995; Memon,
Holley, Milne, Koehnken, & Bull, 1994;
Stevenson & Leung, 1992; Warren et al., 1999).
Some skills might be more easily taught than
others. Wood and Garven (2000) have con-
cluded, based on their experience training CPS
and law enforcement, that more serious inter-
viewing errors such as suggestiveness and im-
proper reinforcement can be eliminated with
short training programs. Improving other inter-
view skills, such as rapport building and the use
of open-ended questions, may require more ex-
tensive supervision and frequent feedback ses-
sions. In fact, research by Lamb and colleagues
have demonstrated that interviewers who use a
highly structured protocol and receive regular
supervision and feedback substantially im-
proved the quality of their interviews (Lamb,
Sternberg, Orbach, Esplin, & Mitchell, 2002;
Lamb, Sternberg, Orbach, Hershkowitz, et al.,
2002). Further research is needed to explore
whether regular supervision and feedback is
key to cementing what is learned in other
training programs as well.
VIDEOTAPING CHILD INTERVIEWS
Many professionals consider it best practice
to videotape child forensic interviews, and hun-
dreds of jurisdictions routinely videotape inter-
views. Other professionals, however, oppose it
vigorously (see Myers, 1993). Advocates argue
that recording investigative interviews yields a
more accurate and credible rendering of the al-
leged abuse, including children’s demeanor
when they disclose it (Berliner, 1992; Broderick,
Berliner, & Berkowitz, 1999; MacFarlane &
Krebs, 1986). Videotapes make interviewers
more accountable and facilitate training and su-
pervision of their work. Videos, they claim, help
families overcome denial, convince perpetra-
tors of the strength of the case against them, and
help victims remember and avoid recantations.
The result, they report, is greater family support
and more perpetrator confessions. Videotaping
can help make additional interviews unneces-
sary and can sometimes be entered as evidence
in court, saving child victims from the need to
testify.
Opponents argue that legal proceedings be-
come overly focused on the videotape. Defense
attorneys, they say, can focus on children’s in-
consistencies and interviewers’ mistakes rather
than children’s stories and can speciously but
effectively attack details of interviews (Martin
& Besharov, 1991; Stern, 1992). Vieth (1999) ar-
gued that videotaping is often detrimental un-
less investigators are well trained in interview-
ing and prosecutors, defense attorneys, and
judges are trained to evaluate the recording.
Concern has also been raised about child inter-
viewees becoming embarrassed or frightened
or reacting behaviorally to the fact of being vid-
eotaped (Martin & Besharov, 1991; see Myers,
1993).
Research on videotaping is only at a begin-
ning stage but has addressed some important
questions. Two studies found that videotapes
were more accurate than verbatim notes (Ber-
liner & Lieb, 2001; Lamb, Orbach, Sternberg,
Hershkowitz, & Horowitz, 2000). In the Lamb
et al. (2000) study, interviewers tended to report
in their notes that they obtained details from
less leading questions that the videotapes re-
vealed were, in fact, obtained from more lead-
ing questions. Two studies found that the
majority of videotaped children reported expe-
riencing no more than minor discomfort or even
found videotaping helpful (Berliner & Lieb,
2001; Henry, 1999). Henry (1999) found that
children were interviewed fewer times on aver-
age in one county that videotaped than in two
other counties in the same state that did not, but
this comparison is confounded by other differ-
ences between the jurisdictions.
An evaluation team with the California At-
torney General’s Office (1994) surveyed profes-
sionals’ opinions in two counties that had re-
cently introduced videotaping as part of the
implementation of an MDT. Of those respond-
ing, 88% felt that videotaping was useful and
258 TRAUMA, VIOLENCE, & ABUSE / July 2005
30% that it was harmful (respondents could
identify both positive and negative effects), and
95% responded that they recommend videotap-
ing routinely or selectively in the future. Wilson
and Davies’s (1998) study of British police in-
vestigations had a mundane but telling finding:
A large minority of videotapes had poor sound
and visual quality, making it difficult to see and
hear children.
Thus, research suggests that videotaping in-
deed provides substantially more accurate doc-
umentation than even the best note taking and
that the emotional effect on children is minimal.
Professionals generally report finding video-
taping useful in practice, although the technical
quality of the videotapes is important. How-
ever, there is only minimal research on most of
the stated advantages and disadvantages of
videotaping, especially on the effects of video-
taping on criminal justice outcomes.
FORENSIC MEDICAL EXAMS
Forensic medical examinations are typically
requested in child abuse investigations to iden-
tify physical evidence of abuse for the prosecu-
tion of the alleged offender, to screen for medi-
cal conditions related to sexual contact, and to
reassure victims and parents about the child’s
physical well-being (Britton, 1998). Although
only a small minority of cases of suspected sex-
ual abuse result in physical evidence (see re-
views in DeJong, 1998; Hegar, Ticson,
Velasquez, & Bernier, 2002), medical findings
are related to an increased likelihood of success-
ful criminal prosecution (Bradshaw & Marks,
1990; Cross, DeVos, & Whitcomb, 1994; Palusci
et al., 1999).
Child forensic medical exams require special-
ized knowledge. Most pediatricians do not have
the skills to identify the subtle signs needed to
make a differential diagnosis between abuse
and other conditions. Many do not know how to
collect and use forensic evidence or how to tes-
tify effectively in court. There is growing inter-
est in improving medical examiners’ skills
through training and education. Research sup-
ports this development. Several studies indicate
that specialized and experienced medical exam-
iners provide higher quality and more consis-
tent decision making in cases of suspected sex-
ual abuse (Adams & Wells, 1993; Brayden,
Altemier, Yeager, & Muram, 1991; Paradise
et al., 1997; Paradise, Winter, Finkel, Berenson,
& Beiser, 1999). Experienced medical personnel
might also be more comfortable with the exam
process and more aware of information needed
by patients, thereby reducing stress levels for
children and their caretakers. However, re-
search has not documented whether training
for medical personnel improves victims’
experience of the examination (Britton, 1998;
DeJong, 1998; Dubowitz, 1998).
The use of new technologies in forensic medi-
cal exams is also considered to be best practice
(Adams, 1997; Finkel, 1998). Photocolposcopy,
videocolposcopy, and computer imaging tech-
nology are described as improving the diagnos-
tic abilities of medical practitioners and possi-
bly improving the experience of patients. These
technologies, which magnify tissue and pro-
vide enhanced visual images, are quickly be-
coming standard practice among specialized
medical examiners. A survey by the Section on
Child Abuse and Neglect of the American
Academy of Pediatrics (AAP) found that 70% of
the 170 members who responded to the survey
used the colposcope and interpreted
colposcopic findings (Adams, 1997). It is likely,
however, that many medical forensic examiners
rely on more traditional technologies. New
technologies are costly and require trained per-
sonnel. Research is needed to help practitioners
and communities weigh the costs and benefits of
incorporating tools such as the colposcope into
clinical practice (Adams, 1997; Finkel, 1998;
Levitt, 1998).
Although one of the most important out-
comes of the exam may be to reassure victims of
their physical integrity, this has to be weighed
against evidence that children may experience
the exam as invasive and stressful. Although
most children do not report difficulty with ex-
ams, approximately a third of children under-
going an examination report a negative experi-
ence of some kind (Allard-Dansereau, Hebert,
Tremblay, & Bernard-Bonnin, 2001; Britton,
1998; Davies & Seymour, 2001; Lazebnik et al.,
1994; Prior, 2001). Research points to several
ways to improve the experience for children.
Jones et al. / CRIMINAL INVESTIGATIONS OF CHILD ABUSE 259
There is evidence that the emotional support
provided by the medical professional is impor-
tant to the child’s overall experience of the exam
(Allard-Dansereau et al., 2001; Davies & Sey-
mour, 2001). Furthermore, children and care-
givers are often poorly prepared for what the
exams entail and the less information they have,
the greater their anxiety (Steward, Schmitz,
Steward, Joye, & Reinhart, 1995; Waibel-Duncan
& Sanger, 1999). Practitioners could reduce chil-
dren’s anxiety by explaining procedures and
purposes to children prior to the exam.
VICTIM ADVOCACY AND
SUPPORT PROGRAMS
Legal proceedings are also stressful for child
victims and their families. The numerous delays
can be frustrating, the time requirements oner-
ous, and the settings, “legalese,” and adver-
sarial nature of the process intimidating. In ad-
dition, professionals have expressed concern
that children may experience secondary trauma
from testifying about painful and personal vic-
timization experiences and from facing the ac-
cused in court (e.g., DeFrancis, 1969; New-
berger, 1987; Weiss & Berg, 1982).
Although no general or lasting negative ef-
fects of prosecution on children have been
found, there are indica-
tions that certain aspects
of trial and pretrial expe-
riences can have a nega-
tive impact (Goodman
et al., 1992; Runyan,
Everson, Edelsohn,
Hunter & Coulter, 1988;
Whitcomb, Runyan, et al.,
1994; see also Whitcomb,
Goodman, Runyan, &
Hoak, 1994). In particular,
multiple testimonies
(Goodman et al., 1992;
Whitcomb, Runyan, et al.,
1994) and long and harsh cross-examination
have been found to increase distress for chil-
dren (Whitcomb, Runyan, et al., 1994). Further-
more, children report experiencing high levels
of fear prior to and during legal proceedings,
and families report frustrations with the numer-
ous delays of the legal process and dissatisfac-
tion with prosecution outcomes (Berliner &
Conte, 1995; Goodman et al., 1992; Sas, Hurley,
Hatch, Malla, & Dick, 1993).
To increase information and support to vic-
tims and their families, many court systems pro-
vide victim advocacy programs. These pro-
grams are designed to prepare victims,
witnesses, and their families for the court pro-
cess. They may also provide emergency ser-
vices, counseling, personal advocacy, claims as-
sistance, and other court-related services.
District attorneys’ offices in some jurisdictions
have victim witness advocates on staff to help
children and families in these ways (see, e.g.,
Spath, 2003). Some legal systems also provide
court preparation programs for children that
are designed to reduce children’s anxiety and
help them testify effectively. These programs in-
volve talking over the legal process with chil-
dren, familiarizing them with the roles of differ-
ent legal professionals, and educating them
about what to expect if they testify. Educational
materials or strategies might include reading
materials, toys, role-playing, and/or tours of
the courtroom.
Currently, no outcome research that we are
aware of is available on the effectiveness of gen-
eral victim/witness programs, but one initial
study has demonstrated that court preparation
can be effective in improving outcomes for chil-
dren. This evaluation (Sas, n.d.) found that a
court preparation program improved children’s
knowledge about the court process and reduced
their anxiety about testifying. More research is
needed to understand the scope of legal sup-
ports available to child victims and families and
to better understand the impact of these
programs.
ACCESS TO MENTAL HEALTH TREATMENT
Child abuse can have devastating effects on
the mental health of children and families, and
for some children, investigation and prosecu-
tion can exacerbate these problems. Child vic-
tims commonly have symptoms of anxiety and
depression and experience high rates of post-
traumatic stress disorder (PTSD) (Deblinger,
McLeer, Atkins, Ralphe, & Foa, 1989;
Mannarino, Cohen, & Gregor, 1989). It is consid-
ered best practice to evaluate children’s mental
260 TRAUMA, VIOLENCE, & ABUSE / July 2005
Currently, no
outcome research
that we are aware of
is available on the
effectiveness of
general victim/
witness programs, but
one initial study has
demonstrated that
court preparation
can be effective in
improving outcomes
for children.
health as a component of a comprehensive in-
vestigation and to refer troubled children for
mental health treatment as soon as possible. To
this end, many investigative agencies have de-
veloped referral links with treatment providers.
Research reviews have identified several
therapeutic approaches that are successful in re-
ducing symptoms of anxiety, depression, and
PTSD in abused children and improving care-
giver skills (Chadwick Center for Children and
Families, 2004; Saunders, Berliner, & Hanson,
2002). A particularly strong record of effective-
ness has been established for trauma-focused
cognitive-behavioral therapy (e.g., Cohen &
Mannarino, 1996; Deblinger, Steer, &
Lippmann, 1999), cognitive-behavioral therapy
for physical abuse (Kolko & Swenson, 2002);
and parent-child interaction therapy (PCIT)
(Borrego, Urquiza, Rasmussen, & Zebell,
1999).
There is also evidence for the need to improve
nonoffending caregiver support for children
(see N. A. Elliot & Carnes, 2001 for a review of
this literature). Maternal support has been
shown to be predictive of greater resiliency in
child abuse victims (Spacarelli & Kim, 1995),
less child distress (Morrison & Clavenna-
Valleroy, 1998), and reduced child behavior
problems (Everson, Hunter, Runyon, Edelsohn,
& Coulter, 1989; Goodman et al., 1992;
Whitcomb, Runyan, et al., 1994). Children with
supportive caregivers also appear more likely to
have their cases prosecuted and are less likely to
be removed from the home (Cross et al., 1994;
Cross, Martell, McDonald, & Ahl, 1999; DeVos,
Cross, Peeler, Whitcomb, & Stober, 1992;
Everson et al., 1989). Other research has found
that disclosures are more likely and recanta-
tions less likely with greater parental support
(D. M. Elliot & Briere, 1994; Lawson & Chaffin,
1992; Sorenson & Snow, 1991). Outcome re-
search on treatment programs for nonoffending
caregivers has thus far been limited mostly to
cognitive-behavioral treatment programs, but
these data indicate that such programs can im-
prove caregivers’ emotional functioning and in-
crease their support of their children (e.g., Celano,
Hazzard, Webb, & McCall, 1996; Deblinger
et al., 1999; Deblinger, Stauffer, & Steer, 2001).
Although a number of therapies have been
shown to be effective in improving the well-be-
ing of victims and their families, it is not known
how many communities offer such treatment
options. Most children likely receive therapeu-
tic treatments with little or no empirical support
for treating abuse-related difficulties; many
more may be offered no therapeutic support at
all. An important first step is to identify meth-
ods to match children in need of treatment with
appropriate services in their community. Al-
though establishing referral protocols between
investigating and therapeutic agencies would
seem a likely strategy for improving victim ac-
cess to treatment, no research documents the
use of referral protocols or explores their effec-
tiveness. Case review, or other follow-up proce-
dures may be necessary to ensure that children
receive needed services. In addition, communi-
ties need to increase the availability of treat-
ment providers trained to offer empirically sup-
ported treatments for child abuse and trauma
(Chadwick Center for Children and Families,
2004). Increasing education and training
opportunities for professionals would be one
method for improving this availability.
CHILDREN’S ADVOCACY CENTERS
The CAC model incorporates many of the in-
novations described above as standard elements
of practice in specialized nonprofit agencies or
departments (Simone, Cross, Jones, & Walsh,
2005). CACs aim to provide a child-friendly en-
vironment, use team interviews conducted by
trained child forensic interviewers, offer medical
and therapeutic services on-site or through refer-
ral protocols, and provide victim advocacy and
sometimes court education programs as well. A
CAC membership organization, the National
Children’s Alliance (NCA), was developed in
the United States, in part to establish and over-
see standards of practice for member CACs (see
http://www.nca-online.org/). Membership in
the NCA has increased from 34 registered cen-
ters in 1993 to more than 478 full or associate
centers in 2003 across 49 states (National Chil-
dren’s Alliance, 2003). A survey of a representa-
tive sample of NCA member CACs found that
they provided the following services (Jackson,
2004):
•One hundred percent reported having a child-
friendly facility.
Jones et al. / CRIMINAL INVESTIGATIONS OF CHILD ABUSE 261
•All CACs surveyed had a multidisciplinary team
with an average of 7 members, typically including
law enforcement, CPS, prosecution, health care,
mental health, and victim advocates.
•A majority (68%) had specially trained interviewers
on-site and 100% provided ongoing training for
CAC staff.
•One hundred percent reported that they provided
children and families with access to mental health
services, with 51% providing these services on-site.
•Approximately half (53%) provided on-site medical
exams, with the vast majority (90%) of exams con-
ducted by physicians.
•Almost all CACs (92%) reported having multidisci-
plinary case review procedures.
•The vast majority (94%) helped clients obtain victim
advocacy services, and 48% provided victim advo-
cacy services on-site.
•Ninety-two percent reported a case tracking system,
with 65% having a computerized system.
To the extent that CACs make use of innova-
tive practices such as multidisciplinary teams
and increased training, they should expect to
see related improvements in investigation out-
comes. There may also be additional positive
outcomes resulting from their efforts to provide
child-friendly interview environments and to
consolidate services in one location, for exam-
ple. However, the impact of CACs has not been
adequately evaluated. The few existing evalua-
tion studies have disparate results, in part be-
cause of limited research methods and
measures but perhaps more because of actual
differences between the CACs studied. Al-
though the NCA ensures that its member CACs
meet certain standards of practice, the agencies
vary widely in their goals and agency involve-
ment and also play different roles in their com-
munities (see Walsh, Jones, & Cross, 2003).
Given these differences, the impact of CACs can
be expected to vary as well.
Kenty and Meyers (1991) contrasted sexual
abuse cases handled by a fledgling CAC to a
group of non-CAC police and CPS cases from
the same community. The CAC greatly facili-
tated joint police-social worker communication
and featured joint police-CPS interviews (re-
ducing the need for redundant interviewing) in
59% of cases versus 0% in the comparison. The
CAC group had more thorough investigations,
more frequent supportive contacts with the vic-
tim and family members, and increased service
delivery and medical consultation in cases.
There were no significant differences on arrest
and prosecution. The nature of this CAC makes
it difficult to generalize these results to other
CACs, however. A major component was a new,
specialized sexual abuse intake unit of the state
child protective agency—unusual for most
CACs. It is difficult to know to what extent the
advantages of the new program were because of
the CAC per se versus the specialized CPS unit.
As noted above, Steele et al. (1994) found no
difference between CAC and non-CAC cases on
number of interviews in one community. More
agencies actually conducted interviews in CAC
cases, on average, than in comparison cases.
Steele and colleagues suggest that greater com-
prehensiveness of the CAC evaluations may ex-
plain the greater number of agencies interview-
ing a child, on average. But their interviews
with professionals involved with this newly es-
tablished CAC also suggested that profession-
als were sometimes required by their agency to
conduct a separate interview themselves, al-
though in many cases it was a cursory interview
designed to minimize children having to retell
the story of their abuse. Large caseloads and
scheduling problems also led some profession-
als to interview children separately and not use
the team interview, which can take more of a
professional’s time and require adapting to
other professionals’ schedules.
Another evaluation study similarly found no
differences between a sample of CAC clients
and a comparison sample in the number of in-
vestigative interviews conducted with children,
the number of days from disclosure of abuse to
medical exam, or the caregivers’ experience
with the investigator’s handling of the case
(Hicks et al., 2003). This evaluation did find,
however, that significantly more CAC clients
were referred for counseling than in the com-
parison sample.
The impact of CACs on criminal justice out-
comes varied across studies. Two studies
(Jenson, Jacobson, Unrau, & Robinson, 1996;
Kenty & Meyers, 1991) found no effect of their
CACs on criminal justice outcomes, but Steele
and colleagues (1994) found that prosecution
and incarceration were greater for the CAC
group than the comparison.
262 TRAUMA, VIOLENCE, & ABUSE / July 2005
Professional and parent satisfaction with
CACs was positive, on average, across the stud-
ies that measured it (Jenson et al., 1996; Steele
et al., 1994), although Jenson and colleagues
found that parent satisfaction declined some-
what at 3-month follow-up, indicating the need
for more intensive follow-up services. Jenson
and colleagues also found that children were
satisfied with their experiences at the CAC.
More evaluation research on CACs with
better comparisons is badly needed, especially
because most of the above-mentioned research
is 7 to 8 years old and does not reflect the greater
program development of CACs in this decade.
A multi-site CAC evaluation project is currently
under way (Cross & Jones, 2002), and there are
efforts to bring together additional outcome
data on CACs (C. Kirchner, personal communi-
cation, March 2003). CACs themselves are
working to increase the quality of their informa-
tion databases with an eye toward improving
outcome data in the future.
Even with direct outcome research still in de-
velopment, it is evident that CACs incorporate
many current best practices. As described
above, many of these practices are supported by
or influenced by existing research. The current
state of knowledge suggests that CACs, as well
as other agencies that include these practices in
their standards, are more likely to see favorable
outcomes than agencies that do not use these
practices. Whether CACs represent an effect
that is more than the sum of their parts and have
a clear impact on important child, family, and so-
cial outcomes will need to be examined further.
CONCLUSION
Although new procedures in child abuse in-
vestigations need to be evaluated carefully, ex-
isting research offers some support for many
current practices. Even though field research on
child abuse investigations is still in its infancy
and outcomes are only beginning to be studied,
there is an empirical basis for many areas of
practice, and new research shows the potential
to guide practice in the near future. Practitio-
ners following many best practices can argue
that much of their work has at least preliminary
scientific support. For example, multiple stud-
ies have documented the problems of using in-
appropriate interview techniques with children
and the corresponding improvements when de-
velopmentally appropriate questioning is used.
Agency practices linked to this research, such as
the use of specialized training for forensic
interviewers, can clearly be described as
research-based best practice.
Research on other investigation practices de-
scribed in this article is still in early stages of de-
velopment. However, given that policy must be
made and practice carried out regardless of the
state of research, even preliminary findings can
provide some guidance and bolster arguments
for best practice. For example, some findings
suggest that multidisciplinary teams can have
positive effects on assessments and prosecution
outcomes. Likewise, the limited available re-
search indicates that child abuse medical exam-
iners who are specially trained will be more
likely to collect better evidence and make more
consistent decisions. Some research also indi-
cates that social and emotional support can im-
prove children’s experiences with the court pro-
cess and that child mental health treatment can
help child victims recover. Data also suggest
that interventions with nonoffending care-
givers can help improve their mental health and
increase their support for their children.
Research is only beginning to clarify areas in
which professionals disagree on what consti-
tutes best practice, but it is clear that research
can help resolve these in the future. One of the
problems is that research is often still too frag-
mentary to examine thoroughly both sides of
the debate. Some studies already suggest that
some of the fears about videotaping child inter-
views are unfounded, but most of the concerns
about this practice have not been empirically
tested. Similarly, research allays some of the
concern about the emotional impact of forensic
medical examinations, but has not identified
the universe of cases for which the benefits of fo-
rensic medical examinations outweigh the
costs. Nevertheless, investigators can bring to
the discussion objective information from
research.
This review has useful implications for inves-
tigation agencies. The investigation practices
described above are complementary and can be
Jones et al. / CRIMINAL INVESTIGATIONS OF CHILD ABUSE 263
264 TRAUMA, VIOLENCE, & ABUSE / July 2005
incorporated individually or in combination.
The CAC model, by definition, aims to put into
practice a number of different investigation re-
forms. Child abuse investigators can use the in-
formation included in this report to assess in-
vestigation practices in
their community and
make decisions about
next-step reforms based
on the research evi-
dence. The information
reviewed here can also
help defend existing
practice. Many CACs,
for example, worry that
current and potential
funders want to see out-
comes to justify their in-
vestment, yet there are
few evaluations that CACs can cite, and CACs
often lack the resources and skills to do outcome
research. It is important to increase resources
for outcome research and recruit people with
skills to do it. New research is in progress (Cross
& Jones, 2002; C. Kirchner, personal communi-
cation, March 2003). In the meantime, investiga-
tion professionals need to identify all the areas
in which their practice is consistent with the
latest research.
This review focuses on what has been accom-
plished. But there is no denying that the prover-
bial glass is perhaps only one quarter full, and
what has been accomplished should not invite
complacency. We have highlighted what re-
searchers already offer practitioners, but it is
clear that they owe them so much more. New re-
search is needed in every area discussed here,
particularly on medical examinations, multi-
disciplinary teams, investigation methods, and
interventions to support and treat children and
families. Practitioners should not have to an-
swer questions about practice or respond to the
demand for outcome data all by themselves.
We call on researchers to do more to serve the
needs of professionals responding to child
victimization.
Yet is unrealistic to expect that all new prac-
tices have solid empirical support prior to wide-
spread dissemination. Research and practice in-
novations move at a different pace and respond
to different demands. However, children and
society benefit when there is increased dialogue
between those who provide the public with the
best services they have to offer and those who
study the best ways to serve the public. Such an
exchange can move the child abuse professional
field closer toward protecting children and
helping them recover from victimization.
IMPLICATIONS FOR PRACTICE, POLICY, AND RESEARCH
•Child abuse professionals and policy makers
should not assume that investigation “best
practices” have strong outcome research es-
tablishing their efficacy. In reality, little out-
come research on these practices has been
conducted.
•However, policy makers and practitioners can
cite preliminary research that supports the
goals and directions for many innovative in-
vestigation methods and programs.
•There is evidence to recommend the use of
multidisciplinary teams, trained forensic inter-
viewers, and trained and experienced medi-
cal examiners in child abuse investigations.
•There is also evidence that some mental
health treatment approaches can reduce
stress and improve emotional well-being for
victims and their families.
•More research is needed on successful meth-
ods for increasing availability of and access to
such services.
•For some popular practices, such as the use of
videotaped testimony, victim advocacy pro-
grams, and Children’s Advocacy Centers
(CACs), more research is necessary before
their impact can be fully understood.
•Practitioners and policy makers need to know
about relevant research when considering or
implementing new practices and programs.
Regularly including brief research summaries in
professional newsletters is one recommended
way of increasing access to such information.
•Researchers must play an equally active role in
disseminating research outcomes to practitio-
ners. Researchers should increase efforts, for
example, to submit summary forms of their
findings to publications with a broader, more
practitioner-oriented readership.
New research is
needed in every
area discussed
here, particularly
on medical
examinations,
multidisciplinary
teams, investigation
methods, and
interventions to
support and treat
children and families.
Jones et al. / CRIMINAL INVESTIGATIONS OF CHILD ABUSE 265
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Sage.
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Children’s Advocacy Centers: Understanding the
impact of a phenomenon. In K. A. Kendall-Tackett &
S. M. Giacomoni (Eds.), Child victimization (pp. 22-24).
Kingston, NJ: Civic Research Institute.
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Office for Victims of Crime. (1999, June). Breaking the
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justice response to child victims and witnesses (OVC Mono-
graph). Washington, DC: Author.
Lisa M. Jones, Ph.D., is a research assis-
tant professor of psychology in the Crimes
Against Children Research Center at the Uni-
versity of New Hampshire. She is assistant
director of the Multi-Site Evaluation of Chil-
dren’s Advocacy Centers. Other research pro-
jects include studies of child abuse trends, fos-
ter parenting, and the process of change for abusive
parents. She received her degree in clinical psychology
from the University of Rhode Island in 1999.
Theodore P. Cross, Ph.D., is the director of
the Multi-Site Evaluation of Children’s
Advocacy Centers in the Crimes against Chil-
dren Research Center at the University of
New Hampshire. He has been conducting
research on system response to troubled chil-
dren for more than 10 years, including studies of prosecu-
tion of child abuse, outcomes of foster care, and the organi-
zation of children’s mental health services. He also teaches
graduate-level statistics and maintains a private practice
in child clinical psychology.
Wendy A. Walsh, Ph.D., is a research
assistant professor of sociology in the Crimes
against Children Research Center at the Uni-
versity of New Hampshire. She is currently
working on the Multi-Site Evaluation of
Children’s Advocacy Centers. Other projects
include the prosecution of child abuse and
Internet-related child victimization. She has worked on
program evaluations of CPS, child welfare risk assessment
systems, and family resource centers.
Monique Simone, M.S.W., is a research
associate in the Crimes Against Children
Research Center at the University of New
Hampshire for the Multi-Site Evaluation of
Children’s Advocacy Centers. She has worked
on program evaluations for rape crisis centers
and child advocacy centers. Other projects have concerned
prosecution case flow and outcomes.
268 TRAUMA, VIOLENCE, & ABUSE / July 2005
