The National Children's Advocacy Center (NCAC)
Extended Forensic Evaluation Model

Continuum of Interventions with Children

The primary interventions with children when sexual abuse is suspected or indicated include the initial investigative interview, forensic evaluation, forensically sensitive therapy and traditional therapy. The interventions vary on a number of dimensions, including:

• Time involvement
• Goals
• Strategies
• Tools
• Consumer

The initial investigative interview is typically the first intervention when a report of suspected sexual abuse is made. It is generally conducted by law enforcement professionals and/or interviewers employed by a child welfare agency. Usually 1 or 2 forensic interviews are conducted with a given child.

Forensic evaluation is a process of extended assessment of a child who is too frightened or young to be able to fully disclose his/her experiences in an initial forensic interview. This model describes the details of a forensic evaluation protocol developed at the National Children's Advocacy Center (NCAC). The current NCAC protocol involves one session with the non-offending caregiver and five sessions with the child, with each session one week apart and one hour in duration. The goals of forensic evaluation are fact-finding and clinical assessment. Investigative techniques are paired with selected therapeutic techniques to allow facts to be discovered in a non-threatening legally defensible manner.

Forensically sensitive therapy is employed at the conclusion of the fact-finding process, when a decision has been made that sexual abuse is likely to have occurred and the child needs assistance in resolving traumagenic states. The approach is used when there are pending criminal or juvenile court matters, and the child needs immediate treatment. The approach is designed to help the child begin the healing process while still preserving the integrity of the case in terms of credibility in court. Cognitive behavioral strategies are the primary methodologies. Traditional child therapy strategies are also used, with the avoidance of both projective techniques and both interpretation of play or art. All therapeutic techniques used are empirically based.

Traditional therapy may or may not be longer in duration than forensically sensitive therapy, but the main difference is that any appropriate child therapy can be used, including interpretation of the child's art and play, and the use of projective techniques.

The table below delineates the differences between therapy and forensic evaluation. The American Professional Society on the Abuse of Children (APSAC) publishes a statement on Therapist Roles and Responsibilities. Therapists working in the field of child maltreatment must recognize that clinical and forensic roles are different, and become informed on the appropriate approaches used in each role.

Therapy Compared with Forensic Evaluation

Information to be Gathered During Forensic Evaluation

The NCAC forensic evaluation protocol was designed as a fact-finding system to be used in gathering information which will assist prosecutory and child protective decisions. A secondary purpose of the protocol is to gather information regarding the child's trauma issues if abuse has occurred and to establish a foundation for the healing process.

Fact-Finding

Specific details and information pertaining to alleged or suspected abuse must be gathered. More specific and detailed disclosures generally have higher credibility. Some of the facts gathered include:

• Specific details: The who, what, when, where and how of the alleged offense(s)
• Developmental factors: How the child's developmental level relates to any disclosures obtained
• Motivational factors affecting the disclosure
• Alternative explanations for the disclosure

By carefully gathering detailed facts, the forensic evaluator can increase the chances of successful prosecution and/or provide enough additional information for CPS to support child protective measures.

Trauma Assessment

Throughout the evaluation, the evaluator is looking for possible signs of trauma. Full-fledged Post Traumatic Stress Disorder (PTSD) is present in only about 20-30% of children during initial investigation (Friedrich, 1990). However, individual symptoms incorporated in the PTSD diagnosis are seen frequently. A few of the symptoms commonly observed include: detachment from others, decreasing interest in activities, sleep problems, outbursts of anger and increased behavioral problems. In addition to these acute trauma symptoms, there are a number of traumagenic states commonly seen in children who have been abused, including: powerlessness, loss and betrayal, stigmatization, eroticization, destructiveness and attachment disorder (James, 1989). The child is observed throughout the evaluation for acute trauma symptoms, as well as the more generalized traumagenic states. On completion, if the child is exhibiting signs of trauma, the evaluator makes appropriate treatment recommendations. The assessment process provides a foundation for the healing process for sexually abused children because an important component of the recovery process is the ability to discuss the events in a safe and accepting environment.

The National Children's Advocacy Center (NCAC) originated in 1985 in Huntsville, Alabama. The Madison County Multidisciplinary Team in Huntsville reviews and decides cases involving child sexual abuse and severe physical abuse. The team collects evidence through medical examinations by physicians, investigative interviews by law enforcement and CPS, and related investigative work by all team members. In most cases, these efforts yield adequate information for decision making on prosecution and child protective issues. However, in many cases (approximately 26% during a pilot study period) the child is unable or unwilling to freely disclose abuse during the investigative interview even though concerning factors raise a high index of abuse suspicion.

For many children, abuse disclosure is a process, not an event (Sorenson and Snow, 1991). Front line investigative interviewing guidelines are designed to respond to children who are in the active disclosure phase of that process. Numerous studies have shown there to be a subset of children who may need time and safety with a professional in order to present facts that can be used to help make protection, prosecution and treatment planning decisions (Berliner & Conte, 1993, Bourg et al, 1999, Elliot & Briere, 1994, Gonzalez et al, 1993, Keary & Fitzpatrick, 1994). Rather than discount children who cannot disclose at the first interview in cases with concerning factors, the team can refer them for extended forensic evaluation

The multidisciplinary team refers a child to the NCAC intervention program for forensic evaluation when:

• The child does not disclose abuse to investigators, but exhibits behaviors or other indicators strongly suggestive of victimization
• The extent or nature of abuse is not disclosed by the child during the initial investigative interview by Law Enforcement/DHR
• When the information gathered in the initial investigative interview needs further clarification.

The purposes of the Forensic Evaluation are:

• To determine the likelihood of whether or not the child has been abused, and to identify suspected perpetrators.
• To gather forensically sound facts necessary for child protection and law enforcement officials understanding of what, if anything, has happened.
• To allow the child to disclose over time in a non-threatening environment and to assess the extent and nature of the alleged abuse.
• To gather information regarding the child's social and behavioral functioning in order to make treatment recommendations and to establish a foundation for effective treatment if needed.

The efficacy of the protocol has been examined in two studies, a pilot project in Huntsville (Carnes, Wilson & Nelson-Gardell, 1999) and a nationwide multi-site project (Carnes, Nelson-Gardell and Wilson, 1999). The average recommended length of evaluation is 1 session with the non-offending caregiver and 5 sessions with the child. Some children require fewer sessions, others require more, and it is up to the clinician to manage the case according to the factors presented. Mental health professionals conduct the evaluations. In the multi-site study, children were randomly assigned to 4-session (1 session with the non-offending caregiver and 3 with the child, or 8-session (1 session with the caregiver and 7 with the child) versions of the model in order to study the effects of pace on evaluation outcomes. The 8-session condition was significantly more likely to produce successful outcomes than the 4-session condition. Analysis of disclosure patterns in the 8-session condition revealed that 95.3% of new disclosures were obtained by the 5th session with the child. Only 51.2% of the new disclosures had been obtained by the 3rd session with the child. Disclosures obtained on the 6th and 7th sessions with the child were enhanced or repeated reports of detail. Therefore, although the 8-session condition produced superior results to the 4-session condition, it appeared that seven sessions with the child were more than enough to achieve credible disclosures. With five child sessions, the likelihood of obtaining any available credible disclosure information is maximized, and the suggestibility risks of longer evaluations are minimized.

This extended evaluation protocol has produced positive outcomes in the legal arena, including criminal, family and civil courts. In the pilot study, 71% of the cases evaluated according to this protocol had successful outcomes in judicial proceedings. In the multi-site project, 73% of the cases had successful judicial outcomes.

The cases that were ultimately successful in the legal arena would have been abandoned after the first investigative interview without the aid of an empirically based extended assessment model. Historically, when an initial interview produced unclear results, investigators were forced to walk away from the case due to lack of evidence, and would sometimes refer the case to a therapist to see what would "cook out" in a clinical setting. Using this model, mental health professionals who have both clinical and forensic training can evaluate this subset of cases in a structured, forensically sound manner, and there is a greater chance that these children can be protected, and the offenders held accountable. Clinical and forensic roles must be clearly separated for this model to be appropriately applied. A clinician who does a forensic evaluation of a child should not do the therapy for that same child unless clinical considerations make it imperative. Although clinicians performing forensic evaluations frequently manage a caseload of both forensic and therapy cases, they generally do not provide both services to the same child. A summary of evaluator qualifications appears at the end of this document.

Stage 1

Prior to beginning the evaluation, case information is collected from law enforcement and CPS investigators. The evaluator attempts to learn the professionals' views of the nature and circumstances of the allegations, and any possible alternative explanations for the allegations (e.g. cases with unusual hostility among parties involved). Any available documented medical information is gathered and the medical specialist's opinion regarding that information is sought.

The evaluator then interviews the alleged non-offending caregiver (NOC). At times this involves more than one interview, such as when the child's parents are estranged and both are allegedly non-offending. Information is gathered on a variety of topics:

• Family history and dynamics
• Current family composition
• Names and relationships of any other significant individuals in the child's life
• Child's social and developmental history
• Care routines
• Access to sexual information
• Family names for body parts
• The NOC's understanding of the current allegations or concerns

The NOC completes two behavioral checklists at this initial session, the Child Behavioral Checklist (Achenbach, 1988) and the Child Sexual Behavior Inventory (Friedrich, 1990). These checklists measure overall behavioral functioning and sexual behavioral functioning, respectively. The evaluator gains appropriate permission and obtains the same checklist information from any other significant caregivers and teachers involved with the child.

Alleged offending parents are generally not interviewed in this model. Frequently, however, information obtained in the forensic evaluation is used by law enforcement to confront the alleged offender. If the evaluator determines that it is necessary to obtain an informational interview from an alleged offending caregiver (e.g. if there is extreme hostility between the parties, or particularly confusing case circumstances), the interview should take place at a time when the child is not present. There is a risk (although this has not been empirically validated) that a child observing the professional warmth, small talk and handshake between professional and adult may misinterpret these behaviors as indicative of a previous relationship or friendship (Conte, 1992). If the child made this assumption, it could affect the trust level with the evaluator. The child is not interviewed in the presence of the alleged offender. Such a procedure would be experimental and not consistent with current standards of practice. It would be potentially traumatic to the child and there is no data to show that behavior in such dyads discriminates between abusive and non-abusive relationships.

Neither is the child interviewed in the presence of the NOC. The NOC may transport the child to the sessions, but does not actively participate in the sessions. The NOC is encouraged not to be overly involved in discussing the content of the child's sessions with the child. If the child begins discussing the sessions or makes further disclosures at home, the NOC is advised to listen supportively, but not to attempt to interview the child, and to bring this information to the attention of the evaluator. The forensic evaluation procedure is explained as part of the investigative process, and the NOC is informed that it is in the best interest of all concerned if discussion of the information obtained in the evaluation be reserved until completion. The NOC is also advised that if any information affecting the child's immediate safety were to be disclosed, the evaluator would immediately report this to him or her. The evaluator provides the NOC with a handbook (Carnes, 1998) that provides information on the legal system, children's reactions to abuse, offender behaviors and normal reactions of non-offending caregivers.

After collecting background information and before seeing the child for the first time, it is useful for the evaluator to make some strategic decisions and consider possible alternative explanations for the current concerns.

Develop alternative explanations

The evaluator should consider who made the report and why, and explore the circumstances surrounding the situation. The possibility of a benign explanation for the concerns and the possibility of false allegations must be ruled out. In cases where there is extreme hostility between parties, careful assessment is needed.

Consider how specific a questioning strategy to use

A primary consideration is the risk of possible continuing abuse. The age of the child will affect questioning strategies, a younger child will require greater structure to focus on the topic and to provide memory cues. If there was a previous report, the evaluator considers whether it was accidental or purposeful and whether it was to a family member or a mandated reporter. If there are unequivocal medical findings or some other convincing physical evidence, the evaluator may want to be more direct in questioning strategy. If behavioral indicators are the only concerning factor, high specificity may be less advisable. Concerning potential uses of the information, the evaluator will want to consider the different levels of stringency in different courts, and choose a questioning strategy accordingly.

Consider the responses of family, community and system

Foster or alternative placement, inappropriate responses from caregivers or friends or media attention may significantly affect the child's trust level. Quality of previous interviews or previous medical intervention may have affected the child's willingness to share information. In cases like these, the evaluator may decide to spend more time in the rapport building stages because the trust will need to be built.

The child sessions are designed to be approximately 50 minutes long and approximately a week apart. In some circumstances, more than one session may need to be completed in a week. Also, sessions may need to be decreased in length with some children, particularly preschoolers or other children with very short attention spans. In any case, the evaluator should be flexible and aware of the needs of the child and the case, and schedule the sessions accordingly. The demeanor of the evaluator should be casual, friendly and kind. Reflective listening is more effective with children than effusiveness or excessive use of positive reinforcement such as "That's great", or "Oh wow, you're really smart".

Research indicates that a kind, friendly and reflective approach enhances memory, decreases suggestibility and is most helpful to children and families (Goodman & Clark-Stewart, 1991, 1993, Berliner and Conte, 1995, Bourg et al, 1999, Poole & Lamb, 1998). The evaluator is more than just a witness to possible statements of abuse; he or she is also establishing a foundation for treatment. If the child was, in fact, abused, the ability to make a clear statement and to be believed and supported by an adult are extremely important first steps in the trauma recovery process.

The stages of the NCAC protocol are described in a specific order here, beginning with more general activities and moving into more abuse specific techniques over time. The protocol is not a cookbook for doing an evaluation exactly the same way every time. Experienced evaluators will use it as a set of empirically based techniques built into an empirically based structure, and will recognize that the child and the case circumstances dictate which techniques to use and when to use them. For example, specific forensic interviewing techniques are built into later stages of the protocol. However, sometimes children make spontaneous disclosures in earlier stages, and when this happens, the evaluator moves into the investigative interviewing mode to gain additional details of the disclosure.

Stage 2

During the second stage, rapport is built with the child and developmental factors are assessed. The goals of this stage are to: (1) establish the context of the evaluation and the role of the evaluator, (2) establish a precedent for narrative responses and (3) assess the child's developmental status. The evaluator explains her role as someone who helps children, and expands upon this as deemed appropriate for the individual child. The evaluator encourages the child to provide narrative descriptions whenever possible during rapport building to model and practice that style of communication. The evaluator may ask the child to give a narrative description of a recent salient event such as a birthday party or, if the child is very young, the evaluator may ask the child to tell about a favorite game or movie.

The context of the evaluation is established by discussing the "ground rules":

• Whatever you say is okay, you won't get in trouble.
• You know more than me about what happened.
• Don't guess, tell me if you don't know.
• You can correct me or disagree.
• If I repeat a question, it doesn't mean the first answer was wrong.
• If a question is too hard, we can come back to it.
• Always tell the truth.

The two primary goals of developmental assessment are to determine the child's capacity for giving specific, credible accounts of events and to begin to learn about the domains that challenge our ability to enter the child's world (e.g. the child's affective/expressive capabilities and the ways in which the child perceives connections between events, people and places)

Developmental assessment is focused on the following content areas:

• Knowledge of basic life facts: DOB, address, city/state of residence
• Speech and language: lengths of words and sentences, idiosyncrasies of speech
• Basic concepts of first, last, always, beside, before, inside, outside, etc.
• Social relatedness (overly friendly/withdrawn)
• Ability to use a model to represent self
• Ability to establish time frames
• Knowledge of colors and quantities
• Vocabulary and knowledge of feelings
• Understanding of truth and lies

These are the broad assessment categories. The information is not gathered as in a test with right or wrong answers, but the assessment is woven into child-friendly activities and practice interviews about neutral events. Developmental assessment is a primary focus of the first stage and is also an ongoing process throughout the evaluation. Specific techniques to tailor the assessment for preschoolers and elementary age children, and guidelines for developing rapport with older children and adolescents are articulated elsewhere (Carnes & LeDuc, 1998). No specific or focused efforts are made to draw out abuse-specific information at this initial stage.

Stage 3

The focus of the third stage is concentrated on social and behavioral assessment. This is accomplished through review of behavioral checklists and developmentally appropriate in-session activities with the child.

Behavioral Checklists

The Child Behavior Checklist (CBCL, Achenbach, 1988) and the Trauma Symptom Checklist for Children (TSCC, Briere, 1996) provide useful information on the child's behavioral functioning. The empirical literature generally does not support the notion that children display consistent psychological responses to sexual abuse (Berliner & Conte, 1993). Therefore, these checklists are not used to attempt to discriminate abused from non-abused children. However, they are useful for assessing general behavioral functioning of the child and to help formulate treatment recommendations. The CBCL is completed by parents, caregivers, and teachers. It can be very informative to check inter-rater agreement between parents and teachers on this instrument. The TSCC is a self-report measure for children 8 years and older. Timing of the TSCC depends upon the case and the child, and it is up to the evaluator to determine at what stage of the evaluation it should be administered. Children completing the TSCC sometimes want to talk about the information contained in the checklist, so it can be a useful way to begin discussing the child's feelings and perceptions. It does contain sexually explicit questions, so the evaluator must decide at what point she wishes to introduce that element of the evaluation.

The Child Sexual Behavior Inventory (CSBI, Friedrich,1990), a parent or caregiver report instrument, measures sexual behavior, the only indicator that has been empirically shown to discriminate between abused and non-abused children (Friedrich, 1993). The instrument has scales that help discriminate sexual behaviors that are related to the child's developmental stage from sexual behaviors that are more likely due to sexual victimization or exposure. The instrument is not used as a sole indicator, but the results are considered along with the larger picture obtained with the full evaluation.

In-session activities

The evaluator uses developmentally appropriate techniques to begin to explore the child's self-understanding and self-esteem. Perceptions of others in the child's environment are explored. The child may be asked to discuss people he or she likes or dislikes being with and may be asked his or her favorite/least favorite thing about various people. The evaluator should discuss both alleged non-offenders and alleged offenders. Daily activities and routines are explored, a particularly useful technique with pre-school children, who are better able to describe scripted activities than specific events (Poole & Lamb, 1998, Sivan, 1991). Details of appropriate activities are described elsewhere (Carnes & LeDuc, 1998).

Stage 4

During the fourth stage, the focus turns to abuse-specific questioning. The evaluator should remain neutral and maintain a hypothesis-testing approach (Poole & Lamb, 1998) during these and all sessions of the evaluation, and should use open-ended neutral prompts whenever possible. The topic of abuse should first be approached obliquely, but may later need to be approached more directly, particularly with younger children, who may not be able to recognize the need to focus on the topic of concern.

The evaluator should remain aware of the child's affective reactions and cues, and be willing to digress from the interviewing task in order to restore the child's emotional balance before returning to focused questioning. Leaving the cognitive arena for a moment and focusing for a short period on pleasant sensory details such as the softness of a stuffed toy or pretty colors may give the child enough control to be able to tolerate completion of the interview (Bourg, et al, 1999).

Introducing the topic of concern

There are a variety of means to introduce the topic of concern. The main principle is to be able to introduce the topic of abuse in a general way, without specifically stating the allegations. Some techniques are described here, the usefulness of which depend upon the child's developmental stage and cognitive acumen and the case circumstances.

• Life context questions. The evaluator uses questions that focus the child's attention on possible contexts of abuse such as care routines, substance abuse, discipline in the home or critical times or events during which the abuse may have occurred.
• Abuse context questions. The evaluator may raise the topic by discussing privacy and safety, or asking the child if there are problems at home. Another possible approach is to discuss secrets, those that are good and not so good (or "yucky" to a small child).
• The "touch survey" technique may be used with young children to assess the types of touch they have experienced and their feelings related to those touches (Hewitt & Arrowood, 1994, Hewitt, 1998). This empirically based technique explores a variety of types of touching, both positive and negative, and the child's perceptions of those touches.
• Discussion of types of touching and body parts inventory. These techniques are useful for focusing a child on the topic of concern, particularly younger children. In a multi-site project evaluating this protocol, Carnes, Nelson-Gardell and Wilson (1999) yielded a 48% disclosure rate. In another study assessing an extended evaluation model (Gries, et al, 1996), interviewers elicited disclosures 34.4% of the time.
• Escalating the level of inquiry, the evaluator may ask specific questions about a suspected individual, but not mention abuse. Then questions about abuse, but not about suspected individuals, may be raised.
• Finally, if necessary, the evaluator may ask questions pertaining to the allegations or concerns related to abuse, without stating specific details, and then ask the child to elaborate. The evaluator may open this subject by saying, "Do you know why you have been sent to talk to me?" or "I understand something may have happened to you. Please tell me everything that happened, from beginning to end."

Suggestive and coercive questioning techniques should be avoided. If the evaluator uses forced choice questions such as yes-no or multiple choice, these questions should be paired with open ended questions to seek the child's elaboration.

Gaining more specific detail

When children disclose abuse, they may at first provide skeletal descriptions due to anxiety or developmental limitations. They are more likely to make errors of omission than commission, therefore it is helpful for evaluators to offer supports such as memory retrieval cues and props (Steward, et al, 1993). Several techniques are useful for gaining more specific details that will increase the credibility of the disclosure and enhance the ability to make the most accurate decisions on protection and prosecution issues.

• Cognitive interviewing (Saywitz, Geiselman & Bornstein, 1992) and narrative elaboration (Saywitz, Snyder &, Lamphear, 1996) techniques may be employed to gain more detailed narratives from children who have made a sparse disclosure. These techniques teach children memory retrieval strategies, increase completeness of memory and improve resistance to suggestibility.
• The child can create free-style drawings to demonstrate any verbal descriptions of abuse. Evaluators should ask the child to describe in detail what has been drawn. Especially with younger children, the content and meaning of the drawing may not be readily apparent. Adult interpretation of a child's free-style drawing is not appropriate in this context. Using drawings in combination with verbal disclosure has been shown to increase quantity and credibility of detail, especially for school-age children (Butler, Gross & Hayne, 1995, Brennan & Fisher, 1998).
• Models such as dolls or drawings may be used as clarification and/or demonstration aids. Evaluators may choose to start with dolls or drawings without anatomical detail, and proceed to detailed models if necessary to aid the child in describing the experience. It is important to clarify that the child and evaluator use the same names for body parts, so a body parts inventory may be done using a doll or drawing. Many times children have limited language skills and limited cognitive understanding of abusive experiences. Demonstration aids may be useful in these cases to supplement the verbal description. The credibility of a reasonably clear verbal disclosure may also be enhanced by the demonstration of that disclosure using a model. Anatomically detailed dolls are to be used with caution, and only when absolutely needed to assist the child's communication regarding a verbally disclosed event, and then strictly following the guidelines for use of the dolls established by APSAC (1995). Evaluators should proceed in accordance with their own jurisdictional issues pertaining to anatomical dolls.

Several areas affecting the credibility of the child's statement can be examined before concluding the evaluation.

• Unusual or improbable elements may exist for a variety of reasons, including perpetrator attempts to confuse or frighten the child, traumagenic memory distortion, and various psychological coping mechanisms of the child (Everson, 1997). Some research has shown that statements containing bizarre or improbable elements may be more likely in more severely abused children (Dahlenberg, 1996). The evaluator should gently challenge the improbable elements, and should seek additional detail to clarify the child's statements.
• Inconsistencies. Session to session inconsistency is well documented and normal, particularly in preschoolers. Young children may not yet have internalized the "story model" that aids both encoding and retrieval of memory. Inconsistency may exist because a child is explaining different incidents or different aspects of the same incident. It may be that the child doesn't comprehend the evaluator's questions and is guessing. Encourage narrative regarding inconsistent statements, and listen carefully. Mark the topic, using questions like: "where were you when he touched you", not "where were you?". Ask the child to describe the incident of concern from beginning to end, not leaving anything out.
• Possible coaching. Gently challenge the concerning statements at the end of the session with casual neutral tone. Challenges drop rates of false reports dramatically. Examples of such challenges are:
  • Are you sure about____?
  • Were you there when it happened, or did someone tell you about it?
  • What did you see/feel/taste/touch while daddy poked your potty?
• Possible fabrication. Again, gentle challenges are the recommended procedure:
  • How come you told officer Jim__ and told me___?
  • I'm confused, you said___before and now you are saying___, can you help me understand?

Stage 5

During the last stage, the evaluator does closure work with the child, including final review and clarification of any abuse disclosures made. The evaluator also summarizes the forensic evaluation experience with the child and discusses any plans for a therapy referral. Regardless of whether or not a disclosure has been made, the evaluator discusses body safety issues with the child. The evaluation is closed with neutral topics and a supportive tone from the evaluator. The child is provided with a means to contact the evaluator in the future.

During the process of evaluation, any new information pertaining to the abuse allegations is immediately relayed to the appropriate investigative team members for follow up. Upon completion of the forensic evaluation, the evaluator collates and summarizes all corroborative information relevant to the case which may include, but is not limited to, reports from Law enforcement agencies, DHR, medical professionals, family members, day care or school. The evaluator uses a Forensic Evaluation Critical Analysis Guide to assess the credibility of the child's statement. The guide includes the assessment of factors such as specific details obtained, developmental factors, emotional content, behavioral checklist results, corroborative information, motivational factors and alternative explanations.

A written report is then prepared for the multidisciplinary team. The forensic evaluation report includes abuse disclosure or non-disclosure, the disclosure credibility examination, reactions and consequences of the alleged abuse, summary of family issues, summary of corroborative reports and treatment recommendations.

The professionals who conduct forensic evaluations should possess characteristics similar to those defined in the APSAC Practice Guidelines on Psychosocial Evaluation of Suspected Sexual Abuse in Children (APSAC, 1997). The following characteristics are defined in the guidelines:

1. The evaluator should possess a graduate level mental health degree in a recognized discipline (e.g. psychiatry, psychology, social work, nursing or child development) or be supervised by a professional with a graduate level degree.
2. The evaluator should have professional experience assessing and treating children and families, and professional experience with sexually abused children. A minimum of two years of professional experience with sexually abused children is expected; three to five years are preferred for forensic evaluators. If the evaluator does not possess such experience, supervision is essential.
3. The evaluator must have had specialized training in child development and child sexual abuse. This training should be documented in terms of formal course work, supervision, or attendance at conferences, seminars and workshops.
4. The evaluator should be knowledgeable about the dynamics and the emotional and behavioral consequences of sexual abuse experiences. The evaluator should be familiar with the professional literature and with current issues relevant to understanding and evaluating sexual abuse experiences.
5. The evaluator should be familiar with different cultural values and practices that may effect definitions of sexual abuse, child and/or family comfort with the evaluation process, child and/or family willingness to provide complete and accurate information, and the evaluator's own interpretation of responses.
6. The evaluator should have experience in conducting forensic evaluations and providing expert testimony. If the evaluator does not possess such experience, supervision is essential.
7. The evaluator should approach the evaluation with an open mind to all possible responses from the child and all possible explanations for the concern about sexual abuse. The evaluator should recognize that all sources of information have limitations and may contain inaccuracies. In forming an opinion, the evaluator should consider plausible alternative hypotheses.

Forensic Evaluation

is a process of extended assessment of a child who is too frightened or young to be able to fully disclose his/her experiences in an initial forensic interview. This model describes the details of a forensic evaluation protocol developed at the National Children's Advocacy Center (NCAC). The current NCAC protocol involves one session with the non-offending caregiver and five sessions with the child, with each session one week apart and one hour in duration. The goals of forensic evaluation are fact-finding and clinical assessment. Investigative techniques are paired with selected therapeutic techniques to allow facts to be discovered in a non-threatening legally defensible manner. For more details on regarding extended forensic assessments, see "The National Children's Advocacy Center's Extended Forensic Evaluation Model," by Connie N. Carnes.

Achenbach, T.M. (1988). Child Behavior Checklist. Burlington, VT: Center for Children, Youth and Families, U. of Vermont.

American Professional Society on the Abuse of Children. (1997). Guidelines for psychosocial evaluation of child sexual abuse. Chicago: Author.

American Professional Society on the Abuse of Children. (1995). Use of Anatomical Dolls in Child Sexual Abuse Assessments. Chicago: Author.

Bourg, W., Broderick, R., Flagor, R., Kelly, R., Ervin, D., Butler, J. (1999). A child interviewer's guidebook. Thousand Oaks, CA: Sage

Berliner, L. & Conte, J. (1993). Sexual abuse evaluations: Conceptual and empirical obstacles. Child Abuse and Neglect. Vol. 17, pp.111-125.

Berliner, L. & Conte, J. (1995). The effects of disclosure and intervention on sexually abused children. Child Abuse and Neglect. Vol. 19, No. 3, pp.371-384.

Brennan, K.H., & Fisher, R.P. (1998). Drawing as a technique to facilitate children's recall. Manuscript in preparation. (Cited in Poole & Lamb, 1998).

Butler, S.G., Gross, J., & Hayne, H. (1995). The effect of draing on memory performance in young children. Developmental Psychology, 31, 597-608.

Briere, J. (1996). Trauma Symptom Checklist for Children. Odessa, FL: Psychological Assessment Resources, Inc.

Carnes, C. (1998). To guide you through the system: A handbook for parents of sexually abused children. Huntsville, AL: National Children's Advocacy Center.

Carnes, C., & LeDuc, D. (1998). Forensic evaluation of children when sexual abuse is suspected. Huntsville, AL:NCAC.

Carnes, C., Wilson, C., & Nelson-Gardell, D. (1999). Extended forensic evaluation when sexual abuse is suspected: A model and preliminary data. Child Maltreatment. August.

Carnes, C., Nelson-Gardell, D. & Wilson, C. (1999). Extended forensic evaluation when sexual abuse is suspected: A multi-site field study. Manuscript in preparation.

Conte, J. (1992). Has this child been sexually abused? Dilemmas for the mental health professional who seeks the answer. Criminal Justice and Behavior. Vol. 19, No. 1.

Dahlenberg, C. (1996). Fantastic elements in child disclosure of abuse. APSAC Advisor, 9, 5-8.

Everson, (1997). Understanding bizarre, improbable and fantastic elements in children's accounts of abuse. Child Maltreatment. 2, 134-149.

Friedrich, W. (1990). Child Sexual Behavior Inventory. Rochester, MN: Mayo Clinic.

Friedrich, W. (1993). Sexual victimization and sexual behavior in children: A review of recent literature. Child Abuse and Neglect. Vol. 17, pp. 59-66.

Gonzalez., L.S., Waterman, J., Kelly, R., McCord, J., & Oliveri, M.K. (1993). Children's patterns of disclosures and recantations of sexual and ritualistic abuse allegations in psychotherapy. Child Abuse and Neglect, 17,281-289.

Goodman, G. & Clarke-Stewart, A. (1991). Suggestibility in children's testimony: Implications for sexual abuse investigations, In J. Doris (Ed.), The suggestibility of children's recollections: Implications for eyewitness testimony. (pp.92-105). Washington, DC: American Psychological Association.

Gries, L., Goh, D. & Cavanaugh, J. (1996). Factors associated with disclosure during child sexual abuse assessment. Journal of Child Sexual Abuse, Vol. 5(3).

Hewitt, S., & Arrowood, A. (1994). Systematic touch exploration as a screening procedure for child abuse: A pilot study. Journal of Child Sexual Abuse, Vol. 3(2). The Haworth Press, Inc.

Hewitt, S. (1998). Small Voices: Assessing allegations of sexual abuse in preschool children. Thousand Oaks, CA: Sage Publications, Inc.

Keary, K. & Fitzpatrick, C. (1994). Children's disclosure of sexual abuse during formal investigation. Child Abuse and Neglect, Vol. 18(7), pp.543-548.

Poole, D, and Lamb, M. (1998). Investigative Interviews of Children. Washington DC: American Psychological Association.

Saywitz, K., Geiselman, R. and Bornstein, G. (1992). Effects of Cognitive Interviewing and Practice on Children's Recall Performance. Journal of Applied Psychology, 77, 744-756.

Saywitz, K., Snyder, L., Lamphear, V. (1996). Helping Children Tell What Happened: A Follow-Up Study of the Narrative Elaboration Procedure. Child Maltreatment, 1, 200-212.

Sorenson, T. & Snow, B. (1991). How children tell: The process of disclosure in child sexual abuse. Child Welfare. 70(1), 3-15.

Steward, M., Bussey, K., Goodman, G., Saywitz, K. (1993). Implications of developmental research for interviewing children. Child Abuse and Neglect. Vol, 17, pp. 25-37.

Sivan, A. (1991). Preschool child development: Implications for investigation of child abuse allegations. Child Abuse and Neglect. Vol. 15, pp.485-493.