Child Advocacy Center Research Articles

Investigation of perceived parental attitude in children exposed to sexual abuse: A case-control study.

The enduring impact of children being subjected to sexual abuse is characterized by lasting traumatic effects. This study aims to assess the influence of perceived parental attitudes on the incidence of sexual abuse in children who have experienced such abuse, comparing them with a control group. The research took place at the Child Advocacy Center (CAC) of a hospital in northern Turkey and in the pediatric outpatient clinics of the same institution. The study evaluated 101 children who were exposed to sexual abuse and 100 children who were not. Data collection took place between November 2022 and August 2023. The study employed a 'Descriptive Information Form' and the 'Parental Attitude Scale' for both case and control groups. The t-test for independent samples, descriptive statistics, and logistic regression analysis were used for data analysis. Analysis of scores from the Parental Attitude Scale revealed significantly lower mean scores in acceptance-involvement and strictness-supervision in the case group (p < .05). The mean scores for 'acceptance-involvement' (X¯ = 22.82 ± 6.26, X¯ = 25.71 ± 3.89) were highest in the case and control groups. Neglectful attitude (38.6%) was more prevalent in the case group, while the control group exhibited a higher frequency of democratic attitude (37%). In terms of predictors, acceptance-involvement (OR = 1.091, p = .005) and maternal employment (OR = 4.410, p < .001) were identified as the most significant predictors of exposed to sexual abuse. The study's Cronbach's alpha value for the scale was α = .743. The study's findings on parental attitudes suggest a potential connection between children's exposure to sexual abuse and inadequate parental acceptance, involvement, supervision, and control.

Mixed-method examination of early maladaptive schemas and coping among children at a child advocacy center.

The present study examined (a) the presence of early maladaptive schemas and coping responses in children who have experienced maltreatment, (b) the relationship between early maladaptive schemas and coping responses, and (c) how qualitative findings compare to previous theoretical structures in quantitative studies. There were 100 participants (Mage = 10.72 years, SD = 3.35; 64 girls, 30 boys, six transgender/nonbinary), with 70% identifying as White. Data were collected in collaboration with a community child advocacy center through forensic interviews in cases of reported child abuse. Early maladaptive schemas were assessed using an adapted version of the Dusseldorf Illustrated Schema Questionnaire for Children. Coping responses were assessed using the COPE Inventory. Information about individual and abuse factors was gathered from case reports. Child advocacy center staff completed the measures based on information obtained during forensic interviews. All assessed early maladaptive schemas were endorsed in this sample; children reported an ability to adapt through the use of socially supported and self-sufficient coping responses. Hierarchical cluster analysis examining word similarity within coded texts demonstrated that subjugation and self-sacrifice were most strongly related. This mixed-method study integrating children's voices contributes a new perspective on early maladaptive schemas and coping responses that can provide education to multidisciplinary teams involved in forensic interviews. However, limits to generalizability must be considered given that the sample was derived from one region in the U.S. Midwest. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Factors facilitating and delaying disclosure and reporting of child sexual abuse: insights from forensic interviews

ABSTRACT In light of limited existing knowledge, we aimed to examine the connection between disclosure facilitators and delays in the context of forensic interviews. We examined interview records from 403 children under 18 suspected of sexual abuse at a child advocacy center. The forensic interview records, family interview forms, and psychiatric examination reports in the files were retrospectively examined. Frequency, mean, and chi-square tests were implemented to analyze the data. The reasons for facilitating and delaying the disclosure of abuse were evaluated using a descriptive analysis method. Of the cases, 79.4% were girls, and 74% were in the 12–18 age group. It was determined that the presence of witnesses, evidence, and messages (16.37%) and discomfort with the suspect’s/abuser’s behavior (11.66%) facilitated the disclosure of abuse. On the other hand, reporting of abuse was delayed due to the suspect’s/abuser’s threats (18.85%) and the victim’s fear, embarrassment and avoidance of her/his family (10.66%). The characteristics of abuse and disclosure reasons varied based on age groups and the intimacy level of the suspect. It has been observed that pre-adolescent children may face cognitive obstacles in disclosing abuse.

Using an AI-based avatar for interviewer training at Children's Advocacy Centers: Proof of Concept.

This proof-of- concept study focused on interviewers' behaviors and perceptions when interacting with a dynamic AI child avatar alleging abuse. Professionals (N = 68) took part in a virtual reality (VR) study in which they questioned an avatar presented as a child victim of sexual or physical abuse. Of interest was how interviewers questioned the avatar, how productive the child avatar was in response, and how interviewers perceived the VR interaction. Findings suggested alignment between interviewers' virtual questioning approaches and interviewers' typical questioning behavior in real-world investigative interviews, with a diverse range of questions used to elicit disclosures from the child avatar. The avatar responded to most question types as children typically do, though more nuanced programming of the avatar's productivity in response to complex question types is needed. Participants rated the avatar positively and felt comfortable with the VR experience. Results underscored the potential of AI-based interview training as a scalable, standardized alternative to traditional methods.

Children’s Experiences of Undergoing Forensic Interviews and Forensic Medical Examinations in a Danish Child Advocacy Center

Child abuse is a severe global problem associated with various negative consequences. It is therefore important that the services received at Child Advocacy Centers (CACs) are perceived as positive as possible by children affected by abuse. Preliminary research indicates that CACs are successful in terms of providing coordinated, professional services. However, existing research has primarily focused on service and criminal justice system outputs, rather than documenting the experiences of the target group: i.e., children undergoing the CAC proceedings. The present study seeks to investigate the children’s experiences of the forensic procedures in a CAC. Qualitative interviews were conducted with 15 children undergoing case proceedings at a Danish CAC. The overall experiences of the children of the forensic interview and forensic medical examination were documented. Additionally, five overall themes were constructed using Thematic Analysis: Localities and surroundings, Relational and communicative work, Ambivalent experiences, Need of information and overview, and Missing out on everyday life. The findings of the current study underline the importance of the physical environment of the CAC, the need of information and overview as well as strong relational and communicative skills among professional as core elements in establishing positive encounters with the CAC. Furthermore, the results indicate how negative experiences of visiting a CAC are not necessarily directly linked to the CAC but may be a result of the children experiencing missing out on well-liked everyday activities. Altogether these results are important to consider when planning future CAC visits to support the well-being of the child.

Child Sexual Abuse in Boys: A Retrospective Investigation

Background: Although recent studies have increased public awareness of child sexual abuse, certain aspects of the issue remain unclear. While research on sexual abuse in girls is abundant, there is limited focus on boys in our country. This study aims to explore the characteristics of cases involving sexual abuse of boys in the province of Türkiye. Methods: The study is descriptive and retrospective in nature. A total of 245 boys who underwent forensic interviews for alleged sexual abuse between September 2017 and March 2023 at the Child Advocacy Center in the province of Türkiye were retrospectively examined. Results: The study included 245 boys aged 3-18 with a mean age of 11.04±3.39. The most common type of sexual abuse was non-penetrative contact (57.6%). Delayed disclosure was primarily attributed to factors such as threat, fear, and shame. Sexual abuse predominantly occurred in public places (56.5%). There were significant among age groups concerning the identity of the reporters, initial disclosure persons, the existence of abuse, and reporting time. However, no significant differences were found in the presence of multiple suspects, recurrent abuse, and the incident location. Post-abuse behavioral changes in children included fear of the perpetrator (15.5%), emotional changes (15.5%), physiological changes (9.4%), and the displaying of risky behaviors (4.1%). Conclusion: The study emphasized the importance of not overlooking sexual abuse among male children. The findings underscore the need for enhanced awareness and intervention strategies to address sexual abuse in boys within the country.

Functionality of Child Advocacy Centers in the Light of Practices

Çocuk İzlem Merkezi (ÇİM), cinsel istismar mağduru çocuk ve ergenlere yönelik adli, tıbbi ve sosyal işlemlerin tek bir merkezden yürütülmesine olanak sağlayan merkezlerdir. ÇİM’in adli boyutunu yöneten, ÇİM öncesi ve sonrası süreci bilen farklı meslek gruplarına mensup personeller tarafından uygulamanın işlevselliğinin değerlendirildiği çalışmalar oldukça kısıtlıdır. Amaç: ÇİM’ler kurulmadan önce ve kurulduktan sonra cinsel istismar mağduru çocuğun adli ayağında çalışmış kişilerin deneyimlerinden hareketle ÇİM’lerin işlevselliğinin ortaya konulması ve literatürdeki boşluğun doldurulması amaçlanmıştır. Buna göre, merkezin iyi yönleri tespit edilir iken eksik kalınan noktalarda nelerin yapılabileceği konusu tartışılacaktır. Yöntem: Araştırma nitel araştırma deseninde, ÇİM’in adli ayağını oluşturan 15 profesyonelin yarı yapılandırılmış görüşmelerinden oluşmaktadır. Veriler içerik analizi tekniği ile analiz edilmiştir. Veriler yorumlanırken temalar tespit edilmiştir. ÇİM kurulmadan önceki süreçler ve merkezin işlevlerine yönelik söylemler olmak üzere iki genel tematik alan oluşturulmuştur. Bulgular: Personel yetersizliğinden ve kayıt cihazlarından kaynaklı birtakım aksaklıkların olduğu vurgulansa da katılımcıların ortak görüşü; ÇİM’in mağdur çocuklar açısından olumlu ve faydalı olduğu yönündedir.

Evaluation of Victim and Abuse Characteristics in Child Sexual Abuse: A Child Advocacy Center Experience

Amaç: Bakırköy Prof. Dr. Mazhar Osman Ruh ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi bünyesinde hizmet veren Çocuk İzlem Merkezinde (ÇİM) değerlendirilen hastaların başvuru şekilleri ve nedenleri, ailelerinin demografik özellikleri, uygulanan prosedürler ve sağlanan hizmetleri gözden geçirmeyi amaçladık.&#x0D; &#x0D; Yöntem: 2015-2020 tarihleri arasında olası cinsel istismar şüphesi ile değerlendirilen vakaların dosyaları retrospektif olarak tarandı. Yapılan adli ve psikiyatrik görüşme ile cinsel istismar tanısı konmuş olan vakalar çalışmaya dahil edildi. Vakaların demografik bilgileri, bildirim şekilleri, istismarcının yaşı, mağdurla olan yakınlık derecesi, paydaş kurumlarca yapılan işlemler, diğer işlemler gibi veriler kayıt edildi.&#x0D; &#x0D; Bulgular: Çalışmaya toplam 384 vaka dahil edildi. Vakaların 320 tanesi (% 83.3) kız iken 64 (%16.7) tanesi erkek idi. Vakaların ortalama yaşı 12.7 (±3.17) yıl idi. İstismarların 268’i (%69.8) basit cinsel istismar iken 114’ü (%29.7) nitelikli cinsel istismar şeklinde idi. Basit cinsel istismarda bulunan kişiler daha çok yabancılar iken (n=78, %29.1, p

A conceptual analysis of system responses to the issue of problematic sexual behaviors in children and recommendations for future work in Children's Advocacy Center multidisciplinary teams.

Problematic sexual behavior (PSB) in children is a common, yet frequently misunderstood and mishandled issue facing communities. Because of the intersection of children both causing harm and being harmed, societies across the globe struggle with whether to punish or support during these times. For Children's Advocacy Centers (CACs), whose mandate it is to support victimized children, this tension is exacerbated. CACs have historically relied on identifying a "perpetrator" and "victim" when providing their services, however PSB displaying youth do not fit this classic dichotomy. Compared with other children, PSB displaying youth are more likely to experience greater incidents and types of violent childhood trauma, have increased parent instability, decreased familial support, and struggle with co-occurring mental health diagnoses. Due to the stigma and fear surrounding sexual behaviors in children and systemic barriers including varied definitions of PSB, uncertainty regarding how to respond within the context of child-serving roles, and the criminalization of children's behaviors, access to supportive services is complicated and challenging. Treatment completion rates for this population are as low as 13%, despite most methods being short-term, non-invasive, and community based. This conceptual analysis paper identifies five key themes in the literature that influence these barriers and proposes an interdisciplinary approach for CAC multidisciplinary teams (MDTs) to better support this vulnerable population.

Randomized Controlled Pilot Trial: Project Support Positive Parenting Module Following Sexual Abuse

Purpose: Support from a nonoffending caregiver can play a critical role in helping children recover from sexual abuse. However, many caregivers lack the skills to effectively support their child during the aftermath of a sexual abuse disclosure. This randomized controlled pilot trial examined a brief parenting intervention (Project Support Positive Parenting module) delivered by paraprofessionals to families waiting for intensive, trauma-focused therapy at a children's advocacy center. Methods: After a pretreatment assessment, 21 families were randomized to the intervention or a treatment-as-usual control group. Families also completed a posttreatment assessment. Results: Caregivers who received the Project Support module reported improved caregiver support and parenting self-efficacy, and their families were more likely to engage in trauma-focused therapy. Caregivers and service providers reported high levels of satisfaction with the program. Discussion: Although the results should be interpreted as preliminary, they offer promising evidence for brief parenting programs following a sexual abuse disclosure.

Client characteristics and service use at the first hospital-based Canadian child and youth advocacy center: An analysis of case tracking data

BackgroundThe Child and Youth Advocacy Center (CYAC) model supports a coordinated response for young victims of abuse and their families. The model is prevalent in the United States, with more recent growth across Canada. ObjectiveThis descriptive study summarizes case tracking data to profile the client population, referral characteristics, use of services, and associations between client characteristics and service use in child maltreatment investigations referred to the first hospital-based Canadian CYAC over time. This data illustrates the potential to use CYAC case tracking data in understanding the use of, and client populations served by, this emerging collaborative service model in Canada.Participants and Setting Participants included children and youth served at SeaStar Child and Youth Advocacy Center in Halifax, Nova Scotia (N = 1,364) in its first seven years of operation. MethodsDescriptive statistics were calculated for client and case characteristics. Differences in characteristics between time periods were assessed using Chi-square tests. Risk ratios (RR) with 95% confidence intervals (CI) for the associations between characteristics and the use of specific services were estimated using log-binomial regression. ResultsThe most common indication for referral to this CYAC was sexual assault (53.3 %). Most clients were female (60.9 %), with a median client age of 10.0 years (IQR 6.0 to 13.0 years). In over half of all cases the alleged perpetrator was a family member (56.0 %) and most alleged perpetrators were adults (79.9 %). Medical exams were provided in 13.4 % of referrals and were less likely in children aged > 7 years (age 7–12, RR = 0.38, CI 0.27–0.51; and age > 12, RR = 0.41, CI 0.29–0.58), in referrals for sexual assault compared to physical assault (RR = 0.69, CI 0.52–0.90), and when the alleged perpetrator was an acquaintance rather than a family member (RR = 0.48, CI 0.34–0.67). Child and youth advocate support was provided in 76.1 % of cases and was slightly more likely in sexual assault and ‘other’ types of referrals (RR = 1.14, CI 1.06–1.22; and RR = 1.13, CI 1.02–1.26, respectively). Canine Assisted Intervention (CAI) was offered in 38.6 % of cases and was more likely in referrals for sexual assault (RR = 1.23, CI 1.01–1.50). Of those who had CAI, 41 % had an Accredited Facility Dog present with them during their forensic interview; this accompaniment in interview was more likely for clients who were older (RR = 2.15, CI 1.15–4.01) and female (RR = 2.56, CI 1.34–4.90). There were few differences in client and case characteristics or service use over time. ConclusionsThis study provides descriptive context of child maltreatment investigations referred to a Canadian hospital-based CYAC. Given the recognized variability among CYACs in scope and setting, this profile contributes to a broader understanding of the client population and service uptake at a CYAC which varies from the prototypical US-based model most often represented in the existing literature. This information contributes to a more detailed understanding of the CYAC model in practice in Canada, which can help to inform the growth and development of CYACs in the future.

Associations of caregiver-adolescent conflict and caregiver emotional support with adolescent trauma symptoms and adjustment after sexual abuse

BackgroundEmotional support from a caregiver is believed to be important for reducing the likelihood of adolescent trauma symptoms and adjustment problems after sexual abuse. Conflict with a caregiver, another relational dynamic, is very common during adolescence, but little is known about how it might operate in tandem with emotional support to influence adolescent trauma symptoms and adjustment after sexual abuse. ObjectiveTo better understand how caregiver emotional support and caregiver-adolescent conflict jointly contribute to adolescent trauma symptoms and adjustment after sexual abuse. Participants and settingParticipants were 477 adolescents (Mage = 13.59, SD = 1.77) and a non-offending caregiver presenting at a children's advocacy center. MethodsAdolescents completed measures of caregiver-adolescent conflict, caregiver emotional support, and their own trauma symptoms and adjustment. Caregivers completed a measure of adolescent adjustment. ResultsCaregiver-adolescent conflict and caregiver emotional support each correlated in the expected direction with adolescent trauma symptoms and adjustment (conflict correlations ranged from 0.27 to 0.38, all p values ≤.001; support correlations ranged from −0.15 to −0.21, all p values ≤.01). Regression analyses, which simultaneously considered conflict and support, indicated that conflict related to adolescent trauma symptoms and each of the measures of adolescent adjustment, whereas caregiver emotional support contributed to caregiver reports of adolescent adjustment. Caregiver-adolescent conflict did not moderate any of the relations between caregiver emotional support and adolescent trauma symptoms or adjustment. ConclusionsIn the aftermath of sexual abuse, caregiver-adolescent conflict contributes to adolescent trauma symptoms and adjustment.

Impressions of child advocacy center leaders: How problematic sexual behavior in children and adolescents is perceived by community professionals

BackgroundConsistent with the goals of National Children's Alliance, Children's Advocacy Centers (CACs) are optimal for addressing needs related to problematic sexual behavior (PSB) of youth due to their multidisciplinary approach and emphasis on community-level evidence-based interventions (Kelley et al., 2019). To promote child well-being and safety, decisions of the CAC's multidisciplinary team must be based on an accurate understanding of youth with PSB, child sexual development, and best-practice responses. However, misperceptions about youth who have engaged in PSB appear to broadly persist (Hackett, Masson, et al., 2013), leading to obstacles for CACs in addressing PSB. ObjectiveTo better understand and address the training and service needs of CACs across the country, the goal of this study was to assess CAC community professionals' (e.g., MDT members) perceptions of children and adolescents with PSB, as reported by CAC leaders. Participants and settingParticipants were 351 CACs from 47 US states, a representative sample based on regional and community distributions. MethodA designated point-of-contact (e.g., the Director) for each CAC completed an online survey reflecting on their CAC's professional community's perceptions of youth with PSB. ResultsFindings suggested that a number of misperceptions about youth with PSB, particularly adolescents, are commonly reported for CAC professional communities. Prevalent misperceptions surrounded the etiology of PSB, treatment-related needs, and differences between youth with PSB and adults. ConclusionsResults can be used to inform policy, practice, training, and resource utilization to address youth with PSB in CACs, with specific recommendations provided to enhance an evidence-based approach.

Caregivers' Perceptions of Child Trauma Symptomatology, Stress, and Child Abuse Disclosures.

Caregivers consider child abuse disclosures stressful life events, but research has not investigated whether this stress affects caregiver ratings of child trauma symptomatology. Secondary data from a Child Advocacy Center in the Midwestern United States between the period of January 1, 2018, and April 31, 2019, stepwise logistic regression models, and change in estimate calculations were used to assess (1) the relationship between child abuse disclosure(s) and caregiver stress and (2) the association between caregiver stress disclosure and clinically significant ratings on the Trauma Symptom Checklist for Young Children (TSCYC). While a child's physical abuse disclosure was associated with caregiver stress and caregiver stress was significantly associated with clinically significant ratings for child depression and anger/aggression TSCYC scales, abuse disclosure did not affect the relationship between caregiver stress and TSCYC scale ratings. Moving forward, caregiver-reported stress should be considered when utilizing caregiver-completed child trauma symptom screens.

Parent-child concordance and treatment outcome of trauma-focused cognitive behavioral therapy in a child advocacy center

Child maltreatment has been associated with the development of Post-Traumatic Stress (PTS) symptoms. Research suggests that parent-child concordance on ratings of child PTS symptoms after maltreatment may pose clinical implications that can guide treatment. The current study examines parent-child concordance of child PTS symptoms and changes in symptoms from pre- to post-treatment with Trauma-Focused Cognitive Behavioral Therapy using archival clinical records of 29 children seen in a Child Advocacy Center. Cohen’s Kappa and Intraclass Correlation Coefficient analyses indicated that child and parent ratings were only concurrent post-treatment. PTS symptoms as rated by parents and children decreased significantly from pre- to post-treatment. Findings highlight the importance of comparing cross-informant ratings and support using evidence-based treatment to reduce PTS symptoms in children.

Improving teamwork in multidisciplinary cross-sector teams: Adaption and pilot testing of a team training for Child Advocacy Center teams

BackgroundEffective teamwork is critical to the mission of Child Advocacy Center (CAC) multidisciplinary teams. Team interventions designed to fit the unique cross-organizational context of CAC teams may improve teamwork in CACs. MethodsA collaborative, community-engaged approach was used to adapt TeamSTEPPS, an evidence-based team training for healthcare, for CAC multidisciplinary teams. The adapted training was piloted with one team and evaluated using mixed methods. Team members completed pre-training (n = 26) and follow-up surveys (n = 22) and participated in qualitative interviews (n = 9). ResultsThe adaptation process resulted in the creation of TeamTRACS (Team Training in Roles, Awareness, Communication, and Support). Participants rated TeamTRACS as highly acceptable, appropriate, feasible, relevant, and useful for CAC teams. They identified positive and negative aspects of the training, ideas for improvement, and future uses for TeamTRACS. ConclusionsTeamTRACS is a feasible approach to team training in CACs, and team members find the content and skills relevant and useful. Additional research is needed to test the effectiveness of TeamTRACS and identify appropriate implementation strategies to support its use.

Black Moms Matter: A Qualitative Approach to Understanding Barriers to Service Utilization at a Children's Advocacy Center Following Childhood Abuse.

Black families are significantly less likely to receive evidence-based trauma treatment services; however, little is known about factors impacting engagement, particularly at Children's Advocacy Centers (CACs). The goal of this study is to better understand barriers and facilitators of service utilization for Black caregivers of CAC referred youth. Participants (n = 15) were randomly selected Black maternal caregivers (ages 26-42) recruited from a pool of individuals who were referred to receive CAC services. Black maternal caregivers reported barriers to accessing services at CACs including a lack of assistance and information in the referral and onboarding process, transportation issues, childcare, employment hours, system mistrust, stigma associated with the service system, and outside stressors such as stressors related to parenting. Maternal caregivers also shared suggestions for improving services at CACs including increasing the length, breadth, and clarity of investigations conducted by child protection services and law enforcement (LE) agencies, providing case management services, and having more diverse staff and discussing racial stressors. We conclude by identifying specific barriers to the initiation and engagement in services for Black families, and we provide suggestions for CACs seeking to improve engagement of Black families referred for trauma-related mental health services.

Increasing Access to Medical Forensic Care for the Pediatric Patient.

Child sexual abuse is a major public health problem. About one in every four girls and one in every 13 boys in the United States experience sexual abuse. In order to best serve these patients and families, the forensic nurse examiner team from a large urban Level 1 trauma center partnered with the local child advocacy center to provide ready access to educated, competent pediatric examiners who provide developmentally appropriate medical forensic care in a child-friendly environment. Consistent with national best practice standards, this occurs as part of a coordinated, colocated, highly functional multidisciplinary team. These services are provided free of charge and regardless of timeline from abuse. This partnership removes several key barriers to this care, including difficulty coordinating with multiple organizations, cost, lack of knowledge regarding available resources, and decreased ability to provide medical forensic care to nonacute patients.

When Disclosure Fails to Substantiate Abuse: Child and Perpetrator Race Predict Child Sexual Abuse Substantiation.

We examined the effects of child race, perpetrator race, and abuse disclosure status (within the context of a formal forensic interview) on abuse substantiation outcomes. Specifically, we coded child sexual abuse disclosure, abuse substantiation, and race of 315 children (80% girls, M age = 10, age range = 2-17; 75% White, 9% Black, 12% Biracial, 3% Hispanic, 1% Asian) who underwent a child forensic interview in a Midwestern child advocacy center. Supporting hypotheses, abuse substantiation was more likely in cases involving (a) abuse disclosure (vs. no disclosure), (b) White children (vs. children of color), and (c) perpetrators of color (vs. White perpetrators). Also supporting hypotheses, the effect of abuse disclosure on increased abuse substantiation was greater for White children than for children of color. This research suggests that even when children of color disclose their experiences of sexual abuse, they nonetheless face barriers to abuse substantiation.

Screening for and Responding to Suicidality Among Youth Presenting to a Children's Advocacy Center (CAC).

Youth presenting to a Children's Advocacy Center (CAC) for a forensic interview are at increased risk for suicidality, but no data exist for suicidality or suicide screening and response at the time of the forensic interview. The current study applied a suicide and traumatic stress screening and response protocol, the Care Process Model for Pediatric Traumatic Stress (CPM-PTS), with youth (11-18 years) presenting for a forensic interview to one of 16 participating CAC locations, 2018-2020.46.2% of youth screened for traumatic stress and suicidality (N = 1651) endorsed thoughts of suicide or self-harm in the past two weeks, and 13.6% were assessed as high risk for suicide. High symptoms of traumatic stress increased the risk of suicidal thinking as well as of high risk suicidality. CAC workers, both clinicians and non-clinicians, facilitated screening and provided prevention response. Suicide screening and response at the CAC at the time of the forensic interview appears important and feasible.