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Contract 2022-036A#2022-036-A The mission of the Lake Sumter Children's Advocacy Center is to provide a child -friendly, community-basedfacility where a child victim can be safely interviewed, provided with crisis counseling, receive medical exams and long-term specialized therapy, when needed. We work together with agency representatives to provide child abuse victims with all necessary services in a single location. Memorandum of Agreement CHILD ABUSE INVESTIGATIVE PROTOCOL May 1, 2022 to May 1, 2025 The Lake Sumter Children's Advocacy Center (CAC) recognizes that the strength of the Multidisciplinary Team (MDT) is the varied training and expertise that each member contributes. In addition, it is understood team members must abide by Florida Statutes, their employers' policies and/or agency protocols. The NOT is comprised of a group of identified individuals (or their designees) who respond together to allegations of abuse (as defined by this agreement) in Lake and Sumter Counties. This group also meets at regularly scheduled times to serve as the case review team for cases referred to the MDT for review. Criteria for cases referred to the MDT are defined in this document. Nothing in the Agreement is meant to supersede federal law, state statutes, or local ordinances. In the event any provision in these guidelines becomes inconsistent with Federal law, state statutes, or local ordinances, the federal law, state statute, or local ordinance will prevail. The MOA is signed by identified agency directors or senior management who has reviewed the MOA and agrees to the procedures outlined herein. The MOA will be reviewed and updated every three years. This review process will be initiated by the Executive Director of the CAC. Each team member will follow their approved protocol for investigating alleged child sexual abuse and/or physical abuse. The identified participants agree to abide by this memorandum of Agreement to ensure: • Timely response to alleged child abuse allegations in Lake and Sumter Counties • Coordination of investigative, prosecution and treatment efforts. • Child victims access needed services in a child -friendly environment • Child victims and/or children at risk of abuse are protected from imminent harm • Child victims are seen in Lake or Sumter County. • Victims and alleged offenders are kept separate at all times. CASE REFERRAL CRITERIA: Children between the ages of birth to 18 who meet the criteria below are referred for CPT services. Sub section 39.303 (2). Florida Statutes specifies the types of cases that must be referred by DCF to CPT for assessment and other appropriate available support services. Non -mandatory cases may also be referred and will be staffed with CPT to determine if forensic interviews and or medical exams are appropriate. Mandatory referral cases include those involving: • Injuries to the head, bruises to the neck or head, bums or fractures in a child of any age. • Bruises anywhere on a child five (5) years of age or younger. • Any report alleging sexual abuse of a child (Sexual Abuse Threatened Harm is not mandatory. Victims of child -on -child sexual abuse may be accepted for Team services but are not mandatory referrals) • Any sexually transmitted disease in a prepubescent child. • Reported malnutrition of a child and failure of a child to thrive. • Reported medical neglect of a child. • Any family in which one or more children have been pronounced dead on arrival at a hospital or other health care facility or have been injured and later died because of suspected abuse, abandonment, or neglect, when any sibling or other child remains in the home. • Symptoms of serious emotional problems in a child when emotional or other abuse, abandonment, or neglect is suspected. • Human trafficking for sex cases are eligible for CPT assessment services, though not mandatory unless the victim is being trafficked by a family member or caretaker. Situations requiring emergency exams may be indicated in the following cases: • Preverbal children whose age makes injuries suspect • Children whose injuries make returning to their environment of origin potentially dangerous • Alleged sexual abuse in which there are evidence collection issues MDT CASE REVIEW CRITERIA FOR REFERRAL: • Serious physical injury or serious neglect. • Sexual abuse of a child (after consultation with CPT intake personnel) • Three or more prior reports on any identified child. • Complex cases that place a child at high risk for safety. • Chronic neglect that impacts safety and well-being of child. • Verified medical neglect of a child. • Allegations of Human Trafficking of a child. Multidisciplinary case reviews are meant to assist in the investigation and prosecution and to avoid gaps in the system of care for the child victim and their family. Any investigative information shared at case review is within the total discretion of the originating agency. Each agency shall operate within their own specific guidelines, mandates, and procedures. All parties shall keep confidential any information received as part of the multidisciplinary case review team pursuant to Florida Stature 119.07. K COMPOSITION OF THE TEAM The MDT will be facilitated by the Lake Sumter Child Protection Team (CPT) Team Coordinator, or designee. The team may be composed of representatives of the following community partners: • Lake Sumter Children's Advocacy Center o CPT Team Coordinator or designee o CPT Medical Provider or designee o Clinical Supervisor or designee o Family Advocate or designee • Department of Children and Families (DCF) • Community Law Enforcement • State Attorney's Office TEAM MEMBER RESPONSIBILITIES The Lake Sumter Children's Advocacy Center will: • Provide a neutral, child friendly, safe environment where child victims can receive services at no cost. • Make the Center available for recorded forensic interviews and medical exams during regular business hours (8:30AM to 5:OOPM Monday through Friday). These services can be scheduled by first calling the CAC Child Protection Team (CPT) at (352-323-8303) to staff the case. • Make the Center available afterhours for cases that are determined by Law Enforcement, DCF and CPT to be an emergency. The emergency on -call phone will be available afterhours, on weekends, and holidays at (352-459-3058). • Provide workspace, as available, to law enforcement, protective investigators, and the State Attorney's Office. • Disseminate child abuse statistical information, as appropriate, within the community. • Create community awareness related to the issues of child abuse. • Coordinate periodic community training to improve skill level in the investigation of child abuse and service provision to child abuse victims. • Track case information until final disposition in NCAtrak database and share with MDT members as appropriate. • Facilitate quarterly partner meetings to include MDT members to allow feedback on the CAC/CPT procedures and operational policies. This meeting will also allow discussion on team communication issues and other issues affecting case progression. Meeting will be facilitated by the CPT Team Coordinator. • Provide crisis assessment and intervention, risk assessment, and safety planning and support for children and family members at all stages of involvement with the CAC. Through the Child Protection Team, the CAC will: o Facilitate and/or arrange periodic trainings that will ensure all Multidisciplinary Team members have a minimum level of comprehension of: ■ the role of the CAC/CPT in child abuse cases 3 ■ the role of a multidisciplinary team in child abuse cases. o Staff cases referred by DCF CPI and/or Law Enforcement and determine if the case meets criteria established in the CPT handbook and this MOA. The CPT handbook is available for review by MDT members. If deemed appropriate, CPT services will be scheduled at a time best suited for DCF, Law Enforcement and the family. o Determine the need for any interpreters if the child speaks another language or if the child requires a sign language interpreter. DCF has a working relationship with the Florida Deaf Academy to provide sign language interpreters if needed. The CAC also currently has one trained forensic interviewer who speaks Spanish. If other languages are required, the CAC maintains a list of interpreters and has access to interpreters through the Language Line through DCF. o Conduct a digitally recorded forensic interviews by a trained CPT interviewer who has completed the 40-hour APSAC training on forensic interviewing and has been determined, by the CPT Team Coordinator, to be appropriate for the case. This will be determined by the availability of each interviewer, prior contact with the child, objectivity, knowledge of forensic interviewing techniques, experience in interviewing child victims, ability to establish rapport with the child, and any special needs such as language, cultural considerations etc. The forensic interviewer will: ■ Ensure privacy for the child by limiting the observation of the interview to those MDT investigative members directly involved in the investigation (Law Enforcement and DCF.) ■ Meet with appropriate law enforcement, DCF personnel and other MDT investigative members prior to the interview to ascertain any necessary information and/or questions prior to the interview. This will assist in coordinating information gathering to avoid duplication by team members. ■ Identify developmental and cultural factors that may influence communication between the child and the interviewer by conducting a pre -interview with the parents/caretakers. ■ Record the forensic interview on the CAC I Record System. DCF, State Attorney, and Law Enforcement will receive a copy of the recorded interview on DVD upon request in accordance with Florida Statutes. ■ Utilize language appropriate to the child victims' individual developmental level. There is opportunity for team members to communicate with one another before the interview is concluded. This will usually be accomplished by the forensic interviewer taking a short break before the end of the interview to confer with team. ■ Limit interview aids used, if deemed necessary, to paper/pens and "gingerbread" boy and girl body diagrams. Each child will be evaluated individually, and appropriate APSAC interview components will be utilized. The following components may be utilized for the forensic interview: • Introduction of Self, Role and Purpose of the Interview • Informing child about documentation method • Reviewing "rules to lessen suggestibility" with the child, to include giving permission to say, "I don't know," giving permission to correct interviewer's mistakes, and giving permission to admit lack of understanding. II N • Convey to the child that the interviewer does not know what happened and cannot help the child with his/her answers. • Give permission to admit lack of memory. • Give permission not to answer. • Explain repeated questions. • Truth/Lie Discussion • Assessing truth/lie competency • Eliciting a promise to tell the truth • Narrative event practice • Introducing topic of concern • Substantive questions to gather details. This is when evidence may be introduced, as this would have already been discussed by the MDT members during the pre -meeting as a possibility and agreed upon that this may be necessary. Introducing evidence is done as generally and neutrally as possible to maintain the integrity of the Forensic Interview. • Closure Document the date and time of the interview in the chronological case progress record of the case file, along with the names and roles of all persons observing the interview. Provide a written report to Child Protective Investigator and /or Law Enforcement will be provided by the CPT interviewer within 10 days of the conclusion of the interview. Documentation of the written report includes the following: • Date of the interview • Location of the interview • Name of the CPT case coordinator or other trained professional conducting the interview • Abuse Report number • Name of the child being interviewed and DOB • The agency or individual requesting the interview • Summary of the interview • Interview findings (related to the alleged abuse or neglect and any other pertinent information) • Method of recording the interview (if recorded) Determine the initial need for a forensic medical exam based upon established criteria and the reported allegation and observations reported by the Protective Investigator and/or information gathered during the forensic interview. Provide a Children's Medical Services approved ARNP or Pediatrician trained specifically in child abuse to provide timely medical exams for alleged abused children. The medical provider will: ■ Ensure the health and safety of the child ■ Reassure the child about what has happened to his or her body ■ Identify and document physical and forensically significant findings that may be a result of the alleged abuse. E ■ Provide, at a minimum, a verbal report to investigators and Law Enforcement accompanying the child to the exam at the conclusion of the medical examination. ■ Provide medical exam report for DCF/Law Enforcement within 10 days, or less, of examination ■ Provide a written CPT report of a social assessment to DCF and/or law enforcement within 20 business days. ■ Document medical findings according to professional standards and share with the MDT as appropriate. Data regarding whether an exam was conducted, the medical provider's name, and any findings will be documented in the CAC case tracking system (NCAtrak.) ■ Convey the need for additional medical testing (e.g. HIV, X-rays, CT scans, MRI's, etc.) to appropriate MDT members in order to maintain clear communications and a team effort to protect the child. ■ Contact LabCorp to pick the specimens up at the CAC following the collection/packaging of specimens for STD testing. Test results will be sent to CAC/CPT Medical provider. ■ Dispense Plan B and prophylactic antibiotics when deemed necessary, as per the Center for Disease Control STD guidelines. ■ Package evidence collected for the Florida Department of Law Enforcement (FDLE) according to FDLE guidelines and given to Law Enforcement at the conclusion of the medical exam. ■ Limit multiple medical exams by consulting with hospital or private physicians who may have also examined the child. o Determine the need for Multidisciplinary Team Case Review based upon established criteria. Case review meetings will be utilized as an opportunity for team members to increase their understanding of the complexity of child abuse cases. Scheduling, docket preparation and distribution for Lake and Sumter County will be the responsibility of CPT. The CPT Team Coordinator or designee will: ■ Facilitate and participate in Multi -disciplinary Team Case Reviews held at least once a month and emergency MDT Team Case Reviews as appropriate, to ensure child victims access all available and necessary services. ■ Notify all participating agencies and MDT members via email of the docket for case review in advance of the MDT meeting. ■ Ensure MDT members sign confidentiality forms for each case reviewed. ■ Ensure MDT members share information about child abuse allegations, investigations, charges, and any evidence collected in accordance with Florida statutes Section 119.07 and relevant judicial rules. All proceedings of team meetings will be confidential and signed statements of confidentiality will be maintained for each case reviewed by the team. Legal, ethical, and professional standards of practice will be upheld to ensure client privacy. ■ Ensure a verbal update is presented by each MDT member interacting with the designated victim and/or family. ■ Ensure the CPT medical provider participates in Multidisciplinary Team Case 0 Reviews and Emergency Multidisciplinary Case Reviews to assist in evaluating the child's medical needs and discusses the formal medical report, when appropriate. Ensure notes are taken during the staffmg. These notes include a summary of the discussion, the action plan decided upon by the MDT, the person responsible for each action item and the due date for the item to be completed. Follow up case reviews to determine progress towards action items will be determined by the MDT team and facilitated by the CPT Team Coordinator. Document the MDT Case review into the CAC NCAtrak data base. Ensure MDT members who are not able to attend the meeting have been provided with a call -in number on a designated conference line to participate. Through the Mental Health Program, the CAC will: o Uphold the purpose of mental health services to: ■ Reduce the emotional impact of disclosure of physical and/or sexual abuse and neglect. ■ Promote healing, self-awareness, and self -growth. ■ Change individual behavior and family relationships to reduce/eliminate the risk of abuse/neglect occurring in the future. o Provide information on mental health service options for child victim and non -offending family members. o Offer mental health services, at no charge, to all clients and non -offending family members. Mental Health services are accessible to all clients in several ways: ■ Mental health services are offered to the child and family during crisis counseling immediately following the forensic interview. ■ Other community agencies may refer a child victim of abuse by completing the Counseling Referral Form and returning the form to the CAC. The Clinical Supervisor or designee will assign for counseling follow-up with the family. ■ Parents or caretakers can refer their child to services by contacting the CAC. Self - referrals from children will also be accepted. The Clinical Supervisor or designee will follow up on these referrals and will obtain the necessary parent or caretaker permissions o Provide mental health services by designated qualified mental health staff with a minimum of master's level education. o Provide crisis counseling during the initial visit and as needed to the child victims and their non -offending family members. o Provide evidenced -based counseling to child victims of abuse and provide information regarding other community mental health agencies when appropriate. o Provide individual or group therapy to the non -offending parent and/or other family members on an as needed basis or and provide information regarding other community mental health agencies when appropriate. o Provide court education to child victim and family as needed. o Communicate with other mental health services providers involved with the child with a completed release of information signed by the parent/guardian. 7 o Maintain mental health records stored in a locked filing cabinet and password protected online records in the CAC database NCAtrak. o Record data that includes the provider's name, attendance information, and progress towards established goals in the CAC case tracking system. o Conduct a Trauma Assessment on each child entering counseling. The Children's Functional Assessment Rating Scale is administered to all children pre and post counseling. The UCLA PSTD Reaction Index for Children/Adolescents is administered as appropriate. o Ensure the Clinical Supervisor or designee participates in Multidisciplinary Team Case Reviews and Emergency Multidisciplinary Case Reviews to assist in evaluating children's mental health treatment needs and monitor the child's mental health to share with MDT team. The Clinical Supervisor or designee will also act in the capacity of the Family Advocate if one has not been assigned or is unavailable. o Facilitate coordinated case management meetings with all individuals providing victim advocacy services. Through the Family Advocate Program, the CAC will: o Provide a volunteer Family Advocate to child victims and non -offending family members when required. o Provide information, crisis intervention, and assistance to the child victim and the victim's family. o Provide information regarding the MDT response to their case. o Provide support services to include follow-up contact via in -person contact, phone or correspondence to victims and non -offending caregivers. o Participate in coordinated case management meetings to: ■ Acquire information from MDT members pertaining to appropriate support services needed for the child victim and family. ■ Provide the parties involved with information regarding the civil and/or criminal justice system and be a consistent contact person throughout the criminal justice process as needed. ■ Keep team members informed of the family dynamics and the child/family's attitude toward prosecution. o Support continuity of care to ensure family needs are met. o Provide the child victim and family with a better understanding of the criminal justice system and their role in it as needed. o Educate family about process and available therapeutic and legal services. o Provide information and referral services to victim and family. o Provide information and assistance with applying for Victim Compensation through the Attorney General's Office. o Accompany the child and family to court when needed. o Participate, when appropriate, in Multidisciplinary Team Case Reviews and Emergency Multidisciplinary Case Reviews to ensure child victims access all available and necessary services. When a Family Advocate has not been assigned or is unavailable, the Clinical Supervisor or designee will act in this capacity. 8 The Department of Children & Families, Circuit 5, and Protective Investigation Unit will: • Investigate alleged child abuse within the guidelines of Statute 39 • In those cases where Law Enforcement assumes primary investigative jurisdiction, DCF shall coordinate with the investigating Law Enforcement agency prior to scheduling a forensic interview and /or forensic medical examination of a child victim. • Investigators are to contact CPT to refer all cases mandated by Chapter 39. Non -mandatory cases may also be referred at DCF's discretion. Non -mandatory cases will be staffed with CPT to determine the need for a Forensic interview/medical exam. Investigators should be prepared to provide the following information: o Child's name, date of birth, social security number, race, and gender o Parents and sibling(s) name, date of birth, social security number (if available). o Address/City, all applicable telephone numbers. o Allegation made. o Most recent contact with alleged perpetrator. o If the situation considered emergent and the reason(s) it is considered as such. o Current location of the child. o Child's current safety status. o Prior DCF reports on family. o Observations and statements from child and other household members. o All pertinent information such as documentation of body bruising, vaginal or anal penetration, date of alleged penetration, etc. related to the request of forensic medical exam. • Consult with law enforcement, CPT, State Attorney's Office and/or other community professionals regarding the necessity of conducting a medical examination for the purpose of collecting evidence of abuse. • Transport, accompany, or meet the child victim at the CAC for the purpose of a forensic interview and /or forensic medical examination. • Provide information on the case disposition for case tracking purposes. • Refer child victims to the CAC for counseling, when appropriate. • Designate appropriate Child Protective Investigator to participate in scheduled Multidisciplinary Team Case Reviews held at least once a month, to ensure child victims have access all available and necessary services. • Participate in emergency Multidisciplinary Team Case Review when appropriate. Determination of Crucial Information: The DCF investigator will determine the following: o validity of the complaint o extent of the injuries o need for immediate emergency medical treatment o existence of prior abusive reports o extent additional referrals are made for medical evaluations that may be required to collect evidence o need to remove the child from an abusive environment 0 The evaluation (interview and examination) done to determine this information shall be conducted in a manner which preserves the health and dignity of the child while obtaining the facts necessary to pursue the case through legal channels. Every effort should be made to interact with the child in a non -threatening, child friendly environment such as the CAC. DCF shall immediately notify the appropriate Law Enforcement Agency, if required, upon receipt of a child abuse complaint and shall provide the agency with a copy of the complaint. The appropriate Law Enforcement investigator is to be notified by DCF prior to the medical exam or forensic interview. The DCF investigator should obtain the LE case number to determine the detective assigned to the case. E-mail and telephone communication should be utilized to contact other agencies. A specially trained CPT interviewer will conduct the Forensic Interview at the CAC by scheduled appointment. Taped interviews are evidence; they become the property of LE since the rules of evidence custody will apply. Forensic Interviews should be in conjunction with the medical exam, when possible. Community Law Enforcement will: • Notify DCF if determination is made that the case involves DCF. • Participate in the initial contact investigation of alleged child abuse that may result in criminal charges. • Request a forensic medical examination from CPT immediately, or no later than within 72 hours, for children sexually victimized for the collection of DNA and other evidence, when needed. • Provide pertinent information relevant to the case to include: o Child's name, date of birth, social security number, race, and gender. o Parents and sibling(s) name, date of birth, social security number (if available). o Address/City, all applicable telephone numbers. o Allegation made. o Most recent contact with alleged perpetrator. o If the situation considered emergent and the reason(s) it is considered as such. o Current location of the child/current safety status of the child. o Documentation of body bruising, vaginal or anal penetration, date of alleged penetration, etc. related to the request of forensic medical exam. • Share relevant information related to the alleged abuse with Multidisciplinary Team • Provide information, as provided by law enforcement, on the case disposition for case tracking purposes. • Refer child victims to the CAC for counseling, when appropriate. • Case Detective or designee will participate in scheduled Multi -disciplinary Team Case Reviews held at least once a month when appropriate, to ensure child victims access all available and necessary services. • Case Detective or designee will participate in emergency Multidisciplinary Team Case Review when appropriate. 10 The State Attorney's Office will: • Observe the digitally recorded forensic interview as requested and available. • Assist law enforcement and DCF in determining the validity of criminal prosecution. • Provide information on the case disposition for case tracking purposes. • Share relevant information related to the alleged abuse with MDT. • Provide the SAO Victim Advocate who will: o Educate the family about the criminal justice system o Keep the family apprised throughout the criminal justice process o Participate in coordinated case management meetings • Refer child victims to the CAC for counseling, when appropriate. • Participate in scheduled Multi -disciplinary Team Case Reviews held at least once a month, to ensure child victims access all available and necessary services. • Participate in emergency Multidisciplinary Team Case Review when appropriate. CONFIDENTIALITY MDT Members and/or their representatives will abide by the laws of confidentiality as outlined in Florida Statute regarding children who are victims of abuse. At all times, confidentiality will be observed. All members of the MDT will have access to information not available as public information. Team members are expected to be sensitive to the need to share information only "on a need -to -know basis." Upon execution of this Agreement by all parties, a copy of the signatory page for each agency will be provided to all participating agencies. Agency Na3ne: re/Date Printed/Typed Name f Title � cob 11 The State Attorney's Office will: • Observe the digitally recorded forensic interview as requested and available. • Assist law enforcement and DCF in determining the validity of criminal prosecution. • Provide information on the case disposition for case tracking purposes. • Share relevant information related to the alleged abuse with MDT. • Provide the SAO Victim Advocate who will: o Educate the family about the criminal justice system o Keep the family apprised throughout the criminal justice process o Participate in coordinated case management meetings • Refer child victims to the CAC for counseling, when appropriate. • Participate in scheduled Multi -disciplinary Team Case Reviews held at least once a month, to ensure child victims access all available and necessary services. • Participate in emergency Multidisciplinary Team Case Review when appropriate. CONFIDENTIALITY MDT Members and/or their representatives will abide by the laws of confidentiality as outlined in Florida Statute regarding children who are victims of abuse. At all times, confidentiality will be observed. All members of the MDT will have access to information not available as public information. Team members are expected to be sensitive to the need to share information only "on a need -to -know basis." Upon execution of this Agreement by all parties, a copy of the signatory page for each agency will be provided to all participating agencies. Agency Name: ©1 ern (�CZ V _ Printed/Typed Name hycn-4 CRrF Title 11