title: The contribution of children's advocacy centers to felony prosecutions of child sexual abuse.
abstract: OBJECTIVE
  To describe trends of felony sexual abuse prosecutions between 1992 and 2002 for two districts of a large urban city that differed primarily in their use of children's advocacy centers (CACs) for sexual abuse evaluations in children.
  
  
  METHODS
  Aggregate data for two districts of a large urban city were provided from 1992 to 2002 from the district attorney's office, child protective services (CPS) agency, and all CACs serving both districts. Summary statistics were calculated over time and compared between both districts for ecologic trends using negative binomial regression.
  
  
  RESULTS
  Over the time period of the study, substantiated reports of child sexual abuse declined: District 1 experienced a 59% decrease in the incidence of reports, while District 2 experienced a 49% decrease in the incidence of reports. Despite this decrease, felony prosecutions of child sexual abuse increased in District 1 (from 56.6 to 93.0 prosecutions/100,000 children, rate ratio 1.64, 95% CI 1.38-1.95), but did not significantly increase in District 2 (from 58.0 to 54.9 prosecutions/100,000 children, rate ratio 0.94, 95% CI 0.73-1.23); by 2002, the rate of felony prosecutions in District 1 was 69% greater (95% CI 37-109%) than the rate in District 2. In 1992, CACs in District 1 evaluated approximately 400 children, increasing to 1,187 children by 2002. The number of children evaluated by CACs in District 2 increased modestly from nearly 800 in 1992 to 1,000 in 2002.
  
  
  CONCLUSIONS
  Felony prosecutions of child sexual abuse doubled in a district where the use of CACs nearly tripled, while no increase in felony prosecutions of child sexual abuse was found in a neighboring district, where the use of CACs remained fairly constant over time.
  
  
  CONCLUSIONS
  Though many limitations exist when bringing together ecological data from different agencies, the strength of the association we observed between increased CAC use and increased felony prosecutions, and the stepwise fashion in which it occurred should support future research to confirm our findings and to delineate which attributes of CAC performance might impact the likelihood of prosecution of child sexual abuse.
authors.affiliation: Lincoln Child Advocacy Center, Lincoln Medical and Mental Health Center, Department of Pediatrics, Bronx, NY 10451, USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Miller
authors.forename: David
authors.initials: D
authors.lastname: Rubin
mesh_terms: D000293:Adolescent; D002648:Child; D002650:Child Abuse, Sexual / Q000331:legislation & jurisprudence* / Q000639:trends; D002651:Child Advocacy / Q000331:legislation & jurisprudence*; D002669:Child Welfare; D002675:Child, Preschool; D003625:Data Collection / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011678:Punishment; D014481:United States; D014505:Urban Population