Child Advocacy Centers, Child Medical Evaluations, and Multidisciplinary Team Information Sharing: New Law Goes into Effect on July 1

Across North Carolina, there are 55 child advocacy centers (CACs) providing services to children who have experienced maltreatment, including physical or sexual abuse. County departments of social services and local law enforcement agencies often coordinate with CACs to conduct child medical evaluations and forensic interviews in investigations of child maltreatment. On July 1, 2024, a new law goes into effect that regulates CACs, creates new mandatory multidisciplinary teams involving CACs (with statutorily prescribed membership requirements), authorizes information sharing between members of a CAC multidisciplinary team, and provides new confidentiality protections for a child’s CAC records and information. Read on to learn more about how Session Law 2023-96 affects cases referred to a CAC by departments of social services or law enforcement agencies.

The New Statutory Structure

S.L. 2023-96 adds a new Article 3A (“Child Advocacy Centers”) to Chapter 108A of the General Statutes. The statutory citations included in the new Article 3A of S.L. 2023-96 were changed when Article 3A was codified. The correct statutory citations are identified in this post.

Definitions and New Standards for Child Advocacy Centers

Article 3A begins with a lengthy new set of definitions that apply throughout the Article, including but not limited to definitions of key terms like child, child maltreatment, child medical evaluation, forensic interview, law enforcement child medical evaluation, and multidisciplinary team.

Prior to the enactment of S.L. 2023-96, “child advocacy center” was not a term defined in state law. Under the new G.S. 108A-77.1(5), a “children’s advocacy center” is now defined as:

“A child-focused, trauma-informed, facility-based program in good standing with Children’s Advocacy Centers of North Carolina, Inc., that assists in the coordination of the investigation of child maltreatment by promoting a coordinated, multidisciplinary response to cases of child maltreatment in which representatives from law enforcement, child protective services, prosecution, mental health, forensic interviewing, medical, or victim advocacy groups or disciplines collaborate regarding the investigation, prosecution, safety, treatment, and support services, including forensic interviews, medical examinations, mental health services, advocacy, consultation, and training, to be provided, directly or by formalized agreements, for children suspected to be victims of child maltreatment and their appropriate caregivers.”

The new law establishes requirements that a CAC must meet in order to receive state funds, federal funds administered or distributed by a state agency, or any other funds appropriated or allocated by the North Carolina General Assembly. Specifically, G.S. 108A-77.2 enumerates a list of 18 different requirements that a CAC must satisfy in order to receive such funding. The requirements include being in good standing with Children’s Advocacy Centers for North Carolina, the oversight and guidance organization for CACs operating within the state. A CAC that wants to maintain eligibility for state funding must also provide all services to a child client regardless of the child or child’s family’s ability to pay for those services. G.S. 108A-77.2 includes many other requirements for CACs related to training, referrals, service provision, governance, and case tracking that are beyond the scope of this post.

CAC Multidisciplinary Teams

As one of the new eligibility requirements for funding, G.S. 108A-77.2(a)(5) requires that each CAC maintain a multidisciplinary team, which must meet on a regularly scheduled basis to conduct case reviews. As defined in G.S. 108A-77.1(10), a multidisciplinary team works “solely on behalf of children served by a Children’s Advocacy Center” and is charged with working collaboratively pursuant to a written protocol to (i) share information that will inform the investigation and prosecution of child maltreatment cases and (ii) coordinate services in response to reports of child maltreatment. G.S. 108A-77.2(a)(7) requires each CAC to provide a space for CAC multidisciplinary meetings. Some multidisciplinary teams may, however, choose to meet in a different location.

Under the new law, each CAC multidisciplinary team must include, at a minimum:

• a member of “participating law enforcement agencies;”
• the district attorney or assistant district attorney;
• a member of the child protective services unit of the local department of social services (DSS);
• a local mental health provider;
• a local health care provider;
• a victim advocate; and
• CAC staff.

See G.S. 108A-77.1(10). A CAC multidisciplinary team may also include “other professionals involved in the delivery of services to victims of child maltreatment and their appropriate caregivers.” Id. Each CAC must maintain a written interagency agreement signed by authorized representatives of all multidisciplinary team participants, which commits the participants to “the multidisciplinary model for the investigation of child maltreatment.” This interagency agreement must be reviewed and signed annually. G.S. 108A-77.2(a)(6).

Each CAC is also required to develop and maintain written protocols that comply with state and federal laws and standards governing multidisciplinary team case review, information sharing among multidisciplinary team members, functions of the multidisciplinary team, and roles and responsibilities of multidisciplinary team members, in addition to several other topics. The protocols must be reviewed at least every three years and updated as needed to reflect current practice or changes to applicable laws. G.S. 108A-77.2(a)(8).

Information Sharing on a CAC Multidisciplinary Team

S.L. 2023-96 also speaks to information sharing between members of a CAC multidisciplinary team. Specifically, the new law authorizes both DSS and other members of the CAC multidisciplinary team to share information “that is relevant to the protection of a child with the multidisciplinary team, subject to State and federal statutes and rules.” See G.S. 108A-77.3(a)-(b). DSS is already permitted to share such information under existing state law when necessary to assess a report of abuse, neglect, or dependency or when necessary to arrange or provide protective services to a child (see, e.g., G.S. 7B-302(e); 10A NCAC 71A .0113(b)). CAC multidisciplinary team members cannot share information that they would be prohibited from disclosing to each other under applicable federal law. For example, patient identifying information from a substance use disorder treatment program subject to 42 C.F.R. Part 2 could not be re-disclosed by one team member to other team members unless the disclosure was specifically allowed under 42 C.F.R. Part 2 (such as a disclosure pursuant to written patient consent or a court order that satisfies Part 2’s requirements).

The new G.S. 108A-77.3(b) authorizes the chief district court judge of the judicial district “in which the multidisciplinary team sits” to enter an administrative order designating certain agencies within that jurisdiction to share information concerning a case of suspected child maltreatment in which a local DSS is not involved. An existing state law, G.S. 7B-3100, already authorizes a chief district court judge to enter an administrative order authorizing local agencies to share information in cases involving children who are being assessed by DSS for abuse, neglect, or dependency and/or for whom a DSS is providing protective services, regardless of whether a petition alleging abuse, neglect, or dependency has been filed with a district court.

The new information sharing provisions of G.S. 108A-77.3(b), which apply to cases in which a local DSS is not involved, are similar to G.S. 7B-3100. Agencies designated to share information under a G.S. 108A-77.3(b) administrative order must share information with each other upon request if that information is “relevant to the protection of a child in any case of child maltreatment being discussed by the multidisciplinary team,” unless the agency is prohibited from sharing such information under federal law. Designated agencies may only share such information for as long as (i) the child’s case is being investigated by law enforcement, or (ii) the child is receiving services at the CAC. Any information shared under a G.S. 108A-77.3(b) administrative order must remain confidential unless disclosure is required by law, must be withheld from public inspection, and may only be used as necessary for a designated agency to perform its required duties. Just like G.S. 7B-3100, G.S. 108A-77.3(b) also explicitly states that it does not require the disclosure or release of any information in the possession of a district attorney.

Due to this new law, some judicial districts may now have two separate administrative orders that allow information sharing related to juveniles:

1.An administrative order entered pursuant to S. 108A-77.3(b), which designates local agencies authorized to share information concerning cases of suspected child maltreatment in which DSS is not involved. This would include, for example, cases of suspected physical or sexual abuse of a child that are being investigated solely by law enforcement.

2.An administrative order entered pursuant to S. 7B-3100, which designates local agencies authorized to share information when it is relevant to (i) any assessment of a report of child abuse, neglect, or dependency or the provision or arrangement of protective services in a child abuse, neglect, or dependency case by a local DSS, (ii) any case in which a petition is filed alleging that a juvenile is abused, neglected, dependent, undisciplined, or delinquent, or (iii) any case in which a vulnerable juvenile is receiving juvenile consultation services. Agencies authorized to share information regarding a juvenile under G.S. 7B-3100 are also listed in 14B NCAC 11A .0301.

It is possible that some local agencies (including those participating on the CAC multidisciplinary team) may be listed as agencies authorized to share information on both administrative orders.

Access to the Records of Children’s Advocacy Centers

S.L. 2023-96 creates new confidentiality protections for records and information of a child that are held by a CAC, while also clarifying certain instances in which a CAC is permitted to release such information. These provisions are all found at the new G.S. 108A-77.4, which divides CAC case records and information into three different categories: (1) those in a case referred to a CAC by a local DSS; (2) those in a case referred to a CAC by law enforcement; and (3) all other records of a child that are created, compiled, maintained, or received by a Children’s Advocacy Center. Per the new G.S. 108A-77.4(h), records in any of these categories are not public records under G.S. Chapter 132.

If a child’s case is referred to a CAC by DSS, G.S. 108A-77.4(a) applies. The following records and information are confidential and are treated as part of the DSS record for the juvenile receiving protective services: (1) a child medical evaluation; (2) a forensic interview; and (3) any other information received by a DSS from a CAC, including any electronic records. Any disclosure of such information or records is governed under existing child welfare confidentiality statutes: G.S. 7B-302(a1), 7B-505.1, 7B-601(c), 7B-2901(b), and 7B-3100. S.L. 2023-96 clarifies that a child medical evaluation may be provided by a provider who is rostered with the North Carolina Child Medical Evaluation Program, which may or may not be at a CAC. G.S. 108A-77.5; see G.S. 108A-77.1(4). A child medical evaluation that is performed by a health care provider rostered with the North Carolina Child Medical Evaluation Program continues to be subject to G.S. 7B-505.1(d), which only allows disclosure of a child medical evaluation pursuant to the provisions of G.S. 7B-700 (the statute that governs information sharing and discovery in abuse, neglect, dependency, and termination of parental rights cases).

If a child’s case is referred to a CAC by law enforcement, G.S. 108A-77.4(b) and (c) apply. The following records and information are confidential and may only be released under circumstances described in the new law: (1) a child medical evaluation performed at the request of law enforcement during an investigation of child maltreatment; (2) a forensic interview; and (3) any other information received by law enforcement from a CAC, including electronic records. Records and information in these three categories may only be released or made available to:

• The North Carolina Department of Health and Human Services (NCDHHS) and county departments of social services;
• Law enforcement agencies, a prosecuting district attorney, or the Attorney General;
• Health care providers or local LME/MCOs providing medical or psychiatric care or services to the child (in the case of medical or mental health records);
• The North Carolina Child Fatality Task Force; or
• As permitted under S. 7B-3100.

All other records of a child that are created, compiled, maintained, or received by a CAC may only be released pursuant to a court order upon a finding by the court that (1) the records are necessary for the determination of a criminal, civil, or administrative matter, and (2) the information cannot be obtained from NCDHHS, a law enforcement agency, the prosecuting attorney, a local DSS, or the Attorney General. See G.S. 108A-77.4(d). The court must order an in camera inspection and protective order for the records. Following an in camera inspection, a court must only release information from the records that is “material and relevant to the matter before the court and necessary to the proper administration of justice.” Id. For civil and administrative matters, the new law requires that a CAC must receive notice and an opportunity to be heard prior to the court’s issuance of an order to disclose such records. Id.

CAC staff may share information (i) with another CAC to the extent necessary for the provision of services to a child; and (ii) with Children’s Advocacy Centers of North Carolina or other contract service providers when necessary for a child, caregiver, or the CAC to receive essential support or services. G.S. 108A-77.4(e), (f). The law prohibits any person or agency from duplicating or disclosing information created or compiled at a CAC, though NCDHHS, a local DSS, law enforcement agencies, prosecuting attorneys, courts of competent jurisdiction, and the Attorney General are all exempt from this prohibition. See G.S. 108A-77.4(g).

Who is a “Child” for Purposes of this New Law?

For cases referred by law enforcement to a CAC, the definition of “child” under the new G.S. 108A-77.1(2) includes any person less than 18 years old and “any individual who has a developmental disability, as defined in G.S. 122C-3(12a), that severely impacts conceptual, social, and practical areas of living to the extent the individual is unable to live in an independent environment.” This means that the confidentiality and information sharing provisions described above (including the administrative order under G.S. 108A-77.3(b)) will in some cases apply to the records and information of adults with developmental disabilities being served by a CAC, not just juveniles, so long as those cases have been referred to the CAC by law enforcement.

Limited Immunity Provisions

The new law provides immunity from civil liability to a board member, staff member, or volunteer of a CAC or Children’s Advocacy Centers of North Carolina, for the performance of any acts within the scope of the person’s duties or participation in a judicial proceeding “if the person acts in good faith.” G.S. 108A-77.6. This immunity does not cover acts of gross negligence, wanton conduct, or intentional wrongdoing.

G.S. 108A-77.3(d) also provides that CAC multidisciplinary team members who participate in good faith in team discussions by providing information about a child’s case that is under team review will be immune for any civil or criminal liability for such disclosures, unless the disclosures were due to gross negligence, wanton conduct, or intentional wrongdoing. This does not, however, relieve multidisciplinary team members of any potential liability arising from a violation of federal confidentiality laws.

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