Who is advocating for children under six? Uncovering unmet needs in child advocacy centers

• Child Advocacy Centers can expand the system of care for abused children ages 0–5.
• Children 0–2 are less likely to be referred for or be in therapy at the investigation start.
• Advocates have variable perceptions about the effects of trauma on young children.
• Advocates do not tend to receive mental health training for abused children 0–5.
• The service delivery system needs to be expanded for very young, abused children.

Evidence suggests that children under the age of 6 years are affected by trauma, yet there are few studies available to determine how well their needs are addressed in the mental health system. Child Advocacy Centers (CACs) offer a promising avenue for expanding the system of care for very young children exposed to sexual and/or physical abuse. This study used a mixed-methods approach to examine the type and extent of CAC services for very young children in one state. Quantitative results revealed that the youngest children were less likely to be referred for counseling and less likely to already be engaged in counseling when an investigation is initiated. Qualitative results from interviews with CAC advocates suggest that advocates have variable perceptions regarding the effects of trauma on young children, and they do not consistently receive training in the mental health needs of traumatized children under 6. Our results confirm the need for an expanded system of service delivery for the youngest and most vulnerable child maltreatment victims.