Practical Magic: Understanding Lived Experience Through Data, with Seth Boughton

Season 5, Episode 3

“Practical Magic: Understanding Lived Experience Through Data,” with Seth Boughton

[Intro music beings]

[Intro]

Teresa Huizar:
Hi, I’m Teresa Huizar, your host of One in Ten. In today’s episode, “Practical Magic: Understanding Lived Experience Through Data,” I speak with Seth Boughton, director of data at the Ohio Chapter of Children’s Advocacy Centers, about how we measure the impact of our work.

One of the most vexing questions in child abuse intervention is: How do we know that the work we do makes a difference? And to whom? We can count the number of kids we serve and the services we provide, but how do we know this actually makes a meaningful difference in the quality of the multidisciplinary team response—and most importantly, by the children and families we serve every single day?

Now enter OMS, our Outcome Measurement System. A decade ago, CACs [Children’s Advocacy Centers] of Texas, the State Chapter of CACs in Texas, approached us with work that they had done on this very question in partnership with the University of Texas at Austin and that they felt might have national significance. Then fast-forward another 10 years to our present work, with UNH to validate the services and build out an online survey system that now includes caregiver satisfaction surveys and follow-up surveys, multidisciplinary team satisfaction surveys, and youth satisfaction surveys. As we release our latest Healing, Justice, and Trust report, which is our annual performance report for the more than 90% of CACs that use our Outcome Measurement System, it’s an important moment to take stock of what we know about these outcomes—and further areas to explore.

Now, admittedly, I’m a bit of a data nerd, but I think you’ll find this conversation as thought-provoking as I did. Please take a listen.

[2:02] Teresa Huizar:
Hi, Seth. Welcome to One in Ten.

Seth Boughton:
Thank you. I’m glad to be here. Appreciate the opportunity.

[00:00:06] Teresa Huizar:
Oh, absolutely. So, talk to me a little bit about—I don’t really remember ever hearing you talk about—kind of how you came to this work with both CACs and data. Really looking at how Children’s Advocacy Centers are performing.

Seth Boughton:
Yeah, absolutely. So I originally started out doing clinical work. You might hear our child here in the background. But originally came to this work working clinically as an on-call mental health specialist, performing on-call, on-site evaluations for youth presenting with suicidal ideation, homicidal ideation, or severe psychotic features with risk to self or others.

So during that work, I worked with a number of youth that had been trafficked locally in the area. Decided to go back and get my doctoral degree. And during that period of education, my advisor linked me up with Kaitlin Lounsbury at NCA and did a data internship with her.

So then an opportunity came up. They had created a statewide human trafficking response coordinator position at the Ohio Network of Children Advocacy Centers. So I did that for a number of years until that grant was up. And then at that point I transitioned to being their data specialist. Because the human trafficking grant was very data focused.

We developed a number of instruments to collect that data, and we thought we could really kind of expand out those services to really meet the data needs for our Children’s Advocacy Centers and really drive some, you know, data driven decision making.

[3:45] Teresa Huizar:
You know, it’s interesting because you’ve had both kind of the national overview, not only because of your internship but the work that you’re doing with us now on a contract basis.

But then you’ve also had this other window, this sort of drilling deep into the work of Children’s Advocacy Centers in one state. And I’m wondering, you know, in a few minutes we’ll talk more in depth about the Outcome Measurement System in our recent report. But I’m wondering, when you think about that state work that you’ve done, what do you think has been the most surprising thing that you’ve either seen crop up in the data or the way that CACs approached the data?

Seth Boughton:
One of the things that I find really interesting, being able to kind of see things at all of those tiers of involvement throughout our Chapters. I tend to see that CACs can be specifically very agile when presented with data, and so there’s a huge opportunity. And our CACs, you know—I love a data nerd and they really took to this idea that we could really take data out of this kind of abstract space and really turn it into something practical.

Something that could really be kind of a wheels meet the road situation where we could identify specific challenges or potential promising practices and then really use the data to either substantiate that, you know, these positive outcomes we’re seeing are real or, when we’re encountering a challenge, we could use that data to really identify potential solutions to that.

So it’s something I really have loved about this position is the opportunity to really do—you know, it’s very easy for statistics to become a very abstract thing. It’s very often a descriptive process. And the people who are on the ground level doing the work out there in the field, they know what they’re encountering out there. But data can open up opportunities to really, like, identify what populations are we not seeing that we’d like to be seen identified. And then when we start interacting with our MDTs or like with the youth survey, then we can really start getting feedback from the kids that are receiving our services. Or we can track down, like, this MDT has phenomenal successes in terms of their ability to effectively, cohesively work together to facilitate prosecution of abusers.

It was a nice shift, as I got into this work, to really just see how practical that data could be.

[6:07] Teresa Huizar:
I think you raise a good point, which is, oftentimes when funders request certain data, you know, because we’re all busy people, often organizations gear their data collection almost exclusively to funder requirements, right? They need these numbers. Let me turn them in. But there’s a bigger opportunity here, which is to really proactively collect the kind of data that can shape programs.

And I think that you’re right to identify that as really exciting. And also that there’s this hunger in the field for that kind of information and to use it to inform the work.

[6:39]
I want to catch our listeners up, because they’re not all Children’s Advocacy Center staff, on the Outcome Measurement System. Because I think that we’re going to spend a little time talking about that. And it has some unique features and so, you know, it’s a project that NCA took on—gosh, I’m trying to think what year I came—after I came to NCA. We’ve been doing it at least a decade. And it was something that was an outgrowth, as you know, of work that CACs of Texas had done where they were really working with the University of Texas at Austin to look at indicators of success for Children’s Advocacy Centers. And they were gracious enough to allow us to partner with them and then expand it significantly since then.

And so, in the intervening time period, we’ve, you know, developed some additional surveys. So now I think it would be important for listeners to know, it includes a multidisciplinary team satisfaction survey, a survey for caregivers at the time of the first appointment, a follow up survey for caregivers that can be, up to, I think 90 days later. And then—and I’m most interested in this probably—our youth survey, which is for ages 10 to 17 to get feedback directly from the kids served.

And I’m just wondering, you know, if you think back about years ago when you first came to us as an intern, you know, and you first heard about the Outcome Measurement System and saw Children’s Advocacy Centers using it, you know, is it something that you had seen similarly before or was somewhat new and surprising to you?

Seth Boughton:
Yeah, so, I was fairly new to my knowledge of the CAC ecosystem when I came aboard as an intern. But I had had experience working with larger database systems previously, during my master’s in doctoral study. Most of those databases were largely robustly funded, large data, usually pertaining to medical research.

Teresa Huizar:
Interesting.

Seth Boughton:
And so, very often, one of the limitations we would see that really limited the amount of research insights we could gain in response to like something like, say specific populations like children and youth—

Teresa Huizar:
Mm-hmm.

Seth Boughton:
—being served. One of the things we always ran into was that we would have these very small sample sizes. We wouldn’t be able to collect a large sample of data from those populations.

And I think one of the things that was really incredible to me about the OMS system is, (A) it was something that was developed from the ground up. Like you said, Texas developing that in partnership. And so it was something that was developed by the practitioners themselves. And so it was something that was already informed by the people doing the work. And then on top of that, then seeing the absolute scale of it and the amount of potential that that opens up in terms of research and insights.

I think it was something like 56,000 responses on the Initial Caregiver Visit Survey, something like—

Teresa Huizar:
That’s right.

Seth Boughton:
—yeah, I’m just pulling these numbers, so—

Teresa Huizar:
Yeah.

Seth Boughton:
—correct me if I’m wrong. But like another 10,000 from the follow up, which is an incredible return rate. Then there was like, , let’s see, was it 15,000? Something like that?

Teresa Huizar:
It was pretty close to that for the youth survey. Yeah.

Seth Boughton:
Yeah.

Teresa Huizar:
I think it might have been 13,000, but I mean, still a huge in, you know, a huge sample size when you’re thinking about survey research.

Seth Boughton:
Yeah. And so the amount of analysis that you can do and the amount of insights that that allows you to do. And the fact that it has this granular makeup to it so that you can actually—you can go into the OMS system, and our CACs can pull that data at the CAC level, at the state level, at the regional level. It allows you to have this economy of scale that allows you to really utilize this data to address needs at every level. Anything from, you know, national policy, state legislation, um, you know, to, to the active engagement and work that our CACs are doing.

So I really hadn’t seen anything like that prior to getting the opportunity to do that internship with Kaitlin.

[10:54] Teresa Huizar:
Yeah, I think people, it is interesting how often they’ll talk about the return rate on the surveys because it’s so unusual, first of all, to have a good return rate at all without having to pester people to follow up.

But the second thing is, it’s just such large numbers that the findings are robust. You know, you can trust them by virtue of the sheer volume of it, which I think is a really positive thing.

And one of the things I’m thinking about with the Initial Caregiver Survey—you know, one of the things I was struck by when we started looking at the data initially is, it kind of turned on its head some assumptions we had had about some things.

And one of the examples I’ll give you, Seth, you know, we had been asking CAC directors for a while in our CAC Census, which is a programmatic survey we do of Children’s Advocacy Centers every other year about, you know, what would it take to get engagement rates better with mental health services? So why do some families not follow through?

And you can imagine that CACs were very focused, and appropriately so, on things they could do around physical and concrete barriers. Things like, you know, adding transportation services or dealing with childcare needs or those kinds of things.

Then we got the OMS results back where we’re asking the caregivers themselves, and they have all those options to pick too. They can pick waitlists, they can pick transportation, they can pick all those things. And yet that’s not what they’re picking. By and large, they’re picking: They just didn’t think it was necessary.

Seth Boughton:
Yeah.

Teresa Huizar:
So it was an attitudinal barrier. And I remember our first comparison of that data was like this eureka moment about: Look at the power of data. We could have been solving the wrong problem all along.

And it really led NCA to develop the work that we now do in motivational interviewing and family engagement in our E3 program. So I think it’s—you know, it helps CACs for sure. But I think the thing that has been powerful to us, too, at NCA is, it has the same promise for us nationally that we can make sure that we’re getting a good return on our own investment by really directing resources to those things that caregivers are saying that they need and not to things that might have little to do with their decision ultimately to get their kid to therapy.

Seth Boughton:
Absolutely. Absolutely. And I think that it’s something that we saw in our own state level data as we were kind of navigating our way through the pandemic that we really saw that, you know, with the rise of telemedicine and telehealth—

Teresa Huizar:
Mmm. Mmm.

Seth Boughton:
—and systems like that. A lot of those physical barriers have been, you know, eroded. Suddenly—

Teresa Huizar:
That’s right.

Seth Boughton:
—a center that’s in, like, say a rural community that’s perhaps under-resourced can, through something like telehealth or telemedicine, gain access to services that are normally provided physically to a well-resourced community. And so we were digging in on like Gini Index data to look at kind of those resource disparities and things like that.

And what we kept coming to was: You can start addressing those things, but like you said—and this goes outside of the CAC world to my own mental health practice—it was a fairly novel concept to think of the idea of family literacy on mental health services.

Teresa Huizar:
Mm-hmm.

Seth Boughton:
And so something like that E3 that has been provided that really informs the family members on, like: This is why evidence-based treatments are something we want to focus on. This is why trauma informed is important. These are the potential benefits that your child might see when linked up with these services. Because it’s very easy at face value to, you know, and I can say that for my own self, before I started pursuing a career in mental health practice, that when someone said “therapy,” I really just thought, you know, sitting on a couch with an old guy … [Teresa laughs.] Something like that.

And when you start really learning about how something like Trauma-Focused CBT [Cognitive Behavioral Therapy] or something like EMDR [eye movement desensitization and reprocessing therapy], or any of those types of things, how they actually engage the brain and how they actually progress our initiative for healing. Then suddenly the buy-in can be so much higher for those families.

So it’s really great to see how data has then been translated into something that can be such a powerful program to increase how families connect to services and see the value of connecting to those services.

[15:29] Teresa Huizar:
One of the things I was struck by that you were talking about a little bit earlier too, is, you know, early on we decided that CACs really needed to be able to benchmark themselves. You know, to know where they started, but also—and to look at their data over time. Like, are things improving or are they not improving? Or what is happening? But also to benchmark themselves against how others performed within their state, regionally, nationally. And so there—as you mentioned—there’s a dashboard where people can see that in real time. If you work for a CAC, you can see your data real time and adjust accordingly.

And I just remember early on when that started, how powerful it was to people to see. For example, I remember one state, which I won’t name, but early on they could see that their state on case review specifically was not performing as well as other states. And it really made them stop and look and say, “There’s something that we are doing collectively in terms of our framework, the way we think about case review and are implementing it, that is making our MDT see it as less meaningful to them than in other states. What could that be?”

And I think having a window—I mean, sometimes you know, like an MDT is getting a little disgruntled with you. People stop showing up at case review or they come late or they don’t come prepared. But when you have the data that says clearly that they don’t feel like it’s a good use of their time, basically, then all of a sudden it’s like an urgency comes to: “OK, now I know what the actual problem is and I have the information that I need to try to problem solve this with my partners.”

And I’m wondering, you know when you have looked at the data, just say more broadly, is there anything else that’s kind of jumped out to you? For me, that was kind of like another aha moment because we saw some of the biggest differences in data across not only states but CACs. One CAC could be extremely high performing on it; another might be really struggling with case review.

But are there other areas within the surveys where you’ve seen sort of a similar thing, these big disparities between those who are at peak performance and those that may have an opportunity to grow?

Seth Boughton:
Yeah, absolutely. So I think one of the things that is now an opportunity for us, with say the youth survey, is being able to do more of a comparison between the perceptions of adults of the services that their child is receiving versus the children’s.

Teresa Huizar:
Themselves, yes.

Seth Boughton:
Exactly. Their perception of how they’ve received those services.

[18:05]
And I think that—let’s see, was it ChildSafe? That they really focused in on that youth survey—

Teresa Huizar:
Interesting.

Seth Boughton:
—to gain some additional insights onto how they could build a more child-friendly—

Teresa Huizar:
Wonderful.

Seth Boughton:
—building. One of the recommendations that was provided was a desire to have like less—we would call it clinically, back when I was working—“dead silence.”

Teresa Huizar:
Mm.

Seth Boughton:
The idea that when you bring a child into a silent space, there’s this pressure to remain silent. That’s kind of like when you go—

Teresa Huizar:
That’s interesting.

Seth Boughton:
—into a library or something like that.

Teresa Huizar:
Yeah.

Seth Boughton:
And so by just providing, I think it was nature sounds—

Teresa Huizar:
Interesting.

Seth Boughton:
—it’s been a while since I read the article on it. But they provided some nature sounds into that space and then suddenly it didn’t seem like such a quiet … you didn’t have to break the silence—

Teresa Huizar:
That’s interesting.

Seth Boughton:
—to communicate your experience. And so there was already just enough sound there.

And it also is something that we found in our own clinical work with my team back in Illinois that—and this was outside CACs—but it was if you just had some ambient music around, something like that, it also allowed for more comfort in the silence as kind of as that child’s just taking time to process or think about that experience before responding. Just having that noise to fill that space in between allowed them an opportunity to feel comfortable and not feel like there was a clock running on how soon they needed to respond.

And also, for our early clinicians who were very early, you know, in their own practice, it allowed them to, in turn, feel a lot more comfortable with allowing space for that silence, which is so important when we’re probing into these like sensitive and traumatic spaces.

Teresa Huizar: T
hat’s interesting.

Seth Boughton:
Yeah. Yeah.

[20:01] Teresa Huizar:
You know, as you were talking, I was thinking, um, because one of the things we do, as you know, at the end of these surveys, we let kids comment. Just open-ended, like whatever they want to say about it. And some of those comments are some of the most interesting things you’ll ever read.

Now a lot of ‘em are, “I really like Jimmy, he was fantastic.” Or, you know, things like that. But for the ones that are more … I hate to use the word substantive, but maybe more pointed, a lot of them have to do with the environment. That’s what I’ve noticed.

Seth Boughton:
Right.

Teresa Huizar:
That they’re very sensitive to: Is it too cold in the room? You know, exactly what you’re saying about noise. The sort of visuals when they come in, you know, the colors people will comment on. Just, it’s very interesting because we’ve known this for a long time.

I mean, as you know, Children’s Advocacy Centers have focused on the physical environment, being kid-focused, and, you know, tailored to kids’ needs since day one. However, I think over time, I’m not going to say that we forgot how important that was, but maybe we thought it was of secondary importance to certain other things. And kids are reminding us how important it is. Because for their experience, they’re judging whether people are welcoming and friendly and all those things in part based on their own physical comfort, basically. Which makes sense. Like that’s how we inhabit spaces too.

But it’s easy to forget that. And I just have been so taken with all of the comments that they’ve made about that and how sometimes it’s very different than the way that adults experience it.

I was talking about this to a group of CAC directors, and one of them was commenting on the fact that they had sort of purposely kept their CAC somewhat cold. They were co-located space and a lot of the uniforms that different people were wearing were hot, you know. The temperature in the building was kept kind of colder, but kids were commenting on their youth survey that it was too cold.

Seth Boughton:
Yeah.

Teresa Huizar:
And so they were like, “You know what? This is about the kids and not the adults, so we’re amping up the temperature a little bit.” So it’s just, it’s interesting how you can get such granular information from kids if you ask.

Seth Boughton:
Yes, absolutely. And I always talk about, with our own CACs, this idea that there are three real key components to getting a full picture of anything.

Teresa Huizar:
Mmm.

Seth Boughton:
And so one of them is you want quantitative data—

Teresa Huizar:
Sure.

Seth Boughton:
—because going back to those empirical quantitative measures becomes very, very important to substantiate that the qualitative material is rooted in what’s actually physically measurable out there in the world.

But then the other part of that is then you want to get information from the people who are providing services, because they’re the ones who are doing the work every day. And we fulfilled that with the MDT survey, um, getting that kind of feedback.

And then the third component is, you need to be listening to the voices of the people you’re serving. And so by bringing in these caregiver initial feedback surveys, the follow-up surveys, and the youth surveys, we’re able to get a much more complete picture of how the environment that we’re all living in.

Because that CAC becomes—I always kind of go back to the mindfulness analogy of: This is water. And so it’s the idea that we exist within our treatment spaces so long that subtle changes, things where we can make those, those little differences in the experience of the families coming into our centers. We can become very quickly kind of blind to—

Teresa Huizar:
Mmm.

Seth Boughton:
—over time.

And so getting that continuous feedback on how we as individuals but also as the space itself are evaluated and received by the children and families we serve,  it just is going to allow us to continue to evolve into the kind of, next-generation service space. And so that’s really exciting, to see how data can really, you know, not only answer the questions that we’ve thought of, but answer questions that maybe we wouldn’t have ever thought to ask.

So that’s really phenomenal to see.

[24:04] Teresa Huizar:
Well, and I think the other thing that you’re pointing out here, which is important, is how even small changes in practice that are based on data can make a big difference to the kids and families that we’re serving. You know, CACs of Texas, when we took on this project, told us about one that had happened within their own state. Which is, part of the caregiver service is asking them if all of their child’s questions have been answered. Slightly phrased differently, but that’s the gist of it.

Seth Boughton:
Yeah.

Teresa Huizar:
And a lot of parents were not scoring that terribly high. They were like, “I don’t know. I have no idea.”

And that is because in the forensic interview room, the forensic interviewer was asking the child if they had any other questions. But where’s the parent when that’s going? Well, they’re in the waiting area. They have no idea that their kids been asked that question. And so just changing the practice to make sure that whatever’s said in the forensic interview room, that in front of the parent, you’re also asking both of them, you know: any other questions before they leave? You know, telling them what to do if they have questions when they get home, really reassured the parent that they could feel that their child had had their questions answered, too. And I think, you know, that reassurance during what is certainly a very traumatic day for the parents themselves, I think, was very important to their own peace of mind.

So, you know, sometimes we think that all the changes that need to be made have to be these big, monumental changes, but sometimes what really is comforting for a parent just requires a very small or minor change or tweak in our practice.

Seth Boughton:
Absolutely.

[25:38] Teresa Huizar:
Just overall, what have you seen in the way that OMS and any other data collection that you all are doing—because I know that you have a much more widespread way of drilling into data than just OMS. Where have you seen it shape practice most within the CAC setting?

Seth Boughton:
So what we’ve been seeing, largely, is that it has strengthened our partnerships with our other allies within the MDT context.

And so not only does it advance the work that our CACs are doing, it is informing the practice by our child service, protective service agencies. It’s enhancing the responses by law enforcement to be more trauma informed. And it’s also helping our prosecutors make cases for greater investment in engagement with our CACs as a way to solidify their cases so that we do identify abusers and effectively and efficiently prosecute them through that cohesive sharing of information and data all within the MDT context.

[26:46] Teresa Huizar:
I think that one of the things that you’re noting that is so important is that CACs and other MDT professionals that are using the data well are making sure that everybody on the MDT is aware of the findings. You know, that it’s not something just for staff. But that the multidisciplinary team as a whole holds the responsibility for how kids and families are treated at the CAC, and their satisfaction, and therefore, the data’s as important for a prosecutor or law enforcement or CPS as it is for a CAC staff person.

And I think that sort of collective ownership, that if you have an indicator and it’s not doing well, guess what? We all own the solution to fixing that, but also celebrating the success.

And I think, you know, I want to turn to that in a minute in looking at the national numbers, but I think not just when you look at this last year’s data but if you look over the last 10 years data, I think the incredible story here is that overall so many families have gotten services that they have found to be helpful.

Seth Boughton:
Absolutely. And when you’re looking at, in the data, you are finding that, you know, we get honest responses to these surveys. When there is feedback on what we could be changing or doing better within our CACs, we do get that kind of feedback.

Teresa Huizar:
That’s right.

Seth Boughton:
And so we know that the surveys are being asked in a way that is neutral and impartial. That we aren’t, you know, putting a finger on the scale and that we are providing these surveys at times when the experience is fresh. When the youth that we’re serving, or the MDT, I believe they receive them like every six months, we’re getting a very wide feed and a very honest feed of what those experiences are.

With that in account, we do see that, you know, very often in the mid to high nineties, we’re seeing caregivers and youth both respond with favorable measurements of their experiences. Now we can get more granular, and we can start looking at like, where are we, you know, meeting expectations and where are we exceeding those expectations?

Teresa Huizar:
That’s right.

Seth Boughton:
And so like the great thing is, is that the way we’re benchmarking these things—to kind of get back to that benchmarking measure—is benchmarking can stop at the, “We’ve hit all of our baseline goals,” but the way we’re collecting the data, it allows us to add on that caveat of, you know, we have feedback from the caregivers that, you know, this center, this Chapter, this region is doing something extraordinary that is really going above and beyond. And then we can really explore like what is that difference? What are they doing different within their center or their Chapter or their region that is making them have that higher indices of families or children who are saying, “This was critical for me. This was the factor that made all the difference in my experience.”

So it’s really wonderful, and it allows us to just continue advancing the CAC network as a whole, kind of raising all ships by really, you know, being able to identify how do we keep advancing and improving in that way.

[30:02] Teresa Huizar:
You know, I like the fact that you’re really talking about positive variants.

You know, so often we just sort of scan for problems. Like, “OK, what’s scoring the lowest? Let’s get right on there.” But I think what you’re pointing out, which is so important, is we should also be scanning for super performers because they can teach us something about what they’re doing. Maybe some small tweak in their own practice that they learned over time, that if other people adopt that or are exposed to it or even can consider it, it may make a big difference in our performance overall.

[30:34]
So when you think about like, you know, we view OMS as something ever-evolving. As you know, we added the youth survey not too long ago. Gosh. I mean, time flies. I can’t remember exactly when. Was it a year, two years? I don’t know. Whenever we did it [laughter], it was an important thing to do. But we’re not satisfied. You know, there’s always going to be something new to add or to examine.

When you think about the data, because you’ve been in it a lot and helped us write our last Healing, Justice, and Trust report, what do you think are sort of emerging areas of exploration for data we already have? And then I’m going to ask you to think about what might be possible in the future, you know, in terms of even exploring or adding, whether it’s new survey tools or additional questions or something else.

So let’s start with the issue about the data we have now. What is still to be examined? What do we still need to know more about or have the opportunity to know more about?

Seth Boughton:
I could break it down into two categories.

I think that the first one that we certainly have robust enough data to start exploring with what we have currently. When we look at the caregiver feedback and combine that with our MDT surveys, we can start really teasing out—and we kind of had spoken about this already—which is what are those fundamental barriers to access? Both physical and those more, like, experiential barriers?

Teresa Huizar:
Mm-hmm.

Seth Boughton:
And so I feel like there are some really huge opportunities, especially when we start looking at how we’re interfacing with other large systems of care at the national level.

So thinking of, once again, law enforcement, child protective service agencies. One of the areas where I could see opportunity for growth is, there is a significant shortage of qualified, trauma-informed mental health professionals.

Teresa Huizar:
Mm-hmm.

Seth Boughton:
Especially within our under-resourced areas. And telehealth is going to get us part of the way there, but with telehealth as a solution, we’re still winding up with an inundation of additional people requesting services from a very small number of individuals in well-resourced areas.

And so we see that those waitlist times are just getting longer and longer. And so we saw that families who have been waiting 60 days or more for services. And based on my own work as a crisis worker, 60 days is an eternity. So when we start thinking about how do we create systems so that those waitlists are reduced but individuals continue to have access to trauma-informed mental healthcare regardless of where they live. I think there’s an opportunity to perhaps partner with MSW programs in a similar way that medical systems of care partner with medical programming at that level. And so I think there’s an opportunity to engage with clinical mental health programs and the educated, trained individuals who are coming out of those systems to invite them into the CAC system.

I can speak from my own experience that coming out of my MSW program, I was not aware of Child Advocacy Centers. And if someone had said there is an entire national network of individuals providing care to children who have been through traumatic circumstances, it would’ve been the first place I would’ve put my application in. And so I think there’s a really huge opportunity for us to drive a building of a comprehensive mental health network through that form of engagement. And it seems like the data can support those kinds of cases as an opportunity.

So that would be very exciting. Now I am not, by any means, you know, have the details on what that would look like, how that would work, or anything like that.

Teresa Huizar:
But you can see the opportunity. Yeah.

Seth Boughton:
But you can see the opportunity there. And that’s really neat that the data can tell you that kind of story, and you can start thinking about those types of solutions.

The other domain where I see a potential for future growth and development: One of the things that I find really beautiful about the OMS system is centers can customize their questions and their dashboard to explore areas that they’ve identified individually as needs.

So it becomes a form of like almost crowdsourcing.

Teresa Huizar:
Mm-hmm.

Seth Boughton:
Where we can dive into: What are the questions that people tend to be adding to this thing? And if we have a sufficient quantity of centers who are all identifying that, you know, “This is the area we need to know the most about,” then that becomes something that we can integrate into the national survey. And then suddenly, once again, we’re increasing that sample size. Suddenly, you know, as opposed to a single center asking, you know, 500 individuals for their input on this question, suddenly we could have 13- 15,000 individuals providing us information.

And once again, when we get all that narrative, that rich narrative data, then we can start really kind of teasing apart, like, how do we address this? So something that I see kind of emerging as a common question that people are adding in is related to work hours impacting access to services.

Teresa Huizar:
Interesting.

Seth Boughton:
And so when we start talking to caregivers, I think asking them about their experience at the CAC is phenomenal and asking them about their barriers that they’re encountering, you know—and we do ask questions around like, transportation time. It’s a very comprehensive list of questions that we have regarding those barriers.

But that piece about, you know—various periods of time we have had recessions. And that puts families in a state where, you know, you may be working two or three different jobs just to keep your home and keep food on the table. And so what do we do as a system of care and response to make sure that that doesn’t become a fundamental barrier to those services? And, you know, what the answer to that question is, I think is a larger discussion. But I think that being able to tease apart and use … kind of the brain trust of our entire network of, you know, 900+ CACs? A thousand+ CACs?

Teresa Huizar:
That’s right.

Seth Boughton:
Yeah. You know, that is a huge amount of people with eyes on the families and communities we’re serving. And so we have so many places where we can build that knowledge and identify what do we need to know next.

[37:09] Teresa Huizar:
That’s such a good question. What do we need to know next? Right.

And not just being satisfied with the information that we have today. That, you know, there are changes as you’re saying, and kind of at the macro level that may drive changes all the way down to programmatic changes within a CAC. And so thinking about what that means and how we gather information and plan for the future, I think is critical.

[37:32]
Well, Seth, I’m wondering, let’s just say that NIJ just decided to give us a vast grant to do whatever we needed to, not just within OMS but to really research and look at areas in the field that need more attention.

What would be kind of your top three or four things that you say, “Gosh, these are really gaps that we need to know more about right now?”

Seth Boughton:
Yeah, absolutely. So, I mean, I will tell you what my pet projects would be based off of data interests.

Teresa Huizar:
Yeah. Please.

Seth Boughton:
So my area of study has been human trafficking. And it’s how I got engaged with my work with the Ohio Network of Children’s Advocacy Centers.

We have a standing and existing national network that responds and already has a structure built around trauma-informed responses to children in crisis. And so I think that there’s a huge opportunity to interface with—and like, if we’re really talking like a massive NIJ type situation [laughter], I would love to see a partnership with like NCMEC, like that to really dig in and see how we can take the existing structure—because we really wouldn’t have to be reinventing the wheel here—but really have CACs established as, in addition to a place that responds to child abuse, but also being a place that referrals can occur for child trafficking.

One of the largest gaps that I saw when I was working clinical practices, we would find an identified child who had been trafficked, but the next question was, well, where do these children go? What—

Teresa Huizar:
Mmm.

Seth Boughton:
—where can they go for services? Where can they go for that—

Teresa Huizar:
Yes.

Seth Boughton:
—healing, justice, and have that trust to really, you know, bring in the [Healing, Justice, and Trust] report here. So I think that there’s a huge opportunity.

I think we tend to focus a lot on trying to determine absolute numbers. And it’s very difficult to get absolute numbers. We can only know the number of kids we’re serving, but I think that there’s some work that I’ve been doing in partnership with Eyes Up Appalachia that has really been focused on looking at prevalence studies differently and really looking at what are the risk profiles that we tend to see among youth.

And I think that if we could scale something like that with the amount of, you know, data pool that we tend to pull in on an annual level, there are questions that are 20 years old in the field of human trafficking and—very much so, even more so for child traffickin—that we could actually get concrete answers on if we had that type of funding and the, the systems that NCA already established nationally. Um, so that would be my real, like pie in the sky. I would look to see that.

Another one is looking at kind of lesser identified barriers. And so one of the ones that I know came up very frequently in my clinical experience was linguistically isolated households. And so

Teresa Huizar:
Mm-hmm.

Seth Boughton:
These are households that aren’t just like low English proficiency, but within whatever community they exist they’re not speaking the dominant language, whether that is English, Spanish, whatever language that is.

Teresa Huizar:
Interesting.

Seth Boughton:
And so, if we could really ascertain and make a map of what those linguistically isolated households are at as granular a level as we could get, then we could actually create services that are oriented specifically to serving those linguistically isolated communities. And that would greatly expand the number of kids that we’re able to serve at a national level.

And then, gosh, a third one. [Laughter] This is like genie—

Teresa Huizar:
You’re dreaming big. [Laughter]

Seth Boughton:
Yeah. So I think the third one that I would be interested in, and I don’t know if this would fall under an NIJ or whether we’d have to apply for a larger grant.

Teresa Huizar:
Okay.

Seth Boughton:
But the idea of expansion of the multidisciplinary team model and CACs, we already exist in other countries. But it’s really a model that should have kind of this global reach. So if I was really to go—you can see I’m just kind of scaling up with time.

[Laughter]

Seth Boughton:
But I would love to see the types of foundational studies that we would need in order to kind of identify like, what does a CAC look like in and fill-in-the-blank country?

Teresa Huizar:
Mmm.

Seth Boughton:
And really make this system a global network. You know, most countries have some version of a child protective services agency. Every country, for the most part, I believe, has law enforcement and prosecutors and a judicial system. So we have these systems that we’ve identified as being so critical to our society that are global in nature.

And I feel like the CAC is a very logical thing. Because we know that child abuse occurs everywhere. We know that child trafficking occurs everywhere. I always use the phrase of, “It’s always local somewhere.” And so those localities should have CACs as well. So that would be if we had all the money in the world and we could just do, you know, do a global study.

Teresa Huizar:
Let’s talk to the Gates Foundation about that one, Seth, maybe.

Seth Boughton:
Yeah, yeah … they can help us out.

Teresa Huizar:
Yeah, right? [Laughter]

Seth Boughton:
That would be great.

Teresa Huizar:
Excellent, excellent. Well, listen, from your lips to God’s ears on all of those things,

[Laughter]

Teresa Huizar:
I think they’re all important aspirations for our future as a movement.

[43:06]
So I’m wondering, Seth, you know, what have I not asked you that I should have or that you want to make sure that we talk about today?

Seth Boughton:
Let’s see. You hit—I had a list of bullet points and you have hit all of them.

[Laughter]

Seth Boughton:
I think that the next step is I am very, very interested in the research future for NCA.

Teresa Huizar:
Mm-hmm.

Seth Boughton:
I think that there are huge—we have been collecting data for so long and it has served our CACs at a phenomenal level. And it’s been great to see how all of this data has been instrumentalized at and operationalized by our CACs to advance their practice and the practice of their partners.

There are so many questions that we have in the field of child mental health service, trauma-informed services for, you know, youth presenting with problematic sexual behaviors. How do we create greater transparency, in terms of large data systems? Things like—I mean, I had a chance to dig into a SACWIS system once, and there is a wealth of information there. And so I think there’s a real opportunity here for us to really—we don’t have to wait for the data. Or we don’t have to publish, you know, 10,000 IRBs to start getting at these answers. We can really start answering questions that are decades old in terms of research.

So I don’t know. I think that it’s almost perhaps if I can ask a question to you.

Teresa Huizar:
Sure.

[44:42] Seth Boughton:
You know, what is that research future for NCA? I think that there’s just a huge opportunity there.

Teresa Huizar:
We’re going to have to go back to Gates again, right. [Laughter]

Seth Boughton:
Yes.

Teresa Huizar:
But yes. I am like you. I’m a data person. I absolutely love research and think that it’s—that we sit on a lot of data that no one ever publishes that could inform the field at large. And then there are other, you know, research partnerships that we could be engaged in that would help answer some of those questions. And we have a long list of our own stuff. We’ll have to compare our research questions list one day.

So, I think this is, speaking of leading and growing edge, this is NCA’s leading and growing edge too. So I appreciate you asking that question because I think it’s going to be ever more important to the field, you know?

Seth Boughton:
Absolutely. Love it.

[Outro music fades in]

[45:31] Teresa Huizar:
All right. Well thank you again for coming on to One in Ten and sharing your information with our listeners.

And for those of you who would like to know more about our Outcome Measurement System, you can find that on our website, and our One in Ten podcast website.

Thanks, Seth.

Seth Boughton: Thank you so much.

[Outro]

[45:51] Teresa Huizar:
Thank you for listening to One in Ten. If you liked this episode, please share it with a friend. And for more information about this episode or any of our others, please visit our podcast website at OneInTenPodcast.org.