**5. Systemic factors in CSA**

Following disclosure or discovery of suspected CSA, a child and family's life may have an influx of professionals involved with the aim of child protection, assessment and promotion of the victim's physical and mental health, prosecution of the perpetrator, and family healing and recovery. Ideally, these efforts are coordinated in order to minimize deleterious impact on the CSA victim and family. In the United States, Child Advocacy Centers (CAC) were developed in response to the desire to limit redundant interviewing of the victim and to coordinate investigative and therapeutic response to CSA [37]. These CACs utilize a multidisciplinary team of medical, mental health, child protective and law enforcement professionals in a "one stop shop" approach to CSA with interagency communication and collaboration. In 2011, The National Children's Alliance in the United States (U.S.), developed Standards to ensure that children across the U.S. receive consistent, evidence based services that help them recover from CSA and other types of child abuse [38]. These Standards are updated every five years, with the most recent Standards from 2017 and to date there are more than 880 CACs in the United States, spanning all 50 states. In 2018, 367,797 children in the U.S. were served by CACs, with an increase in 29% from 2008 to 2018 [38]. However, even with this increase, there are still over ten million children living in the U.S. in areas without a CAC. Additionally,

internationally, many countries lack the funding and infrastructure to implement a coordinated and multidisciplinary response to CSA.

Increased caregiver and child satisfaction were found with these coordination efforts in evaluation and intervention with CSA [37]. CACs can serve as a model for coordinated multidisciplinary services that reduce retraumatization of the CSA victim due to limiting the child having to repeatedly disclose their CSA experiences to police, lawyers, doctors, therapists, investigators and judges [38].
