I understand that Kay Phillips Child Advocacy Center is an interdisciplinary program having direct contact with area agencies involved in the protection of children. To better serve children and families, the interdisciplinary process brings together professionals from the fields of child protective services, mental health, medical, education, legal, law enforcement, and others. Cooperation and coordination between the area agencies responding to alleged child maltreatment is key to KPCAC’S ability to provide optimal service to clients and families. In order to ensure cooperation, KPCAC developed memoranda of agreement (MOA) outlining the specific response guidelines, roles and responsibilities of each agency. A list of these agencies is printed on the back of the release.

I also understand that there are exceptions to the rule for which written consent must be obtained. These exceptions include suspected child abuse or when a person is a danger to him/herself or others. These situations may require involving the Department of Social Services, Law Enforcement, or a Mental Health agency and these contacts are required by law and do not require consent.

Each person seen as part of the identified client’s forensic interview shall sign below. By signing, participant or participant’s caregiver(s) agree to voluntarily participate in the interview focused on the identified client. For the purpose of providing a quality forensic interview(s), I authorize KPCAC to record the forensic interview of the client identified below.

This forensic interview has been requested as part of an investigation by law enforcement and/or the Department of Social Services.

I understand and agree as the current caregiver, that the identified client is being seen at Kay Phillips Child Advocacy Center for the purpose of a forensic interview. This is per South Carolina code 63-7-920 (sub-paragraph c), which also coincides with the CAC definition and legislation in South Carolina code 63-11-310.

I hereby acknowledge that I have received and have been given an opportunity to review a copy of the KPCAC Notice of Privacy Practices.

Currently, KPCAC has signed Memoranda of Agreement with the following agencies in the tri-county area:

Dorchester County Agencies:
Dorchester County Department of Social Services
Dorchester Department of Juvenile Justice
Dorchester/Charleston Department of Mental Health
Dorchester Alcohol and Drug Commission
Dorchester District II School District
Dorchester District IV School District
Dorchester Guardian Ad Litem
Charleston/ Dorchester Department of Mental Health
Dorchester Department of Disabilities and Special Needs
Dorchester County Sheriff’s Office
Harleyville Police Department
Ridgeville Police Department
St. George Police Department
Summerville Police Department
Dorchester County First Steps

Berkeley County Agencies:
Berkeley County Guardian Ad Litem
Berkeley County Department of Social Services
Berkeley County Department of Juvenile Justice
Berkeley County School District
Ernest E. Kennedy Center
Callen- Lacey Center for Children
Berkeley County Citizens
Berkeley County Sheriff’s Department
Goose Creek Police Department
Hanahan Police Department
Monks Corner Police Department
Berkeley County Department of Mental Health

Charleston County Agencies:
Dorchester/Charleston Department of Mental Health
Charleston Department of Social Services
Dee Norton Children's Advocacy Center
Charleston County Sheriff’s Office

Tri-County Agencies:
Carolina Youth Development Center
South Carolina Department of Health and Environmental Control-Trident Public Health District
North Charleston Police Department
MUSC Department of Pediatrics
MUSC National Crime Victims Research and Treatment Center
MUSC Department of Psychiatry and Behavioral Sciences Medical Center
My Sister’s House
Parents Anonymous of SC
People Against Rape
Palmetto Behavioral Health System
Lowcountry Equine-Assisted Psychotherapy
Continuum of Care
Palmetto Youth Connections

Other Agencies:
Calhoun County Department of Social Services
Orangeburg Department of Social Services
Cottageville Police Department
Department of the Air Force, Office of Special Investigations
Orangeburg County Sheriff’s Office
Navy Criminal Investigative Services, Charleston
Hope Haven of the Low Country
Thornwel
First Circuit Solicitor’s Office
Ninth Circuit Solicitor’s Office
Colleton County DSS
Florence Crittenton
628th Medical Group, Family Advocacy Program
Windwood Farm Home for Children and Windwood Family Services
Carolina Pediatric & Carolina Teen Center
Colleton Co. Sheriff’s Department
Golden Care Solutions LLC
HALOs
Lakeside Family Center