Commissioner, Administration on Children, Youth and Families
Administration on Children and Families
U.S. Department of Health and Human Services (HHS)
Breaking the Silence on Child Abuse: Protection, Prevention, Intervention, and Deterrence
Subcommittee on Children and Families
Committee on Health, Education, Labor and Pensions
United States Senate
Tuesday December 13, 2011
Chairwoman Mikulski, Ranking Member Burr, and members of the Subcommittee, thank you for accepting my written testimony for your hearing on the issue of child abuse. Recent events have brought much attention to this issue, and the Department of Health and Human Services (HHS) welcomes this opportunity to address the Federal role of HHS in preventing child abuse and neglect, protecting its victims, and treating its effects on children and families.
In my position as Commissioner of the Administration on Children, Youth and Families, I am well acquainted with the national scope of abuse and neglect and our Nation’s response. Prior to joining the Administration, I served as the Director of the Illinois Department of Children and Family Services from 2003 to 2007, and subsequently as the Chief of Staff of the Chicago Public Schools. In these positions, I gained a comprehensive understanding of the State role in the prevention of maltreatment, the protection of children, and the treatment of the impacts of abuse and neglect. In my statement, I will provide an overview of a key piece of Federal legislation addressing child abuse, the Child Abuse Prevention and Treatment Act (CAPTA), and the roles of Federal and State government in implementing the Act. Although there are other statutes related to child abuse and neglect, my statement will be restricted to a discussion of CAPTA.
The Child Abuse Prevention and Treatment Act is a fundamental component of Federal legislation related to the prevention of and response to child maltreatment perpetrated by caregivers. The Act, originally passed in 1974, has been reauthorized and amended several times, most recently in December 2010. When enacted, CAPTA was the original legislation mandating that States have in place systems for reporting, investigating, and responding to abuse.
As summarized in an overview of the legislation’s history produced by HHS, “CAPTA provides Federal funding to States in support of prevention, assessment, investigation, prosecution, and treatment activities and also provides grants to public agencies and nonprofit organizations, including Indian Tribes and Tribal organizations, for demonstration programs and projects. Additionally, CAPTA identifies the Federal role in supporting research, evaluation, technical assistance, and data collection activities; established the Office on Child Abuse and Neglect [located in the Children’s Bureau in the U.S. Department of Health and Human Services]; and mandates [the] Child Welfare Information Gateway,” a clearinghouse of information about child welfare practice.
The Act includes a minimum definition of abuse and neglect as follows: “the term ‘child abuse and neglect’ means, at a minimum, any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act which presents an imminent risk of serious harm.” States may choose to put forth an expanded definition of child abuse and neglect that builds on that provided by CAPTA, and the Act’s implementation is highly State-specific. Most States recognize four major types of maltreatment; physical abuse; sexual abuse; and emotional abuse or neglect. Other types of maltreatment, such as educational or medical neglect, are codified in some States. In certain States, exceptions to definitions of abuse and neglect are provided to ensure that religious beliefs, cultural practices, and financial insecurity in and of themselves do not constitute maltreatment.
According to the basic definition, CAPTA applies specifically to cases of child abuse and neglect at the hands of persons with some relationship or regular responsibility for a child. States may indicate in statute which persons can be reported to child protective services as perpetrators of maltreatment. This generally includes parents, guardians, foster parents, relatives, or other caregivers responsible for the child’s welfare. State definitions range from broad (as in Oregon, where “Responsible person may include any person.”) to narrow (as in Connecticut, where “Responsible persons include the child’s parent or guardian.”). In most States, cases of maltreatment perpetrated by strangers, acquaintances, or others not defined in statute as persons responsible for the child are classified as assault and fall under the jurisdiction of the criminal justice system. For the remainder of my testimony, I will address the issue of maltreatment as defined by CAPTA.
Data reported in this testimony come from the National Child Abuse and Neglect Data System (NCANDS), a database to which States voluntarily submit information about reported cases of maltreatment on an annual basis. Statistics reflected below are drawn from the most recent report of this data, Child Maltreatment 2010, released on December 8, 2011, which reflects submissions from all fifty States, the District of Columbia, and the Commonwealth of Puerto Rico.
In addition to providing information about reports, investigations, and services in cases of suspected maltreatment, States furnish data to the Federal government about confirmed instances of abuse and neglect. The following table illustrates the most common types of maltreatment and the relationship of the perpetrators to the children in question.
Table 1: Maltreatment Types and Perpetrators, 2010
Percent of Maltreatment Cases
Number of Maltreatment Cases
|TYPE OF MALTREATMENT|
|PERPETRATOR OF MALTREATMENT|
Data Source: U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2011). Child Maltreatment 2010.
In order to receive CAPTA funds, States must meet certain requirements including the establishment and maintenance of systems for the reporting of abuse and neglect. Most States have hotlines that can be called to report suspected maltreatment. When a call is made, a hotline operator asks the caller a series of questions, according to the protocol of the State or jurisdiction, in order to establish the details of the referral and determine whether the criteria for an investigation have been met. According to the Child Welfare Information Gateway, “In approximately 27 States, cases in which the suspected abuse is caused by someone other than a family member, or in which the abuse involves sexual abuse or severe injury to the child, are considered crimes and must be cross-reported to law enforcement agencies for investigation.”
In 2010, approximately 3.3 million referrals of suspected abuse pertaining to six million children were made in the US. While many referrals are made by individuals acting purely out of concern for a child, the majority are made by people who are required by State law to report any suspected maltreatment. As of April 2010, mandated reporters in almost all States included those who regularly encounter and work with children, such as teachers, child care providers, and doctors. Of all referrals received in 2010, 57 percent were made by professionals such as teachers, law enforcement and legal personnel, and social services staff. Anonymous sources, other relatives, parents, and friends and neighbors made the remainder of referrals.
When a hotline call is received, an operator will determinate whether there is a reasonable suspicion of harm to a child by a caretaker to warrant an investigation by the child protective services agency. This decision is generally made according to specific criteria defined by the State or jurisdiction in which the referral is made. If the reporter is unable to provide sufficient evidence of abuse or neglect, usually because these necessary details are unknown or the screening criteria for maltreatment were not met, the referral will be screened out and no further action will be taken. When referrals are screened in, they become known as reports. Of the 3.3 million referrals received in 2010, 1.8 million pertaining to 3 million children were screened in as reports warranting a response.
Approximately nine percent of the reports in 2010 were categorized as “Alternative Response,”  meaning that an alternative approach to usual child welfare investigative response was used. In these cases, maltreatment may or may not have occurred. According to Child Maltreatment 2010, “Cases assigned this response often include early determinations that the children have a low-risk of maltreatment. This response usually includes the voluntary acceptance of Child Protective Services and the mutual agreement of family needs.” This is in contrast to the investigative response, in which assessment and services are generally mandated following a caseworker’s independent determination that the family has needs requiring intervention. In five percent of referrals resulting in an alternative response, a child welfare worker determined that maltreatment had in fact occurred.,
When an investigation does take place, the child welfare worker assessing the report determines whether or not there is evidence of maltreatment. Again, most States require that certain criteria be met before such a determination is made. If these criteria are not met, the investigator will deem the report “unsubstantiated.” However, if evidence of maltreatment is apparent, the case will be “substantiated.” In some States, there is a third category for cases in which there is insufficient evidence to confirm maltreatment, but there is reason to believe that a child faces significant risk in the current setting. Such cases are deemed “indicated.” In 2010, 19 percent of reports were substantiated, 63 percent were unsubstantiated, and one percent was indicated. Including the children who had been maltreated and received an alternative response, approximately 695,000 children were the victims of maltreatment in 2010. Thus, the national rate of maltreatment in 2010 was about 9.2 victims per 1,000 children.
Figure 1. General Process for Child Protective Services, from Referral through Removal
Following an investigation of a report of maltreatment, the determination made either by the investigator or a child welfare caseworker influences whether or not a formal case will be opened for services. While most children and families receiving services from the child welfare system have been the subject of substantiated or indicated reports of maltreatment, services are sometimes delivered to families with unsubstantiated reports. In these cases, typically the investigator or caseworker has determined that, while there is no evidence of maltreatment, the family could benefit from preventive services to keep abuse or neglect from happening. In 2010, approximately 425,000 (61 percent) of victims and 552,000 (24 percent) of non-victims received post-investigation services.
Services delivered fall into two categories: in-home services and out-of-home services. In-home services are delivered to intact families where the child or children have not been removed. Out-of-home services include foster care and other services for children who have been removed from their homes and taken into State custody. According to NCANDS calculations, of the six million children who were the subject of hotline reports in 2010, approximately 229,000 children were placed in foster care as a result of reported maltreatment (see Appendix A).
In accordance with CAPTA, the Children’s Bureau in the U.S. Department of Health and Human Services provides funds to States to support activities including:
- Intake, assessment, screening, and investigation of child abuse and neglect reports; risk and safety assessment protocols;
- Training for child protective services workers and mandated reporters;
- Programs and procedures for the identification, prevention, and treatment of child abuse and neglect;
- Development and implementation of procedures for collaboration among child protection services, domestic violence, and other agencies;
- Services to disabled infants with life-threatening conditions and their families;
- Addressing the needs of infants born with prenatal drug exposure;
- Referring children not at risk of imminent harm to community services;
- Implementing criminal record checks for prospective foster and adoptive parents and other adults in their homes; and
- Protecting the legal rights of families and alleged perpetrators, and supporting Citizen Review Panels.
In FY 2011, $26,482,000 in CAPTA State grants were awarded to all 50 States, the District of Columbia and five territories. Grants are based on an initial allocation of $50,000 per State with additional funds distributed in proportion to the State’s population of children under the age of 18. Grant amounts ranged from $55,608 to the Northern Mariana Islands to about $3 million to California.
Additionally, in FY 2011, $41,606,000 in Community-Based Child Abuse Prevention (CBCAP) grants were provided to a lead State agency to disburse funds for community-based child abuse and neglect prevention activities. Funds are used to develop, operate, expand and enhance community-based efforts to strengthen and support families to:
- Prevent child abuse and neglect;
- Foster the development of a continuum of preventive services through State and community-based public private partnerships; and
- Finance public information activities focusing on the healthy and positive development of families and child abuse and neglect prevention activities.
Voluntary home visiting programs are a core local service, as are programs that focus on prevention services to families that include children or parents with disabilities. Grant amounts ranged from $200,000 to several of the territories to about $3.6 million to California.
In FY 2011, $25,793,000 was awarded to State, Tribal, agency, and university grantees for Child Abuse Discretionary Activities through CAPTA. These funds support a number of research and demonstration grants and contracts that seek to expand the evidence base for child welfare programs with the goal of improving child outcomes as lessons learned are adopted by communities across the country.
The program funds research on the causes, prevention, identification and treatment of child abuse and neglect, and investigative, administrative and judicial procedures. It also funds projects to compile, publish and disseminate training materials; provide technical assistance; demonstrate and evaluate methods and procedures to prevent and treat child abuse and neglect; and develop or expand effective collaboration between child protective services and domestic violence agencies. In addition, the program funds a national resource center on issues relating to child maltreatment and a national clearinghouse, the Child Welfare Information Gateway, which gathers and disseminates information on promising programs of prevention and treatment and on the incidence of child abuse and neglect.
Research and demonstration grants are awarded competitively to public and private agencies, including State and local government agencies, universities, and voluntary and faith-based organizations. Contracts may be awarded to public, nonprofit and proprietary organizations. Two Quality Improvement Centers are funded through this program:
- The National Quality Improvement Center on Early Childhood works to improve the social, physical, behavioral, cognitive, and emotional well-being of children zero to five years old, and their families, who are at risk of abuse and neglect. The Center fosters collaborative research and demonstration projects across the child abuse prevention, child welfare, early childhood, and other health, education, and social service systems.
- The National Quality Improvement Center on Differential Response in Child Protective Services works to generate knowledge about effective models of differential response in child welfare. The Center also supports the capacity building at the State and local levels to improve child welfare outcomes for children and their families who come to the attention of the child welfare system.
In summary, while CAPTA establishes minimum standards, States determine many of the specific rules related to what constitutes abuse and neglect, who must report that abuse and neglect, and when abuse and neglect is handled through the child welfare system and when it is handled through law enforcement. Through CAPTA, the Federal government supports State activities that prevent, assess, investigate, prosecute, and treat the effects of child maltreatment. CAPTA also includes provisions for tracking maltreatment and testing new approaches to addressing abuse and neglect. CAPTA serves as an important Federal tool for protecting children from abuse and neglect.
Appendix A. FY 2010 Flow of Children through Child Protective Services
 U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau, Child Welfare Information Gateway (2010). Cross-Reporting among Responders to Child Abuse and Neglect: Summary of State Laws. Available at:
Last revised: January 6, 2012