Testimony

Statement by
Wade Horn, PH.D
Assistant Secretary for Children and Families
U.S. Department of Health and Human Services
on
HHS- Statement For May 20th Hearing
before the
The Committee on Government Reform
U.S. House of Representatives

May 20, 2004

Mr. Chairman and members of the Committee, thank you for the opportunity to appear before you to discuss the Federal government's coordination efforts to prevent and respond to child abuse and neglect. Child abuse and neglect is a tragedy that continues to affect too many children and families in our country. During 2002, an estimated 896,000 children were found to be victims of neglect or abuse - a rate equal to 12.3 out of every 1,000 children in the United States. Approximately 1,400 children, three-quarters of whom were younger than four years old, lost their lives due to child maltreatment in 2002. That is the equivalent of almost four children dying every day.

The Bush Administration is committed to improving our national response to this terrible problem. I would like to share with you the steps we are taking - both ongoing and new targeted funding and legislative initiatives -- to strengthen child welfare and combat child abuse. These steps are critical to addressing weaknesses in the Nation's child welfare infrastructure so that child abuse can be halted and more children can be promised a safe and stable home in which they can grow and thrive. However, there is no question in my mind that far more must be done. The plethora of disparate programs and funding streams that are mired with unique and complex rules and limitations make it extremely difficult for States to develop and manage effective child welfare systems.

The Administration has acted on several fronts to ensure that proposals for reform support flexibility and innovation, recognizing that funding alone will not produce effective solutions to our greatest problems. For example, the President's welfare reform proposal sought to provide States with the opportunity to seek "super-waivers" to support multilateral strategies to address self-sufficiency. Our child welfare legislative proposal, which I will speak to in more detail later, offers States a similar advantage in addressing State-specific child protection and child welfare issues.

We are proud of the efforts we are making to assist States, Tribes and communities in strengthening child abuse prevention and child welfare programs and to build and disseminate knowledge about effective practices in preventing and responding to child maltreatment. We are working with our Federal and State partners to more effectively coordinate programs impacting this vulnerable population and increasing the resources and flexibility available to States and communities to prevent and intervene effectively in cases of child abuse and neglect. We have proposed bold new legislative initiatives that would provide much needed flexibility to States in managing their programs and we would be willing to work with this Committee to explore any additional steps that could be taken to remove statutory barriers to real coordination among the range of child welfare programs.

ACF Programs to Address Child Abuse and Neglect and Child Welfare

As Assistant Secretary for Children and Families, I am responsible for overseeing many Federal programs specifically targeted to child abuse and neglect and the child welfare service system. Within the Administration for Children and Families (ACF), we implement programs designed to prevent child maltreatment, support and strengthen State Child Protective Service (CPS) systems, provide home and community-based services to assist families at-risk or in crisis, help support children in foster care and children who are adopted, and help prepare children who "age out" of foster care without a permanent home to prepare for independent living.

We also fund research, demonstration and evaluation projects relating to child abuse and neglect prevention and treatment; data collection on child abuse, foster care and adoption; information dissemination activities; and technical assistance to help States and communities respond to child maltreatment and improve the functioning of their child welfare programs. Importantly, we also have an oversight role in monitoring the performance of State child welfare programs and in holding States accountable for improving outcomes for children in the child welfare system - for instance by preventing the repeat maltreatment of children reported to CPS.

Among the programs administered by ACF are those authorized by the Child Abuse Prevention and Treatment Act (CAPTA), the Federal statute that has long served as a focal point of our Nation's efforts to address child abuse and neglect. Reauthorized in June 2003, under the Keeping Children and Families Safe Act of 2003, CAPTA provides broad guidelines for States to follow in operating statewide child abuse and neglect programs. The CAPTA State grant program provides funds for States to operate and improve their CPS systems. As you know, CPS is at the center of every community's child protection efforts. In most jurisdictions, CPS is the agency mandated by law to conduct an initial assessment or investigation of reports of child abuse and neglect. It also offers services to families and children where maltreatment has occurred or is likely to occur.

Through CAPTA, ACF also funds the Community-Based Grants for Child Abuse Prevention (CBCAP). These grants provide funding to States to develop, operate, expand, and enhance community-based, prevention-focused programs and activities designed to strengthen and support families to prevent child abuse and neglect. The funds provided to States support many activities, including specific prevention programs such as parent education, parent support, respite care, home visiting, outreach and education, and other family support services. Equally important, the program supports the development and support of prevention networks - efforts to knit together public and private agencies and organizations that work with children and families. In addition, the program funds training and technical assistance in both program implementation and evaluation.

CAPTA also authorizes funding to build our knowledge in the field of child abuse and to disseminate best practices. Examples of projects we have recently funded through CAPTA include:

  • Eight cooperative agreements with programs all across the country that will replicate "Family Connections," a program previously evaluated and demonstrated to be effective in reducing the risk of child maltreatment. Developed at the University of Maryland, School of Social Work, Family Connections is a neglect prevention program that is based in the community with a strong emphasis on comprehensive assessments, social support, and emergency assistance for families. The replication projects will be testing this model in a variety of different geographic areas and with new populations such as families with disabled children, Asian families, rural families, and other families living in at-risk communities. To assist in maximizing the effectiveness of this effort, the Department's Centers for Disease Control and Prevention (CDC) will provide information on lessons learned from child abuse prevention interventions funded by CDC. We also invited a health economist from the CDC to provide technical assistance to our grantees on conducting cost analyses of prevention programs.

  • Four grants that will support rigorous evaluations of several different prevention programs such as a statewide home visiting program, a national parent aide program, a social marketing campaign to prevent child abuse, and a prison-based program that helps incarcerated men learn to be good fathers.

  • A cluster of cooperative agreements to strengthen child welfare systems using a "Systems of Care" approach. A Systems of Care approach is rooted in the development of a strong infrastructure of interagency collaboration, and is characterized by individualized care practices, culturally competent services and supports, child and family involvement in all aspects of the system, and measures of accountability. Cooperative agreements were awarded to nine child welfare agencies and one Tribal organization to build home and community-based "Systems of Care" to improve outcomes for children and families in the child welfare system.

I should add that this grant area was an outgrowth of the State Child and Family Services Reviews that we have now completed in all States to assess the performance of their child welfare systems. These reviews indicated that serious deficiencies exist, especially in terms of providing needed prevention services, assuring children's safety, and protecting their well-being. If States are to be successful in addressing these issues and in meeting the complex needs of children and families, they must look not only to the child welfare agency, but to improved connections with mental health, substance abuse, juvenile justice, education and other service systems that are crucial in providing a coordinated response to the problems associated with child abuse and neglect.

Federal Coordination Efforts

Similarly, Federal programs and agencies must work together to share knowledge, pool resources, and otherwise coordinate related programs within the constraints I acknowledged earlier. ACF some years ago created the Federal Interagency Work Group on Child Abuse and Neglect to provide a forum for collaboration among Federal agencies with an interest in child maltreatment. The group shares information, plans and implements joint activities, makes policy and programmatic recommendations, and works toward establishing complementary agendas in the areas of training, research, legislation, information dissemination, and delivery of services as they relate to the prevention, intervention, and treatment of child abuse and neglect.

Led by the Office on Child Abuse and Neglect (OCAN) within ACF's Children's Bureau, the Federal Interagency Work Group on Child Abuse and Neglect is composed of representatives from a number of components within our own Department, such as the Maternal and Child Health Bureau at HRSA, the Substance Abuse and Mental Health Services Administration (SAMHSA), the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH), as well as officials from the Departments of Education, Justice, Defense, Housing and Urban Development, Agriculture, Defense, and others.

In recent years, different Work Group members have formed innovative partnerships to provide funding and support for a broad range of training, technical assistance, evaluation, and research related projects. For example:

  • The Children's Bureau within ACF and the Center for Substance Abuse Treatment at SAMHSA are jointly funding the National Center on Substance Abuse and Child Welfare. Parental substance abuse is a significant factor in many cases of child abuse and neglect and special efforts are needed to help child welfare agencies and substance abuse treatment agencies work together to address parents' addiction problems and children's needs for safety, emotional security and permanency in their lives. To date, the Center has provided thousands of hours of training and technical assistance, developed and disseminated numerous publications and training curricula, and will launch its first national conference on substance abuse, child welfare and the dependency court this July in Baltimore, MD.

  • The Children's Bureau has been one of eight Federal agencies, including several components of HHS and the Department of Justice, working on an initiative to bring the issue of the co-occurrence of child abuse and domestic violence to the forefront. Beginning with the joint development of a publication, Effective Intervention in Domestic Violence & Child Maltreatment Cases: Guidelines for Policy and Practice, popularly known as the "greenbook" and culminating in the current funding of six demonstration grant sites around the country, the Greenbook Project has been an excellent example of the power of collaboration.

  • The Research Subcommittee of the Federal Interagency Work Group on Child Abuse and Neglect was the catalyst for the Child Abuse and Neglect Definitions Project. This project was a response to the research field's concern about the lack of consistent definitions as an obstacle to maximizing the use of research findings.

  • The Children's Bureau through an interagency agreement with the Indian Health Service (IHS) provides funding for training of Tribal social service staff in dealing with cases of child abuse and neglect, especially child sexual abuse.

  • The National Institutes of Health (NIH) convened in 1997 a working group of its major research institutes and offices supporting research on child abuse and neglect to (1) assess the state-of-the-science, (2) make recommendations for a research agenda, and (3) develop plans for future coordination efforts at the agency. The NIH Child Abuse and Neglect Working Group (CANWG) meets monthly to coordinate relevant NIH research efforts and regularly meets with ACF and representatives of other Federal agencies. The CANWG sponsored a number of workshops to stimulate child abuse and neglect research. In addition, NIH components are participating in two program initiatives: "Research on Children Exposed to Violence," which is designed to encourage new knowledge on the incidence, prevalence, nature, and consequences of child exposure to violence, as well as on interventions designed to prevent or ameliorate the short and long-term effects of violence exposure on child development; and, "Research on Child Neglect," which is designed to stimulate research on the related area of child neglect, including physical, educational, and emotional neglect.

  • CDC works with State public health agencies, researchers, and other partners to prevent child maltreatment before it ever occurs by determining who is at risk for child maltreatment and monitoring trends over time at the State level. CDC conducts intramural and extramural public health research to: 1) identify factors that put children at risk and/or protect children from harm and 2) test the effectiveness or efficacy of interventions aimed to prevent child maltreatment. CDC also is building capacity at the State level by funding States to collect data related to child maltreatment, develop strategic plans to prevent child maltreatment, and support three statewide sexual abuse prevention collaboratives to promote the development and implementation of child sexual abuse programs.

These are just a few of the highlights of interagency activities focusing on child abuse and neglect. New requirements in the recent reauthorization of CAPTA place a strong emphasis on interagency collaborations across child protective services, health, mental health, juvenile justice, education, and other public and private agencies. In response to one new requirement, for instance, the Children's Bureau has met with representatives of the Department of Education and intends to provide guidance to the field on the new requirement that CPS refer all children under age three who are victims of abuse or neglect to Part C of the Individuals with Disabilities Education Act (IDEA), a program that funds State efforts to identify, evaluate and provide early intervention services to infants and toddlers with disabilities and their families.

Surgeon General's Workshop on Child Abuse and Neglect

Under the Secretary's focus of One Department and through our close interactions with other Federal agencies involved in child abuse prevention, we have come a long way in our efforts to coordinate, share expertise, and maximize the effectiveness of these programs. Recognizing the importance of coordination, I would like to take this opportunity to highlight a new collaboration effort that ACF and other Federal partners are promoting through the Office of the Surgeon General.

On April 1, 2004, at a press conference commemorating National Child Abuse Prevention Month, I was pleased to join Congressman Tom DeLay and Surgeon General Richard H. Carmona in announcing a new joint initiative to bring a public health perspective to the prevention of child maltreatment. Since that time, officials from several agencies within HHS, as well as the Departments of Education and Justice have been meeting regularly to further this effort. On June 16th the Surgeon General will host the first Federal Workshop on Prevention of Child Maltreatment - A National Priority. As part of this activity, I will join Surgeon General Carmona and other Administration officials from other key Federal Departments to engage in a focused examination of how to improve Federal program effectiveness and efficiency in this arena.

This Workshop will bring together Federal partners to explore strategies and opportunities for preventing maltreatment. A second Workshop will forge key partnerships between researchers, health care practitioners, advocates, faith-based organizations and families and victims, with the purpose of preventing the immediate and long-term consequences of child maltreatment. Our goal is to achieve effective integration of age-appropriate health, social and mental health services at the community or regional level. We seek to build on assets and strengthen collaborations between community and faith-based programs and government programs that identify, assess, treat and provide long-term treatment and prevention services for children and families. We are hopeful that these efforts will provide insights into how we can build on current successes and expand the field to a new dimension that includes a public health approach to preventing child maltreatment.

Increasing Funding for Child Abuse and Neglect Prevention and Treatment

As I mentioned earlier, in addition to these ongoing efforts, key legislative changes are needed to strengthen our ability to protect children and help them to grow up in safe, stable homes. The President's budget for FY 2005 includes a number of important provisions to provide both increased funding targeted to child abuse and neglect and greater flexibility in the use of Federal foster care dollars.

First, the President has proposed increasing funding for the Promoting Safe and Stable Families program by $1 billion over five years. Although Congress has only appropriated half that increase thus far, the Administration stands firm in its commitment to seek full funding for this vital program. These funds would provide community-based services to support families and prevent abuse, preserve families in crisis, help to safely reunify children with their families when they have had to be removed from the home, and promote and support adoption of children placed in foster care who cannot return to their own families.

The President's FY 2005 budget also seeks to nearly double the funding level for the CAPTA State grant program and the Community-Based Child Abuse Prevention program which I described earlier in my testimony. These increased funds requested for the CAPTA State grants would enable State child protective service systems to expand post-investigative service for child victims, shorten the time to the delivery of post-investigative services and increase services to other at-risk families. Likewise, increased funding for the Community-Based Child Abuse Prevention program would boost the availability of prevention services to approximately 55,000 more families. We urge the Congress to support these vital investments in our Nation's families as you proceed with work on the FY 2005 budget.

While increased funding is needed, President Bush realizes effective child welfare is not just about more money. It also is about greater flexibility. Therefore, the Administration proposed a legislative change which would offer States the option to receive foster care funding under title IV-E of the Social Security Act as a capped, flexible source of funds. Under the plan, States and Tribes would have the option of using funds now designated solely for foster care to support a range of abuse-prevention services and programs. The proposal provides the flexibility and sustained financial support necessary to build innovative programs for children and families aimed at preventing maltreatment and removal from home. We urge the Congress to make this legislation a reality and give States the flexibility needed to design more effective programs.

Conclusion

We know that we must continue to be aggressive in finding ways to prevent child abuse in this country. This is a challenge that no one entity, organization or unit of government can handle alone. The President has put forth a bold vision for strengthening child welfare but it will take all of us working together to address this issue, and bring new hope to the thousands of children who suffer abuse or neglect. We look forward to working with the Committee and other Members of Congress on solutions in addressing this national problem.

I would be pleased to answer any questions at this time.

Last Revised: May 24, 2004