Capstone Final Paper

Running Head: CAPTA AND INTERVENTION PROGRAMS
How does the federal child abuse legislation, CAPTA, affect the
formation of effective intervention programs in Pennsylvania and
Illinois?
Samantha Petersen
Master of Public Health Degree Candidate
Community & Global Public Health
College of Health Sciences
Faculty Mentor: Laura Lessard, PhD, MPH
A Public Health Capstone Project presented to the faculty of Arcadia University, Community
and Global Public Health, College of Health Sciences in partial fulfillment of the requirements
for the Master of Public Health degree.

CAPTA AND INTERVENTION PROGRAMS

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TABLE OF CONTENTS
Abstract………………………………………………………………………………………...…iv
List of Tables and Figures………………………………………………………………….……...v
Introduction…………………………………………………………………………….……….....1
Theoretical Foundations……………………………………………………………………......…6
Organizational Change (Community Organization) Theory……………………………...6
Previous Research Utilizing Community Organization Theory…..…………………....…8
Application of the Theory to the Current Study…………………………………………10
Literature Review……………………………………………….……………………...………...12
Definitions of Child Abuse……………………………………….…………………...…12
Risk Factors Associated with Child Abuse………………………..…………...………...14
Protective Factors of Child Abuse…………………………………………..…………...18
Consequences of Child Abuse………………………………………………..………….19
Child Abuse Prevention – The Public Health Approach……………………..……….…20
CAPTA: The Law at the Federal Level………………………………………..………..23
CAPTA: The Law as it Affects States…………………………………………..………26
Methods……………………………………………………………………………………...…...34
Study Design…………………………………………………………………………......34
Sample……………………………………………………………………………………34
Data Collection…………………………………………………………………..............34
Results……………………………………….…………………………………………………...35
Structure in Pennsylvania………………………………………………………………..35
Structure in Illinois………………………………………………………………………39


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Budget in Pennsylvania……………………………………………………………...…..45
Budget in Illinois………………………………………………………………...………46
Reports Submitted by Pennsylvania……………………………………………………..47
Reports Submitted by Illinois……………………………………………………………52
Discussion…………………………………………………………………………………….….65
Recommendations…………………………………………………………………………….….68
References……………………………………………………………………………………..…69


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ABSTRACT
Background: Child abuse is an international health problem that can result in many physical,
psychological, and financial consequences. Although child abuse is a worldwide issue, it is
increasing in the United States. In an effort to combat this issue, the United States government
adopted the Child Abuse Prevention and Treatment Act [CAPTA], a law that provides States
support to prevent, study, identify, and treat child abuse. Since CAPTA heavily impacts
formation of successful child abuse intervention programs, it is important that these programs be
assessed for efficacy in states with similar child populations and CAPTA funding, such as
Pennsylvania and Illinois.
Purpose: To explore the differences between child abuse intervention programs in Pennsylvania
and Illinois, how those differences are affected by the federal legislation, CAPTA, and what
changes should be made to CAPTA to increase its effectiveness.
Methods: A comprehensive policy analysis of CAPTA was completed, in which CAPTA was
the subject of a search engine exploration. Aspects of the law were then reviewed and
summarized. Federal and state government and child welfare websites for both Pennsylvania
and Illinois were also perused for documents related to CAPTA implementation specific to each
state. Based on documents reviewed, three topics were selected for comparison between the two
states: structure of child welfare organizations responsible for implementing CAPTA, reports
submitted by both States outlining activities that were completed to fulfill CAPTA regulations,
and a budget from each State’s child welfare organization that provides a breakdown funding
streams.
Results: The Bureau of Child Welfare Services is responsible for monitoring the delivery of
services to children and families in Pennsylvania, while the Department of Children and Family
Services performs similar duties in Illinois. Both States possess three active citizen review
panels, as stipulated by CAPTA, with Pennsylvania’s made up of volunteers found outside the
realm of child welfare services, and Illinois’ comprised of individuals who are already members
of child protection advisory groups. Reports outlining activities completed by both States
revealed that Pennsylvania strives to improve three core elements in their child welfare practice
model, while Illinois’ improvement plan focuses on five strategies that cut across three domains.
Budgets for both Pennsylvania and Illinois revealed near identical child and family service
expenditures.
Conclusion: Although both States fulfill base CAPTA requirements, they have implemented the
law very differently. Pennsylvania has a complex, subdivided child welfare agency with citizen
review panels that give the “citizen’s” perspective, while Illinois possesses a less intricate child
welfare entity with panels made up of experts. Although spending for child welfare
programming is the same in both States, Pennsylvania’s approach to program improvement
focuses on less key elements than does Illinois’. Based on these findings, a proposed change to
child welfare laws includes forming a multifaceted, multidisciplinary lead agency that works
collaboratively with other organizations to share ideas, forms goals, and aims to make few, yet
long-lasting, systemic improvements at a time. With these changes, child abuse incidence in
both States could diminish.


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TABLES AND FIGURES
Table 1. Pennsylvania Office of Children, Youth and Families Regional Offices
Table 2. Illinois Department of Children and Family Services Divisions and Offices
Table 3. Illinois Department of Children and Family Services Advisory Groups
Table 4. Budget for the Pennsylvania Department of Public Welfare, Fiscal Year 2014-2015 ($
Amounts in Thousands)
Table 5. Budget for the Illinois Department of Children & Family Services, Fiscal Year 2015 ($
Amounts in Thousands)
Table 6. Pennsylvania’s Child Welfare Practice Model – Primary Elements
Table 7. Illinois DCFS Programs and Services Offered in Relation to Safety, Permanency, and
Well-being
Figure 1. Structure of Pennsylvania’s Department of Public Welfare
Figure 2. Structure of Illinois’ Department of Children and Family Services
Figure 3. Pennsylvania’s Child Welfare Practice Model
Figure 4. Illinois’ Program Improvement Plan (PIP)


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Introduction
Child maltreatment, or abuse and neglect occurring to children under 18 years of age, is
an international health problem that can result in long-term, large-scale consequences (World
Health Organization, 2010). It comprises any act of omission or commission by a caregiver that
results in threat of harm, potential harm, or harm to a child, including physical abuse, emotional
abuse, sexual abuse, and intimate partner violence (acts of commission) (CDC, 2010b). Child
maltreatment that constitutes acts of omission are neglect, including physical, medical/dental,
emotional, or educational neglect, and failure to supervise (CDC, 2010b; WHO, 2010). Because
child maltreatment definitions, the type of maltreatment studied, and the quality and quantity of
maltreatment statistics and self-report surveys vary country-to-country, statistics are difficult to
obtain (WHO, 2010).
Despite this issue, a few studies have shown that 25 to 50 percent of children worldwide
report experiencing physical abuse, with 20 percent of women and five to ten percent of men
reporting being sexually abused (WHO, 2010). In addition, there are approximately 31,000
homicide deaths of children under fifteen years old, a number that underestimates the true scope
of the problem, as deaths caused by child maltreatment could be attributed to drowning, falls,
burns, and other sources (WHO, 2010). In regions experiencing armed conflict and in refugee
settings, females are extremely vulnerable to maltreatment, including sexual violence, abuse and
exploitation by armed forces and community workers (WHO, 2010).
In the United States, violence against children is increasing, from 763,000 confirmed
cases in 2009 (CDC, 2012) to approximately 868,000 in 2010 (USDHHS, 2011). There are over
three million child abuse referrals each year involving more than six million children, resulting
in six reports every minute (CDC, 2012; USDHHS, 2011). Of those cases, more than 75% were


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due to neglect, with physical and sexual abuse (17.6% and 9.1%, respectively) following close
behind (USDHHS, 2011).
Two states within the U.S., Pennsylvania and Illinois, have almost identical total
populations (12,763,536 and 12,875,255, respectively) and child populations (2,739,386 and
3,064,065, respectively), and would therefore make ideal comparison populations regarding the
topic of child maltreatment (U.S. Census Bureau, 2012). Within the state of Pennsylvania,
26,664 cases of suspected child abuse were reported in 2012, an increase of 2,286 reports from
the previous year, with 13.4 percent of these reports substantiated (substantiated reports are child
maltreatment allegations in which a child protection worker has deemed abuse has occurred)
(Pennsylvania Department of Public Welfare, 2012; American Humane Association, 2013). In
comparison, Illinois reported 106,236 child abuse cases, indicating an increase of 4.7 percent
from 2011 (Illinois Department of Children and Family Services, 2013). Indicated cases of child
abuse, or cases in which child abuse was substantiated by local staff based on medical evidence,
perpetrator admission, or investigation, in the state of Illinois also rose, from 27,951 to 28,787
(PDPW, 2012; IDCFS, 2013).
Victim demography is another notable topic to compare between these states. In
Pennsylvania, 7,088 children were removed from the environment in which they were abused, 67
percent of all substantiated reports involved girls versus 33 percent boys, and the living
arrangement resulting in the highest number of substantiated child abuse cases involved single-
parent families (PDPW, 2012). On the other hand, Illinois saw the number of indicated abuse
cases involving girls in 50 percent of those cases, over boys at 49.1 percent (IDCFS, 2013).
Child maltreatment produces both short-term consequences for the victim, and numerous
long-term physical, emotional, and financial penalties. Physical issues occurring to the victims


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include injuries, disabilities, changes in the structure and function of the brain, heart and
immunity problems resultant from stress, and a greater risk of developing obesity and even
cancer (CDC, 2010; WHO, 2011). Psychological problems are also major consequences of child
abuse. Child maltreatment has been shown to increase the exhibition of risky behavior in its
victims, including smoking, accidental pregnancies, and drug and alcohol abuse (WHO, 2011).
Depression, developmental delays, antisocial behaviors, and physical aggression have also been
linked to child abuse (CDC, 2010; PPN, 2010; Zolotor, Theodore, Runyan, Chang & Laskey,
2011). The financial burden of child abuse is also astounding, with the United States spending
approximately $124 billion dollars every year on hospitalizations, psychological therapy,
juvenile delinquent and prison systems, and special education for victims (PPN, 2010).
In an effort to combat this issue, the United States Federal government adopted the Child
Abuse Prevention & Treatment Act [CAPTA] in 1974, the only federal law at the time aimed at
preventing, studying, identifying, and treating child maltreatment (Child Welfare League of
America, n.d.). CAPTA, which was reauthorized in December 2010, provides support to states
in their child abuse prevention and treatment practices through three main programs: State
Grants to Improve Child Protective Services, the Research, Demonstration, and Technical
Assistance program, and Community-based Grants for the Prevention of Child Abuse or Neglect
(CWLA, n.d.).
The first, entitled State Grants to Improve Child Protective Services (Section 106),
provides funding to states to cultivate novel ways to improving their Child Protective Services
[CPS] systems (CWLA, n.d.). States must meet eligibility requirements in order to qualify for
federal funding, including having mandatory reporting laws, maintaining victim confidentiality,
and appointing citizen review panels (CWLA, n.d.). In Fiscal Year [FY] 2011, the U.S.


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government gave $26 million in basic state grants to all 50 states, in addition to the District of
Columbia and Puerto Rico (CWLA, n.d.; USDHHS, 2013).
The second program outlined in CAPTA funds state plans to enhance child abuse and
neglect prevention and treatment (CWLA, n.d.). The Research, Demonstration, and Technical
Assistance (Sections 101-105) program provides discretionary funds to improve research,
training, program development, technical assistance, data collection, and data distribution, to
support the prevention and management of child maltreatment (CWLA, n.d.). This program also
provides funding to a few national initiatives, two of which include the National Child Abuse
and Neglect Data System and the National Office of Child Abuse and Neglect (CWLA, n.d.)
The National Child Abuse and Neglect Data System [NCANDS] collects voluntary data about
child abuse and neglect reports from the District of Columbia, Puerto Rico, and all fifty states
(USDHHS, n.d.). This data is used to examine trends in child maltreatment (USDHHS, n.d.).
The Office of Child Abuse and Neglect was created in 1996 to lead and coordinate the Federal
Interagency Workgroup on Child Abuse and Neglect whose main goals include providing a place
for relevant federal employees to communicate about child maltreatment programs and provide a
basis for mutual action so that resources can be maximized (USDHHS, 2012). For FY 2011, $26
million was earmarked for states to utilize (CWLA, n.d.).
Community-based Grants for the Prevention of Child Abuse or Neglect (CBCAP, Title
III), established in 1996, supports states’ efforts to coordinate the resources of public and private
organizations, as well as the development, everyday operation, and advancement of community-
based prevention programs (CWLA, n.d.). This funding is authorized to states based on the size
of the child population, and in FY 2011, $80 million in CBCAP grants were allocated (CWLA,
n.d.).


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Another notable funding program, called Children’s Justice Act Grants (Section 107),
provides money to states to advance investigation, prosecution, and management of child abuse
cases (CWLA, n.d.). Priority funds are given to programs that focus on sexual abuse,
exploitation, fatalities from abuse, and maltreatment of disabled children (CWLA, n.d.). Justice
Act grants may provide up to $20 million to states, as set aside from the Crime Victims Fund, an
account made up of fines from federal offenses (CWLA, n.d.).
Due to the large amount of federal funding funneled toward states to develop child abuse
and neglect prevention and treatment programs, several states have created long-term plans for
implementing the CAPTA legislation. The Commonwealth of Pennsylvania has developed a Five
Year Child and Family Services Plan [CFSP] for FFY 2010-2014 that focuses on developing and
expanding the Pennsylvania Practice Model, in which children and their families, child welfare
representatives, and other child and family services partners work together to model the values
of, and skills to be utilized by, the child welfare system to improve outcomes of children and
their families (Commonwealth of PA Department of Public Welfare, 2009; University of
Pittsburgh School of Social Work, 2012). This plan aims to shift practice from compliance-
based to quality improvement through the measurement of outcome-based indicators, with the
main goals and objectives to safely reduce out-of-home placements, increase the safety of
children and communities, reduce re-entry of out-of home placements, and enhance permanence
and timeliness to permanence (Commonwealth of PA DPW, 2009).
In Illinois, the Department of Children and Family Services [DCFS] is responsible for
carrying out CAPTA (Illinois Department of Children and Family Services, 2011). Under this
agency, the Department of Child Protection implements many of the child abuse prevention and
treatment programs and grants, which include Citizen Review Panels (Illinois DCFS, 2011).


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The main goals of this department are to offer protective services to prevent further harm to
children and any siblings, stabilize the home environment, protect the best interest of the child,
and maintain a healthy family life (Illinois DCFS, 2007).
Because of the extent of the child maltreatment issue, it is important for intervention
programs to be developed and implemented successfully. Since CAPTA heavily impacts
formation of successful child abuse intervention programs in states, it is of utmost importance
that these programs be assessed for efficacy in states with similar child populations and CAPTA
funding. Pennsylvania and Illinois fit this model. Therefore, the purpose of this project is to
explore the differences between child abuse intervention programs in Pennsylvania and Illinois,
and how those differences are affected by the federal legislation, CAPTA (The Child Abuse
Prevention and Treatment Act). Research questions related to this project are:
1. How has CAPTA been implemented differently in Pennsylvania and Illinois?
2. Given these two states’ experiences, what changes, if any, should be applied to existing laws
related to child abuse intervention that could lead to decreased child abuse incidence?
Theoretical Foundation: Organizational Change (Community Organization) Theory
The organizational change theory is rooted in American history, beginning in the late
1800s when social workers devised the term community organization to explain their
coordination of services for the poor and immigrants (Glanz, Rimer & Viswanath, 2008). Early
practice emphasized collaboration and cooperation to help communities improve their problem-
solving ability, but by the 1950s, the concept had evolved to highlight conflict and confrontation
approaches to bring about social change (Glanz et al., 2008). To date, the practice of community
organization has been utilized in civil rights, gay rights, women’s rights, and disability rights
movements, as well as throughout the AIDS crisis (Glanz et al., 2008).


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Key constructs in the community organization theory include: empowerment, critical
consciousness, community capacity, issue selection, and participation and relevance (Glanz et
al., 2008). Empowerment, or community empowerment, is the social action process stressing the
removal of barriers to change and transformation of the social and political environments of
individuals, communities, and governmental institutions to improve justness and quality of life
(Glanz et al., 2008). On the individual level, empowerment involves people’s perceived control
over their lives, awareness of their place in society, and their political effectiveness and
participation in change (Glanz et al., 2008). “Powerlessness” is a common feeling among
individuals who have experienced lack of empowerment due to poverty, chronic stressors, and
lack of control and assets required to improve their health (Glanz et al., 2008). Empowerment at
the organizational and community levels includes both processes they complete and goals they
have reached to influence change (Glanz et al., 2008). Two examples include an increased sense
of community and an effective gain in resources that results in decreased health inequalities for
community members (Glanz et al., 2008).
Community capacity, another construct in the community organization theory, is defined
as a community’s qualities that affect its ability to identify and address public health and social
issues (Glanz et al., 2008). This involves multiple aspects, including leadership, support
networks, reflection, sense of community, active participation, access to power, expression of
values, and skills and assets (Glanz et al., 2008). In recent years, community capacity has also
comprised the ideas of community competence and social capital, the latter of which involves the
social relationships between community members that encourage cooperation between the
groups for mutual benefit (Glanz et al., 2008). Trust, civic engagement and reciprocity are all
examples of social capital (Glanz et al., 2008).


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Community building has also gained importance in the health behavior change field,
placing emphasis on community resources, a common identity, and the use of task-oriented
organization (Glanz et al., 2008). The National Black Women’s Health Project uses this concept
by focusing on empowerment, social change awareness, and strength-based community building
to increase the health statuses of black women (Glanz et al., 2008).
Issue selection is the last major concept in the community organization theory, and
involves the identification and differentiation of issues the community feels need to change
(Glanz et al., 2008). Good issues should be winnable and explicit, unify the community,
encourage community involvement for resolving the issue, affect an abundance of people, and be
a part of a larger strategy for health behavior or social change (Glanz et al., 2008). Participation
of community members in the change process, and relevance of the selected issue also heavily
impact this construct (Glanz et al., 2008).
Previous Research Utilizing the Community Organization Theory
Although few child abuse studies have utilized this theory, research involving partner
abuse, social work, and family violence have successfully applied its constructs (Chan, Lam, &
Cheng, 2009; Wills, Ritchie, & Wilson, 2008; Whiteside, Tsey, & Cadet-James, 2011).
Empowerment is one of the more commonly applied constructs in this theory, useful to many
researchers designing anti-abuse interventions targeting behavior change in health care providers
(Chan et al., 2009; Wills et al., 2008; Whiteside et al., 2011). A study aiming to improve the
detection and quality of assessment of child and partner abuse utilized the concept of
empowerment to address the issue in a multifaceted way (Wills et al., 2008). Researchers drew
upon existing models related to abuse to address barriers to health behavior change, including
clinicians’ feelings of powerlessness over the victims’ outcomes, allowing providers to improve


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detection and assessment of abuse, and sustain it over time – a hallmark of community
empowerment (Wills et al., 2008). Similarly, social workers used the empowerment framework
to improve the health of children and their mothers in a group of Indigenous Australians
(Whiteside et al., 2011). By encouraging patient empowerment, providers were better able to
place values at the top of any patient engagement, thereby simplifying their duties, and elevating
the health statuses of their patients (Whiteside et al., 2011).
Because there is a strong relationship between family violence (family violence includes
numerous types of abuse among family members, including child abuse, spousal abuse, and elder
abuse) and community, the constructs of community capacity and community building have been
growing in popularity among public health researchers (Chan et al. 2009). In the study with the
goal to increase detection and adequate assessment of child and partner abuse cases, community
capacity was positively influenced (Wills et al., 2008). Before the intervention, changing clinical
practices was difficult for many clinicians due to the various needs and expectations of the
professions and the services each provided (Wills et al., 2008). By tailoring training and practice
strategies to each unique group, including modeling of the behavior change by each group’s own
people and internal championing of the behavior change by clinical supervisors, high rates of
routine questioning, and therefore, increased detection and assessments of abuse were made
(Wills et al., 2008). In another study, researchers constructed a framework around this construct
to promote family violence prevention in an at-risk Hong Kong city (Chan et al., 2009).
Researchers argued that, by developing collective community efficacy through the building of
collaborative partnerships between the government and NGOs, and local people and grassroots
organizations, community capacity would be strengthened and family violence prevention would
be increased (Chan et al., 2009).


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Community building is another widely used construct in abuse research (Chan et al.,
2009; Wills et al., 2008). Researchers in the study aimed at increasing quality of assessment and
detection of partner abuse and child abuse also utilized community building to reach their goal
(Wills et al. 2008). Providing adequate resources to behavior change, as well as encouraging the
collaboration between several community agencies to carry out the intervention and make the
behavior change, were performed by researchers at the outset, eventually leading to
improvements in assessment quality and detection of these two types of abuse (Wills et al.,
2008). Similarly, researchers in Hong Kong have proposed a community-wide framework, in
which government organizations, grassroots agencies, and community members alike, work to
utilize current and increase community resources to combat family violence (Chan et al., 2009).
Previous research has revealed that many abuse cases involve both child physical abuse
and partner abuse (abuse in which one member of a relationship is abused by the other) (Chan et
al., 2009; Wills et al., 2008).
Issue selection, although not emphasized as much as the previous three constructs, holds
a significant place in abuse research (Chan et al., 2009; Wills et al, 2008). As part of the
proposed framework for increasing family violence prevention in Hong Kong, researchers noted
that, before any positive changes can be made, the community needs to identify family violence
as an issue worthy of their efforts to change (Chan et al., 2009). Researchers also implemented
an intervention aimed at improving the detection and assessment quality of both partner and
child abuse types in Hawke’s Bay, New Zealand, after the tragic death of a child sparked
community interest in services available for children (Wills et al., 2008).
Application of the Theory to the Current Study


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Altogether, the main constructs of the community organization theory can be applied to
this project in several ways. In terms of empowerment, barriers to the adoption of child abuse
intervention programs should be identified and removed (such as poverty, stress, and lack of
control). Cultural strengths and assets that will allow for the adoption of intervention programs
should also be emphasized, and community members should be aware of their social context and
the community social structure itself, and how these will affect their ability to adopt the
intervention program and ultimately, the health behavior change. Political efficacy is important
for community members to consider, as the power to make child abuse policy changes or
prevention program design changes will make the programs more effective. On the
organizational level, organizations need to assess how they are working to gain new resources,
provide adequate resources, and remove barriers to communities so they can successfully
implement prevention programs. How they are promoting child abuse awareness and prevention
should also be considered. At the community level, community members should be engaged in
the design and implementation of prevention programs, and given the tools to successfully adopt
the health behavior change.
Community capacity should require the engagement of community members in the
identification of the problems leading to increased child abuse incidence and the adoption of
prevention programs that will give them tools and knowledge to be able to solve this issue for
themselves in the future. Communities should also encourage community leaders to become
involved in prevention, and agree on child abuse prevention goals, and the ways they can achieve
these goals. There should also be collaboration between community members, governmental
organizations trying to implement programs, as well as political representatives who can
implement policy changes to increase the chances of successful program implementation. Last,


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existing social networks of community members should be utilized and improved upon so social
and financial support for the prevention program is raised.
The last construct, issue selection, can involve conducting interviews and focus groups to
identify issues with community participation in existing prevention programs, as well as future
problems in the implementation of programs, and why child abuse is an important issue to
address. Communities need to decide which processes need the most change and address them
first (as part of a larger picture to change), and they should be aware that it takes equal
participation of all members, who have important needs, power, and resources, to help in the
effective implementation of prevention programs.
Literature Review
Definitions of Child Abuse
Consistent child abuse and neglect definitions, as well as data sources, are critical for
calculating child victimization rates (Leeb, Paulozzi, Melanson, Simon, & Arias, 2008). Despite
their importance, there remains a lack of uniform definitions that negatively impact public health
efforts to combat this issue (Leeb et al., 2008; Tang, 2008; The Protect Our Children Committee,
n.d.). Many organizations who address the problem of child maltreatment, including Child
Protective Services [CPS], researchers, physicians and other health practitioners, child advocates,
legal and medical populations, and public health workers, utilize their own definitions, which
hampers communication efforts between these different sectors, and therefore limits their ability
to effectively identify, track, treat, and prevent child abuse (Leeb et al., 2008; Tang, 2008; The
Protect Our Children Committee, n.d.).
The Illinois Department of Children & Family Services, an organization dedicated to
combatting child maltreatment, defines child abuse as “the mistreatment of a child under the age


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of 18 by a parent or their romantic partner, an immediate relative or someone living in their
home, a caretaker such as a babysitter or daycare worker, or any person responsible for the
child’s welfare, such as a healthcare provider, educator, coach or youth program volunteer that
results in injury or puts the child at serious risk of injury” (IDCFS, 2009). The Protect Our
Children Committee, an organization in Pennsylvania that promotes community responsibility to
protect children from abuse, further delineates child abuse to include “any recent act or failure to
act by a perpetrator to a child under 18 years of age that causes non-accidental serious physical
injury, or non-accidental serious mental injury, sexual abuse, or sexual exploitation, and serious
neglect (The Protect Our Children Committee, n.d.). Yet another definition, from the United
States National Library of Medicine, states “child abuse is doing something or failing to do
something that results in harm to a child or puts a child at risk of harm” (U.S. National Library of
Medicine, 2013). The Library goes on to define physical child abuse apart from neglect and
child psychological abuse, child sexual abuse, and shaken baby syndrome, further differentiating
the topic of child maltreatment (U.S. NLM, 2013).
Although these are only three examples of varying child abuse definitions, even slight
discrepancies between classifications can disrupt anti-child abuse efforts by differing
organizations (Leeb et al., 2008; Tang, 2008; The Protect Our Children Committee, n.d.). There
are already gaps in current investigative practices, including injury evaluation and cases
involving multiple perpetrators, and, when combined with victimization rates calculated from a
single data source, lead to inaccurate statistics, issues with child abuse identification and
assessment, and therefore, problems treating and preventing this problem (Leeb et al., 2008; The
Protect Our Children Committee, n.d.). This is especially evident regarding calculations of child
fatalities as a result of maltreatment (Leeb et al., 2008; Tang, 2008). For example, the NCANDS


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Child Maltreatment 2004 report documented that 2.0 per 100,000 children ages zero to 17 years
of age had died as a result of abuse, whereas 2002 death certificate data showed that only 0.28
children per 100,000 ages zero to 17 years old had been abused to the point of death (Leeb et al.,
2008).
These varying definitions and limited data sources cause the public health work force to
struggle to respond to the issue of child abuse effectively (Leeb et al., 2008). They not only limit
public health officials’ ability to rank the problem of child abuse in comparison to other public
health issues, but hinders their ability to identify and treat the people most at risk for perpetrating
child abuse (Leeb et al., 2008). Monitoring changes in child abuse incidence and prevalence is
also a large issue regarding inconsistent definitions and data sets, resulting in difficulty assessing
and improving existing child abuse intervention and prevention programs (Leeb et al., 2008).
Risk Factors Associated with Child Abuse
Individual risk factors for victimization. Individual risk factors for victimization
include children being younger than four years of age or an adolescent, children being female,
low socioeconomic status, special needs that increase the workload of caregivers, such as mental
retardation, chronic physical illnesses, or disabilities, falling short of fulfilling expectations of
parents, persistent crying, and having unique physical features (CDC, 2013; Jud, Lips, &
Landolt, 2010; WHO, 2010).
Research has revealed that young children are at an increased risk experiencing neglect,
and that females are more likely to be victims of sexual abuse compared to males, with all other
types of abuse being evenly distributed over the genders (Jud et al., 2010). Children with lower
socioeconomic statuses are also at a greater risk of being physically maltreated, over those who
were victims of sexual abuse (Jud et al., 2010).


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Disabled children are also at an increased risk for being abused, compared to their non-
disabled peers, and many experience multiple forms of abuse (Stalker & McArthur, 2010;
Svensson, Bornehag, & Janson, 2010). Specifically, children with difficulties communicating
and those that have behavioral disorders are at a greater risk for experiencing abuse, and those
with learning disabilities and concentration issues experience physical abuse more often (Stalker
& McArthur, 2010). Age is also a factor for child abuse among disabled children. Younger
children with health or orthopedic impairments, communication issues, learning disabilities, and
behavioral disorders are more likely to be abused over their older counterparts, as well as male
children with special needs over their female counterparts with special needs (Stalker &
McArthur, 2010; Svensson, Bornehag, & Janson, 2010).
Individual risk factors for perpetration. Risk factors for perpetration are numerous,
and involve individuals, families, and communities (CDC, 2013; WHO, 2010). Individual risk
factors for perpetration are: parent history of child abuse in their family of origin (child abuse
occurred in the home when they were growing up), non-biological and temporary caregivers
occupying the home (such as a mother’s boyfriend), history of substance abuse or mental health
problems in the family, parental lack of understanding of needs of children or parenting skills,
including difficulty bonding with a newborn and trouble nurturing the child, parental emotions or
thoughts that vindicate maltreatment, parental qualities like young age, single parenthood,
multiple dependent children, low income and education, having unrealistic expectations of child
development, and being involved in criminal activity (CDC, 2013; WHO, 2010).
Some researchers have found that parents with mental disorders, such as mixed anxiety
and depressive disorder and posttraumatic stress disorder, report more experiences of child abuse
and more contact with parental conflict than parents without mental disease (Jakupčević &


16
Ajduković, 2011). This risk factor relates to the risk factor of parents with adverse mental health
outcomes – both contribute to child abuse perpetration. Similarly, research has revealed that
children living with unrelated adults have six times the risk of dying from abuse-related
unintentional injuries, with children living with step or foster parents, or other related adults, also
having an increased risk of dying from abuse (Schnitzer & Ewigman, 2008).
Much research has been conducted in regards to the involvement of drugs and alcohol in
a family, and its connection to the perpetration of child abuse and neglect. In a 2012 study aimed
at examining care-giver alcohol abuse and its association with recurrent child maltreatment
cases, researchers found that children were significantly more likely to experience multiple
incidences of abuse when a caregiver abused alcohol over children whose caregivers did not
abuse alcohol (Laslett, Room, Dietze, & Ferris, 2012). This result also appeared in children
whose families displayed other risk factors for recurrent child abuse, including characteristics of
decreased socioeconomic status (Laslett et al., 2012). Childcare providers who abused drugs
experienced the same increased risk of recurrent child abuse perpetration in comparison with
those who abused only alcohol (Laslett et al., 2012). Similarly, parental substance or alcohol
abuse was found to be a risk factor in families reported to child protective services regarding
child sexual abuse (Martin, Najman, Williams, Bor, Gorton, & Alati, 2011). Overall, both drug
and alcohol abuse by a caregiver, as well as certain familial risk factors, all contribute to an
increased risk of recurrent child abuse (Laslett et al., 2012).
Other parental mental health problems, such as depression, schizophrenia, mania, and
antisocial behaviors, also lead to an increased risk of both child sexual abuse perpetration, and
child emotional maltreatment and neglect (Kohl, Kagotho, & Dixon, 2011; Martin et al., 2011).


17
Parents with mixed anxiety and depressive disorder, and fathers with posttraumatic stress
disorders were also more likely to commit acts of child abuse (Jakupčević & Ajduković, 2011).
Parental qualities, such as lack of understanding about child rearing and unrealistic
expectations, emotions that vindicate child maltreatment, and even smoking, are associated with
child abuse perpetration (CDC, 2013; Jakupčević & Ajduković, 2011; Martin et al., 2011; WHO,
2010). Lower maternal education and the mother’s unmarried status are very strongly associated
with child sexual abuse perpetration (Martin et al., 2011).
Familial risk factors for perpetration. Familial risk factors of perpetration of child
abuse and neglect include social isolation, family disorganization, disbanding, and violence,
including domestic violence, high parenting stress in combination with poor parent-child
interactions and adverse relationships, lack of support for raising children from the extended
family, and physical, mental, or developmental health problems of a family member (CDC,
2013; Jakupčević & Ajduković, 2011; WHO, 2010).
Feelings of social isolation and lack of familial support for raising children are two big
familiar risk factors for child abuse perpetration (CDC, 2013; WHO, 2010). Compared with
parents in the general population, parents with mental disorders report lower perceived social
support, as well as low social support for child rearing, from both family members and friends
(Jakupčević & Ajduković, 2011).
Additionally, parents with mixed anxiety depressive disorder and posttraumatic stress
disorder reported poorer relationships with partners, more frequent conflicts with partners,
insults, and physical violence from partners, compared to parents without mental disease
(Jakupčević & Ajduković, 2011). These results show that family disorganization and violence
are risk factors for child maltreatment.


18
Community risk factors for perpetration. Last, there are various risk characteristics
pertaining to perpetration of child abuse and neglect on a community level. These include: high
community violence, inadequate social connections and concentrated neighborhood
disadvantage, such as poverty and high unemployment rates, social inequality and the existence
of legal policies that lead to this, including gender inequality, lack of sufficient housing and other
services to support families, high accessibility to alcohol and drugs, including an increased
concentration of alcohol retailers, lack of legislation and programs that prevent child
maltreatment and other forms of child labor, including child pornography and prostitution, and
cultural norms that emphasize the use of corporal punishment, violence toward other people, or
decrease the status of the child within familial relationships (CDC, 2013; WHO, 2010).
Neighborhoods with many residents of low socioeconomic background contribute to the
perpetration of many types of child abuse, especially sexual abuse (Martin et al., 2011).
Increased criminal activity and antisocial behaviors are common in these types of
neighborhoods, and contribute child sexual abuse (Martin et al., 2011). Low socioeconomic
status may also lead to poor parent-child interactions, increasing the child’s exposure to sexual
abuse (Martin et al., 2011).
Protective factors of child abuse
Protective factors are characteristics that safeguard children from experiencing abuse and
neglect, and, although not studied as extensively as risk factors, are still important for predicting
child abuse victimization and perpetration (CDC, 2013). There are only a few researched and
proven protective factors for child abuse, with the main one being supportive family networks
and social environments (CDC 2013). Additionally, these six factors have been identified as
predictors of child welfare success: two primary caregivers, an older primary caregiver (older


19
than 26 years of age), low or moderate risk of neglect in the future, low or moderate risk of
future abuse, no substance abuse within the family, and no poverty (Orsi, Winokur, Crawford,
Mace, & Batchelder, 2012). Despite there being only a few protective factors, further research is
being made into these promising protective qualities, beginning at the familial level: access to
quality health care and social services, sufficient housing, household rules and child supervising,
nurturing parenting skills, employment of the parents, secure family relationships, and supportive
adults outside of the family who can act as role models (CDC, 2013). An additional possible
child abuse protective factor lies at the community level, and involves communities that support
families and promote child abuse prevention (CDC, 2013).
Consequences of Child Abuse
Child abuse and neglect have several long-term consequences that can affect the health of
children well into adulthood, and costs the United States billions of dollars annually (CDC,
2013). Physical health effects, psychological consequences, behavioral health effects, and
consequences to society are results from this issue, and are important to understand when
designing prevention programs and anti-child abuse legislation (CDC, 2013; Covington, 2013).
Several studies have also found links between child physical abuse, emotional abuse, and
neglect, and mental and physical health issues. Adult physical health issues resultant from child
abuse include: sexually transmitted infections, increased risk of developing eating disorders,
such as bulimia, and other health conditions, including asthma, allergies, circulation and heart
problems, high blood pressure, arthritis, ulcers, and liver problems, chronic pain, smoking, and
physical inactivity, diabetes, lung disease, malnutrition, and vision problems (Norman, Byambaa,
De, Butchart, Scott, & Vos, 2012; Sikes & Hays, 2010; Widom, Czaja, Bentley, & Johnson,
2012; Wilson & Widom, 2008).


20
Mental health and social disorders are also numerous. Depression, suicide, Post-
traumatic Stress Disorder, and anxiety abound, as do increased drug use and abuse, risky sexual
behaviors, high risk for re-victimization, and criminal behaviors (Norman, Byambaa, De,
Butchart, Scott, & Vos, 2012; Sikes & Hays, 2010; Wilson & Widom, 2008). Additionally,
victims of child abuse have reported experiencing limited or no contact with their families of
origin, small social networks, difficulty making and keeping friends, and volatile relationships
(Frederick & Goddard, 2008). Overall, these studies show the negative consequences for child
victims that extend into adulthood and the large societal burden that results, as well as the
importance of child abuse prevention in the future (Norman et al., 2012).
Studies have also shown differences in long-term health diseases associated with
different types of maltreatment. Neglected children experience developmental difficulties
including failure to thrive, brain underdevelopment, poor school performance, low self-esteem,
behavioral problem, and increased risk for psychopathology (Tang, 2008). Neglected children
also fare worse than abused children in the area of cognitive development, including poorer
academic performance, and also more significant developmental delays, and have displayed an
increased risk for diabetes, vision problems, oral health issues, and poorer lung functioning
(Tang, 2008; Widom et al., 2012). Victims of physical abuse have fared worse in being at-risk
for malnutrition and diabetes as adults, and sexual abuse victims being at-risk for malnutrition
alone (Widom et al., 2012).
Child Abuse Prevention - The Public Health Approach
Due to the far-reaching, long-term consequences of child maltreatment, prevention has
become the new focus of many agencies and clinical studies. In the past, important advances in
child abuse focused on punishing perpetrators and protecting the most severely abused children


21
(Covington, 2013). New research, however, shows the potential benefits of a public health
approach to child maltreatment, which would address the wide range of risk factors for abuse at
the individual, familial, community, and societal levels (Covington, 2013; Zimmerman & Mercy,
2010).
The public health approach draws from multiple disciplines and involves many steps.
These steps include: defining, surveilling, and researching child abuse and child abuse
interventions, identifying risk factors and protective factors for child abuse, understanding the
consequences of child abuse, and developing and assessing prevention strategies, with an
emphasis on primary prevention (CDC, n.d.; Covington, 2013). As discussed above, child abuse
definitions differ widely across disciplines, and therefore affect the process of monitoring child
abuse. Additionally, current reporting systems only count child abuse cases when they meet
certain standards within the criminal justice system (Covington, 2013). For example, the
NCANDS system, a federal system that publishes data on children involved with child protective
services, mainly counts child abuse fatalities of children already known to child protective
services, which underestimates the number of fatalities (Covington, 2013). Likewise, state death
records of children who died from abuse are underestimated, since many child maltreatment
deaths are not attributed to abuse (Covington, 2013). A public health approach to defining and
monitoring the problem will likely use a broad population approach to counting maltreatment,
which will reveal more accurate statistics (Covington, 2013).
Understanding risk and protective factors is also an important step to developing
successful child abuse prevention programming (Covington, 2013). Once identified, risk factors
can be minimized and protective factors increased, to give the prevention program an increased
chance of being successful (CDC, n.d.; Covington, 2013). Although not all risk factors are easily


22
modifiable, and some are not as causally related to the problem as others are, they are important
to identify and understand when designing child abuse prevention programs (Covington, 2013).
Child abuse prevention programs should also account for the long-term health
consequences of maltreatment (Covington, 2013). Once long-term consequences are identified,
prevention program implementers can argue that prevention of child abuse will promote the
health and well being of children into adulthood (Covington, 2013). Current child abuse
programs should also be rigorously assessed, which will allow researchers to learn the best
approaches to implementing and disseminating the programs (CDC, n.d.).
Another main step in the public health approach to child abuse is to implement
prevention programs, with an emphasis on primary prevention, that can positively impact larger
portions of at-risk children over secondary or tertiary prevention, which contain treatment for
child abuse victims (CDC, n.d.; Covington, 2013).
The last main part of the public health approach to child abuse places emphasis on
population health, rather than the health of individuals who experience child abuse (CDC, n.d.).
While the individual victim’s health should not be overlooked, population-level methodologies
to this issue will allow lasting, positive change in the elements that put children at risk for abuse
(CDC, n.d.).
Overall, the public health approach is well suited for addressing child abuse prevention.
Not only is it science-based and emphasizes defining, surveilling, and researching child abuse,
but it encompasses many disciplines that make it ideal to combat a multifaceted issue like child
abuse (CDC, n.d.; Covington, 2013). Many divisions, including health, business, criminal
justice, behavioral science, advocacy, education, and media, play nominal roles in violence


23
prevention (CDC, n.d.). Child abuse is also a risk factor for many other health problems, which
utilize the sectors mentioned above (CDC, n.d.).
CAPTA: The Law at the Federal Level
Section 101. Section 101 of CAPTA states that the Secretary of Health and Human
Services (known as Secretary from now on) may launch an office known as the Office on Child
Abuse and Neglect, with the sole purpose of implementing and organizing the functions of the
Act, and ensuring that such functions are accomplished with proficiency when carried out by
other entities within the Department of Health and Human Services (DHHS, 2011b).
Section 102. Section 102 of CAPTA encompasses several stipulations relating to an
advisory board on child abuse and neglect (DHHS, 2011b). First, the Act states that the
Secretary may form an advisory board that will make recommendations to the Secretary and
appropriate Congressional committees relating to specific child abuse and neglect issues,
including prevention, research, intervention, and treatment (DHHS, 2011b). The Secretary will
nominate individuals for the advisory board by publishing a notice in the Federal Register, and
will appoint individuals to the board who represent fourteen different characteristics, including
law, psychology, social services, health care providers, state and local government, organizations
providing services to disabled persons, organizations providing services to adolescents, teachers,
parent self-help organizations, parents’ groups, volunteer groups, family rights groups, children’s
rights advocates, and Indian tribes or tribal organizations (DHHS, 2011b). Board vacancies will
be filled in the manner stated above, and officers, including a chairperson and vice-chairperson,
will be elected upon the board’s first meeting (DHHS, 2011b). The board must also submit a
report to the Secretary and Congressional committees, detailing recommendations for
coordinating family violence prevention activities, changes to laws and programs that will reduce


24
the number of unsubstantiated child abuse reports and increase the ability to substantiate
legitimate child abuse cases, and modifications needed to encourage coordinated child
protection/child welfare data collection (DHHS, 2011b).
Section 103. In Section 103 of CAPTA, there are details concerning a national
clearinghouse for information relating to child abuse, to be established by the Secretary (DHHS,
2011b). Through this clearinghouse, the Secretary will be able to maintain and disperse
information about effective child abuse prevention, assessment, treatment, and identification
programs, the medical diagnosis and subsequent treatment of child abuse, best practices for
responding to child abuse and making improvements to child protective systems, and incidence
of child abuse in the United States (DHHS, 2011b). The clearinghouse should also provide
requested assistance in the evaluation or identification of effective methods for the investigation
and prosecution of child abuse cases, methods for decreasing psychological trauma to victims,
and successful child abuse programs implemented by the States (DHHS, 2011b). Additionally,
the clearinghouse should collect and disperse information relating to training resources
available at the State and local levels (DHHS, 2011b).
In conjunction with the clearinghouse, the Secretary will perform these duties: consult
with other Federal agencies that maintain clearinghouses; consult with the head of each agency
involved in the fight against child abuse on the development of the clearinghouse, and the
sharing of information with other agencies and clearinghouses; construct a Federal data system
which coordinates existing child welfare data systems and keeps case-specific data confidential;
collect, construct, and disseminate State child abuse reporting information; compose, evaluate,
and issue a summary of the research conducted in Section 104(a); compile and publish
information describing best practices being used in the United States for making referrals related


25
to the health needs of child abuse victims; and inquires about public feedback into the
components of this clearinghouse (DHHS, 2011b).
Section 104. Section 104 of CAPTA pertains to interdisciplinary, long-term research,
carried out by the Secretary, that provides information needed to improve both the protection of
children from abuse and the well-being of abuse victims (DHHS, 2011b). This research may
focus on: the nature and scope of child abuse; causes, identification, cultural and socioeconomic
distinctions, and consequences of child abuse; effective methods for improving the relationship
of abused infants and toddlers with their caregivers, when appropriate; effective and culturally
sensitive investigative and legal systems regarding child abuse; analysis and dispersement of best
practices; ideal approaches to interagency collaboration to improve services and treatment for
abuse victims; procedures and programs that improve actions such as screening, medical and
forensic diagnosis, health evaluations, and the collaboration between child protective services,
clinicians, and childhood intervention providers; analysis of gaps in prevention services;
effectual alliances between child protective services and domestic violence service providers; the
nature, scope, and methodology of voluntary relinquishment of children for foster care; effect of
child abuse on the incidence of disabilities; information regarding different responses to child
abuse; child abuse problems facing Indians, Native Hawaiians, and Alaska Natives; and data
relating to the national incidence of child abuse (DHHS, 2011b). Following this research, the
Secretary shall submit a report to the Committee on Education and the Workforce (House of
Representatives) and the Committee on Health, Education, Labor and Pensions (Senate) (DHHS,
2011b).
Other Secretarial duties outlined in this section relate to conducting a study on shaken
baby syndrome, providing technical assistance to organizations in the planning, development,


26
evaluation, improvement, and carrying out of child abuse programs, publishing information
about training resources, having authority to make grants and enter into grant contracts,
compiling a peer review process to evaluate and review grant applications, appointing members
to the peer review panel, and ensuring the panel is using scientifically valid criteria for its
reviews (DHHS, 2011b).
Sections 109 through 110. Section 109 states that the Secretary must suggest
regulations and make necessary arrangements to ensure effective coordination between child
abuse programs outlined in CAPTA and other programs assisted by Federal grants (DHHS,
2011b). Section 110 outlines additional child abuse reports that need to be developed and
distributed to the appropriate parties (DHHS, 2011b).
CAPTA: The Law as it Affects States
Section 105. Section 105 addresses grants to States, Indian tribes or tribal organizations,
and public or private agencies, in which the Secretary may make grants to and enter into
contracts with the entities listed above (DHHS, 2011b). These grants or contracts must be
related to training programs, triage procedures, mutual support programs, kinship care, linkages
between child protective services and health agencies, and collaborations between child
protective services and domestic violence services (DHHS, 2011b). Discretionary grants may
also be awarded for these programs: respite and crisis nursery programs under the supervision of
hospitals, respite nursery programs provided by community-based agencies, programs based
within children’s hospitals that improve medical diagnosis of child abuse and for health
evaluations of children, disseminating hospital-based information and referral services to parents
of disabled children and child victims of abuse, and other new programs that show promise in


27
combatting child abuse (DHHS, 2011b). This section also advises the Secretary to evaluate each
of the grantees in this section for effectiveness (DHHS, 2011b).
Section 106. Section 106 relates to grants to States for child abuse or neglect prevention
and treatment programs (DHHS, 2011b). The Secretary may make grants to States that apply for
a grant to improve the child protective services system in these ways: intake, screening, and
investigation of child abuse reports, improving interagency protocols and legal preparation, case
management, development of risk and safety assessment tools, developing technology that
supports the program, creating, strengthening, and managing training, enhancing skills and
qualifications of people providing services to children and families, developing and
implementing research-based strategies and training procedures for mandated reporters,
operating programs that assist families of disabled infants to obtain services, developing
information to improve public education about the child protection system, creating and
improving the capacity of community-based programs to integrate strategies between parents and
professionals to fight child abuse, supporting and improving interagency collaboration between
the child protection system and the juvenile justice system, and the child protection system and
public health agencies, and last, creating and implementing procedures for collaboration between
the child protection system, domestic violence services, and other agencies (DHHS, 2011b).
States may become eligible for these grants after submitting a plan to the Secretary
specifying the elements of the child protective services system the State will address with the
grant, and the plan will be evaluated and revised by the State when there are changes in
programming outlined in the plan (DHHS, 2011b). Additionally, States must notify the
Secretary of any fundamental changes relating to child abuse prevention that may affect the
State’s eligibility for the grant and in how the grant is used (DHHS, 2011b).


28
This section also outlines content of the plans submitted by States. According to
CAPTA, these main elements should be included in each State plan: an assurance that this State
plan is coordinated with the State plan under the Social Security Act relating to child welfare and
family support services; certification from the State’s Governor that the State is enforcing a law
or operating a program relating to child abuse that includes child abuse reporting procedures,
policies or the development of policies for babies born with illegal drug abuse or withdrawal
symptoms or a Fetal Alcohol Spectrum Disorder, procedures for the screening, analysis, and
investigation of child abuse reports, triage policies for referring children not in immediate danger
to preventive services, policies for urgent steps to be taken to uphold the safety of a victim of
child abuse, including placement in a safe environment, immunity to individuals making good
faith child abuse reports, procedures to protect the rights of the child or child’s parents by
preserving the confidentiality of all records and giving a State the right to disclose those records
to government entities whose jobs include protecting children from abuse, allowance for public
disclosure of case findings in which an abused child died or nearly died, cooperation of all
parties involved in the investigation, prosecution, and treatment of child abuse, expungement of
records in cases that are unsubstantiated or false, provisions for a specially trained adult to
represent the child in a child abuse court proceeding, the establishment of citizen review panels,
procedures for terminating parental rights in cases regarding abandoned infants, mechanisms
assuring the State does not require a child to be reunited with a parent if the parent has
committed murder, voluntary manslaughter, felony assault, sexual abuse against the child or
other children, or is a registered sex offender, requirements that a child protective services
representative inform the individual of any complaints against him or her, procedures for training
child protective services representatives, provisions for improvements to the training and


29
supervision of caseworkers, referral of an abused child under age three to early intervention
services, requiring criminal background checks for potential foster and adoptive parents, and
provisions for technology systems that support the State child protective service system; State
procedures for responding to reports of medical neglect; a description of services provided to
prevent child abuse, training to personnel for decision making in cases of child abuse, training
for mandatory reporters, policies encouraging family involvement in decision making for abused
children, and policies that promote inter-agency collaboration; an assurance that services under
this law address the needs of homeless youth; and an assurance that the State has collaborated
with prevention agencies and affected families when evolving the State plan (DHHS, 2011b).
The second part of this section addresses citizen review panels, in that each State
receiving a grant must establish at least three, with members broadly representing the community
in which each is established (DHHS, 2011b). The basic function of a citizen review panel is to
assess the extent to which local and State child protection agencies are effectively carrying out
their responsibilities (DHHS, 2011b). Additionally, each panel should develop an annual report
summarizing its activities and recommendations for improvement to the State and local child
protection services systems (DHHS, 2011b).
Section 106 also states that each State receiving a grant must work with the Secretary to
furnish a report comprising child abuse statistics specific to that State (DHHS, 2011b).
Examples of statistics included in this report are: the number of children reported as victims of
child abuse, the number of families receiving preventive services, the agency response time for
investigations of child abuse reports, and the number of child protective service employees
responsible for the intake, screening, assessment, and investigation of reports (DHHS, 2011b).


30
Part (f) of Section 106 outlines the amount of money allotted to each state receiving a
grant (DHHS, 2011b). Generally, each state receives a flat amount of $50,000, plus a sum that
reflects the number of children under eighteen in the particular State or territory in relation to the
number of children under eighteen in all States and territories (DHSS, 2011b).
Section 107. Section 107 tackles grants to states for programs regarding the investigation
and prosecution of child abuse and neglect cases (DHHS, 2011b). The Secretary can make
grants to States for the purpose of developing and running programs designed to improve the
evaluation and investigation of suspected child abuse cases and child abuse-related fatalities, as
well as suspected child abuse cases involving disabled children, and the examination and
prosecution of these cases (DHHS, 2011b). To be eligible for the grant, each State must
establish a task force on children’s justice made up of individuals with experience and familiarity
regarding the criminal justice system, as well as issues of child abuse and child abuse-related
fatalities (DHHS, 2011b). Police officers, judges, parents, child advocates, health professionals,
and adult former victims of child abuse are examples of eligible task force members (DHHS,
2011b). This task force is responsible for reviewing and assessing State investigative and
judicial handling of child abuse cases, and for making procedure and training recommendations
that the State will adopt (DHHS, 2011b). General recommendation categories include:
administrative, investigative, and legal handling of child abuse cases in a fashion that minimizes
additional trauma to the victim and the victim’s family while simultaneously ensuring fairness to
the accused perpetrator; programs for testing novel approaches which may improve resolution of
court proceedings or the effectiveness of legal and administrative action in child abuse cases; and
reform of State laws, protocols, and other regulations to provide comprehensive protection of
children (DHHS, 2011b).


31
Title II, Section 201. Title II, Section 201 of CAPTA addresses community-based grants
for preventing child abuse and neglect, with the purpose of supporting community-based efforts
to develop, expand, improve, and run activities to prevent child abuse, and to support a
knowledge of diverse populations so that preventing and treating child abuse will be more
effective (DHHS, 2011b). The Secretary will award these grants to the State’s lead entity to
cultivate, manage, expand, and improve accessible, appropriate, and effective prevention-focused
programs and activities that support families; support the development of preventive services for
children and families; fund the maintenance, expansion, improvement, or start-up of community-
based child abuse prevention programs identified in CAPTA as an unmet need; maximize
funding through leveraging funds designated for supporting prevention-focused; and finance
public information actions that highlight the healthy development of children and parents, as well
as the promotion of child abuse prevention activities (DHHS, 2011b).
Section 202. This section outlines eligibility requirements for States receiving a Title II
grant (DHHS, 2011b). A state is eligible for a grant if: the State’s Governor has selected a lead
entity to administer the grant; the designated lead entity is an existing public or private entity
with the skill to work with agencies to provide training and technical assistance, and that has the
ability to involve parents who can provide leadership in the running and assessment of programs;
in determining the lead entity, the Governor gives priority consideration to a trust fund advisory
board of the State or an established entity that leverages funds for child abuse prevention
activities; the Governor assures that the lead entity will provide community-based and
prevention-focused programs designed to support families to prevent child abuse; the Governor
assures that the lead entity will provide direction through a collaborative, public-private structure
with representation from public and private sector members; the Governor assures that the lead


32
entity will provide aim for communication, funding from all sources, evaluation of activities,
training and technical assistance, and reporting functions; the Governor assures that the lead
entity has shown commitment to parental participation and support to community-based and
prevention-focused activities; the Governor assures that the lead entity is capable of working
with child abuse prevention organizations to continually develop services for children and
families; the Governor assures that the lead entity is capable of providing operational support to
child abuse prevention programs; and the Governor assures that the lead entity will integrate
experienced people and agencies to work with families with children with disabilities and child
abuse prevention activities (DHHS, 2011b).
Section 203. Section 203 states the guidelines for the amount of each grant given
(DHHS, 2011b). One percent of the appropriated amount is allotted to Indian tribes, with 70
percent of this amount allotted to each State in proportion to the number of children under the
age of 18 residing in the State, and the remaining 30 percent allotted to each State in proportion
to the amount of non-Federal funds directed through the lead entity (DHHS, 2011b).
Section 204. This section outlines program requirements for community-based,
prevention-focused activities relating to child abuse (DHHS, 2011b). Programs are required to
evaluate community assets through a planning process involving parents and local agencies and
nonprofit organizations, as well as devise a strategy to provide comprehensive family-centered,
preventive services for families, especially young parents, families with young children, and
parents who are former victims of child abuse (DHHS, 2011b). Additional requirements for
local programs include: provide core child abuse prevention services, provide access to optional
services (may include childcare, referral to and counseling for adoption services and for families
with disabled children, referral to educational services, peer counseling, self-sufficiency skills


33
training, and domestic violence services), develop leadership roles for parents in the operation
and maintenance of programs, promote prevention by providing leadership in assembling local
and private resources, and participate with additional community-based programs designed to
support families in the prevention of child abuse (DHHS, 2011b).
Section 206. Section 206 maintains that States must measure their performance and relay
this information in reports to the Secretary (DHHS, 2011b). These reports should demonstrate
that the State is effectively developing, running, and expanding community-based and
prevention-focused activities that prevent child abuse, supplying a catalog and description of
services that meet community needs and are supplied to families by local programs, and proving
that the State is addressing those unmet needs (DHHS, 2011b). These reports should also
describe the number families served and the involvement of families in the operation and
evaluation of prevention programs (DHHS, 2011b). States should also demonstrate, through
these reports, that families who have utilized the services are satisfied and that they are working
to establish and expand new funding mechanisms for these programs (DHHS, 2011b).
Additionally, these reports should contain a description of program evaluation results, as well as
an implementation plan to ensure the leadership of parents in the fostering of these prevention
programs (DHHS, 2011b).
Section 207. Section 207, entitled “The National Network for Community-Based Family
Resource Programs”, states that the Secretary may distribute funds from the State allotment to
support activities of the lead entity, which may include creating and maintaining a peer review
process and an information clearinghouse, funding a yearly symposium on system change efforts
that result from prevention-focused programs and State-to-State technical assistance through


34
conferences, and establishing, operating, and maintaining a communication system between
various lead entities (DHHS, 2011b).
Methods
Study Design
This study is primarily a comprehensive health policy analysis of the federal legislation,
CAPTA (Child Abuse Prevention and Treatment Act). The purpose of this study is to explore
the differences between child abuse intervention programs in Pennsylvania and Illinois, how
those differences are affected by CAPTA, and what changes should be made to CAPTA to
increase its effectiveness.
Sample
Inclusion criteria. Studies and documents were included in the project if they were
written in English and reported any information pertaining to the search terms below. For the
portion of the project dedicated to comparing programs in Pennsylvania and Illinois, only
programs that are currently being implemented were included for review.
Exclusion criteria. Documents containing CAPTA implementation in other states were
excluded from the study. Additionally, programs that only served as child abuse referral sources,
programs that only provided legal guidance to child abuse victims, foundations that provided
financial support to child abuse programs, but did not have a physical program themselves, and
programs that did not publish all of the pertinent information required for the project, were
excluded from the study.
Data Collection
To complete the policy analysis, CAPTA was the primary subject in a search engine
exploration. Search terms comprised CAPTA and its synonyms, including Child Abuse


35
Prevention and Treatment Act, Child Abuse Prevention and Treatment Reauthorization Act of
2010, Child Abuse Prevention and Treatment Act State Plan, Child Abuse Prevention and
Treatment Act of 1974, Public Law 93-247, PL 93-247, anti-child abuse legislation, child abuse
legislation, child abuse law, child abuse policy, Child Protective Services Law (a term specific to
Pennsylvania), and Abused and Neglected Child Reporting Act (a term specific to Illinois).
Other websites were also explored, involving federal and state government and child welfare
websites, such as hhs.gov, gpo.gov, and pccyfs.org, and related documents were reviewed for
information regarding CAPTA and its implementation. CAPTA implementation specific to both
states of comparison was also researched.
Major CAPTA sections were then summarized, and these were pared down to three
points on which CAPTA implementation could be compared between Pennsylvania and Illinois.
The major points for comparison included: structure of child welfare organizations responsible
for implementing CAPTA, plans or reports submitted by States outlining activities to be
completed/were completed to fulfill CAPTA regulations, and a budget from each State’s child
welfare organization that specifies funding sources and provides a breakdown of programs
funded.
To address the second research question relating to suggested changes to child abuse laws
in Pennsylvania and Illinois, results from the comparison were reviewed, and recommendations
were made for each state in the comparison group.
Results
Structure in Pennsylvania
The primary entity responsible for monitoring the delivery of services to children and
families in Pennsylvania is the Bureau of Child Welfare Services, shown in Figure 1, a chart


36
detailing the structure of Pennsylvania’s Department of Public Welfare (Bureau of Child Welfare
Services, 2012). The Bureau, overseen by Director Roseann Perry, carries out these activities
through its Division of Licensing and the four Regional Offices of the Office of Children, Youth
and Families [OCYF], which is a branch of the State’s Department of Public Welfare [DPW]
(BCWS, 2012). These offices are located in Philadelphia (Southeast Region), Pittsburgh
(Western Region), Scranton (Northeast Region), and Harrisburg (Central Region), and the
Regional Directors are: Raheemah Shamsid-Deen Hampton, Director of the Southeast Regional
Office; Elaine Bobick, Director of the Western Regional Office; Jacqulyn Maddon, Director of
the Northeast Regional Office; and Gabi Williams, Director of the Central Regional Office
(Pennsylvania Department of Public Welfare, 2012). The Regional Offices, Directors, and
counties each office serves are detailed in Table 1 below. (DPW, 2012).
The Division of Licensing, a part of the Bureau of Child Welfare Services, regulates
children and youth agencies, adoption agencies, foster care agencies, child day treatment
facilities, and child residential facilities, and provides aim and monitoring for all statewide
licensing activities (Bureau of Child Welfare Services, 2012). The four Regional Offices help
facilitate the Division’s management of these entities (Bureau of Child Welfare Services, 2012).
The Bureau of Child Welfare Services also works with other Bureaus in the Office of
Children, Youth and Families, as depicted in Figure 1, to coordinate services and ensure
conformity with federal and state regulations (Bureau of Child Welfare Services, 2012).
Specifically, the Bureau of Child Welfare Services works with the Bureau of Policy and Program
Development and its Director, Cathy Utz, to ensure that provider operations are following best
practices standards, as well as the Bureau of Budget and Program Support and Director Cliff


37
Crowe, to analyze program and budget estimates for all of Pennsylvania’s county child social
services organizations (Bureau of Child Welfare Services, 2012).
As regulated by CAPTA, States receiving funds must establish citizen review panels to
evaluate the State’s child welfare agency and make suggestions for improvement (University of
Pittsburgh, 2012). In 2008, a subcommittee was formed from Pennsylvania’s CAPTA
workgroup to define the structure, with the help of the Office of Children, Youth and Families,
of the citizen review panels (University of Kentucky, 2011). Recruitment for the panels was to
be extended beyond traditional individuals involved in county and state child welfare decision-
making entities, placing an emphasis on the recruitment of volunteers with a “citizen’s”
perspective (University of Kentucky, 2011). Panels were also to be assigned the task of
assessing policies and procedures relating to the child protective system and its effectiveness in
carrying out its responsibilities, and were to reflect Pennsylvania’s diversity by being placed in
different regions, so that county-specific child welfare solutions could be made (University of
Kentucky, 2011).
Pennsylvania established three citizen review panels in 2010, following these guidelines,
in the South Central, Northeast, and Northwest regions of the State (University of Kentucky,
2011). CAPTA funds help cover expenses incurred through the citizen review panel process,
including the operation and support of the citizen review panels and the citizen review panel
program manager position, development and delivery of training to mandated reporters, travel to
the annual State Liaison Officers Meeting and CPS-related conferences for the State Liaison
Officer and other staff, and research and analysis of work related to safety assessment (DPW,
2013).
Figure 1. Structure of Pennsylvania’s Department of Public Welfare (DPW, 2014b)


38
Pennsylvania State
Government
Department of Public
Welfare
Beverly D. Mackareth,
Secretary
Executive Offices
Administration
Karen Deklinski, Director
Budget
David Spishock, Director
General Counsel
Kenneth J. Serafin, Director
Legislative Affairs
Mark J. Rosenstein, Director
Policy Development
Angela Logan, Director
Press and Communications
Eric Kiehl, Director
Program Offices
Child Development
Barbara Minzenberg,
Director
Children, Youth and
Families
Cathy Utz, Acting Director
Bureas
Budget and Program
Support
Cliff Crowe, Director
Child Welfare Services
Roseann Perry, Director
Ellen Whitesell, Director of
Licensing
Juvenile Justice Services
Michael Pennington,
Director
Policy, Programs and
Operations
Cathy Utz, Director
Regional Offices
Southeast (Philadelphia)
Raheemah Shamsid-Deen
Hampton, Director
Western (Pittsburgh)
Elaine Bobick, Director
Northeast (Scranton)
Jacqulyn Maddon, Director
Central (Harrisburg)
Gabi Williams, Director
Developmental Programs
Fred Lokuta, Director
Income Maintenance
Lourdes Padilla, Director
Long Term Living
Bonnie Rose, Director
Medical Assistance
Vincent Gordon, Director
Mental Health and
Substance Abuse Services
Dennis Marion, Director


39
Table 1. Pennsylvania Office of Children, Youth and Families Regional Offices (DPW,
2012)
Regional Offices Director Counties Served
Southeast Region (office located
in Philadelphia)
Raheemah
Shamsid-Deen
Hampton
Bucks, Chester, Delaware, Montgomery,
Philadelphia
Western Region (office located
in Pittsburgh)
Elaine Bobick Allegheny, Armstrong, Beaver, Butler,
Cameron, Clarion, Clearfield, Crawford,
Elk, Erie, Fayette, Forest, Greene, Indiana,
Jefferson, Lawrence, McKean, Mercer,
Potter, Venango, Warren, Washington,
Westmoreland
Northeast Region (office located
in Scranton)
Jacqulyn
Maddon
Berks, Bradford, Carbon, Lackawanna,
Lehigh, Luzerne, Monroe, Northampton,
Pike, Schuylkill, Sullivan, Susquehanna,
Tioga, Wayne, Wyoming
Central Region (office located in
Harrisburg)
Gabi Williams Adams, Bedford, Blair, Cambria, Centre,
Clinton, Columbia, Cumberland, Dauphin,
Franklin, Fulton, Huntingdon, Juniata,
Lancaster, Lebanon, Lycoming, Mifflin,
Montour, Northumberland, Perry, Snyder,
Somerset, Union, York
Structure in Illinois
The State of Illinois utilizes the Department of Children and Family Services [DCFS] to
strengthen and support children and families, providing child abuse prevention programs, child
protection, foster care and adoption assistance, training to professionals, and a number of
counseling and referral hotlines (DCFS, 2009a). The mission of the Illinois DCFS is to protect
children reported as abused and expand their families’ power to care for them properly, provide
for the well-being of children in the care of the DCFS, as well as permanent, suitable families for
children who cannot safely return to their families, emphasize early child abuse intervention and
prevention activities, and collaborate with communities to fulfill these duties (DCFS, 2009a).


40
The Department of Children and Family Services is one of over 80 government agencies
providing services to Illinois residents (State of Illinois, 2013). As shown in Figure 2, the DCFS
is broken down into multiple divisions and offices, each with their own Director (DCFS, 2009a).
Arthur Bishop, Director of the DCFS, oversees twelve separate divisions, as well as the Chief of
Staff, Carolyn Ross, who supervises nine additional offices (DCFS, 2014b). These offices and
corresponding directors can be found detailed in Table 2.
The DCFS also enlists the support of 16 advisory groups, shown in Table 3 (DCFS,
2009b). The specific roles of these groups vary, but all serve to support the DCFS in its goal to
protect Illinois children (DCFS, 2009b). Examples of specific advisory groups and primary
duties include: the African American Advisory Council, which assists the DCFS in providing
suitable, culturally-sensitive services to African Americans; the Illinois Adoption Advisory
Council, which advises DCFS Director on activities involving guardianship and adoption
services; and the Partnering with Parents Advisory Council, which supports and engages parents
in an effort to move their cases forward more rapidly and effectively (DCFS, 2009b).
The Office of the Inspector General [OIG] of the Illinois DCFS was established by the
Illinois General Assembly in June 1993 with the purpose of improving the State’s child welfare
system (DCFS, 2009c). The OIG, as depicted in Figure 2, is a small branch of the DCFS that
investigates misconduct, improper performance of a legal act, or illegal activity and violations
completed by DCFS employees, service providers and contractors, and foster parents (DCFS,
2009c). It responds to complaints filed by all types of people, including the judiciary system and
biological parents, may conduct a systemic review of areas with high complaint levels, and will
assess deaths or serious injuries of children recently involved in the child welfare system (DCFS,
2009c). All reports prepared by the OIG are submitted to the Director of the DCFS, and contain


41
a complaint summary, a case history, details of the DCFS’ interaction with the family, an
analysis of the findings, and recommendations for case-specific and systemic changes to be made
to the child welfare system (DCFS, 2009c). The current Inspector General is Denise Kane,
shown in Figure 2 (DCFS, 2014b).
Illinois’ four citizen review panels were established in July of 1999, formed from three of
the advisory groups mentioned above, including the Statewide Citizens’ Committee on Child
Abuse and Neglect, the Child Death Review Team’s Executive Council, and the Children’s
Justice Task Force (University of Kentucky, 2011). These panels meet quarterly or bi-monthly
to research specific child abuse cases and make suggestions for improving child welfare policies
within the State (University of Kentucky, 2011). The chairperson and vice-chairperson of each
panel are also members of the Citizen Review Panels Steering Committee, alongside DCFS
Administrators and other coordinators, which meets two times a year to present data, set goals,
and analyze the progress being made with previous suggestions for improvement (University of
Kentucky, 2011).
Figure 2. Structure of Illinois’ Department of Children and Family Services (DCFS, 2014b)


42
Table 2. Illinois Department of Children and Family Services Divisions and Offices (DCFS,
2014b)
DCFS Director Division/Office Director Division/Office Name
Arthur Bishop
Director of the IL DCFS
None – Vacant Position Division of Support Services
Larry Small Division of Clinical Practice
& Development
Matt Grady Division of Budget & Finance
Joan Nelson-Phillips Division of Quality Assurance
& Research
Sheila Riley Office of Affirmative Action
Keith Schoonover Offices of Information
Services
Dr. Cynthia Tate Office of Child Well-Being
Debra Dyer-Webster Office of the DCFS Guardian
Karen Hawkins Office of Communication
Dixie Peterson Office of Legal Services
Bill Wolfe Office of Procurement and
Contracts
Chris Boyster Office of Legislative Affairs
Carolyn Ross
Chief of Staff
Deb McCarrel Bureau of Operations
Greg Donathan Division of Policy and
Advocacy
Denice Murray Division of Regulation &
Monitoring
Diane Cottrell Office of Administrative Case
Review
Illinois State
Goverment
Department of
Children and
Family Services
Denise Kane
Inspector
General
Arthur Bishop
Director
12 Divisions and
Offices
Carolyn Ross
Chief of Staff
2 Deputy Chiefs
of Staff
1 Special
Assistant to the
Chief of Staff
9 Divisions and
Offices
16 Advisory
Groups


43
Daniel Fitzgerald Office of Community Services
Tammy Grant Office of Employee Services
Debra Matlock Office of Compliance and
Strategic Planning
Robert Blackwell Office of Racial Equity
None – Vacant Position Senior Policy Advisor
Table 3. Illinois Department of Children and Family Services Advisory Groups (DCFS,
2009b)
Advisory Group Chair Person Number of Members Basic Functions
African American
Advisory Council
Michael D. Burns 22 Assists the DCFS in
providing suitable,
culturally-sensitive
services to African
Americans
Asian American
Advisory Council
Miaona Ye-Sippi 10
Child Death Review
Team
• Lori Chassee,
Aurora
location
• Duane
Northrup,
Champaign
location
• Susan Storcel,
Cook A
location
• Diane Scruggs,
Cook B
location
• Daniel Cuneo,
East St. Louis
location
• Sheryl L.
Woodham,
Marion
location
• Frankie
Cunningham,
Peoria location
• Joanna Deuth,
Rockford
location
• Tracy Lower,
• 21, Aurora
location
• 26, Champaign
location
• 31, Cook A
location
• 26, Cook B
location
• 21, East St.
Louis location
• 23, Marion
location
• 22, Peoria
location
• 18, Rockford
location
• 20, Springfield
location


44
Springfield
location
Child Endangerment
Risk Assessment
Protocol Advisory
Committee
14 Forms and
implements a child
endangerment risk
assessment protocol
Child Welfare
Advisory Committee
53 Advises DCFS on
programming and
the budget, relating
to the purchase of
child welfare
services
Child Welfare
Employee Licensure
Board
9
Children and Family
Services Advisory
Council
4
Children’s Justice Task
Force
Careyana Brenham 27
Illinois Adoption
Advisory Council
Elizabeth Richmond
James Jones
25 Advises DCFS
Director on
activities involving
guardianship and
adoption services
Illinois African-
American Family
Commission
6
Illinois DCFS
Institutional Review
Board
D. Jean Ortega-Piron 8 Approves research
involving children
and families
receiving services
from the DCFS
Latino Advisory
Committee
Carmen Alvarez 22
Latino Consortium 13
Partnering with Parents
Advisory Council
9 locations, no member
lists
Supports and
engages parents in
an effort to move
their cases forward
more rapidly and
effectively
Statewide Citizen’s
Committee on
Abuse/Neglect
Gwendolyn Mastin 19
Statewide Foster Care Cathy McCoy 23 Advises and


45
Advisory Council consults with the
DCFS Director on
activities involving
foster care services
for abused children
Budget in Pennsylvania
The most recent budget for Pennsylvania’s Department of Public Welfare is presented in
Table 4 below. Although all offices within the DPW are listed, highlighted is the specific budget
for the Office of Children, Youth and Families, the agency responsible for carrying out duties
related to child welfare. In fiscal year [FY] 2013-2014, the OCYF had $1.16 billion available for
spending, and requested $1.19 billion for fiscal year 2014-2015, adding up to a 2.6% budget
increase from FY 13-14 to FY 14-15 (DP, 2014a). Overall, the OCYF accounts for 10.4% of the
entire budget of the DPW, fourth to the Office of Medical Assistance at 46.4%, the Office of
Developmental Programs, at 13.4%, and the Office of Long Term Living, at 12.3% (DPW,
2014a).
Table 4. Budget for the Pennsylvania Department of Public Welfare, Fiscal Year 2014-2015
($ Amounts in Thousands)
(DPW, 2014a)
Program Group FY 12-13 $
Actual
FY 13-14 $
Available
FY 14-15
State $
Request
FY14-15
%
Change
% Of
Budget
by
Program
Office of
Administration
106,686 124,519 152,998 22.9% 1.3%
Office of Children,
Youth and
Families
1,139,294 1,155,780 1,185,324 2.6% 10.4%
Office of Child
Development and
Early Learning
439,518 451,492 455,702 0.9% 4.0%
Office of Income
Maintenance
530,339 559,291 615,083 10.0% 5.4%
Office of Mental 707,173 735,148 776,782 5.7% 6.8%


46
Health
Office of
Developmental
Programs
1,344,200 1,464,384 1,539,012 5.1% 13.4%
Office of Medical
Assistance
5,022,197 5,058,674 5,307,261 4.9% 46.4%
Office of Long
Term Living
1,333,303 1,460,069 1,406,100 -3.7% 12.3%
Total 10,622,710 11,009,357 11,438,262 3.9%
Budget in Illinois
Shown below is the detailed budget of the Illinois Department of Children & Family
Services, fiscal year 2015. In Illinois, the DCFS is the entity responsible for child welfare;
therefore, the budget depicted below is organized by program groups within the DCFS. The
DCFS was allotted $1.18 billion in FY14, and increased this budgeted number by 1.1% to $1.19
billion (DCFS, 2014a). Of the total budget for the DCFS, 66.4% is allotted to family
reunification services (DCFS, 2014a). Child prevention centers make up 0.4% of the total
budget (DCFS, 2014a).
Table 5. Budget for the Illinois Department of Children & Family Services, Fiscal Year
2015
($ Amounts in Thousands)
(DCFS, 2014a)
Program
Group
Program
Name
FY13
Expenditure
s
FY14
Approp.
FY15
Request
FY14-
15 %
Chang
e
% Of
Budget
by
Progra
m
Protective
Services
Child
Advocacy
Centers
3,485.1 3,501.7 3,508.0 0.2% 0.3%
Investigative
Services
101,976.6 107,117.1 111,024.4 3.6% 9.3%
State Central
Registry
11,706.3 11,706.1 12,190.5 4.1% 1.0%
Total 117,168.0 122,324.9 126,722.9 3.6% 10.6%
Adoption & Adoption & 205,117.2 196,664.0 190,847.3 -3.0% 16.0%


47
Guardianship Guardianship
Adoption
Preservation
& Support
11,698.6 11,973.1 12,378.8 3.4% 1.0%
Total 216,875.9 208,637.1 203,226.1 -2.6% 17.0%
Family
Maintenance
Intact Family
Services
27,769.4 31,470.7 34,608.6 10.0% 2.9%
Prevention
Services
3,863.8 5,003.3 4,845.7 -3.1% 0.4%
Total 31,633.2 36,474.0 39,454.4 8.2% 3.3%
Family
Reunification
Behavioral &
Mental Health
18,366.3 18,901.0 18,615.9 -1.5% 1.6%
Day Care 44,257.6 45,148.1 45,939.8 1.8% 3.8%
Family
Reunification
& Substitute
Care
422,564.7 456,860.1 460,778.3 0.9% 38.6%
Health Care
Network
4,053.1 4,214.7 4,222.2 0.2% 0.4%
Institution &
Group Home
242,337.6 246,136.6 251,084.4 2.0% 21.0%
Older Ward
Transition
10,052.0 12,024.1 12,046.6 0.2% 1.0%
Total 741,631.3 783,284.8 792,687.2 1.2% 66.4%
Accountabilit
y
Administrativ
e Case
Review
6,301.1 6,636.5 6,888.4 3.8% 0.6%
Licensing 19,555.7 20,593.1 21,375.2 3.8% 1.8%
Monitoring 3,481.2 3,665.4 3,804.6 3.8% 0.3%
Total 29,338.1 30,895.0 32,068.2 3.8% 2.7%
Agency Total 1,136,646.4 1,181,615.
7
1,194,158.
7
1.1%
Reports submitted by Pennsylvania
The Pennsylvania Department of Public Welfare, Office of Children, Youth and Families
submits several reports each year to the Secretary of the Department of Health and Human
Services detailing elements of the child protective services system it will aim to improve, the
work its citizen review panels have completed, child abuse statistics specific to Pennsylvania,
and performance measures (DHHS, 2011b). In particular, the Annual Progress and Services


48
Report describes the State agency responsible for administering programs, the vision and goals
of the agency, child welfare statistics and plans, and, most notably, the practice model that
guides activities (DPW, 2013). The OCYF coordinates all statewide children’s programs and is
responsible for publishing Pennsylvania’s State Child and Family Services Plan [CFSP] (DPW,
2013).
The Pennsylvania Child Welfare Practice Model uses a joint effort between state and
local level stakeholders to connect the federal Child and Family Services Review [CFSR]
findings and the desired goals of the OCYF in order to implement systemic change (DPW,
2013). Goals and objectives were developed as a result of identified priorities, and were related
to the national goals of improved safety, well being, and permanency for children and families
(DPW, 2013).
The Child Welfare Practice Model was developed by the Practice Model Workgroup in
June 2012, and is a combination of resources from Pennsylvania’s Quality Service Reviews and
practice models from other states, such as Colorado and Utah (DPW, 2013). The model consists
of three main components – outcomes, or areas that need to be improved to achieve goals; values
and principles, or the value base that provides a framework for how child welfare workers are to
collaborate; and skills, or standards that provide a focus, while still allowing flexibility, for how
to best serve each unique child, youth and family (DPW, 2013). Collaboration between child
welfare partners, shared community responsibility and leadership, consistent modeling of the
values and principles, constant demonstration of skills, and a commitment to strength-based,
solution focused practice that engages families are the emphasis of the model (DPW, 2013). The
general model is shown in Figure 3. As depicted, the seven Child and Family Services Review
outcomes are the central part of the model. Systemic factors, strategies for program

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