This secondary qualitative study explored local perceptions of the causes of child maltreatment and prevention needs in 12 counties in a midwestern state through focus groups with relevant stakeholders. The study further explored perspectives on if the existing programs were meeting local needs. A total of 107 individuals took part in 13 focus group sessions across 12 counties as part of a needs assessment process. In this qualitative secondary data analysis, constant comparative analysis—including open, axial, and selective coding—was used to examine perceptions of maltreatment prevention needs and how these coincided with available programs. Stakeholders identified several factors they believed to be causes of child maltreatment across the counties, including intergenerational issues (e.g., cycle of violence), poverty, social isolation, and behavioral health issues. Specific child maltreatment prevention programs were singled out as particularly beneficial, while other types of programs or services such as affordable housing, were noted as missing or inadequate. Participants also highlighted barriers to receiving services across their counties. Despite differences in terms of county characteristics, the findings suggest that causes of maltreatment and service needs are shared across geographic boundaries. While available programs tended to focus on parenting education, counties identified significant maltreatment prevention needs that also ameliorate poverty and substance use.