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The costs of child abuse to society are considerable. In 2008, Prevent Child Abuse America released the second comprehensive report on the direct (immediate intervention) and indirect (long-term) costs of child abuse
and neglect in America. The report estimates that the United States spends $103.8 billion annually in response to child abuse (Wang and Holton, 2007).
The report analyzes information provided by the U.S. Census Bureau and the federal departments of Health and Human Services,
Justice, and others. It estimates that the U.S. spends more than $33.1 billion annually on the direct effects of child abuse.
The largest cost was for the child welfare system: $25.4 billion a year. Other direct costs included hospitalization/treatment
of injuries ($6.6 billion), mental health care ($1.1 billion), and law enforcement interventions ($33.3 million).
The report also projects the indirect or long-term effects of abuse. According to Prevent Child Abuse America, the amount
spent annually treating all of the long-term, indirect effects of child abuse, including special education, mental and physical
health care, juvenile delinquency, lost productivity, and adult criminality is more than $70.7 billion.
There
is a well-documented link between childhood abuse and long-term health effects. These long-term effects can include increased
risk of teen pregnancy or sexually transmitted disease, central nervous system damage, speech problems, inhibited growth,
mental and emotional disturbances, delayed language development, low self-esteem, and aggressive tendencies (Chalk, Gibbons,
and Scarupa, 2002; Kelley, Thornberry, and Smith, 1997).
The Adverse Childhood Experiences (ACE) study also found
that children who suffer maltreatment and/or are exposed to dysfunction in the home have an increased risk of smoking, obesity,
depression, alcoholism, illicit drug use, heart disease, and hepatitis (1999). The new report estimates the costs of this
long-term health and mental health care at $67.8 million.
The most costly long-term effects are those associated
with lost productivity to society from adult survivors of child abuse, who are disproportionately affected by unemployment
and underemployment later in life. The report estimates the cost of lost productivity at $33 billion annually.
Some
of the most costly long-term effects are those associated with responding to adults who, because of earlier abuse, are involved
in criminal activity. The report puts those costs at over $27.9 billion annually. It bases that figure on a National Institute
of Justice study that estimates that 13 percent of all adult violence can be linked to earlier child maltreatment. The report
also includes $7.2 billion in annual costs associated with juvenile delinquency, which is likewise linked to earlier abuse
for many (Maas, Herrenkohl, & Sousa, 2008).
Another indirect cost the report cites is that of lost productivity
to society from adult survivors of child abuse, who are disproportionately affected by unemployment and underemployment later
in life. The report estimates the cost of lost productivity at $33 billion annually.
The cost of child abuse -
whether defined in terms of tax dollars or human suffering - documents a clear need for society to give priority to child
abuse prevention efforts. The mission of Prevent Child Abuse Iowa - to end child abuse in the entire state of Iowa - recognizes
the critical importance of statewide, coordinated prevention efforts.
Child Abuse,
Juvenile Offenses, and Adult Criminal Behavior
Two studies show the extent to which early abuse is related
to later juvenile crime. The first study used juvenile and criminal court records to identify 908 children that were abused
in a Midwestern city from 1967 to 1971 (Maxfield and Widom, 1996). Researchers matched this group of abused children with
a demographically similar group of 667 children who attended the same school and lived in the same five-block radius but who
had not been abused. This matching process minimized the other demographic differences that can exist between groups of abused
and non-abused children.
The study compared the juvenile offense records of the two groups in both 1988 and 1994.
This comparison revealed significant differences between the groups in overall juvenile offenses, including those that involved
violence. Twenty-seven percent of abused children were arrested subsequently for juvenile offenses, compared to 17 percent
of the children who had not been abused. Abused children were also almost twice as likely to be arrested for violent offenses.
A second study likewise confirms the linkage between abuse or neglect and juvenile crime (Smith and Thornberry, 1995). This
study divided seventh and eighth graders in part of Rochester, New York into two groups based on whether or not a student
had suffered maltreatment. The researchers then compared the delinquency behavior of the two groups based on official records
and self-reports. They found that a history of childhood maltreatment "significantly increases the chances of involvement
in delinquency" and "is a significant predictor of the prevalence of official, moderate, and violent delinquency
when race/ethnicity, sex, social class, family structure, and mobility are held constant" (Smith and Thornberry, p. 468).
The researchers released an update of this study in 2001 after re-checking arrest records for the two sampled populations
(Widom and Maxfield). They found that 42% of the abused and neglected children were arrested for a crime as an adult, compared
to 33% of the control group. Those in the abused and neglected group were arrested more often on average than the control
group, with 17% of the abused children having five or more arrests compared to 9% of the control group.
Several
researchers used the same study design to examine 877 children that were abused in the state of Washington from 1980 to 1984
(English, Bradford, and Widom, 2002). The children were identified through court dependency records, meaning they had spent
some time in an out-of-home placement. The study matched this group of abused children with a demographically similar group
of 877 non-abused children. Again, researchers examined the criminal records of both groups through 1998 and compared their
rates of juvenile arrests, adult arrests, and arrests for violent crimes.
The differences they found between
the two groups were more pronounced than in the previous study. Maltreated children were 4.8 times more likely to be arrested
as a juvenile, twice as likely to be arrested as an adult, and 3.1 times more likely to be arrested for a violent crime than
the matched control group. Researchers also found that the abused children were 11 times more likely to be arrested for a
violent crime as a juvenile (8.8% versus 0.8% in the control group).
Furthermore, of the maltreated group, a
total of 40.2% of the males were arrested for a violent crime compared to 16.4% of males in the matched control group. Female
victims, too, were much more likely to be arrested for violent crimes, 15.4% of the abused and neglected females compared
to 2.2% of the control group.
Further suggested reading:
Chalk,
R., Gibbons, A., & Scarupa, H. J. (2002). The Multiple Dimensions of Child Abuse and Neglect: New Insights into an Old
Problem. Washington, DC: Child Trends. Retrieved January 24, 2008 from www.childtrends.org/Files/ChildAbuseRB.pdf
English, D. J., Widom, C. S., & Brandford, C. (2002). Childhood Victimization and Delinquency,
Adult Criminality, and Violent Criminal Behavior: A Replication and Extension. Final Report presented to the National Institute,
Grant No. 97-IJ-CX-0017. Retrieved January 24, 2008 from www.ncjrs.gov/pdffiles1/nij/grants/184894.pdf.
Felitti, V. J., Anda, R. F., Nordenberg, D., et al. (1998).
Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood
Experiences (ACE) Study. American Journal of Preventive Medicine, 14 (4) (1998), 245-258
Kelley,
B. T., Thornberry, T. P., & Smith, C. A. (1997). In the Wake of Childhood Maltreatment. Washington, DC: National Institute
of Justice. Retrieved January 24, 2008 from http://www.ncjrs.gov/pdffiles1/165257.pdf
Maas, C., Herrenkohl, T.I., & Sousa, C. (2008). Review of Research On Child Maltreatment
and Violence in Youth. Trauma, Violence, and Abuse, 9, 56-67.
Maxfield, M.G. & Widom,
C.S. (1996). The Cycle of Violence: Revisited 6 Years Later. Archives of Pediatric and Adolescent Medicine, 150 (April), 390-395
Wang, C. & Holton, J. K. (2007). Total Estimated Cost of Child Abuse and Neglect in the United States.
Prevent Child Abuse America. Retrieved January 29, 2008 from http://www.preventchildabuse.org/about_us/media_releases/pcaa_pew_economic_impact_study_final.pdf
Widom, C. S. & Maxfield, M. G. (2001). An Update on the “Cycle of Violence.”
National Institute of Justice: Research in Brief. Retrieved January 24, 2008 from http://www.ncjrs.gov/pdffiles1/nij/184894.pdf
| | |
For general comments and questions, please contact: Prevent
Child Abuse Iowa
505 Fifth Avenue, Suite 900
Des Moines, Iowa 50309
Phone: 515-244-2200
Toll Free:
800-237-1815
Fax: 515-280-7835
Email: pcaia@pcaiowa.org |
 |  | | | | |
| Prevention
Pays:
The Costs of Not Preventing Child Abuse and Neglect | | Document
Author: National Clearinghouse on Child Abuse and Neglect Information. The Clearinghouse is supported by the Children's
Bureau, Administration on Children, Youth, and Families, Administration for Children and Families, U.S. Department of Health
and Human Services. 11.0. Box 1182, Washington, DC 20013-1182 Contact: E-mail: nccanch@calib.corn
Web: http://www.calib.com/nccanch
Phone: (703) 385-7565
FAX: (703) 385-3206
Date: posted
8/98 | | Child abuse and neglect
cost our society dearly, not only in terms of the trauma caused to the maltreated individuals, but also in economic terms.
Economic costs include the funds spent each year on child welfare services for abused and neglected children as well as the
large sums dedicated to addressing the short- and long-term consequences of abuse and neglect. Effective prevention programs
that promote the safety and well-being of children and families hold potential for lessening the suffering and trauma experienced
by children and greatly reducing these costs. Child abuse and neglect cost our society dearly,
not only in terms of the trauma caused to the maltreated individuals, but also in economic terms. Economic costs include the
funds spent each year on child welfare services for abused and neglected children as well as the large sums dedicated to addressing
the short- and long-term consequences of abuse and neglect. Effective prevention programs that promote the safety and well-being
of children and families hold potential for lessening the suffering and trauma experienced by children and greatly reducing
these costs. To date, few in-depth and rigorous financial analyses have been conducted to give us a solid understanding
of the total costs of maltreatment (i.e., the costs of not preventing child abuse and neglect) as compared with the economic
savings associated with prevention. Nevertheless, several prevention advocates, researchers, and evaluators have begun to
grapple with these issues. The purpose of this paper is to promote greater understanding of what is known about the financial
costs of maltreatment and to encourage continued examination and comparison of these costs with the benefits of prevention.
The paper begins with a discussion of the cost elements that make up the total cost of child maltreatment. The second section
highlights findings from selected studies that have conducted cost-benefit and cost-of-failure analyses. | |
THE COSTS OF CHILD MALTREATMENT Child abuse and neglect have known detrimental effects on the physical,
psychological, cognitive, and behavioral development of children (National Research Council, 1993). These consequences range
from minor to severe and include physical injuries, brain damage, chronic low self-esteem, problems with bonding and forming
relationships, developmental delays, learning disorders, and aggressive behavior. Clinical conditions associated with abuse
and neglect include depression, post-traumatic stress disorder, and conduct disorders. Beyond the trauma inflicted on individual
children, child maltreatment also has been linked with long-term, negative societal consequences. For example, studies associate
child maltreatment with increased risk of low academic achievement, drug use, teen pregnancy, juvenile delinquency, and adult
criminality (Widom, 1992; Kelly, Thornberry, and Smith, 1997). Further, these consequences cost society by expanding the need
for mental health and substance abuse treatment programs, police and court interventions, correctional facilities, and public
assistance programs, and by causing losses in productivity. Calculation of the total financial cost of child maltreatment
must account for both the direct costs as well as the indirect costs of its long-term consequences. Top | Resources Direct Costs
Direct Costs
Direct costs reflect expenditures incurred by the child welfare system
as well as the judicial, law enforcement, health, and mental health systems in responding to abused and neglected children
and their families. Direct costs include expenses associated with hospitalization and medical services provided to treat injuries
resulting from abuse, child protective services (CPS) and/or police investigations; foster care and other outof-home placement
services for maltreated children; and family preservation, rehabilitation, and treatment programs. Government expenditures
for child welfare programs provide a benchmark for estimating a portion of the annual direct costs of child abuse and neglect.
For fiscal year 1998, Federal expenditures to States for major child welfare programs will exceed $4.5 billion. This figure
includes child welfare services, foster care, adoption assistance, and family preservation and support, but excludes Medicaid
dollars, an important source of treatment funding for children and families. Based on a survey of State child welfare agencies
(CWLA, 1997), Federal funding accounts for less than half (42%) of State child welfare expenditures with the remainder supported
by State (49%) and local (9%) funding. A recent study by the Missouri Children's Trust Fund (1997) provides a different
lens through which to view direct costs of maltreatment. The study analyzed the direct economic costs of one type of child
maltreatment-Shaken Baby Syndrome (SBS)-in Missouri over a 10-year period. The study found that the State spent at least $6.9
million, or approximately $32,500 each, on the 214 identified SBS victims. These costs included $4 million in Medicaid expenses,
$1.9 million for Division of Family Services expenditures, and nearly $1 million for Department of Mental Health services.
Indirect Costs
Indirect costs reflect the long-term economic consequences of child maltreatment
in such areas as special education, mental health, substance abuse, teen pregnancy, welfare dependency, domestic violence,
homelessness, juvenile delinquency, and adult criminality. Indirect costs are more difficult to assess than direct costs,
and frequently calculations are based on assumptions or they are extrapolated from research. For example, Deborah Daro (1988)
estimated a national indirect juvenile delinquency cost of $14.9 million based on the following: an estimated 177,300 adolescent
maltreatment victims nationwide in 1983; research indicating a 20 percent delinquency rate among adolescent victims;
and average Cost ($2 1,000 per year) for 2 years of correctional institutionalization for these abused and delinquent youth.
The same analysis estimated that if I percent of severely abused children were to suffer permanent disabilities, the annual
cost of community services for treating children with developmental disabilities would increase by $ 1.1 million. Indirect
costs also may include inferred costs of lost productivity associated with injury, incarceration, long-term unemployment,
or death. For example, Daro's cost analysis (1988) projected that the national cost in future lost productivity of severely
abused or neglected children would be between $658 million and $1.3 billion each year, assuming that their impairments reduce
their future earnings by as little as 5 percent to 10 percent. A Michigan study (Caldwell, 1992) used rates of per capita
income and average lifetime participation in the labor force to generate average lifetime earnings of, and calculate lost
tax revenue from, those children who died as a result of child abuse or preventable infant mortality. The study concluded
that, in addition to the devastating personal losses experienced by the families of the infants and children who died, the
State lost an estimated $46 million in tax revenue. (Although this figure represents the loss of tax revenue over a lifetime,
it can also be interpreted as the per year loss to the State if the rates of tax, abuse, and mortality remain relatively stable.) As
the above examples show, the total financial costs of child abuse and neglect can be quite high. Conversely, the potential
benefits or savings from prevention also are high. These costs and potential savings form the basis of cost-benefit analyses.
PREVENTION COST-BENEFIT ANALYSES
Few in-depth economic analyses have
been conducted to assess the cost-effectiveness of child abuse prevention. Four key studies, presented below, compare the
costs of preventive family support services with the savings generated from the positive outcomes of prevention programs and/or
the direct and indirect costs of not preventing child maltreatment. Many prevention programs, including those referenced in
the studies below, address not only prevention of child abuse and neglect, but also prevention of other threats to child and
family wellbeing. Examples of such threats include preventable health conditions (e.g., low birthweight, infant mortality,
newborn addictions), lack of economic self-sufficiency, social isolation, lack of parenting skills or knowledge, and inappropriate
child rearing behaviors. Several of these other threats also represent precursors or risk factors associated with abuse and
neglect. As such, the benefits generated by addressing these risk factor are included in this broad view of the costs related
to child maltreatment.
Elinira, New York
A 1990 report by David Olds and colleagues presents an economic analysis
within a rigorous evaluation based on a randomized trial of a nurse home visitation program serving 400 pregnant women in
Elmira, New York (Olds et al, 1993). The evaluation indicated that frequent home visits by nurses during pregnancy and the
first 2 years of the child's life improved a wide range of maternal and child health outcomes among adolescent, unmarried,
and low-income first-time mothers (Olds & Kitzman, 1993). The study found that in contrast to women assigned to the comparison
group, nurse visited women experienced: (1) improved health related behaviors (e.g., reduced cigarette use and improved diets)
and use of prenatal services during pregnancy; (2) fewer emergency-room visits for children during the second year of life;
(3) greater workforce participation; and (4) fewer subsequent pregnancies for low-income and unmarried women. In addition,
among poor, unmarried teenage women, the study observed a 75 percent reduction in State-verified cases of child abuse and
neglect during the first 2 years of a child's life. The economic analysis for the Elmira home visitation program
concluded that government savings could offset the program costs for low-income participants within 4 years. The analysis
estimated an average cost of $3,133 per family (1980 dollars) for providing home visitation services to low-income participants,
based on expenditures for nurses' salaries, benefits, supplies, and transportation. These costs were compared with reduced
expenditures in other government programs affected by the positive outcomes of home visitation. The economic impact of improved
maternal and child functioning was evaluated from a standpoint of four government programs-Aid to Families with Dependent
Children, Medicaid, Food Stamps, and CPS-as well as increased tax revenues generated by subsequent employment. Within low-income
families, for the 4-year period following the child's birth, the estimated per family government savings was $3,498 (Olds
et al, 1993). The majority of estimated government savings (based on comparison group expenditures) was derived from reductions
in AFDC and Food Stamp payments, which were associated with increased employment and reduced subsequent pregnancies among
program clients.
Michigan
A 1992 study for the Michigan Children's Trust Fund (Caldwell, 1992) concluded
that providing either comprehensive parent education or home visitation service for every Michigan family expecting its first
child would amount to only 5 percent of the estimated total State cost of maltreatment. Based on an estimated per-family cost
of $712, statewide prevention services were projected at approximately $43 million. In comparison, analysts figured that child
maltreatment and inadequate prenatal care cost the State approximately $823 million. Michigan's total estimated annual
cost of child maltreatment and inadequate prenatal care included direct and indirect costs associated with the following: - Protective
services ($38 million)
- Foster care ($74 million)
- Health costs of low birth weight babies ($256 million)
- Medical treatment of injuries due to abuse ($5 million)
- Special education costs ($6 million)
- Psychological
care for child maltreatment victims ($16 million)
- Juvenile justice system and correction services ($207 million)
- Adult criminality ($175 million)
- Projected tax revenue lost from infant deaths ($46 million).
In
making these estimates, a series of extrapolations were used to account for the proportion of total spending that can be linked
to maltreatment. For example, prior research (Loeber & Stouthamer-Loeber, 1987) suggests that approximately 20 percent
of children from abusive homes commit delinquent acts as juveniles, and 25 percent of these go on to commit crimes as adults.
Based on these findings, the Michigan researchers predicted that of the 39,452 children identified as abused that year, 1,996
would become involved in the adult criminal justice system. With an average annual State adult prison cost of $25,000, and
an average prison sentence of 3.5 years, total adult criminality associated with child abuse and neglect was estimated to
cost $175 million (1,996 x $25,000 x 3.5).
Colorado
A similar 1995 analysis, commissioned by the Colorado Children's Trust Fund,
examined the costs incurred in the State of Colorado by failing to prevent child abuse and neglect, and then compared these
costs with the savings that would accrue from an investment in effective prevention services (Gould & O'Brien, 1995).
The State estimated $190 million in annual direct costs for child maltreatment, including the costs of CPS investigations,
child welfare services to children in their own homes, and out-of-home placements. In addition, annual indirect costs were
calculated based on an assumption that $212 million (approximately 20 percent of the $1 billion total expenditure) in State
social programs were associated with the long-term consequences to individuals maltreated as children (e.g., special education,
AFDC assistance payments, job training programs, youth institutional and community programs, mental health programs for children
and adults, substance and drug abuse programs, victim services, criminal justice programs, domestic violence shelters, and
prisons). Indirect costs ($212 million) and direct costs ($190 million) combined for an estimated total of $402 million in
annual expenditures related to abuse and neglect. The State costs of maltreatment were compared to the potential savings
associated with an intensive home visitor prevention program targeted toward those families most at risk of abuse and neglect.
Based on an estimated $2,000 per family cost of a statewide home visitation program for high risk families with children from
birth to 3 years old, the Colorado analysis projected total costs of $32 million. At the time of the study, $8 million was
being spent in the State on home visitation and family support, thus suggesting a need for $24 million in new money. The Colorado
analysis concluded that if the program were able to reduce child maltreatment expenditures by only 6 percent (.06 x $402 million
annual expenditure), the cost of the prevention investment would be offset.
Allegheny County, Pennsylvania
In a recent study, Bruner (1996) used statistical modeling
to estimate benefits or savings as the potential returns on investment from family centers for high-risk neighborhoods in
Allegheny County, Pennsylvania. This study approaches the cost-of-failure by contrasting the level of spending on remediation,
maintenance, and CPS for residents living in the highest-risk, distressed neighborhoods of the county with the level of spending
in lower risk neighborhoods in the same county. This approach captures real-world comparisons for estimates of "what
could be" (Bruner, 1996). The study first determined the potential "savings" obtainable by transforming
the high-risk neighborhoods into neighborhoods similar to the rest of Allegheny County. This potential savings, or cost-of-failure,
included expenditures across a number of public spending areas most associated with preventable maltreatment and health problems
in childhood AFDC and Medicaid, food stamps, children and youth social services, juvenile justice, jail and prison, and lost
economic activity and tax revenue. The analysis concluded that the county would save approximately $565 million annually in
public spending, or $416.3 million, if these costs were discounted over a 20-year time-frame. Costs were calculated
for establishing family centers to serve populations within the high-risk neighborhoods. This analysis was grounded in the
existing body of research on the various elements needed for children to succeed, the principles of effective front line practice,
and the potential long-term effects of such strategies upon child outcomes. The study projected that to serve 45 percent to
60 percent of all families with very young children in Allegheny County high-risk neighborhoods would require an expansion
of funding of $11.9 million, from $6.6 million (for existing centers with a capacity for 2,640 families) to $18.5 million
(to serve 6,300 to 8,400 families). From a return-on-investment perspective, the $18.5 million expenditure can be compared
with the $416.3 million estimated long-term preventable expenditures. An $18.5 million investment would have to contribute
to reducing such preventable financial costs by only 5 percent for it to be considered cost-effective.
CONCLUSION
In each of the above studies, the analysts concluded that the positive outcomes of
prevention programs, with even relatively small reductions in the rate of child maltreatment, demonstrate that prevention
can be cost effective. Although much remains to be learned about the optimal levels of investment in prevention, these studies
present a starting point for continued analysis and discussion. To estimate the financial costs of the long-term consequences
of child maltreatment on adolescent and adult development and behavior, cost-benefit analyses must take a holistic and
long-term perspective. Most of the investments in prevention, particularly as they apply to investments in families with young
children, are likely to have "payback curves" that extend over a long period of time, with much of the savings occurring
when the child reaches a healthy, productive, and non-violent adulthood (Bruner and Scott, 1994). While additional investment,
research, careful documentation, and well-designed analysis is needed within the prevention fieldboth to assess the effectiveness
of prevention programs as well as its cost-effectiveness - current findings suggest that over the long-term, prevention
pays.
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The report from the Leadership Council on the cost of child abuse
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The Costs of Child Maltreatment
