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The ECONOMIC COST OF Child ABUSE TO SOCIETY

Child abuse and neglect cost our society, 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 (direct costs) as well as the large sums dedicated to addressing the short- and long-term consequences of abuse and neglect (indirect costs).

See also:

"Child sexual abuse is a preventable health problem that has been allowed to spread unabated due to scientific and social neglect."

--PAUL FINK, SCIENCE, VOL 309, AUGUST 2005

“[W]e find an incidence rate for child abuse and neglect that is about ten times as high as the incidence rate for all forms of cancer. . . . [T]here is a multi-billion-dollar research base reliably renewed on an annual basis for cancer treatment and prevention. Nothing remotely similar to this exists for child abuse and neglect.”

---Frank Putnam, M.D., researcher at the National Institute of Mental Health, from “Why is it so Difficult for the Epidemic of Child Abuse to be Taken Seriously?”
Handout: The Costs and Consequences of Child Abuse by Frank W. Putnam

The incidence rate of child abuse and neglect in this country is about ten times as high (40 children per thousand children per year) as the incidence rate for all forms of cancer (3.9 individuals per thousand individuals per year). Yet the federal fiscal year 2001 budget for the National Cancer Institute is $3.74 billion, while funding for CAPTA state grants, CAPTA discretionary grants, and CAPTA Community Based Grants combined totals only $72 million. We as a nation need to confront the substantial societal costs and devastating consequences with the same vigor as we tackle other national emergencies.

--Child Welfare League of America, Testimony submitted to the House Subcommittee on Select Education of the Committee on Education and the Workforce for the hearing on CAPTA: Successes and Failures at Preventing Child Abuse, (August 2, 2001)

Imagine a childhood disease that affects one in five girls and one in seven boys before they reach 18 (Finkelhor & Dziuba-Leatherman, 1994): a disease that can cause dramatic mood swings, erratic behavior, and even severe conduct disorders among those exposed; a disease that breeds distrust of adults and undermines the possibility of experiencing normal sexual relationships; a disease that can have profound implications for an individual's future health by increasing the risk of problems such as substance abuse, sexually transmitted diseases, and suicidal behavior (Crowell & Burgess, 1996); a disease that replicates itself by causing some of its victims to expose future generations to its debilitating effects.

Imagine what we, as a society, would do if such a disease existed. We would spare no expense. We would invest heavily in basic and applied research. We would devise systems to identify those affected and provide services to treat them. We would develop and broadly implement prevention campaigns to protect our children. Wouldn't we?

Such a disease does exist—it’s called child sexual abuse. Our response, however, has been far from the full-court press reserved for traditional diseases or health concerns of equal or even lesser magnitude. Perhaps the perception of sexual abuse as a law enforcement problem or our discomfort in confronting sexual issues contributes to our complacency. Whatever the reason, we have severely underestimated the effects of this problem on our children's health and quality of life.

Excerpted from a commentary by Dr. James Mercy’s, a researcher with the Center for Disease Control and Prevention: Mercy, J. A. (1999). Having New Eyes: Viewing Child Sexual Abuse as a Public Health Problem. Sexual Abuse: A Journal of Research and Treatment, 11(4), 317-321.

ANALYSES

The Adverse Childhood Experiences Study

The Adverse Childhood Experiences (ACE) Study is a major American research project examining the effects of adverse childhood experiences on adult health and well-being. This large scale research project has revealed a powerful relationship between emotional experiences during childhood and physical and mental health during adulthood, including the major causes of adult mortality in the United States.

See also: Child Abuse Can Last a Lifetime. (March 1999). Facts of Life:
Issue Briefings for Health Reporters
, Vol. 4, No. 2.
Adult survivors of childhood physical, emotional, or sexual abuse are not only at increased risk for depression and other mental health disorders, but new evidence suggests they are increasingly more likely to suffer from heart disease, obesity, and other potentially fatal physical conditions. Although it appears that trauma survivors frequently smoke, drink, and overeat as a way to cope with their emotional turmoil, other evidence suggests that the trauma itself may have profound effects on the body that leave it increasingly vulnerable to disease. Researchers, for example, have found that childhood abuse survivors show changes in brain structure and in their physiological responses to stress.

Anda, R.F., Brown, D.W., Felitti, V.J., Dube, S.R., & Giles, W.H. (2008). Adverse childhood experiences and prescription drug use in a cohort study of adult HMO patients. BMC Public Health, 8, 198.
Available free on-line

Prescription drugs account for approximately 11% of national health expenditures. The investigators prospectively assessed the relationship of the Score to prescription drug use in a cohort of 15,033 adult HMO patients (mean follow-up: 6.1 years) and adverse events in childhood. There was a graded relationship between increased adverse experiences during childhood and increased number of prescriptions. Experiencing childhood adverse events substantially increase the number of prescriptions and classes of drugs used for as long as 7 or 8 decades after their occurrence. The increases in prescription drug use were largely mediated by documented ACE-related health and social problems.

Bess, R., Andrews, C., Jantz, A., Russell, V., & Green, R. (2002). The Cost of Protecting Vulnerable Children: What Factors Affect States' Fiscal Decisions? Washington, D.C.: The Urban Institute. Published: December 18, 2002 (PDF)

States spent at least $20 billion on child welfare services in SFY 2000. The survey also found that state child welfare agencies were using a large amount of funds not dedicated to child welfare services (e.g., Medicaid, Temporary Assistance for Needy Families) to meet the needs of the children and families they were serving. In addition, the survey found that states were spending relatively little on prevention. 

Bonomi et al. (2008). Health care utilization and costs associated with childhood abuse. Journal of General Internal Medicine, 23(3), 294-9.
Available free

Objective
Examined long-term health care utilization and costs associated with physical, sexual, or both physical and sexual childhood abuse in 3333 women (mean age, 47 years) randomly selected from the membership files of a large integrated health care delivery system.
Results

Significantly higher annual health care use and costs were observed for women with a child abuse history compared to women without comparable abuse histories. The most pronounced use and costs were observed for women with a history of both physical and sexual child abuse. Total adjusted annual health care costs were 36% higher for women with both abuse types, 22% higher for women with physical abuse only, and 16% higher for women with sexual abuse only.
Conclusions
Child abuse is associated with long-term elevated health care use and costs, particularly for women who suffer both physical and sexual abuse.

Bonomi et al. (2008).

Caldwell, R. A. (1992). The Costs of Child Abuse vs. Child Abuse Prevention: Michigan's Experience. East Lansing, MI: Michigan Children's Trust Fund.
A 1992 study for the Michigan Children's Trust Fund (Caldwell, 1992). 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)
Cost of Child Abuse and Neglect in the United States. (1998). Children's Safety Network Economics and Insurance Resource Center, at the National Public Services Research Institute, Landover, MD.
Farmer, A., & Tiefenthaler, J. (2002). Domestic Violence Reduces Business Productivity and Profit.
This study is based on data sets from publicly available U.S. studies on domestic violence, including the annual National Crime Victimization Surveys (NCV), two Physical Violence in American Families (PVAF) studies and seven studies in The National Violence Against Women Survey (NVAW). Results show that domestic abuse may result in almost 7 million lost work days annually, reduce workplace productivity, increase insurance costs and lower profits. Data analysis indicates that domestic violence causes $975 million in lost wages for the victims just in days missed from work. This does not include the money lost while they are at work as a result of working in lower paying jobs.

The Cost of Child Abuse in Australia (2008).
a joint research report by Access Economics, Australian Childhood Foundation and Child Abuse Prevention Research Australia at Monash University.
http://www.monash.edu.au/news/newsline/story/1373

The first comprehensive, national study of the costs of child abuse and neglect in Australia has found that child abuse and neglect costs Australians ten times more than obesity. The report has also found that the number of cases of abuse in our community may be five times higher than the official figures. It found that the real cost of child abuse to the Australian community in 2007 was $10.7 billion, and could be as high as $30.1 billion, including the monetary value of the pain and suffering that they experience.

The figures account for the costs associated with protecting and caring for child victims of abuse, including the wages for professional workers such as doctors, nurses, police, social workers, judges, probation officers, teachers and foster carers. It also includes responding to crime associated with child abuse and neglect, additional government expenditure on educational assistance for victims, poorer long-term labour market outcomes and an estimate of the total cost of the pain and suffering experienced by child victims of abuse.

While there were 36,000 substantiated reports of child abuse and neglect in Australia in 2007, the report estimates that there approximately 177,000 children abused or neglected and this figure could be even higher. The report also calculated that the cost to the community of the consequences of abuse over the lifetime of children who were abused for the first time in 2007 is approximately $13.7 billion and could be as high as $38.7 billion, including the monetary value of the pain and suffering that they experience.

"The results of this report highlight the urgent need for a national uniform approach to one of Australia's most serious -- and financially crippling -- problems," Professor Goddard said.

Kids First Foundation. (2003). Report into the Cost of Child Abuse and Neglect in Australia.Tugun, Queensland.
Report on Cost of Child Abuse and Neglect in Australia (Part 1) (Part 2)

The report, commissioned by the Kids First Foundation, is the first in Australia to calculate the national short- and long-term costs of child abuse and neglect. It found that child abuse costs Australian taxpayers at least $3.5 billion a year. The costs include an annual medical bill of more than $900 million to treat injuries caused by abuse, and almost $80 million spent trying to save fatally injured children.

The report found child protection programs -- including foster placements and other out-of-home support -- cost the community $558 million a year. Taxpayers foot an annual bill of $556 million, including police, court and jail expenses to prosecute and punish child abusers.

The single greatest cost was long-term social and human problems caused by child abuse, calculated at $1.3 billion annually. That figure included the costs of crimes committed by juvenile delinquents and adult criminals, whose childhood abuse was considered a significant factor in their anti-social behavior. The cost of chronic health problems caused by abuse was not included in this estimate.

Gould, M. S. & O'Brien, T. (1995). Child Maltreatment in Colorado: The Value of Prevention and the Cost of Failure to Prevent . Denver, CO: Center for Human Investment Policy, University of Colorado at Denver.

Colorado Children's Trust Fund examined the costs incurred in the State of Colorado by failing to prevent child abuse and neglect. Colorado 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.

Irazuzta, J. E., McJunkin, J. E., Danadian, K., Arnold, F., & Zhang, J. (1997). Outcome of child abuse. Child Abuse & Neglect, 21, 751-757.

A retrospective cohort study of all patients admitted to the pediatric intensive care unit (PICU) between January 1991 and August 1994 revealed out of 937 admissions; 13 were secondary to child abuse. Cases of child abuse were compared with other admissions for differences in patient-specific health care costs, severity of illness and mortality, and outcome. Cases of child abuse represented 1.4% of admissions and 17% of deaths. Abused patients had the highest severity of illness (61%), hospitalization charges ($30,684), daily charges ($5,294) and mortality rates (53%) of any group. Moreover, 70% of the abused children died and most (60%) of the survivors had severe residual morbidity.

The authors concluded that that interventional medical care in response to severe child abuse is very costly and the ultimate outcome is significantly worse than other diseases. As a result, they determine that is it is imperative to allocate more resources to prevention.

Julich, S. (2002). Cost of Child Sexual Abuse in New Zealand - Doctoral research

Doctoral candidate Shirley Julich spent six years studying how much sexual abuse is costing New Zealand. Dr. Julich found that 8,600 children in New Zealand are sexually abused for the first time every year, and 25% of girls and 9% of boys in New Zealand are sexually abused in some way by the time they reach age 16. This widespread sexual abuse of children is costing New Zealand $2.4 billion a year. This figure comes from adding together the cost of lost earning, extra health bills and the unmet potential of adult survivors of childhood sexual abuse.

She also found that less than 8% of adult victims ever report their abuse and an offender averages 50 victims before being caught. "Survivors said that as children they were threatened with their families falling apart or loved ones going to jail if they told," she says.

"In one case, a girl knew if she told anyone her mother would be beaten." Dr. Julich noted that the results of sexual abuse for many victims is low self-worth, alcohol and drug abuse and ongoing psychological problems.

(see: Schultz, C. (2002, August 15). Abuse carries steep price. Western Leader, Page 5).

Ted Miller, Mark Cohen, & Brian Wiersema. (1996). Victim Cost & Consequences: A New Look. U.S. Department of Justice (PDF I html)
Taking into account short-term medical care, mental health services, lost productivity, and pain and suffering, the cost per adult sexual assault is estimated at $87,000 per episode of sexual violence.3 The subtotal of tangible costs is $5100, including $500 in medical care, $2,200 in lost productivity, and $2,200 in mental health care. Since many rape victims experience more than one episode of sexual violence, the cost per victim is estimated at $110,000.

Macmillan, R. (2000). Adolescent Victimization and Income Deficits in Early Adulthood: Rethinking the Costs of Criminal Violence from a Life Course Perspective. Criminology, 31, 553-87.

Ross Macmillan, a sociologist at the University of Minnesota, prospectively studied a group of American adolescents and found that in addition to pain and suffering, teenage victims of violent crime pay a stiff economic price for having been robbed, assaulted or raped during adolescence.

Macmillan's findings are based on data from a longitudinal survey that began in the mid-1970s and tracked the lives of 1,725 American children ages 11 to 17 through to adulthood. Individuals who had been victimized before age 18 grew up to earn, on average, about a dollar less per hour than similar kids who were not crime victims--a "victimization penalty" of about 14 percent in lifetime average earnings. In contrast, the earnings of those who were first crime victims in their twenties or thereafter were unaffected.

This relationship held up after controlling for every variable that researchers currently believe affect socioeconomic attainment, including age, family income, race, gender, urban residence, neighborhood quality, residential stability, family size and structure, measures of parental control, and involvement in crime and delinquency.

Stewart, A., Dennison, S., & Waterson, E. (2002, October). Pathways from child maltreatment to juvenile offending. T rends and Issues in Crimes and Criminal Justice , #241. Australian Institute of Criminology.
http://www.aic.gov.au/publications/tandi/tandi241.html
Download paper (pdf - 222kB)

Abstract: This study demonstrates a direct path from child maltreatment to juvenile offending. The study focuses on the 41,700 children born in Queensland in 1983. It finds that about 10% of these children came into contact with the Department of Families by the time they were 17 years old because of a child protection matter. About 5% of those in the cohort had a court appearance for a proven offence. Many, but not all, of these children fitted into both categories (that is, coming into contact with the Department as well as having a court appearance).

The authors examine 11 predictive factors for youth offending, and find that children who suffer maltreatment are more likely to offend. Physical abuse and neglect are significant predictive factors, but sexual and emotional abuse are not. 

The authors conclude that preventing child maltreatment is likely to result in a large decrease in juvenile offending. ``By directing attention to those children who are maltreated and ensuring that the maltreatment is not repeated, significant benefits in crime reduction ... can be ... obtained" (p. 6).

Reviews and commentary

Courtney, M. E. (1999). National call to action: Working toward the elimination of child maltreatment. The economics. Child Abuse & Neglect, 23(10), 975-986.

Abstract: No reliable estimates exist of the overall costs to society of child maltreatment that will withstand serious examination. Arguably some of the most important human costs of maltreatment are unquantifiable. Moreover, in many cases it is difficult if not impossible to separate the economics of child abuse and neglect from the economics of a host of other problems facing families. Still, even conservative estimates of government spending on behalf of abused and neglected children and their families illustrate that child maltreatment costs society a great deal, with much of that expense going for deep-end intervention rather than family support and prevention. Government expenditures directed at this social problem have grown rapidly since the rediscovery of child abuse in the 1960s and now exceed spending for a number of essential supports for children and families. Moreover, the new era of continuing commitment to child protection in the context of a revised social contract with the nation's poor raises serious questions about the economics of child maltreatment in the future.

Courtney, M. E. (1998, Spring). The costs of child protection in the context of welfare reform. The Future of Children, 8(1), 88-103.

Abstract:  The financing structure of any large public service system both reveals the priorities held by policymakers and drives the delivery of services. Of the $11.2 billion in public funds for child welfare services, somewhat less than half is federal. As this article explains, federal funds for child welfare overwhelmingly go to support out-of-home care (foster care and adoption services), and these costs have risen sharply in recent years. In contrast, federal funding for child protection investigations, prevention programs, and treatment services is more limited, and expenditures have not risen apace with reports of maltreatment. The article compares the high cost of foster care with the lower per capita cost of cash assistance to poor families and the per-case costs of child protection investigations and service provision. Pointing out that the great majority of families served by the child welfare system are poor, the author argues that child welfare and cash assistance should be seen and analyzed as interrelated programs serving poor families. The article examines the varied ways in which the changes in cash assistance programs introduced by the 1996 federal welfare reform law may increase the need for child welfare services and drive up the costs of child protection.

Dallam, S. J. (2001). The long-term medical consequences of childhood trauma. In K. Franey, R. Geffner, & R. Falconer (Eds.), The cost of child maltreatment: Who pays? We all do. (pp. 1-14). San Diego, CA: Family Violence & Sexual Assault Institute.

Despite the millions of children impacted by abuse or neglect and the well-documented associations between childhood maltreatment and a host of neuropsychiatric conditions (e.g., posttraumatic stress disorder, dissociative disorders, mood disorders, conduct disorders), until recently there has been a relative lack of systematic research on the physiological after-effects of childhood maltreatment.  As a result, few people are aware that childhood maltreatment is a powerful risk factor for health problems in adulthood. This chapter (1) summarizes the effects of maltreatment on the neuroendocrine system; (2) provides an overview of the association between childhood maltreatment and adult health; and (3) examines the potential economic impact of childhood maltreatment on health care utilization.

Dubowitz, H. (1990). Costs and effectiveness of interventions in child maltreatment. Child Abuse and Neglect, 14(2), 177-186.

Abstract:  There has been increasing awareness of the need to prevent child maltreatment at a time of limited public funds. As a result, cost-effectiveness has become important in the planning of health care and social services. Evaluations of child maltreatment interventions that have been analyzed for their cost-effectiveness are reviewed. There has been relatively little work in this area and much of it has serious methodological flaws. Nevertheless, research suggests that home health visitors, lay group counseling, and family and group therapy are promising interventions. Medical foster care has been shown to substantially reduce costs, but its effectiveness has not been determined. Current knowledge on the effectiveness of interventions in child maltreatment is limited, and this needs to be addressed in order to answer the question of cost-effectiveness. Recommendations are made for future research in the field.

Felitti, V. (2002).The Relationship Between Adverse Childhood Experiences and Adult Health: Turning Gold into Lead. The Permanente Journal, 6, 44-47.

Franey, K., Geffner, R., & Falconer, R. (Eds.). (2001). The cost of child maltreatment: Who pays? We all do. San Diego, CA: Family Violence & Sexual Assault Institute. http://www.fvsai.org/bookslist.doc

The harm caused by child maltreatment extends beyond the individual victim to society as a whole. Abused children are at risk for numerous physical and mental health problems that make them more likely than non-abused children to develop eating disorders, depression, personality disorders, and somatic complaints. Children and adults who have been abused utilize physicians and psychiatric services more than nonabused persons. These individual problems can affect other people, as unresolved shame related to abuse can contribute to violence, a continuation of the cycle of abuse, and criminal behavior. The economic costs of abuse are great. This compilation of articles reviews the individual and societal consequences of child maltreatment. Long-term medical and mental health effects are described, as well as the prevalence of abuse history among female inmates, homeless and runaway adolescents, and other women. Cost and benefit estimates are presented in the final section. The articles illustrate the necessity of allocating more resources to the prevention and early intervention of abusive behaviors. Numerous references, numerous figures, numerous tables.

Table of Contents

I. MEDICAL IMPACT

II.  MENTAL HEALTH IMPACT

  • The Cumulative Impact of Abuse across the Left Span: Child Sexual Abuse and Adult Revictimization - Elizabeth Frenkel and Margaret O'Dougherty Wright
  • Adversity and its Outcomes: The Measurement of Childhood Trauma - Evvie Becker
  • Child Abuse and Severity of Disturbance among Adult Psychiatric Inpatients - John Read
  • Type and Severity of Child Abuse and College Students' Lifetime Suicidality - Susan L. Bryant and Lillian M. Range
  • Immediate and Long-Term Impacts of Child Sexual Abuse - John Briere and Diana Elliot

III. SOCIETAL IMPACT

  • Prevalence and Severity of Lifetime Physical and Sexual Abuse among Female Inmates - Angela Browne, Brenda Miller, and Eugene Maguin
  • The Effects of Early Sexual Abuse on Later Sexual Victimization among Female Homeless and Runaway Adolescents - Kimberly A. Tyler, Dan R. Hoyt, and Les B. Whitbeck
  • Early Family Life and Victimization in the Lives of Women - Claire Burke Draucker

IV.  ECONOMIC COSTS

  • Why is it so Difficult for the Epidemic of Child Abuse to be Taken Seriously? - Frank W. Putnam
  • Cost and Benefit Simulation of Analysis of Catastrophic Maltreatment - Sachiko Nobuyasu
  • Working Toward the Elimination of Child Maltreatment: The Economics - Mark E . Courtney
  • Child Abuse in America: Prevalence, Costs, Consequences and Intervention - Bessel A. van der Kolk

FRIENDS National Resource Center For Community-Based Child Abuse Prevention Programs. (2005). Making the case for preventing child abuse and neglect : an overview of cost effective prevention strategies. United States Department of Health and Human Services' Children's Bureau.

There is a growing body of knowledge regarding the value of prevention strategies and programs that can demonstrate positive outcomes for targeted populations. This report provides the following: A brief review of the cost-benefits of child abuse and neglect prevention; Identification of a number of noteworthy prevention programs and strategies, including some evaluation data; Discussion of the limitations of the existing research; Identification of important factors to consider in the replications of prevention programs; and Additional prevention resources for more information.

Kendall-Tackett, K. (2003). Treating the Lifetime Health Effects of Childhood Victimization. Kingston, NJ: Civic Research Institute.

Explains why and how child abuse can lead to long-term, chronic health problems for survivors, and details frequently encountered immune system, gastroenterological and gynecological problems among survivors-and examines the implications for clinical practice.

Kendall-Tackett, K. (Ed.). (2003). Health Consequences of Abuse in the Family: A Clinical Guide for Evidence-Based Practice. Washington, DC: American Psychological Association.

This book looks at the healthcare needs of people who have experienced abuse and subsequently have related chronic diseases and conditions.

National Clearinghouse on Child Abuse and Neglect Information. (2003). Prevention Pays: The Costs of Not Preventing Child Abuse and Neglect. Washington, DC: U.S. Department of Health and Human Services.

This bulletin reviews the factors that should be considered when estimating the cost effectiveness of child abuse prevention programs. Findings from cost-benefit evaluations of family support programs in Elmira, New York; Michigan; Colorado; and Allegheny County, Pennsylvania are summarized. The publication highlights direct and indirect expenditures, as well as methodologies for determining cost savings

National Clearinghouse on Child Abuse and Neglect Information. Making an Economic Case for Prevention. Washington, DC: U.S. Department of Health and Human Services.

Contains information about some common types of economic analyses used by prevention programs, and tips and resources for developing these analyses at the local level.

National Clearinghouse on Child Abuse and Neglect Information. (2003). Long-term Consequences of Child Abuse and Neglect. Washington, DC: U.S. Department of Health and Human Services.

Much research has been done about the possible consequences of child abuse and neglect. The effects vary depending on the circumstances of the abuse or neglect, personal characteristics of the child, and the child's environment. Consequences may be mild or severe; disappear after a short period or last a lifetime; and affect the child physically, psychologically, behaviorally, or in some combination of all three ways. Ultimately, due to related costs to public entities such as the health care, human services, and educational systems, abuse and neglect impact not just the child and family, but society as a whole.

Prevent Child Abuse America. (2001). Total Estimated Cost of Child Abuse and Neglect in the United States: Statistical Evidence.

Using the best available research and conservative estimates, direct costs were estimated at about 24  billion annually and indirect costs at about 70 billion annually. The total cost of child abuse in the US was estimated to be about 94 billion annually.

Total Annual Cost of Child Abuse and Neglect in the United States
Hospitalization
$6,205,395,000
Chronic Health Problems
$2,987,957,400
Mental Health Care System
$425,110,400
Child Welfare System
$14,400,000,000
Law Enforcement
$24,709,800
Judicial System
$341,174,702
Total Direct Costs
$24,384,347,302

Prevent Child Abuse New York. (2001). Causes and consequences: The urgent need to prevent child abuse.

Schnurr, P. P., & Green, B. L. (Eds.). (2004). Trauma and Health: Physical Health Consequences of Exposure to Extreme Stress. Washington, DC: American Psychologial Association.

This volume summarizes findings on trauma and PSTD in relation to health status and disease, somatization, and utilization and cost. Contributors examine the biology of stress and PTSD, and how trauma and PSTD could lead to poor physical health through correlates such as depression, coping, and health behaviors. They also present implications for clinical and health policy.

Tang, B., Jamieson, E., Boyle, M., Libby, A., Gafni, A., & MacMillan, H. (2006). The influence of child abuse on the pattern of expenditures in women's adult health service utilization in Ontario, Canada. Soc Sci Med., 63(7), 17119. [ PubMed ]

Data was gathered as part of a province-wide population health surveys of a probability-based sample of persons aged 15 years and older living in household dwellings in Ontario.
Self-reported health service utilization was collected in four groups of women--those who reported no history of child abuse, those with a history of physical abuse only, those who reported sexual abuse only, and those who reported both physical and sexual (combined) abuse.
Results
The results indicated that having a history of combined abuse nearly doubles mean annual ambulatory self-reported health care costs to 775 dollars (95% CI 504 dollars-1045 dollars) compared to a mean cost of 400 dollars with no abuse (95% CI 357 dollars-443 dollars). Median annual ambulatory self-reported health care costs were also increased in the combined abuse group, to 314 dollars (95% CI 220 dollars-429 dollars), compared to 138 dollars (95% CI 132 dollars-169 dollars) in those with no abuse.
Conclusion
Child abuse in women is significantly associated with increased adult self-reported health care costs.

Washington Council for Prevention of Child Abuse and Neglect - WCPCAN. (2002). Prevention pays.

This document uses research to demonstrate the potential savings created by effective prevention and early intervention programs in the state of Washington.

Wisconsin's Children's Trust Fund. (2005). Invest in Wisconsin's Children Now.

This document compares Wisconsin's current spending on prevention programs to the total cost to "repair the damage" done by child abuse and neglect. The document also includes an illustration of the payoff of prevention and estimates lost tax revenue annually due to deaths caused by child abuse and neglect.

 

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