A Texas Crisis: Toward Reducing Child Maltreatment

By: Dr. M. Ray Perryman
Published in syndication November 16, 2016

There is no social issue more important than protecting children from abuse and neglect. At present, millions of children in the United States are living in households where abuse occurs. More than three million experienced abuse for the first time this year, and many will continue to be maltreated. It's nothing short of tragic, and the consequences for the children involved often last a lifetime.

Dealing with maltreatment is difficult due to both the magnitude and complexity. Resources are insufficient, resulting in overloaded caseworkers, inadequate and disorganized documentation, and too few options in the form of quality foster care homes and support (or efforts to reduce the need for such care). Because of years of chronic underfunding and neglect, nowhere is the problem more acute than in Texas.

In response to this situation in Texas, US District Court Judge Janis Graham Jack ruled in December 2015 that the state's foster care system was unconstitutional in that it failed to protect children from harm. She appointed special masters to come up with proposed solutions and reforms, and the recommendations were filed earlier this month.

Thirty-one "steps/processes/tasks" are recommended, complete with subtasks, implementation dates, and monitoring methodology. Monthly face-to-face visits by caseworkers are recommended, including time alone with each child. Other improvements include better case file systems, 24-hour hotlines to report abuse and neglect, target caseload levels and changes designed to reduce turnover among workers, and multiple measures designed to increase the safety of children in foster care.

Obviously, protecting young people from maltreatment is the primary goal of any and all of these actions. However, given the reality of finite and scarce resources, there will be (and, in fact, already has been in response to hundreds of unaddressed situations) serious debate about whether to commit new resources and, if so, how much. Failing to address this issue is not only a human tragedy, it is also very short-sighted.

The cost of maltreatment is measurable from an economic perspective. A number of studies have quantified the direct social costs (health care, social welfare, juvenile and adult crime, and education costs) associated with child maltreatment. About two years ago, my firm compiled and analyzed available information, updated and refined cost estimates, and calculated the total economic costs as the various direct effects work their way through the US economy in a pro bono effort to inform the discussion.

Direct social costs of child maltreatment include incremental expenses for health care (childhood and adult), social welfare services, criminal justice (juvenile and adult), and education. These costs total hundreds of thousands of dollars per victim. Education level, productivity, and ability to work are affected, thereby reducing lifetime earnings. This loss, in turn, has ripple effects throughout the economy, which we are able to comprehensively model.

The economic consequences of child maltreatment in a given year (2014, which is the year we performed the study) were estimated as they would likely be manifested over the life cycle of the affected individuals. (Given increasing costs of services, such as education and health care, the lifetime totals have likely risen over the past two years.) This approach, known as an "incidence approach" is commonly used in health-related studies and is appropriate for policy evaluation.

We estimate that each individual occurrence of first-time child maltreatment costs the US economy about $1.8 million in total expenditures, $800,000 in gross product and $500,000 in personal income over the lifetime of the affected individual. In Texas alone, child maltreatment in 2014 was estimated to lead to losses of $454.9 billion in lifetime spending, $206.7 billion in lost gross domestic product, and 2.1 million person-years of employment. (Because of cost increases in services as noted above, the failure to address the issue at its core, and the upward trend in the incidence of child maltreatment, these estimates are likely understated.)

Part of the solution to child maltreatment is the availability of alternatives such as quality foster care. A well-functioning safety net system can both reduce the likelihood of further abuse and ameliorate the effects of past abuse. As noted, however, the Texas foster care system is broken.

One promising initiative is Foster Care Redesign, which changes the way the Department of Family and Protective Services procures, contracts, and pays for foster care and other services to children in foster care and their families. Rather than a statewide model, the redesigned structure would be community based, with a single contracted entity (the Single Source Continuum Contractor or SSCC) responsible for ensuring the full continuum of foster care and other services for children in specific geographic areas (catchment areas). The SSCC would be accountable for these children achieving positive outcomes while in foster care.

One reason for shifting to a community-based model is that Texas has one of the largest foster care systems in the United States, both in terms of numbers and geographic area. Administering the system from a central location in Austin has contributed to a number of challenges. In addition, complexities in oversight, payment, and other aspects of the process at times hampered the ability of the system to meet the needs of the youth of Texas.

We estimate that every dollar of State funding required for Foster Care Redesign returns about $3.44 in ultimate revenue or reduced costs to the State. Redesign can initially be more costly, but the long-term benefits in terms of reduced social costs and increased earnings and productivity of the affected individuals lead to sizable fiscal benefits over time. The special masters report recommends that this method be considered as part of the ultimate restructuring.

Child maltreatment is a tragedy that transcends dollars and cents. Nonetheless, budget priorities may well lead to only band-aid solutions. Based on extensive research, I can say with absolute certainty that spending which reduces child maltreatment or improves foster care will be repaid many times over.