The Case for Expanding Boulder County’s Community Infant Program: Paying for Success in Preventing Child Abuse and Neglect
Presentation Outline Pay for Success Background of study The case for early childhood maltreatment prevention The costs of maltreatment Boulder child welfare context PFS analysis 2
Pay for Success
What is Pay for Success? Pay for Success Financing (PFS), uses private capital for upfront investment in social programs where the government agrees to pay for certain measurable results after they are achieved. 4
Elements of Pay for Success Pay-for-Success projects require a payer, service providers, and funders to agree on targeted outcomes around a social challenge. These partners then enter into a multi-year contract, in which the payer agrees to make success payments if targeted outcomes are achieved. Successful Intervention / Provider –supported by data § Payer –usually a government who commits to repay the § investors if project outcomes are achieved Investor(s) –usually private investors for up-front funding § for services (operating costs) Independent Evaluator –third-party who evaluates § success metrics focused on outcomes Intermediary –coordinates parties and contracts § 5
6
Invest in Prevention 100 90 80 70 Percentage of Budget 60 Needed Remedial 50 Short-Term Preventative Funding 40 30 20 10 0 Status Quo Desired State 7
Monetize Down-Stream Cost Savings $ Program Costs Break-Even Point 8
Projecting Benefits: What are we willing to pay for success? Feasibility studies need to evaluate the two main kinds of “success” -- Cost Avoidance and Outcome Improvement “ Success” has two meanings – Cost avoidance actual reductions in government operating costs that are the result of an intervention Outcome improvement measured changes in desired outcomes that are the result of an intervention 9
Background
Project Partners The Wolf Family Foundation
ECCBC PFS Feasibility Study • Collaboration building, assessment of partner priorities, identification and initial analysis of potential interventions. Phase 1 Completed April 2014 • In-depth research on a specific target population, intervention, program outcomes; continued outreach and collaboration Phase 2 building. Completed Oct 2014 • Define specific program outcomes and translate into projected cost savings/avoidance; develop cost-benefit analysis and final Phase 3 report. Completed May 2017
The Case for Early Childhood Maltreatment Prevention
Why Children Under Two? 14
Toxic Stress The prevalence of adverse childhood events (ACEs) in very young children alters the long-term trajectory of their lives in three ways: § Impedes healthy development of brain architecture (neural pathways) which impacts social, emotional and cognitive development § Produces an overabundance of stress hormones that if sustained for prolonged periods have permanent health effects § The consequences of the two processes begin a vicious cycle of behavioral and social consequences (high-risk and anti-social behaviors)
Colorado ACE Study Source: Anderson Mellies (2016) Impact of Adverse Childhood Experiences on Adult Health in Colorado (CDPHE)
Colorado ACE Study Source: Anderson Mellies (2016) Impact of Adverse Childhood Experiences on Adult Health in Colorado (CDPHE)
Child Maltreatment Risk Factors Child Risk Factors § – Children younger than 4 – Physical/cognitive/emotional disability Parental/Family Risk Factors § – Lack of understanding of children’s needs, child development and parenting skills – Parent’s history of child maltreatment – Substance abuse and/or mental health issues – Young age – Low education – Single parent – Large number of dependent children, low income – Low income Community Risk Factors § – Community violence – Concentrated neighborhood disadvantage Source: CDC 18
Boulder County Risk Factors Birth statistic 2015 Education of mother < HS 257 8.81% Low income 929 31.85% Concentrated neighborhood disadvantage 742 25.44% Unmarried 530 18.17% Mother under 20 years 94 3.22% Total births 2917 19
Boulder County Risk Factors Although not mapping the risk factors for child maltreatment, an analysis of the co-occurrence of some factors in Boulder County births in 2015 found: Birth characteristics crosstabs no factors 1404 48.58% one factor 1486 51.42% 1048 36.26% two + two factors 390 13.49% 658 22.77% three + three factors 287 9.93% 371 12.84% four + four factors 242 8.37% five factors 111 3.84% six risk factors 18 0.62% Factors included: foreign born, other than White, non-Hispanic, unmarried, government source of payment, income under $25,000, mothers education less than HS, and very low birth weight. (Source CDPHE) 20
Risk Factor: Age of Child § In 2015, 24% of all screened-in abuse and neglect referrals in Boulder County were for children under the age of 2. § National research indicates one of the greatest risk factors for abuse and neglect is the age of the child, with the youngest children disproportionately victims. § For fatal abuse and neglect the youngest children are even more disproportionately represented—children younger than 3 accounted for more than 70% of fatalities from abuse and neglect. (National Child Abuse and Neglect Data System, ACF, US Dept. HHS)
Source: U.S. Department of Health and Human Services Children’s Bureau, Child Maltreatment 2014
Risk Factor: Age of Child 23
Costs of Child Maltreatment 24
Cost of Child Maltreatment: National Study “The Economic Burden of Child Maltreatment in the United States and Implications for Prevention.” by Xiangming Fang et al., 2012, published in Child Abuse & Neglect Objectives: To present new estimates of the average lifetime costs per child maltreatment victim and aggregate lifetime costs for all new child maltreatment cases incurred in 2008 using an incidence-based approach. 25
Cost Analysis Framing § What’s included – Child Welfare costs (direct) – Health • Short-term (direct) • Long-term (indirect) – Education (indirect) – Justice system (indirect) • Juvenile justice • Adult justice – Lost productivity (indirect)
The Effects of Child Maltreatment Development, speech, and language delay Involvement Child with criminal Abuse & justice Neglect Issues related Mental, to educational physical, achievement behavioral health problems 27
Total Lifetime Costs for All Victims of Maltreatment in Boulder County under Two in 2015 $3,526,739 , 3% $4,017,808 , 4% Total lifetime costs for $521,832 , 0% all new victims under $2,359,406 , 2% two in 2015: $108,650,113 Child Welfare Costs Lifetime cost per victim: Education $218,612 $21,600,322 , 20% Juvenile Justice Adult Justice $71,578,740 , 66% Short Term Health Care Long Term Health Care Productivity Loss $5,045,267 , 5% 28
Total Lifetime Costs for Each Victim of Maltreatment in Boulder County under Two in 2015 $120,000 Graph excludes productivity losses $100,000 $80,000 Cost $60,000 $40,000 $20,000 $0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 60 62 64 Age Child Welfare Education Juvenile Justice Adult Justice Short Term Health Care Long Term Health Care 29
Cost of Child Maltreatment: Education $101,854 for each child Estimated lifetime costs of requiring Special the victims of Education maltreatment in Boulder County under two in 2015 Average $8,923 per each victim $4,434,588 for all victims under two combined 30
Cost of Child Maltreatment: Education § Child maltreatment victims are nearly twice as likely to require special education (SPED) services § Once identified for SPED, students rarely exit, thereby incurring significant costs annually § The average SPED expenditure, above general education costs, is: – $12,393 for Boulder Valley School District – $7,833 for St. Vrain Valley School District 31
Cost of Child Maltreatment: Education In addition to SPED and remedial literacy interventions, research shows many other educational outcomes associated with maltreatment, including: Lower academic achievement—57% lower (Kendall-Tackett and – Eckenrode (1996)) Lower IQ--neglected infants had significantly lower IQ (Gowen – (1993)) Greater incidence of grade repetition—2.5 times more likely to – repeat a grade (Meadows et al. (2011)) Lower high school graduation rates—41% lower (Meadows et al. – (2011)) Increased absenteeism (Leiter (2007), Slade (2007)) – Increased disciplinary referrals and suspensions (Eckenrode et al. – (1993)) 32
Cost of Child Maltreatment: Juvenile Justice Estimated lifetime costs of $14,676 for each youth the victims of in juvenile justice maltreatment in Boulder County under two in 2015 Average $1,050 per each victim $521,832 for all victims under two combined 33
Cost of Child Maltreatment: Criminal Justice Estimated lifetime costs of $97,048 for each victim the victims of that is incarcerated maltreatment in Boulder County under two in 2015 Average $4,747 per each victim $2,359,406 for all victims under two combined 34
Recommend
More recommend
