Economics of Child Protection: Maltreatment, Foster Care, and Intimate Partner Violence

Doyle, Jon; Aizer, Anna

doi:10.1146/annurev-economics-080217-053237

Cited by 61 publications

(38 citation statements)

References 111 publications

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“…Finally, the direct effects of the strain of experiencing poverty itself can limit adults' attentional and cognitive resources [47][48][49][50] available for parenting. Children from low-income families and communities with high rates of poverty are substantially more likely to experience adverse events including abuse or neglect [33,51,52], which is associated with long-term impacts on adult health [53,54] and well-being [1,55]. The leading cause of death of children under five is unintentional injury, which is more common in low-income neighborhoods [56].…”

Section: Protocol Paper Focus: Maternal and Child Health Outcomes Durmentioning

confidence: 99%

Protocol for a randomized controlled trial evaluating the impact of the Nurse-Family Partnership’s home visiting program in South Carolina on maternal and child health outcomes

McConnell

Zhou

Martin

et al. 2020

Trials

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Background Policy-makers are increasingly seeking rigorous evidence on the impact of programs that go beyond typical health care settings to improve outcomes for low-income families during the critical period around the transition to parenthood and through early childhood. Methods This study is a randomized controlled trial evaluating the impact of the Nurse-Family Partnership’s expansion in South Carolina. The scientific trial was made possible by a “Pay for Success” program embedded within a 1915(b) Waiver from Medicaid secured by the South Carolina Department of Health and Human Services. This protocol describes study procedures and defines primary and secondary health-related outcomes that can be observed during the intervention period (including pregnancy through the child’s first 2 years of life). Primary study outcomes include (1) a composite indicator for adverse birth outcomes including being born small for gestational age, low birth weight (less than 2500 g), preterm birth (less than 37 weeks’ gestation), or perinatal mortality (fetal death at or after 20 weeks of gestation or mortality in the first 7 days of life), (2) a composite outcome indicating health care utilization or mortality associated with major injury or concern for abuse or neglect occurring during the child’s first 24 months of life, and (3) an indicator for an inter-birth interval of < 21 months. Secondary outcomes are defined similarly in three domains: (1) improving pregnancy and birth outcomes, (2) improving child health and development, and (3) altering the maternal life course through changes in family planning. Discussion Evidence from this trial on the impact of home visiting services delivered at scale as part of a Medicaid benefit can provide policy-makers and stakeholders with crucial information about the effectiveness of home visiting programs in improving health and well-being for low-income mothers and children and about novel financing mechanisms for cross-silo interventions. Trial registration The trial was registered prospectively on the American Economic Association Trial Registry (the primary registry for academic economists doing policy trials) on 16 February 2016 (AEARCTR-0001039). ClinicalTrials.gov NCT03360539. Registered on 28 November 2017.

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Section: Protocol Paper Focus: Maternal and Child Health Outcomes Durmentioning

confidence: 99%

Protocol for a randomized controlled trial evaluating the impact of the Nurse-Family Partnership’s home visiting program in South Carolina on maternal and child health outcomes

McConnell

Zhou

Martin

et al. 2020

Trials

View full text Add to dashboard Cite

show abstract

“…One interesting feature of our vignette approach could be counted as a strength (for theoretical clarity) and a weakness (for realism): we excluded implicit forms of insurance that exist in the United States. [55] Specifically, for the respondents in the uninsured conditions, we did not make salient the fact that they could get some healthcare in hospital emergency rooms, without showing proof of payment, due to a Federal law called EMTALA. Further, although we did ask them to consider their access to credit when estimating their maximum purchasing power, we did not make especially salient the fact that they could rack up medical bills and ultimately fail to pay them, perhaps even discharging them in bankruptcy.…”

Section: Plos Onementioning

confidence: 99%

Distinguishing moral hazard from access for high-cost healthcare under insurance

et al. 2020

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Health policy has long been preoccupied with the problem that health insurance stimulates spending ("moral hazard"). However, much health spending is costly healthcare that uninsured individuals could not otherwise access. Field studies comparing those with more or less insurance cannot disaggregate moral hazard versus access. Moreover, studies of patients consuming routine low-dollar healthcare are not informative for the high-dollar healthcare that drives most of aggregate healthcare spending in the United States. Methods We test indemnities as an alternative theory-driven counterfactual. Such conditional cash transfers would maintain an opportunity cost for patients, unlike standard insurance, but also guarantee access to the care. Since indemnities do not exist in U.S. healthcare, we fielded two blinded vignette-based survey experiments with 3,000 respondents, randomized to eight clinical vignettes and three insurance types. Our replication uses a population that is weighted to national demographics on three dimensions. Findings Most or all of the spending due to insurance would occur even under an indemnity. The waste attributable to moral hazard is undetectable. Conclusions For high-cost care, policymakers should be more concerned about the foregone efficient spending for those lacking full insurance, rather than the wasteful spending that occurs with full insurance.

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“…Child maltreatment is yet another context in which family change or disruption may serve to benefit a child's wellbeing. Child maltreatment-generally defined as abuse and/or neglectis associated with an extensive array of poor outcomes, including homelessness and criminal justice involvement (Doyle and Aizer 2018), poor socioemotional and cognitive developmental outcomes (Font and Berger 2015), and poor mental and physical health both in childhood and into adulthood (Jonson-Reid, Kohl, and Drake 2012). Therefore, in the most extreme cases of substantiated maltreatment, in which a child is deemed to be at high or imminent risk of further maltreatment if left in their current care setting, decisions to remove a child from the home and place them in foster care may, in fact, be beneficial.…”

Section: Background Family Instability and Child Wellbeingmentioning

confidence: 99%

Instability in Care and Living Arrangements: Putting Foster Youth in Context

Yi¹

2019

Preprint

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Family instability is a key dimension of social inequality in the United States. Child maltreatment is one context in which changes to a child’s care and living arrangements, introduced when a child is placed in foster care, could actively improve a child’s wellbeing. In this study, I analyze a nationally representative sample of child welfare-involved youth to examine whether the association between foster care and instability in care and living arrangements is driven by children’s placement in foster care or by the selectivity of foster youth. I find that compared to children who do not enter foster care, those who do are more likely to experience change in their primary caregiver, availability of a secondary caregiver, and their living arrangement. When I treat the initial transition into foster care as necessary, excluding it from my measures of change, foster care appears to stabilize the structures of children’s care arrangements, while their constitutive relationships remain substantially less so. In addition to answering an important question about the experiences of child welfare-involved youth, this study contributes to the more central situation of “institutionalized” family life—including that shaped by the child welfare system—in broader scholarship and dialogue on childhood and family diversity, instability, and inequality.

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Economics of Child Protection: Maltreatment, Foster Care, and Intimate Partner Violence

Cited by 61 publications

References 111 publications

Protocol for a randomized controlled trial evaluating the impact of the Nurse-Family Partnership’s home visiting program in South Carolina on maternal and child health outcomes

Protocol for a randomized controlled trial evaluating the impact of the Nurse-Family Partnership’s home visiting program in South Carolina on maternal and child health outcomes

Distinguishing moral hazard from access for high-cost healthcare under insurance

Instability in Care and Living Arrangements: Putting Foster Youth in Context

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