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What exactly do you mean by “child abuse and neglect”?

In this report, we define child abuse and neglect as any of the following:

1. Neglect: Failure to provide for a child’s basic physical, educational, or emotional needs.


2. Physical Abuse: Physical injury resulting from hitting, kicking, shaking, burning, or otherwise harming a child.


3. Emotional Abuse: Any pattern of behavior that impairs a child’s emotional development or sense of self-worth, including constant criticism, threats, rejection, and exposure to family violence.


4. Sexual Abuse: Includes indecent exposure, fondling, rape, sexual exploitation or pornography.

What’s the difference between a “victim” and a “survivor”?

Both refer to children who were abused or neglected. In this report, we use the term “survivor” to speak about abused children who are still alive, while we use the term “victim” to speak about children who died as a result of abuse.

How does this estimate of economic impact of child abuse and neglect in California compare to other similar estimates for California?

Our analysis is modelled after this study by the Centers for Disease Control. Since we began doing this analysis, other similar approaches to estimating the economic impact of child abuse and neglect have emerged. Prevent Child Abuse America, authors Klika, Rosenzweig, and Merrick, estimated the economic burden of children abused and neglected in California in 2018 ranged from $55.2 billion to $301 billion. A broader study looking at the annual economic impact of Adverse Childhood Experiences found that these ACEs cost California $112.5 billion per year. In comparison to these estimates, our model is more conservative.

For the time being we’ve opted to continue using our methodology, which estimates the cost to be between $16 and $25 billion per year, as it is the only approach we’re aware of that accounts for country-specific drivers of economic impact like cost of living and wages. We recommend that any policy analysis on the state level consider the full range of estimates (ours and the others above) when considering the return on investment in prevention.

The breakdown of total costs for California by category is virtually identical to the breakdown the CDC found nationally in 2008. For example,

Note that your area’s estimate for each category may be larger or smaller than these national and statewide averages. The factors that influence this include median wages, cost of living, and fatalities as a result of abuse in your area.

Why is the cost expressed as incurring over the lifetime of surviving victims?

There are generally two methods used for economic burden estimates: a prevalence-based approach or an incidence-based approach.

A prevalence-based method provides an estimate of the direct and indirect costs that are accrued to a region within a given year, regardless of when the child was first abused. It includes many numbers that are very difficult (or impossible) to track, such as cost of lost productivity for a 45-year-old that was abused 35 years ago.

In contrast, an incidence-based method estimates the total lifetime costs resulting from new cases of child abuse and neglect that occur within a given time period. This looks at the expected costs across the lifetime of children who were abused in the year of study. Future costs are discounted to their net present value to account for the time value of money.

While both methods are relevant, we determined that an incidence-based approach is more useful for making the case for prevention. In addition, the incidence-based approach more commonly used in the other cost estimation reports we reviewed, and it was the approach used in the research prepared by the CDC linked above.

How does the analysis deal with a child who is repeatedly abused?

Under our analysis, the child who experienced repeated abuse would be counted as a new case each unique year he or she is abused. This allows the estimate to account for all children abused in a given year. However, this also means that users should not add estimates for subsequent years together, as doing so would double-count some children.

My county has reported a different number of substantiated survivors than your report shows. Why?

Our Economic Child Abuse Model is based upon data from the California Child Welfare Indicators Project. Each county has a significant amount of discretion in the child abuse and neglect metrics it reports, and its possible some county’s metrics differ slightly from those used in our Economics of Child Abuse Model. When looking at abuse, we rely on a unique count of children with reports of child abuse, and a unique count of children with substantiated cases of child abuse, because the research estimates costs of abuse across different categories on a per-child basis.

Note this is a unique count of children with at least one substantiated case of abuse in a given calendar year. County metrics that are often different in important ways include:

• Substantiated allegations / referrals: This may be a unique count of all substantiated abuse allegations or referrals – however one child may have had multiple allegations or referrals. In addition, multiple children in a household could have been confirmed to be abused even if only one was involved in an allegation. So, this is not a unique count of children abused.


• Children involved in substantiated referrals: This may be a unique count of all children in a household where abuse occurred – however it includes the siblings of those who were abused, so this is not a unique count of children abused.

Additionally, timing issues can impact the data we use. We rely on CCWIP Data extracted as of December 31 of the prior year. Those extracts are pulled “approximately one month after each quarter ends.” Depending on what time your county aggregates its data, it's possible there were cases of abuse reported towards the end of the prior year that were updated in February or March. Those updates may be reflected in your county’s data, but are not reflected in CCWIP due to differences in data cutoff times.

How did you determine the age of onset for abuse to be 7 years old?

This analysis requires a fixed age from which to base costs. We looked at the weighted average age of abuse for first-time victims in California per the U.S. Department of Health & Human Services Child Maltreatment 2016 report. This report suggests the weighted average age of the first instance of abuse for children is 6.7 years old, so we have assumed that all costs begin at age 7.

Why do you believe this is a conservative estimate of the costs of child abuse and neglect?

First, we’ve used the highest quality research we can find to estimate costs for each category. For an in-depth discussion of our methodology, see our technical appendix.

Second, research suggests that a significant amount of abuse goes unreported, and that the actual number of children abused is higher than the number of substantiated survivors used in this report. Two studies, in particular, suggest rates of abuse are higher. One such study is the Fourth National Incidence Study of Child Abuse and Neglect, published in 2010. This study found that one in 25 children (4%) in America experience abuse or neglect as defined by the child endangerment standard.

A second study that explored this topic is “Violence, Crime, and Abuse Exposure in a National Sample of Children and Youth – An Update”, published by Finkelhor, Turner, Shattuck and Hamby in the Journal of the American Medical Association in 2013. This study found that, on average, 13.8% of children experienced abuse or neglect in the last year. Further, the study found that 11.5% of children at age 7 (the weighted average age for the onset of abuse) were abused and neglected in the last year. This is the basis for our estimated victims of abuse and neglect figures.

We acknowledge each of these studies, as all studies on this topic, have limitations. However, this research combined with our experience working with vulnerable families and survivors of abuse gives us confidence that the actual number of abuse survivors (and thus the estimated costs) is higher than what we show in this report.

What inputs to this calculation are specific to my county, versus statewide?

Each of the different cost categories has different inputs, so some inputs remain the same statewide while others vary county-to-county. The inputs to the calculation that were adjusted for each county include:

• Child population
• Reported cases and substantiated cases
• County-wide cost of healthcare index (an aspect of your overall cost of living)
• Per capita county income

Inputs that remain the same across the state include:

• Incremental cost of special education related to child abuse
• Number of child welfare cases
• GDP Price Deflator

Where can I find historic versions of Safe & Sound's Economics of Abuse Reports?

Please see this link for historic versions. Note that our methodology has changed over the years, and so numbers are not directly comparable. Please reach out to communityaction@safeandsound.org with any questions.

I still have more questions about how you calculated the economic impact of child abuse.

Please see our Technical Appendix for more information. You’re also welcome to contact us at communityaction@safeandsound.org if you have additional questions.