The cost of child abuse and neglect in France: The case of children in placement before their fourth birthday

Abstract

Background: Despite the high prevalence of child abuse and neglect and its consequences on health, very few studies have evaluated the trajectories of children in placement in France, and there are no cost studies available.

Objective: To estimate the cost of abuse and neglect in children in placement before their 4th birthday in France.

Participants and setting: A cohort of children in placement before their 4th birthday in a single nursery between February 1994 and June 2001 was followed from birth until they left care.

Methods: Child protective services (CPS), health, health and social, and judiciary services utilization was derived from a qualitative analysis of the children's files and valued with their unit costs in 2013 euros from the societal perspective. Total costs and mean annual cost per child followed by CPS were calculated overall, by cost category, and by status at admission to the nursery.

Results: 129 children were included. Mean age at first admission was 1.9 years (SD = 1.3). The mean length of follow-up by CPS was 14.3 years (SD = 5.0). Mean annual cost per child was estimated at €53,265 (SD = 42,077), with CPS costs representing 78% of costs. 80% of health care costs were due to psychiatric care. Children with no identified psychosocial risk factors had significantly higher psychiatric care costs and health and social care costs than pre-term children and children with identified psychosocial risk factors.

Conclusion: More research should be carried out to address early and comprehensively the multiple needs of children followed by CPS in the short- and long-term.

Keywords: Child abuse and neglect; Child protective services; Cost analysis; Economic burden.