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Benefit-cost analysis for child abuse and neglect prevention programs

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Benefit-cost analysis for child abuse and neglect prevention programs
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Eorio, Lisa
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Denver, CO
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University of Colorado Denver
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English
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viii, 133 leaves : ; 29 cm

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Child abuse -- Prevention ( lcsh )
Preventive health services -- Costs ( lcsh )
Child abuse -- Prevention ( fast )
Preventive health services -- Costs ( fast )
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bibliography ( marcgt )
theses ( marcgt )
non-fiction ( marcgt )

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Bibliography:
Includes bibliographical references (leaves 128-133).
Thesis:
Submitted in partial fulfillment of the requirements for the degree of Master of Arts, Department of Economics
Statement of Responsibility:
by Lisa Eorio.

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|University of Colorado Denver
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|Auraria Library
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All applicable rights reserved by the source institution and holding location.
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17882239 ( OCLC )
ocm17882239
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LD1190.L53 1986m .E67 ( lcc )

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BENEFIT-COST ANALYSIS FOR CHILD ABUSE AND NEGLECT PREVENTION PROGRAMS by Lisa Eorio B.S., Idaho State University, 1977 A thesis submitted to the Faculty of the Graduate S'chool of the University of Colorado-Denver in partial fulfillment of the requirements for the degree of Master of Arts Department of Economics 1986

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This thesis for the Master of Arts degree by 'Lisa Eorio has been approved for the Department of Economics by Helburn Jana Everett Date g-k 7/{6

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Eorio, Lisa Economics) Benefit-Cost Analysis For. Child Abuse And Neglect Prevention Programs Thesis directed by Professor Suzanne w. Helburn iii The use of benefit-cost analysis is an initial step toward informing decisionmakers and the public of the short and long-run social gains to be received from preventing child maltreatment. Although health care professionals maintain that benefit-cost analysis should not be used to evaluate programs aimed at saving lives, if the analysis is supplemented with information pertaining to program outcomes that could not be quantified in monetary terms, benefit-cost analysis can be a useful tool in this field. Benefit-cost analysis can be used to determine whether a child maltreatment prevention program adds more to social welfare than it takes away and, in turn, to inform decisionmakers and the public of the the social welfare impact of child maltreatment prevention programs. This paper offers a guide for performing a "supplemented" benefit-cost analysis of child maltreatment prevention programs and provides the fundamental information needed to conduct a sound and useful analysis. It contains (1) an overview of child

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maltreatment; (2) a discussion of the theoretical foundation and limitations of benefit-cost analysis; (3) an outline of the analysis procedure; and (4) recommendations for research and evaluation in the future.

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To Cliff, John, Sophia, Janice, and Cynthia

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ACKNOWLEDGMENTS Many individuals contributed to this paper, and, although I do not mention all their names, their assistance is greatly appreciated. I am particularly grateful to my thesis committee--Suzanne Helburn, Jim Vincent, and Jana Everett--for their hard work and valued comments. My gratitude to Suzie Helburn cannot be adequately expressed. She provided .encouragement, inspiration, and direction throughout my work on this paper, as well as before. Larry Reynolds, Department of Economics, Boise State University, provided both material and discussion which allowed me to evaluate concepts used in Chapters III and IV. I am grateful to Dee Hansen Ohi, Helen Lojek, and my husband Cliff Maxwell for their editorial comments. Without the generosity of Frank Powell, the compilation of this thesis would have been vastly more difficult.

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CONTENTS CHAPTER I. INTRODUCTION Arrangements of the Thesis II. AN OVERVIEW OF CHILD MALTREATMENT. Extent of Child Maltreatment Defining Child Maltreatment. Types of Maltreatment. Theories of Causation. Consequences of Maltreatment Prevention Strategies Conclusion III. THE CONCEPTUAL FOUNDATION OF BENEFIT-COST ANALYSIS .. Welfare Criteria The Hicks-Kaldor Criterion and Benefit-Cost Analysis . Conclusion IV. ANALYSIS PROCEDURE Program Definition Choosing Analysis Type Identifying Program Effects. Net-benefit Calculation . Display Non-Measured Effects 1 6 8 8 12 16 21 28 38 41 43 44 50 55 59 59 61 66 71 84

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viii Analysis Report. 84 v. SUMMARY OF PRIOR COST ANALYSES OF CHILD MALTREATMENT PREVENTION PROGRAMS Denver Research Institute Study The Armstrong Analysis Greenspan's Analysis Conclusion VI. CONCLUSIONS AND RECOMMENDATIONS 86 87 96 104 106 TO CAP VOLUNTEERS, INC. 108 Measuring Effectiveness of Prevention Strategies Benefit-Cost Analysis of CAP's Prevention Program. Conclusion. BIBLIOGRAPHY 108 115 126 128

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CHAPTER I INTRODUCTION Decisions to reduce human service budgets appear, at least in part, to be founded on the assumption that recipients of public programs are their only beneficiaries. However, this is rarely the case. The welfare of members ofsociety is highly interdependent, and, as a result, most individual actions impact other members. For example, the indirect effects of child abuse and neglect, (e.g., perpetuation of violence and inhibition of the development of. socially adjusted human beings) diminishes the quality of life of virtually all members of society. Consequently, in addition to helping families with child maltreatment problems, prevention of child abuse and neglect is likely to benefit society as a whole. The intent of this paper, therefore, is to encourage social welfare analysis of child abuse and neglect prevention programs. The information derived from the analysis could then be used to inform the public of the advantage they receive from preventing child maltreatment.

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2 Professionals in the child maltreatment field claim that children growing up in abusive and/or neglectful families tend to have a high level of anger and learn behavior that often means harm to themselves and others. They contend that child maltreatment often leads to juvenile delinquency, assault, abusive and/or neglectful parenting, and murder. In addition, child abuse and neglect can damage its victim's ability to develop personally and socially. The most common problem faced by victims is overcoming their negative self-image. This can contribute to later difficulties in life with poor school performance, alcohol and drug abuse, lack of achievement, promiscuity, poor social relationships, and suicide. Moreover, those who have suffered abuse either do not develop the ability to empathize, or they lose this ability. A lack of empathy contributes further to asocial behavior since the ability to put oneself in another'.s position helps to develop compassion, sympathy, and consideration for others. In light of the problems child maltreatment creates for society, why are human service budgets the first to be cut in times of economic difficulty? Several explanations have been offered. Richard

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3 Steiner (1977), author of Managing the Human Service Organization, claims that welfare budgets are the first to be cut because the public does not recognize their value. He states that human service specialists have "shown the least sophistication and rigor in setting standards for the evaluation of human service programs" because they believe that the public inherently realizes the worth of their efforts (p. 206). On the other economist Robert H. Haveman (1983) argues that studies indicating a program's impact on social welfare are rarely used by congress to base decisions because politicians' self-interests are not linked to the interests of the general public. In his opinion, incentives motivating politicians come from wellorganized, special-interest groups. A similar interpretation is offered by Robert A. Hoekelman (1983) in his introduction to the Pediatric Round Table conference. Dr. Hoekelman contends that the current political climate does not support prevention programs because "politicians do not often buy the concept that prevention of a problem now will save money later" (p. 107). In his opinion, politicians are interested "in balancing this year's budget, not in saving money for the budget of the next administration" (p. 107).

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4 Shortsighted public policies, however, are likely to be damaging in the long-run. If child maltreatment prevention had been a priority in the past, perhaps the current crisis with overcrowding in state correctional facilities would have been avoided. Once aware of the short-and long-term benefits of preventing child maltreatment compared to the cost, one would hope that members of the public will be more inclined to exert pressure on politicians to fund child maltreatment prevention programs. An initial step toward identifying and assessing the desirability of child maltreatment prevention is program evaluation using benefit-cost analysis. Benefit-cost analysis is a policy analysis tool designed to improve the decisionmaking process by providing information on the change in social welfare resulting from a policy, program, or project. In principle, the analysis can quantify the value of all social benefits and costs created by a program and provide a net-benefit figure indicating the impact on social welfare. The intent of the analysis is illustrated by economists A. R. Prest and R. Turvey (1965) in the following description of benefit-cost analysis. They describe the analysis as a

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5 practical way of assessing the desirability of projects, where it is important to take a long view (in the sense of looking at repercussions in the further, as well as the nearer, future) and a wide view (in the sense of allowing for side-effects of many kinds on many persons, industries, regions, etc), i.e., it implies the enumeration and evaluation of all the relevant costs and benefits. (p. 683) However, benefit-cost analysis is a difficult and controversial method to employ. Because benefits and costs must be quantified in dollars and cents to calculate a net-benefit value, the ability of benefit-cost analysis to accurately assess social welfare has been disputed. Critics argue that the requirement to value costs and benefits in monetary terms causes many program effects to be left out of the analysis and, in turn, the decisionmaking process. Furthermore, health care professionals contend that this requirement makes benefit-cost analysis inappropriate for the evaluation of programs like child maltreatment prevention which are aimed at saving or improving quality of life. Valuing program outcomes (i.e., human life) in dollars and cents, they maintain, is meaningless and causes many decisionmakers to distrust the output of the analysis. This and other criticisms are well-founded and must be understood in order to perform a sound benefit-

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6 cost analysis. Many effects of child mal treatment prevention programs (e.g., the avoided cost of public child protection agencies, court involvement, foster horne care, and special education) can, however, be quantified in dollars and cents. Therefore, benefitcost analysis promises to be a useful approach for identifying and presenting the social impact of child maltreatment prevention if (1) a program's net-benefit is calculated using measures readily expressed in monetary terms and {2) the net-benefit calculation is supplemented with a discussion of program effects not included in the calculation. Arrangement of the Thesis This paper offers a guide for performing a "supplemented" social benefit-cost analysis of child maltreatment prevention programs. The following chapter discusses the phenomenon of child maltreatment-its prevalence, causes, effects, and prevention strategies. Chapter III focuses on the theoretical foundation and limitations of benefit-cost analysis, and Chapter IV explains the analysis procedure. Chapter V reviews previous analyses of child maltreatment prevention programs, and the final chapter

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applies the information in the preceding chapters to offer recommendations concerning the analysis of the prevention program offered by Child Abuse Prevention (CAP) Volunteers, Inc. in Denver, co. 7

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CHAPTER II AN OVERVIEW OF CHILD MALTREATMENT Familiarity with the phenomenon of child maltreatment is essential to the economic analysis of child abuse and neglect prevention programs. Child maltreatment is a broad and often ambiguous subject; therefore, research findings concerning (1) the extent of child and neglect; (2) definitions of maltreatment and the various forms it takes; (3) theories of causation; and (4) short and long term consequences must be understood before the social impact of prevention can be determined. Extent of Child Maltreatment The American Association for Protection of Children (1985)--a division of The American Humane Association--found that over one million official reports of child abuse and neglect {involving one and one-half million children) were documented in the United States in 1983. Abuse comprised 27.9 percent of

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9 the reports; neglect, 45.7 percent; abuse and neglect in combination, 19.0 percent; and other types of maltreatment occurred in 7.4 percent of the instances reported. The age of the children involved averaged 7.1 years. Slightly over three percent of the involved children received major physical injury, and 60 percent of these children were under the age of four. Physical injury of a less serious nature was by 23.7 percent of the children; 58.4 percent were deprived of necessities; 10.1 percent were emotionally maltreated; and 8.3 percent incurred "other" types of injuries. Eight and one-half percent of the maltreated children were sexually maltreated, and 40 percent of the reports involved children over 12 years old. However, one out of every four involved victims under 5 years of age. This study also provides information about the perpetrator of abuse and neglect. Eighty-three percent of them were caretakers and 95 percent of these caretakers were the child's natural parents. Half of the families reported had both male and female caretakers, while 43 percent were headed by a single female. Sixty percent of the perpetrators were female, and the average age of the perpetrator was 31.3 years. Forty-seven percent of the households reported were

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10 receiving public assistance. Although these statistics indicate that child maltreatment is a widespread phenomenon, most approximations of child maltreatment in the United States are believed to underestimate its actual rate (Watkins and Bradbard, 1982: 325). The American Humane study indicates that 23.8 of 1,000 children living in the United States were maltreated in 1983; however, it also states that substantiated cases are no more than one-third of the total cases known to professionals. This means that the actual rate of maltreatment is more like 75 out of every 1,000 children rather than 23.8 out of 1,000. The inability to accurately assess the extent of child maltreatment is created by several factors: 1. First and foremost, there is not a consensus on the definition of maltreatment (Bourne, 1979; Watkins & Bradbard, 1982) 2. Second, how maltreatment is defined by the reporting agency influences the number of incidents identified; the broader the definition, the greater the amount of maltreatment. For instance, since the early sixties when Charles Kemp coined the term "battered child syndrome," the meaning of the term maltreatment

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11 has expanded from the implication of battering to mean any action that is harmful to the -child (Watkins and Bradbard, 1982: 323). 3. Third, the method used to collect data also influences the numbers. According to Richard Bourne (1979), statistics on the frequency of maltreatment vary from thousands of cases per year when the incidence of abuse is estimated from cases officially processed by Departments of Public Welfare or the Police to millions of cases per year when they are estimated by questioning a random sample of the population as to its child-rearing techniques (p. 5). The following study cited by Bourne supports his assertion: Professor Richard Gelles and other sociologists who recently studied a nationally representative sample of 1,142 married couples found that violence toward children was an extensive and regular pattern in many families. Twenty percent of the parents surveyed had hit their child with some object during the previous year, while 4.2 percent indicated they had "beaten up" the child, 2.8 percent of the parents reported having threatened the child with a knife or gun, and 2.9 percent actually had used a knife or gun on the child in question. (pp. S-6.) Self-reports also reveal that maltreatment is committed by a wider and more heterogeneous grouping than is indicated by official data. Because official data is limited to processing by public welfare agencies who

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maihly serve the poor and powerless, the affluent and influential are often underrepresented. 12 4. Finally, the attainment of accurate statistics on the actual occurrence of child maltreatment is hindered because (1) parents fail to seek medical assistance for the injured child; (2) parents who are chronic abusers may shift hospitals or doctors to avoid suspicion; (3) physical injuries are often difficult to detect, or maltreatment (as in the cases of emotional neglect and abuse) may be so subtle that they may go unnoticed; (4) physicians may frequently fail to report a maltreatment case; and (5) neighbors may feel that they have no right to interfere in the parental treatment of a child (Watkins & 1982: 325). Defining Child Maltreatment A uniform definition of maltreatment has not been agreed upon because the fundamental elements that must be considered to distinguish abuse from nonabuse vary in every circumstance. This is true, according to James Garbarino and Gwen Gilliam (1980), because the meaning of most actions is determined by the environment in which they occur. For example, (1) the intention of the actor (2) the act's effect upon the

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13 recipient, (3) an observer's value judgment about the act, and (4) the source of the standards for that judgment must be considered to determine what constitutes maltreatment. Richard Bourne (1979) maintains that the ability to define child maltreatment is further complicated when societal values condone physical punishment. Bourne states: Neglect and abuse are difficult to define, especially in a society that frequently mistreats its young. Many of us believe, for example, in corporal punishment: in sparing the rod and spoiling the child. If such punishment is normal child-rearing practice, and if data exist that it is damaging, then abuse might be the rule and not the exception. (p. 5) In spite of the difficulty with defining maltreatment precisely, several definitions exist. Maltreatment is defined in the federal Child Abuse Prevention and Treatment Act of 1974 as the physical or mental injury, sexual abuse, negligent treatment, or maltreatment of a child under the age of 18 by a person who is responsible for the child's welfare under circumstances which indicate the child's health or welfare is harmed or threatened thereby. (Garbarino & Gilliam, 1980: 9-10) A broader, more recent definition is provided by Garbarino and Gilliam (1980) in their book Understanding Abusive Families. They define maltreatment as "acts of ommission or commission by a parent or guardian that are judged by a mixture of

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14 community values and professional expertise to be inappropriate and damaging" (p. 7). The difficulty with defining maltreatment is further heightened by the frequent problem clinicians have in determining whether a child's injury is the result of an accident, illness, or inflicted injury (Bourne, 1979: 1-2). The following case examples illustrate the difficulty clinicians often have when attempting to distinguish abuse from nonabuse. In the first case, parents bring their child into a hospital emergency room with a complaint of fever. During the medical examination the doctors notice round red sores on the youngster's legs which they diagnose as "possible cigarette burns." They later discover that the family has recently returned from a summer retreat and that the burns are actually infected mosquito bites. (Bourne, 1979: 1) Abusive adults will often burn a child with a cigarette; however in this case, what appeared to be an obvious indicator of abuse turned out to be a common childhood ailment. In a second case, a mother brings her daughter to the hospital with small black and blue marks on various parts of the child's body. Doctors perform multiple tests and can find no organic basis for the bruising. Social workers who meet the mother find her appropriately concerned and do not think her capable of abuse. (Bourne, 1979: 1) In this example, further investigation and observation would be required to determine whether abuse has

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occurred. In Bourne's third case example, a child is under the third percentile for both height and weight and falls into the category of "failure to thrive." Physicians cannot exclude a biological explanation for his small size. The family is poor, and it is unclear whether the youngster's condition is a result of poverty and malnutrition beyond the family's control or of neglect wherein the family could provide better care, but fails to do so. (Bourne, 1979: 1) 15 In this case, the parents' intent must be known before the allegation of neglect can be made. If the failure of the parents to adequately feed their child is the result of conditions beyond their control, maltreatment has not occurred. In a final case, a four-year-old has a second-degree burn on his hand. The mother explains that her son had been tossing his plastic car into the air and that it fell into a sink of boiling water which she had prepared for the family wash. A plastic surgeon believes that the youngster would not have been able to hold his hand under the water long enough to receive such a burn. A psychological evaluation of the child shows that he is "persistent" and "strong-willed when pursuing activities in which he is emotionally involved." (Bourne, 1979: 1) Again, the existing information is conflictive. Further investigation would be necessary before a determination of abuse could be made.

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16 Types of Maltreatment Two categorical distinctions are made between types of child maltreatment: abuse and neglect. Abuse generally implies the "commission" of an act or acts damaging to a child's well-being, while neglect is considered to be an "omission", i.e., failure to provide for a child's physical or emotional needs or both (Bourne, 1979: 2). Neglect, although more difficult to detect and prove, is no less serious than abuse; both are potentially damaging to a child's growth and development. As Bourne (1979) explains, "leaving a youngster in dirty diapers, without adequate nourishment or stimulation, is at least as detrimental to a child as is the administration of bruises and broken bones (p. 4). A vast range of maltreatment acts exist, and numerous definitions abound. However, the same difficulty that exists when attempting to determine whether mal treatment .occurred also exists when trying to define the various types of maltreatment; they are more distinct in theory than in practice. No definition, therefore, is without ambiguity (Watkins & Bradbard, 1982: 324).

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17 Physical Abuse Two definitions of physical abuse are: (1) "the infliction of physical injury (e.g., burns, bites) to the child" (Watkins & Bradbard, 1982: 324) and (2) the "inappropriate and developmentally damaging use of force" (Garbarino and Gilliam, 1980: 7). The latter definition is broader and attempts to take into account the growing belief that serious physical harm is a relatively small part of the child maltreatment problem. Although physical damage and death are certainly of great concern, "most professionals recognize that the problem of maltreatment goes well beyond serious physical harm to children" {Garbarino & Gilliam, 1980: 9). Instead, the more likely consequence of physical abuse is developmental damage (i.e., impairment of the development of the child's social, intellectual, and moral competency). Therefore, except in cases of serious physical damage, the actual injury is less important than the way it came about. For example, youngsters who are injured in athletic pursuits typically bear none of the emotional scars that victims of abuse carry. A boy may be proud of the scar above his eye from a boxing match if he sees it as representing athletic prowess. But if the scar came as a result of a beating from his drunken father over a curfew violation, the boy probably

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would feel differently about it. Gilliam, 1980: 10) (Garbarino & The heart of the maltreatment problem, therefore, is believed to lie in the emotional rather than the physical domain. Emotional Abuse 18 Due to the subtle nature of emotional abuse, it is both difficult to define and to prove (Garbarino & Gilliam, 1980: 11). Watkins and Bradbard define emotional abuse as "speech and actions by a caretaker that thwart the healthy personal and social development of a child" (Watkins & Bradbard, 1982: 324). For infants, this typically involves parental refusal to be responsive (e.g., punishing normal behavior such as smiling and vocalization or rejecting the child and stunting the normal parent-infant attachment) For older children, emotional abuse entails a pattern of behavior that punishes the child for normal social behavior and self-esteem. The following interview taken by Garbarino and Gilliam (1980) illustrates the nature of this type of abuse: My dad started grounding me for finding dirty spots on the dishes. The last time he grounded me like that, it went on for six months and it got so bad that I had to start asking for everything: if I could get up, if I could go to the bathroom, if I

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19 could sit down and eat with him, if I could get ready to go to bed, if I could take a bath. You know, everything you take for granted. And his answer to me always was "do you deserve it, do you think you deserve it?" Well, of course, I deserved to eat. I have to eat to live, you know. And it just got really bad. (p. 12) Sexual Abuse Sexual abuse is defined by the National Center on Child Abuse and Neglect as contacts or interactions between a child and an adult when the child is being used for the sexual stimulation of the perpetrator or .another person when the perpetrator is in a position of power or control over the victim. (Garbarino & Gilliam, 1980: 151). Although sexual abuse victims carry some of the same emotional difficulties (e.g., high degree of anger, over-dependency) as do victims of other types of maltreatment, sexual abuse is believed to be a special case. Therefore, the causation theories, consequences, and treatment discussed in this paper may not fully pertain to sexual abuse. Physical Neglect Physical neglect implies the caretaker's "failure to provide a child with a nurturing home environment that supplies the basic necessities of life (i.e., food, clothing, shelter, supervision, and

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20 protection from harm)n (Watkins & Bradbard, 1982: 324). Physical neglect, in general, is a greater threat to infants and young children than adolescent children because younger children are much less capable of handling their own needs. Neglect is also more difficult to successfully treat than abuse because it is harder to teach a caretaker to care about the child than it is to teach a person to use less harmful disciplinary techniques (Bourne, 1979: 5). Emotional Neglect Emotional neglect denotes the "failure of a caretaker to show concern for a child or his/her activities" (Watkins & Bradbard, 1980: 324). Although neglect is distinct from other forms of abuse because it is passive Garbarino and Gilliam (1980) explain that neglect victims are harmed just as severely as victims of more active sorts of abuse: Indifference, forgotten promises, and withdrawal are all inappropriate parental behaviors, damaging to children and teenagers who may feel they are not worth their parents' concern and care. Neglect of this sort may lead to some very self-destructive behavior by its victims. (p. 14) In addition to the five major forms of maltreatment discussed above, medical neglect, educational neglect, abandonment, and the category of

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21 multiple maltreatment exist (Watkins & Bradbard, 1982). Theories of Causation Although child maltreatment has existed throughout the course of history, it has become the focus of extensive research only since the early 1960's when Dr. Charles Kemp and others published an article characterizing abused children as victims of the "battered child syndrome" (Watkins & Bradbard, 1982: 323). Since that time, theories (four of which are discussed below) have been developed to explain why this phenomenon occurs. Earlier theories identified simple cause and effect relationships and offered "unitary" models that emphasized such factors as psychological and sociological to explain the existence of child abuse and neglect (Rosenberg & Reppucci, 1985: 576). However, as time passed and these theories were employed, theorists found that the unitary theories were each "limited to one explanatory lens on one part of a complex picture" and did not provide sufficient and necessary conditions for maltreatment to occur (Newberger & Newberger, 1981: 8). Child maltreatment has since come to be regarded as a multifaceted phenomenenon, and with the emergence of the ecological

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22 model of child maltreatment, the earlier "divergent etiological perspectives have been integrated into a coherent conceptual system" {Rosenberg & Reppucci, 1985: 577). This type of integrated approach "seeks to define how one aspect of experience mediates the effects of another, in order to better understand what renders some families vulnerable and other families strong" {Newberger & Newberger, 1981: 9). Psychological Model The psychological model {also known as the psychoanalytic, or psychiatric model) is an early model which "posits that unconscious parental drives and conflicts determine abusive behavior" (Newberger & Newberger, 1981: 8). This model is based on the assumption that abusing parents are psychotic or ill. However, by the end of the 1960's, most researchers considered only the most violent parents to be psychotic, and they now refrain from classifying abusive parents according to traditional psychiatric diagnostic categories {Watkins & Bradbard, 1982: 325). In fact, research has shown that less than 10 percent of abusers are clinically psychotic (Bourne, 1979: 7). Nonetheless, many abusive parents appear to

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23 have similar psychological charac:teristics. Researchers contend that many abusive parents appear anxious and depressed and consistently exhibit characteristics such as (1) low self-esteem, bad self image and feelings of worthlessness, (2) role reversal where parents want their children to nurture and satisfy them rather than the reverse, (3) unrealistic expectations of the child because parent's own low self-esteem causes them to view children as a potential source of status and admiration, (4) fatalistic attitude toward life causing the parent to show a lack of concern or to take insufficient precautions to care for or protect their childien, and (5) lack of knowledge about child care (Bourne, 1979: 7-8). Sociological Model The sociological (or environmental) model focuses on "social values and the social organization of the culture, community, and the family rather than on individual differences in parents" (Watkins & Bradbard, 1982: 325). This model has three underlying assumptions. First, it assumes that child maltreatment in America is partly due to the "cultural sanction of physical force to resolve interpersonal conflicts"

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24 (Watkins & Bradbard, 1982: 325). Levels of family violence are believed to be microscopic reflections.of the levels of violence in therefore, the amount of violence in society affects the incidence of child abuse. Cross-cultural studies have shown that the murder rate in the United States is ten times as high as in Britain and that the United States is higher than other countries such as Sweden, Israel, and Britain in the amount of violence shown on television (Watkins & Bradbard, 1982: 326). The second assumption made in the sociological model is that maltreatment is a function of parental stress and frustration which, in turn, is associated with parents' socioeconomic status (Watkins & Bradbard, 1982: 326). Studies and statistics often uphold this class-linked however, it has also been argued that lower socioeconomic groups may be over-represented in the statistics because a large number of lower class families receive services from institutions which report the large majority of cases from which research samples are drawn (Newberger & Newberger, 1981: 9). In addition, Watkins and Bradbard (1982) argue that lower class families might be overrepresented because "higher socioeconomic parents more effectively conceal

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25 their abusive behavior" (p. 326) Third, the sociological model assumes that the environment of the family (e.g., poor housing and living conditions, unemployment, and social isolation) is related to child maltreatment (Watkins & Bradbard, 1982: 326-27). Crowded living conditions, the theory maintains, tend to increase the frequency of parentchild interaction and thereby facilitate more aggressive parental actions. Unemployment, particularly by fathers, increases the amount of time the parent is at home and leads to other stressful circumstances that may lead to general dissatisfaction on the part of both spouses. Social isolation diminishes the opportunity for help from support groups and aids in keeping abusive behavior secret (Watkins & Bradbard, 1982: 326-27). Social-Situational Model The social-situational model designates a point in the development of child maltreatment theory where theorists began to realize that no single factor causes child maltreatment to occur (Newberger & Newberger, 1981: 9). This model views child-abuse and neglect as a joint consequence of (1) parent and child

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26 characteristics, (2) patterns of reciprocal interaction among family members, and (3) environmental stresses impinging on the family unit (Watkins & Bradbard, 1982: 327) It suggests that abuse is triggered by some outside stimuli in a family with certain characteristics (e.g., lower rates of interaction, emphasis on the negative aspects when interacting, and physically punitive and inconsistent discipline techniques). In addition, this model considers the role the child's characteristics plays in abuse. Children may possess some physical, mental, or behavioral characteristic (e.g., physical handicaps, retardation, irritability) that makes it more likely that they will suffer some type of maltreatment (Watkins & Bradbard, 1982: 327). Ecological Model The ecological model integrates the divergent points of view taken by the other causative theories to an even greater extent than the social-situational model. It sees child maltreatment as the product of a multiplicity of factors and explains this complex phenomenon in terms of four levels of analysis that are meant to account for all the causative factors and

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27 explanations: (1) ontogenic development, (2) the microsystem, (3) the exosystem, and (4) the macrosystem (Watkins & Bradbard, 1982: 328). Ontogenic development refers to the parents' background which predisposes them to behave in an abusive and or neglectful manner: the microsystem is the events which occur within the immediate family: the exosystem refers to the community in which the family is embedded: and the macrosystem is the culture which entwines the individual family and community in a myriad of attitudes, beliefs, and values (Watkins & Bradbard, 1981: 328). Using these four levels, the ecological approach explains child maltreatment in the following way: a parent's own developmental history (ontogenic development) may predispose him/her to resolve parent/child conflicts using abusive or neglectful tactics when stress factors surface within the family (microsystem) at work, or within the neighborhood (exosystem). The consequences of such maladaptive responses to conflict and stress are interwoven in the parent's own childhood experiences (ontogenic development) and the values and child-rearing practices that are sanctioned by the culture at large (macrosystem). (Watkins & Bradbard, 1981: 328)

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28 Consequences of Maltreatment Physical Damage The most obvious result of child maltreatment is the physical results. These include death, brain damage causing language and learning delay, retardation, and failure to grow to a normal size. One follow-up study on 50 children five years after they had been admitted to the Children's Hospital in Pittsburgh because of fractures sustained during the first year of life indicates what happens to young children who are severely abused and/or neglected. Out of 50 children, the study reports, seventeen of the children could not be traced or, if traced, their families refused cooperation. Of the remaining thirty-three on whom data could be obtained, three had died in hospital from head injuries, two were later killed by their mothers, two were dead from causes unknown, one had been brought in to the hospital dead from malnutrition, five were in state institutions for the mentally retarded. Of the remaining twenty who were available for study, ten had an I.Q. of less than 80, nine had poor speech development, eight had significantly poor emotional health, seven had neurological defects, five had impaired physical development. Only two of the children were normal in all these categories. (Steele, 1975: 191) These children often pose an extra burden on the school system when they reach school age. For example, one study found that 50 percent of the children who were

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brought up in families where there was neglect and abuse have a "selective, significant language delay (Steele, 1975: 192). Developmental Damage 29 Children raised in abusive and neglectful families are deprived of the basic human needs necessary to grow into competent adults and, therefore, often become socially deficient. According to Garbarino and Gilliam (1980), in order for children to learn to communicate effectively, adapt socially, have patience, high self-esteem, social responsibility and empathy, they need (1) to feel that they can affect the world around them, (2) to know who they are and with whom they belong, (3) to receive acceptance from their parents, an unconditional regard that allows them to experiment and make mistakes, (4) to feel a sense of consistency in order to believe that the world is predictable, (5) to feel worthwhile, and (6) to receive affection (p. 169). However, children who are raised in unhealthy circumstances such as abusive and/or neglectful families learn to adapt to those circumstances which, in turn, often damages their ability to develop personally and socially.

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30 Two key processes take place in a child's personal and social development which are relevant to understanding the consequences of abuse and neglect (Garbarino and Gilliam, 1980: 169-172). First, because children become socialized by identifying, imitating, and modeling their parents, those living in dysfunctional families learn undesirable behavior patterns. Garbarino and Gilliam (1980) explain this process in the following way: children learn to be like their parents (in greater or lesser degree) because they are emotionally tied to and spend their formative years with their parents. This process involves both the accumulation of specific behaviors, habits, and characteristics (mode.ling) and the development of a more general identity (identification). Modeling, or setting.an example, is an efficient method of teaching since it includes much more than words. A person who models a behavior is giving information through body language and voice inflection. Through modeling, children grow to become like the people who matter to them and to whom they are important. Thus these processes (modeling, imitation, and identification) are the natural avenues for social and personal development. Without them, the process of becoming human would be almost impossible, because adults could never specifically teach children every detail of personhood. By identifying with their parents' prohibitions in order to avoid punishment, children develop consciences and become effectively socialized. However, the processes of identification and imitation also mean that children will absorb whatever reality is defined for them, even if it is a warped and violent one. (p. 171) Children who grow up in an abusive and/or neglectful

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31 family learn behavior that is often harmful to them and others. The most common personal problem that abuse victims with them throughout their lives are discussed pelow. Low Self-Esteem The most common problem for victims of maltreatment is the task of convincing themselves they are actually worthwhile individuals after having been told and shown for so long that they are not (Garbarino & Gilliam, 1980: 174). Abused and/or neglected children often learn a negative self-concept because rejection (through mistreatment) directly tells children they are not worth much. Damage to an individual's self-esteem occurs through two processes. First, parents represent the world to a child, and the messages the child picks up become the basic assumptions upon which to build an understanding of events in life (Ackley, 1980: 15). Consequently, many adults who were mistreated as children expect other people, at least those in positions of authority, to be as hostile and critical toward them as their parents were. Second, people try to reconcile reality with feelings. Consequently, there is always the possibility that children will

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32 justify parental rejection by blaming and downgrading themselves. Abuse victims are often quoted as saying, "there must have been some reason they beat me; otherwise, why would they have done it?" or "I don't blame them for doing it because I deserved every bit of it" (Garbarino & Gilliam, 1980: 172). Furthermore, when maltreatment victims are unable to fully reconcile themselves to their existence, they are likely to have feelings of anger, rage, frustration, hatred, fear, and pain which work against them in life {Garbarino & Gilliam, 198 0) Anxiety. One result of feelings of low selfesteem is maltreatment victim's tendency to experience a high level of anxiety about the opinions of others (Garbarino & Gilliam, 1980: 175). Anxiety, in turn, is a significant reason for school failure and lack of achievement. Poor social relationships. Research shows that rejected children do not perform well socially; they face the future with less confidence and are more confused, discouraged, and insecure than children reared with parental acceptance (Garbarino & Gilliam, 1980: 177). This could be caused either because

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33 abused individuals set themselves up to become lifelong victims or because they attempt to convince others that they count for something bybeing aggressive. Lack of Empathy Those who have suffered abuse tend either to lose their ability to empathize or not to develop it in the first place. Empathy, however, is desirable from a societal standpoint because it plays a major role in making human society more humane. Empathy is a strong motivator for social responsibility, and one who has it tends to be much less aggressive and more altruistic, sympathetic, and helpful (Garbarino & Gilliam, 1980: 1 76) Other Troubling Behavior Due to the negative feelings (e.g., anger, anxiety, and low self-esteem) experienced by many maltreatment victims, they are more likely to attempt to escape the pain of life through suicide, drug, and alcohol than those who are raised in a nurturing environment (Garbarino & Gilliam, 1980: 178-9). Also, people with psychological problems tend to have a hard time fitting into normal society and experience a myriad of disturbing behavior, such as truancy, poor

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34 school performance, substance abuse and sexual promiscuity (Garbarino & Gilliam, 1980: 180). This behavior can, in turn, lead to problems later in life like low-occupational mobility, drug or alcohol addiction, unwanted pregnancy, and venereal disease. Violent and Antisocial Behavior Child maltreatment, according to clinical psychologist, Dana c. Ackley (1980), at the Community Mental Health Center in Watertown, New York, adds to the perpetuation of violence in our society. In her opinion, another outcome of abuse is the role that violence plays in the adolescent and adult life of abused children. Not only do they abuse their own children, but they also frequently engage in other forms of violent behavior, such as murder and assault. Such violence is not surprising; thinking of parents as models, children see violence as an acceptable behavior. Strong parental messages have far greater impact than any threat society can make. (p. 16) Other theorists also maintain that violence p1ays a significant role in the lives of maltreatment victims. One reason for this, they theorize, is that a child so treated would have an unusual degree of hostility toward the parents and toward the world in general (Curtis, 1963). The control and channeling of this hostility into nondestructive avenues of release

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35 would, in turn, pose a problem for the victim. Also, as explained it is not surprising that maltreatment victims exhibit violent behavior because much of the behavior exhibited in later years is learned at a young age by imitating, modeling, and identifying with Moreover, abuse victims are more likely to identify with the abusive parent rather than the non-abusive parent as a defense mechanism and as a means of regaining a sense of power by assuming the role of aggressor rather than victim (Curtis, 1963). Clinicians report, however, that male victims of mistreatment are more likely to become aggressive and express their anger over being abused in ways that hurt others (Garbarino & Gilliam, 1980: 182). Females, on the other hand, tend to turn the anger inward on themselves and become self-destructive. Cycle of Abuse. One form of violence often exhibited by victims of maltreatment is the abuse and/or neglect of their own children. According to psychiatrist, Brandt F. Steele (1970), people tend to parent like they were parented. Therefore, children who have been abused and neglected provide the pool from which the next generation of neglecting abusive parents are derived.

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36 When men and women become parents, two kinds of memories are activated, often largely unconscious: the memories of what it was like to be a child, and the recollections of how one's parents cared for one in the earliest years. From these two sources the main patterns of child rearing will be derived. This is a normal mechanism; all parents tend to follow their own parents' style of child rearing. If one's early life was unfortunately beset by neglect and abuse, then one is likely to repeat it, and treat one's offspring as one was treated. ( S tee 1 e 1 9 7 5 : 14) Juvenile delinquency. Both theory and studies show that abuse and neglect are closely related to delinquency (Steele, 1975; Garbarino & Gilliam, 1980). Garbarino and Gilliam (1980) write that they are related for three reasons: (1) abuse victims tend to display traits characteristic of predelinquency, (2) both abuse and delinquency spring from common environments, and (3) abuse and aggression go hand in hand (p. 180). Nanette Dembitz (1979), a judge of the Family Court of the State of New York in New York City, also links child maltreatment with delinquency; she states: "whenever I must sentence a hard-core delinquent, I am impelled to consider prevention of juvenile crime through attention to children before the fact, rather than merely to sentence after the fact" (Dembitz, 1979: 920). Furthermore, she agrees with others who claim that the usual tipping factor toward

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37 crime is parental "abuse and neglect of children who in turn claim their victims by rape, mugging and murder11 (Dembitz, 1979: 920). Murder. According to several theorists, a link exists between child maltreatment and homicide (Garbarino & Gilliam, 1980; Steele, 1975). In their book, Garbarino and Gilliam (1980) cite several studies that support their claim that 11when we consider the ultimate form of violence, namely homicide, the link with abuse becomes even clearer11 (p. 183). Political assassinations. Dr. Steele (1975) claims that child abuse and neglect is also involved in political assassinations. According to Dr. Steele, Sirhan Sirhan, who shot Robert Kennedy, was a battered child. He and his brother were both taken into protective custody for a while as small boys because their father was beating them so badly. His brother, who shared the abuse with Sirahan, has also been arrested at least three times for aggressive, violent action. His latest bit of difficulty occurred because he made a verbal threat on the life of Golda Meier. James Earl Ray, who killed Martin Luther King, was an abused child. Arthur Bremer, who shot George Wallace, had a history of infantile abuse and neglect. (p. 193) Most professionals working in the child maltreatment field have little doubt that child abuse and neglect contributes to violent and antisocial behavior; however, some maintain that this relationship

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38 has not been sufficiently substantiated. Although both theory and spot-check studies indicate that maltreatment occurred in many criminals' childhoods, critics maintain that longitudinal studies must be conducted to establish a direct relationship. That is, critics maintain that data collected by questioning a particular segment of society (such as juvenile delinquents or convicted murderers) as to their childhood experiences is.not as reliable as data collected by following abuse victims through adolescence and adulthood to determine the frequency of antisocial behavior. Prevention Strategies As the shortcomings of unitary theoretical explanations for child maltreatment were recognized, prevention strategies changed. following fell to the wayside: Beliefs such as the (1) professionals are the key to the prevention and cure of child maltreatment, (2) "screening11 is an efficient and useful prevention strategy, and (3) short of social revolution, prevention of child maltreatment is impossible (Newberger & Newberger, 1981: 10-11). Eli H. and Carolyn Moore Newberger (1981) report that an

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39 early study shows that social work, psychiatric, and child development services seem no more effective than intervention provided by lay people who befriended families of the victims of child abuse and neglect (p. 11). Also, child maltreatment screening programs labeled such a large number of non-abusing families as abusing or potentially abusing that screening created the potential for a massive problem of inappropriate social labeling. Primary Prevention Strategies Currently acceptable prevention strategies acknowledge the complexity of child maltreatment and the critical factors which the ecological model suggests need attention (Rosenberg & Reppucci, 1985) Primary prevention strategies recommended by proponents of the ecological approach include (1) reducing the number of settings (e.g., schools, institutions, television, and movies) in which violence is held out as the favored method of resolving human conflict (Newberger & Newberger, 1981), (2) providing parent education programs in hospitals and communitites (Newberger & Newberger, 1981; Watkins & Bradbard, 1982; Rosenberg & Reppucci, 1985), (3) reducing social

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40 isolation by making access to other people by telephone and public transportation universally available (Newberger & Newberger, 1981), (4) community enhancement of social networks such as parent support groups, home visitor networks, crisis nurseries, and drop-off centers (Newberger & Newberger, 1981; Watkins & Bradbard, 1982; Rosenberg & Reppucci, 1985, and (6) intervention that targets vulnerable populations especially during periods of transition and stress, through services provided by lay health visitors and parent-aids (Watkins & Bradbard, 1982; Ryan, 1981). Lay Therapy Lay therapy grew out of the professionals' recognition that abusive and neglectful families' needed intensive help and support in their daily lives which caseworkers' and therapists' schedules could not provide (Ryan, 1981: 18). Laypersons could provide the most intense concentration of time and energy available in the treatment process and could offer unconditional, guaranteed friendship. In her postscript to Gail Ryans' booklet, The Lay Person's Role in the Treatment of Child Abuse and Neglect, social worker Helen Alexander describes the role of

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41 laypersons in the following way: the role of lay persons in the health and human services field has expanded and increased dramatically in the past decade, but nowhere has their role been more significant than in the treatment of families of abused and neglected children. Throughout the United States, as well as internationally, lay persons are being utilized to provide the outreach and support these families so deperately. need. By careful consideration of those special qualifications that are not produced through education, but rather by the individual's own life experience, we can provide services that augment and enhance the work of the professionals in this difficult field. (p. 36) Conclusion With time and research, attitudes toward child abuse and neglect have changed. Social scientists and child care professionals have come to realize that child maltreatment is a common occurrence--possibly the rule rather than the exception. They have realized that it occurs in a wide variety of families across the socio-economic spectrum, that it is caused by a vast number of factors, and that it creates numerous undesirable effects. Once it was realized that child maltreatment was a serious social problem with a variety of causal factors that could be successfully addressed by laypeople, trained volunteers began to be used in the area of child maltreatment prevention. This is the

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42 approach to treatment taken by CAP Vounteers, Inc. CAP provides parents with a professionally trained and supervised volunteer who befriends the parent and serves as a role model. CAP's parent-aid prevention program and the treatment philosophy behind it will be discussed more fully in Chapter VI.

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CHAPTER III THE CONCEPTUAL FOUNDATION OF BENEFIT-COST ANALYSIS An understanding of the relevant economic theory underlying benefit-cost analysis is needed to perform a sound analysis. The analysis applies neoclassical welfare economics to determine whether an action creates benefits greater than costs. It can be used to aid private decisionmaking by assessing the impact a particular course of action has on the firm, or it can be used in public decisionmaking to estimate the change in social welfare brought about by a public policy or program. In theory, a social benefit-cost analysis can provide a dollars and cents number which represents the change in social welfare. However, critics are concerned with the ability of welfare economics and, as a result, benefit-cost analysis to accurately assess social welfare. To provide a basic understanding of the theoretical foundation of benefit-cost analysis, this chapter (1) summarizes the welfare criteria offered by welfare economics, (2) critiques the criterion applied by benefit-cost analysis (i.e., the Hicks-Kaldor criterion), and (3) offers an approach

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44 which mitigates its shortcomings. In addition to the claim that benefit-cost analysis is subject to the shortcomings which some economists contend exist in welfare economics, E. J. Mishan {1976) brings up a second concern worth mentioning. According to Mishan, it is frequently alleged that policy recommendations based on welfare theorems are misleading because the analyst "makes recommendations that depend ultimately on his political predilections" (p. 382). This understandable concern with the influence of subjectivity on the analysis is, however, beyond the scope of this chapter which instead focuses on the economic theory underlying benefit-cost analysis. Welfare Criteria Economists' attempts to discriminate between alternative allocations of society's resources developed into a branch of microeconomics known as welfare economics (Mansfield, 1970: 438). In 1909, Italian economist, Vilfredo Pareto, formalized a criterion which states that resources are optimally allocated (and society's welfare is, therefore, maximized) when "it is not possible to increase the

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45 welfare of one individual without decreasing the welfare of at least one other individual" (Freeman, 1983: 82). The concept of Pareto optimality is at the core of many recommendations made by economists; however, critics argue that Pareto optimality is limited as a welfare criterion. Economists realize that an infinite number of alternative Pareto optimum positions exist for an economy, each of which depends on a particular distribution of income (Freeman, 1983: 467). Each alternative distribution would result in a different Pareto optimal position of the economy, but the Pareto optimality rule provides no basis for choosing among these positions (Freeman, 1983: 467). In fact, a situation which is Pareto optimal may be inferior to a situation that is not Pareto optimal depending on the desirability of the existing distribution of income. In E. K. Hunt's (1979) words: it can be shown that unless the existing distribution of wealth and income are socially optimal, a situation that is Pareto optimal may be socially inferior to many situations that are not Pareto optimal but have preferable distributions-of wealth and income. (p. 363) When applying Pareto's rule, no judgment is made about the initial position of the economy. The existing position is accepted and an attempt is made to

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46 determine if a change from that position would create an improvement (Freeman, 1983: 505; Hunt, 1979: 363). However, economists found that Pareto's criterion is not very useful in practice because few economic changes result in no one being made worse off. The inapplicability of Pareto's criterion is illustrated by the following statement by .Hunt (1979). In a world of class conflicts, imperialism, exploitation, alienation, racism, sexism, and scores of other human conflicts, where are the changes that might make some better off without making others worse off? Improve the plight of the oppressed and you worsen the situation of the oppressor (as perceived by the oppressor, of course)! Any important social, political, and economic situations where improving the lot of one social unit is not opposed by naturally antagonistic social units are indeed rare. (Hunt, 1979: 362) For example, a policy to curb monopoly power would be rejected under Pareto's rule. Although, a perfectly competitive market is in society's best interest, according to neoclassical economic theory, a policy to reduce monopoly power would not pass the Pareto criterion because it would harm monopolists by reducing their incomes (Freeman, 1983: 508). Therefore, a criterion was needed to evaluate changes that make some people better off while making others worse off. Such a criterion was offered independently by both John Hicks and Nicholas Kaldor in

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47 1939. Hicks and Kaldor proposed that an improvement( results when a change produces gains that exceed in value the accompanying losses; a change, therefore, such that gainers can {through costless transfers) fully compensate all the losers and remain themselves better off than before. {Mishan, 1973: 14) Their criterion suggests that a policy be accepted if the beneficiaries of the policy would still prefer it if they were required to fully compensate those who might lose from it. But the Hicks-Kaldor criterion does not require that compensation payments actually be paid (Freeman, 1983: 508; Blaug, 1983: 621). It recommends that a policy be accepted if the value of overall gains is large enough for gainers to conceivably compensate losers and still be better off themselves. Hicks and Kaldor reasoned that a policy which creates benefits of greater value than costs is desirable because aggregate social welfare is increased such that the potential exists for no one to be harmed. But their criterion ignores the fact that some people are in fact harmed if compensation payments are not made, and, as stated by Mark Blaug {1983), "there is a world of difference between a potential compensation and an actual compensation" (p. 622). A policy cannot be accepted on

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48 the basis that it increases welfare, therefore, unless compensation payments are actually made. The welfare criterion proposed by Tiber Scitovsky in 1941 was intended to meet another weakness in the Hicks-Kaldor criterion. Scitovsky realized that under certain circumstances, the Hicks-Kaldor criterion will indicate that a change is an improvement, but it will also indicate after the change that a change back to the original state of affairs is also an (Mansfield, 1970: .459). For example, it might happen that the Hicks-Kaldor criterion would indicate that a tax increase was good, but after the tax increase, the Hicks-Kaldor criterion might also indicate that a reduction of taxes to their original level was a good thing (Mansfield, 1970: 459). Therefore, Scitovsky proposed to resolve this ambiguity with a double test. Under Scitovsky's "double criterion," a policy would only be accepted if it met the following two conditions: 1. The move to the new position passes the HicksKaldor test; and 2. The reverse move back to the original position does not pass a Hicks-Kaldor test (Freeman, 1983: 512). In 1938, Abram Bergson proposed a criterion that brought the issue of equity into economists'

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49 evaluation of welfare. Bergson recognized that almost all policy issues involve a change in the distribution of income and argued that a policy can only be judged a welfare improvement on the basis of a social welfare function (i.e., an aggregate measure of national, or social well-being) The social welfare function proposed by Bergson requires that a set of explicit value judgments concerning the resulting income distribution be formulated and included in the social welfare function (Mansfield, 1970: 460). According to Bergson, these value judgment can be made by the legislature, a dictator, the economist, or the general public as indicated by popular vote; but once a social welfare function with equity weights is specified, a policy change can only be judged an improvement on the basis of whether or not it moves society to a higher point on the Bergson social welfare function. I. M. D. Little was also concerned with the relationship between income distribution and social welfare and inserted equity considerations explicitly into his discussion of welfare (Haveman & Weisbrod, 1975: 173). In_his 1957 book, A Critique of Welfare Economics, Little proposes a criterion which accepts a compensation notion similar to Hicks and Kaldor's;

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50 however, while the Hicks-Kaldor criterion is concerned only with the requirement that the overall value of benefits exceed costs, Little's criterion requires, in addition, an explicit judgment that the resulting change in income distribution would cause what he terms a "good" distribution of wealth (Haveman & Weisbrod, 1975: 173). A final standard for judging a change in social welfare--the maximin criterion--was proposed in 1971 by John Rawls. In his book, A Theory of Justice, Rawls' asserts that "all social values are to be distributed equally unless an unequal distribution is to everyone's advantage" (Mansfield, 1970: 440n). When used to evaluate policies that hurt some but benefit'others, the maximin rule accepts only those that "increase the well-being of the least well off" in a society no matter how large the gains to others (Freeman, 1983: 513). The Hicks-Kaldor Criterion and Benefit-Cost Analysis Although economists proposed several alternative criteria for judging social welfare, it is the Hicks-Kaldor criterion which benefit-cost analysis applies (Freeman, 1983: 509; Mishan, 1973: 14-15).

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51 The compensation payments referred to by Hicks and Kaldor are known in economic theory as compensating variations. The compensating variation of those who are harmed by the program is the minimum amount of money that they (the losers) are willing to accept to feel that they have not been harmed by the change. The compensating variation of those who gain from the program is the maximum amount of money that gainers are willing to pay in order to persuade losers to accept the change. Being an application of the Hicks-Kaldor criterion, benefit-cost analysis translates the concept of compensating variations into program costs and benefits. Losers' compensating variations equate to program costs, while gainers' compensating variations are program benefits. If the value of program benefits is large enough for winners to conceivably gain from the change even after compensating losers (i.e., benefits greater than costs) according to the HicksKaldor criterion, the program increases social welfare. The reader might note that if compensation was made, Pareto's criterion would be satisfied. For this reason, a change which satisfies the Hicks-Kaldor criterion is sometimes referred to as a "potential Pareto improvement" (Mishan, 1973)

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52 The primary problem found in the Hicks-Kaldor criterion is its use of money compensation. Critics maintain that money compensation is not a valid measure of utility because a dollar of income does not yield the same utility to every person. It cannot be concluded, they claim, that gainers feel a greater sense of benefit than losers feel a sense of loss simply because gainers' place a higher dollar amount on their feeling of gain and vice versa. William Baumel {1977) illustrates that a dollar is worth more {or less) to some people than others in the following example of a change which benefits individual Y but harms individual X: If Y's gain is worth $200 to him whereas X evaluates his loss at $70, we are not entitled to jump to the conclusion that there is a net gain If X is a poor man or a miser, $70 may mean a great deal to him, whereas if Y is a rich man or a profligate, the $200 may represent a trifle hardly worth his notice. Thus, unless X is actually compensated for his loss {in which case the Kaldor criterion is unnecessary--and the Pareto criterion can do the job) the change may represent a major loss to X and a trivial gain to Y even if it passes the Kaldor criterion with flying colors {p. 530) Hicks and Kaldor introduced the concept of money compensation, according to Baumel, in order to evade the interpersonal comparison of utility required to evaluate a policy change that aids some but harms

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53 others. However, he argues that, by introducing money compensation, the Hicks-Kaldor criterion is "saying, implicitly, that the economist's recommendation should be based on X's and Y's relative willingness and ability to pay for what they want" (Baumel, 1977: 530) Furthermore, by using money compensation to evaluate social welfare, Hicks and Kaldor accept the status quo distribution of income as a measure of the relative of feeling of gainers and losers (Baumel, 1977: 530; Blaug, 1983: 622; Haveman & Weisbrod, 1975: 178). Robert Haveman and Burton Weisbrod (1975) also expressed concern that the Hicks-Kaldor criterion accepts the prevailing distribution of income and does not necessarily insure an improvement in society's welfare unless compensation is paid (p. 178). However, like Little, they maintain that the Hicks-Kaldor criterion can be used to measure a change in social welfare if a clear and precise judgment is made concerning the desirability of the resulting distribution of income. In their discussion of the Hicks-Kaldor criterion, Haveman and Weisbrod (1975) declare, it has been argued--in our judgment properly--that a resource reallocation does not unambiguously

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54 increase economic welfare unless the compensation is actually paid, so. that everyone is really better off, or unless an explicit judgment is made that real economic welfare should be redistributed In short, an explici.t decision regarding the desirability of the income redistributional effects is required before a meaningful statement can be made about the effect of net benefits on real welfare (p. 174). In addition to the issue of including equity effects in the analysis, there is a question concerning the inclusion of intangibie effects. Because gains and losses are valued in the analysis by willingness to pay, some economists argue that noneconomic effects (those not valued in dollars and cents by the marketplace) should not be included in the analysis. Roland McKean, on the other hand, contends that all effects (whether priced in the market or not) must be taken into account for the analysis to reflect the real impact of a change. McKean maintains that people place. a value on aspects of life that are often not priced in the marketplace, and that these value decisions should be considered when evaluating welfare. In McKean's words: Needless to say, in reaching decisions, one should attemptto take into.account all gains and all costs. Some people feel that there are two types of gain or cost, economic and noneconomic, and that economic analysis has nothing to do with the latter. This distinction is neither very sound nor very useful. People pay for--that is, they value-music as well as food, beauty or quiet as well as

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55 aluminum pans, a lower probability of death as well as garbage disposal. The significant categories are not economic. and noneconomic items but (1) gains and costs that can be measured in monetary units (for example, the use of items like typewriters that have market "prices reflecting the marginal evaluations of all users); (2) other commensurable effects (impacts of higher teacher salaries, on the one hand, and of teaching machines, on the other hand, on student's test scores); ( 3) incommensurable effects that can be quantified but not in terms of a common denominator (capability Qf improving science test scores and capability of reducing the incidence of ulcers among students); and (4) nonquantifiable effects. Examples of the last category are impacts of alternative policies on the morale and happiness of students, on the of racial conflicts, and on the probability of protecting individual rights. In taking a position on an issue, each of us implicitly quantifies such considerations. But there is no way to make quantifications that would necessarily be valid' for other persons. This sort of distinction between types of effects does serve a useful purpose, especially in warning us of the limitations of cost-benefit analysis (Quoted in Mansfield, 1982:: 482-83). Conclusion The primary criticism leveled against benefitcost analysis centers the types' of benefits and costs to appropriately include in. the analysis. Some eGonomists maintain that only costs and benefits which have market prices should be in the analysis. They reason that market price represents marginal worth to society, and using market price makes the analysis less subjective. But others maintain that all perceivable

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56 program impact.s must be identified in the analysis for it to provide a valid reflection of social welfare. Therefore, information on distributional effects (who gains and who loses) and intangible effects (those which cannot be measured precisely) must be included in the analysis and the decisionrnaking process. Both sides of the debate offer valid which reveal the trade-off between the two approaches. The first approach includes only effects posessing market prices but excludes many effects, and the second approach provides information on all perceived effects but cannot place a monetary assessment of their worth to society on all effects. Because program costs and benefits are valued in the first approach by dollars and cents so that costs can be subtracted from benefits to obtain a net-benefit number. Programs can then be accepted or rejected on the basis of the net-benefit figure with little input from decisionmakers. This approach is believed by some to be more precise and objective than the approach which leaves the worth of some program effects to the discretion of decisionmakers because effects would be valued differently by various decision-makers and perhaps would also be valued differently by the same decision-

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makers in different ci:i'cumstances (Canada Treasury Board, 1976: 33). However, a net-benefit number which omits some program effects or which 'contains the analyst's rather than decisionmakers' biases is no more valid or useful than the approach which explicitly leaves some moral judgment to decisionmakers but reveals all effects. For the analysis to provide decisionmakers with the best possible information concerning a program's impact on social wel'fare, it must include all program effects and the issue of decisionmakers biases becomes secondary. An approach suggested by Haveman and Weisbrod (1975} can be used to adjust benefit-cost analysis so that it contains information on all perceived program effects. They propose that distributional and other consequences of a program not included in the netbenefit calculation be completely displayed as a "supplement" to the net-benefit calculation which includes only monetarily measurable effects (p. 195). An analysis which provides both a net-benefit figure and a description of distributional and intangible effects will, according to Haveman and Weisbrod, enable decisionmakers to "understand the full range of impacts

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of the decision to be made" (p. 195) A analysis of this type usually leads to more detailed discussions and a clearer appreciation of the various aspects of the program (Canada Treasury Board Secretariat, 1976: 5). 58 A "supplemented" benefit-cost analysis requires that the analysis report include (1) a theoretically sound benefit-cost calculation and (2) a display of the effects contained in the net-benefit calculation. The following chapter provides a discussion of the procedure for performing this type of analysis as it pertains to child abuse and neglect prevention programs.

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CHAPTER IV ANALYSIS PROCEDURE Six steps are required to perform an economic analysis of child maltreatment prevention programs: (1) program definition, (2) choice of appropriate analysis type, (3) identification of program benefits and costs, (4) calculation of riet-benefit, (5) display of effects not included in the net-benefit calculation, and (6) compilation of the report. To perform these steps properly, they must be approached with a solid background of information about purpose and procedure and, therefore, are discussed below. Program Definition The initial step in program evaluation a precise description of goals and processes. This information is useful to both decisionmakers and analysts because it helps relate program goals to benefits (desirable results of the program) and costs (undesirable outcomes). To understand the result of

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60 the analysis, decisionmakers need to be familiar with the program and understand its objective because seemingly minor differences in programs can have major impacts on costs and effects (Shepard & Thompson, 1979: 536). For instance a child abuse and neglect prevention program which targets high-risk persons is likely to have higher costs than one that serves less risky families. Furthermore, the insight analysts gain from defining the program helps them conduct the analysis. An essential piece of information included in the program definition is a statement of program goals in both conceptual and measurable terms (Haveman & Weisbrod, 1975: 170). Also, it includes an explanation of program processes. An adequate program definition, according to Donald S. Shepard and Mark S. Thompson (1979), should answer "the six questions generally covered in the lead to a newspaper article: who, what, when, where, why, and how" (p. 536). In the case of child maltreatment prevention, the program definition should include (1) a description of the program's target population, (2) program objectives in conceptual and quantifiable terms, _(3) why the program is needed, (4) the time period of the analysis, (5) the geographical area

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61 served by the program, and (6) the program's method of achieving its objective. Choosing Analysis Type Two types of analysis (benefit-cost and costeffectiveness) exist within the benefit-cost framework; each performs a different function. Therefore, the type of analysis chosen should depend on the information the analysis is intended to provide. Benefit-cost analysis is designed to determine whether a program's benefits exceed its costs, and costeffectiveness analysis is designed to determine the cost per benefit. When conducting the two analyses, the primary difference is how benefits are quantified. Benefitcost analysis places a monetary value on both costs and benefits, while cost-effectiveness analysis values costs but not benefits in monetary terms. Benefits in a cost-effectiveness analysis are left in physi"cal terms such as healthy life years saved and, therefore, avoids the need to assess the worth of program benefits. But each analysis has advantages and limitations. Benefit-cost analysis quantifies both

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62 benefits and costs in the same units (i.e., dollars and cents) This allows costs to be subtracted from benefits, and an explicit net-benefit number is provided which indicates whether program benefits exceed costs. One advantage with the net-benefit calculation is that it allows programs to be accepted on the condition that benefits at least equal costs, and, beyond that, programs can be evaluated according to how much their benefits exceed their costs (Levin, 1981: 22). Another plus is its wide range of comparability. Because net-benefit is measured in dollars and cents( benefit-cost analysis allows the desirability of the program under study to be compared to a variety of other programs with dissimilar outputs. Cost-effectiveness analysis, on the other hand, allows comparison only between programs with outcomes that can be measured in the same physical units. It has been argued, however, that benefit-cost analysis can only be used to evaluate certain types of programs because the worth of some programs' effects cannot be fully accounted for in terms of money. Henry M. Levin claims that benefit-cost analysis should not be.used unless program benefits can be easily converted into monetary terms, and he uses the

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63 example of a program aimed at improving adult literacy to make this point: while the gains in earnings and certain provided services attributed to higher levels of literacy might be assessed according to their pecuniary worth, how:does one assess such benefits as improvement in self-esteem of the newly literate adults, or their enhanced appreciation of reading materials? (p. 23) Levin recommends that some other mechanism for assessment be found in those cases where the major . benefits are difficult to assess in pecuniary terms. Members of the health care profession also argued that it is not appropriate to assess program OUtCOmeS in dollarS -and CentS When. the program IS aim iS to save or improve quality of life. They claim that art analysis of a health-care program that quantifies program benefits in physical terms. is far more us-eful to decisionmakers than one that places a dollar value on human lives to represent their worth_ to society. Moreover, Milton C. Weinstein and William B. Stason (1977) of the Harvard School of Public Health maintain that many decisionmakers mistrust analyses that assign a monetary value to human life: the major disadvantage of the benefit-cost framework is the requirement that human life and quality of life be valued in dollars. Many decision makers find this point difficult, and do not trust analyses that depend on such valuations. Cost-effectiveness analysis, on the other hand,

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64 requires only that health outcomes be expressed in commensurate units (e.g. quality-adjusted life years), generally involving tradeoffs more palatable to physicians. (p. 733) In cases where program outcomes are difficult to assess in dollars and cents, Levin (1981) contends, it seems more appropriate to compare the results of programs in terms of their effectiveness on some criterion or set of criteria using cost-effectiveness analysis (p. 24). Although this argument is legitimate, costeffectiveness analysis has limitations and does not entirely solve the problem. Of greatest importance is the fact that cost-effectiveness analysis cannot assess a program's impact on social welfare. Because costs and benefits in a analysis are not valued in the same units, it cannot indicate whether program benefits exceed costs. It calculates the programs cost per unit Therefore, costeffectiveness analysis can be used only when decisionmakers aim to minimize the costs associated with the attainment of some objective which has previously been judged desirable (Canada Treasury Board Secretariat, 1976: 5). It cannot establish whether an investment is worthwhile in the first place. In addition, because cost-effectiveness analysis measures program effects in physical terms (i.e., lives saved),

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65 it can only be used to compareprograms that share the same objectives (Levin, 1981: 35) . A dilemma occurs, therefore, when an analysis is needed to evaluate the social impact of a program like child abuse and neglect prevention because its objective cannot be adequately assessed in money terms. While benefit-cost analysis can determine a program's social impact and allows comparison between dissimilar programs, it rarely achieves the ideal of measuring all benefits and costs in money terms. Cost-effectiveness analysis, on the other hand, drops the requirement that benefits be valued in monetary terms, but it does not indicate a program's impact on social welfare. Nor does it alleviate the problem of quantifying all program impacts with the same measure. Although benefit-cost analysis excludes effects that cannot be meaningfully expressed in monetary terms, costeffectiveness analysis excludes program effects that cannot be measured by the single physical measure chosen. Nonetheless, the inability to assess all impacts in the same units (whether monetary or physical) can be mitigated by using the "supplemented" benefit-cost approach discussed in Chapter III. Because a supplemented benefit-cost analysis helps to

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66 lessen the problem of exc.luding program effects from the analysis by describing effects left out of the netbenefit calculation verbally, it can be used to successfully evaluate the social impact of a program like child maltreatment prevention. Identify Program Effects Before program effects can be quantified, they must be identified. Therefore, the benefits and/or costs created by each program objectives must be determined. Two issues should be considered when identifying program effects, and the first pertains to the scope of program effects. Because benefit-cost analysis attempts to identify all program effects regardless of their recipients, program benefits and costs cannot be confined to the monetary flows of the program. In addition to internal effects, impacts that fall outside the domain of the program (externalities) are also included in the analysis. The second issue to be considered deals with the of effects to include in the net-benefit calculation. While all welfare effects, regardless of who they impact, are relevant to the program evaluation, it is important to recognize that some effects only redistribute welfare (equity

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effects}, and others (efficiency effects} expand aggregate welfare (Haveman & Weisbrod, 1975: 18S}. Because the net-benefit portion of the analysis provides information on the program's effect on aggregate welfare, only those effects that alter society's opportunities to produce and consume can be included in the calculation. Therefore, efficiency effects must be distinguished from equity effects. Externalities 67 External effects are benefits received or costs borne by those not associated with an activity for which payment is neither given nor received (Canada Treasury Board, 1976: 12}. Take, for example, the case of a coal burning electric power plant that discharges pollutants into the air. If the pollutants discharged by the plant adversely affect the health of the people living downwind from it, in most cases the firm does not bear the cost of polluting and the individuals harmed do not receive compensation for their loss of health (Freeman, 1983: 245). In this sense, the cost to the people living is external to decisionmakers. Externalities also take the form of benefits.

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For instance, society might receive the benefit of a more informed electorate as a result of education undertaken by individuals to increase their earning power (Canada Treasury Board, 1976: 12). However, this benefit falls on those not associated with the activity and is, therefore, an "external" benefit. 68 Such external costs and benefits are often ignored in private decisionmaking because their impact is not reflected on the books of the firm. However, all effects--regardless of whether they are internal or external to the program--are taken into account in a benefit-cost analysis because they impact social welfare. Efficiency Versus Equity Efficiency effects are those impacts that create an increase or decrease in consumer satisfaction or the amount of resources required to produce goods and services (Haveman and Weisbrod, 1975: 184). Equity effects, on the other hand do not change the volume of production or consumption but alter their distribution among the members of society. Equity effects represents a change in some people's well-being at the expense of the well-being of others (Haveman &

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69 Weisbrod, 1975': 184); consequently, equity effects should not be included in the net-benefit calculation. Distinguishing between efficiency and distributional effects, however, is not always a simple task. Equity effects, according to the authors of Benefit-Cost Analysis Guide (1976), are often revealed by changes in the relative prices of factors of production, or by changes in asset values (p. 10). They provide the following example of a training program to show how a change in compensation can signal an equity effect: let us consider the effects of subsidies for the training of workers who would otherwise be entitled to receive welfare payments. In so far as such training allows workers to acquire skills which raise their productivity in employment, it clearly leads to allocative benefits. But any reductions in welfare payments that are attributable to such training do not in themselves constitute allocative benefits to society, because any relief obtained in this way by the general constitutes a loss to the former recipient of transfer payments. (p. 11) They also provide the following example to illustrate how changes in relative prices can signal the occurrence of distributional effects: let us suppose that the building of a public dam leads to increases in the wages of construction workers, the productivity of these workers remaining unchanged. While consumers and businesses engaged in residential and nonresidential construction elsewhere in the economy may be adversely affected by this change in

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70 prices, their loss will be offset by a corresponding benefit to the workers concerned. In calculating the efficiency effects of constructing such a public dam, the analyst would accordingly ignore any reallocation of resources brought about in the rest of the economy by this change in the relative prices of factors of production. (p. 11.) MATHEMATICA Policy Research, Inc., in their 1982 evaluation of the Job Corps, used a unique approach to distinguish efficiency effects from equity effects and to display program costs and benefits (Thorton, Long, & Mallar, 1982: 15). First, program effects were listed in tabular form indicating whether each was a cost or a benefit. Then a plus sign (+) or a minus sign (-)_ was specified to indicate whether the benefit or cost was a gain or a loss from the perspective of each of three groups: corpsmembers, non-corpsmembers, and society (the sum of corpsmembers and non-corpsmembers). A zero (0) was recorded for effects that had a neutral impact. For example, a benefit of the Job Corps program was to reduce criminal activity, and one of the effects resulting from the reduction was "reduced criminal justice system costs.11 This program benefit was a gain (+) from the perspective of non-corpsmembers but neither a gain nor a loss (0) from corpsmembers' point of view. Combining the two signs indicates that "reduced criminal justice

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71 system costs" is a gain to society as a whole, and, therefore, it is an efficiency benefit. On the other hand, "reduction in stolen property" is a gain to noncorpsmernbers but a.loss to corpsmernbers and therefore, is a wash. The reduction in stolen property is, therefore, a distributional benefit. Net-benefit Calculation The steps which are required to compute the present value of a net-benefits are discussed in this section. It includes (1) further comments on how to identify efficiency effects, (3) the quantification of costs and benefits, (3) discounting, (4) computation of net-present-value, and (5) sensitivity analysis. Efficiency Effects Efficiency in resource allocation is considered a desirable goal because it is sometimes to reallocate resources in ways which will bring about an increase in the value of the aggregate output produced by those resources. The logic behind the net-benefit calculation, correspondingly, is that the increased output of the good whose production is expanded must be

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72 greater than the decrease in the output of the good whose production is decreased (Haveman & Weisbrod, 1975: 170-171). In addition to the need to distinguish between equity and efficiency effects when calculating the programs net-benefit, other issues like the marginal concept and opportunity costs must be understood. The Marginal Concept Only marginal costs and benefits are included in the analysis. Efficiency benefits are those favorable consequences of the program which represent opportunities to increase production or consumption, and efficiency costs are opportunities foregone (decreased) because the program is undertaken. Thus, when changes in production and consumption levels, only extra or marginal costs and benefits are considered. Because accounting data uses average rather than marginal cost, accounting data might have to be adjusted for use in the analysis to reflect marginal rather than average costs.

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73 Opportunity Costs When determining a program's cost to society, what has already been spent on some resource (its sunk cost), is not necessarily its economic cost. Economists are concerned only with a resource's highest value in alternative uses (i.e., its opportunity cost). The following example of a benefits-cost analysis performed to assist in the decision of whether to retain and expand a local airport reveals why only resources with alternative uses should be included in the analysis: the author of this study assigned no opportunity cost to the use of the existing runways at the airport (other than for expenditures incurred in their maintenance) his argument being that these runways had no alternative uses and no scrap value. On the other hand, the land on which the airport in question was situated clearly had alternative uses and was accordingly assigned an opportunity cost in the study . Failure to take account of the differences between marginal and average costs and benefits constitutes a rather elementary defect of many benefit-cost analyses evaluating the desirability of expanding or contracting public programs. (Canada Treasury Board, 1976: 10) Quantification ( Once program effects are identified, a value must be determined for each benefit and cost. The benefit portion of the net-benefit calculation includes either the value of additional goods or services

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produced by the program or the value of cost savings created by the program's output. The cost portion includes the value of resources used by the program (Canada Treasury Board, 1976: 13). 74 Benefit and costs are valued in the analysis by market price. Market price is used to assign a worth to program effects because the benefit of consumption is believed to be equal to the satisfaction or utility derived by the users, and the price users are willing to pay is the best available measure of that satisfaction (Canada Treasury Board, 1976: 13). For various reasons, such as program outputs or inputs being provided free of charge (e.g., volunteers' time, in-kind donations) or resources being unemployed, some resources' market prices may not adequately reflect society's true valuation. In these cases, it may be necessary to adjust the existing price or estimate the correct market prices using a method known as "shadow pricing". Shadow Pricing A "shadow price" simulates what users would be prepared to pay for the services of an output in a competitive market (Canada Treasury Board, 1976: 13). The need for shadow pricing is described below.

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75 In the absence of implicit effects, monopoly power, price or quantity controls, taxes and subsidies, external economies, and other market imperfections, market prices for outputs will be equal to the marginal social costs, or the value of the resources used to produce these outputs, and market prices for inputs will be equal to the value of their marginal contribution to output. Under such circumstances, market prices will adequately measure allocative benefits and costs. There are, however, many instances where existing market prices do not accurately reflect the value of market transactions to society as a result of various distortions _or because market prices may not even exist. In such situations, it may be necessary to impute the allocative benefits and costs of public projects by either adjusting market prices or estimating what the correct market prices would be. These adjusted or imputed prices are called shadow prices and the technique of imputing values in such circumstances is known as shadow pricing. (Canada Treasury board, 1976: 13) Two commonly used methods for deriving shadow prices are {1) the use of price relationships observed in markets for similar items and (2) the use of market information to estimate consumers' willingness to receive the effect of some outcome or to avoid the effect of the outcome {McKean, 19**: 50-52). In his discussion of the first approach, McKean suggests that the worth of a public beach be imputed by using the prices that people pay for similar beaches or facilities operated commercially.. However, he warns that a problem with this approach arises because it is often difficult to determine how similar the items are. The second approach to deriving shadow prices,

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76 willingness to pay, pay might be estimated using the travel-cost method. If the use of a public recreational facility is provided free of charge, the value consumers place on the recreational facilities might be determined by the cost consumers are willing to incur in traveling to the facility (Canada Treasury Board, 1976: 14). Willingness to pay can also be estimated by using the market information provided by the program's "secondary benefits." Secondary benefits are those outcomes generated by the stimulative impact of the program's direct output. For example, the direct benefit of an investment in improving the waterquality of a lake may be to increase the recreational use of the lake (Haveman and Weisbrod, 1975: 180-181). But if the use of the lake is provided free of charge, a shadow price of its value to consumers must be estimated, and secondary effects can supply information concerning society's valuation of the recreational use of the lake. That is, willingness to pay for the additional enjoyment of fishing, swimming and boating can be measured by the value of the project's secondary effects such as the lodging and eating facilities resulting from the increased use of the lake. Unemployed Resources. Observed prices are also

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77 misleading when a resource is involuntarily unemployed because the "sacrifice. (opportunity cost) entailed by using it may be, as in the case of manpower, virtually zero" (McKean, 1968: 42). Whether or not a shadow price should be used in the benefit-cost analysis to reflect the true social cost of employing previously unemployed resources, according to Roland McKean (1968), depends on the real-world situation at the time the input would be used and recommends that, in general, the cost of resources be valued as if they were fully employed: Unemployment today does not necessarily imply unemployment two years from now when the project would be completed. It does not strike me as reasonable, particularly in this latter half of the twentieth century, to assume that mass unemployment will persist year after year. If a depression exists and a project would begin shortly, it might be appropriate to charge a zero price for manpower during the first year of the project, though as a general rule comparisons of alternative proposals are likely to be more accurate if ordinary levels of employment are assumed. (p. 43) McKean's view is shared by the authors of "Benefit-Cost Analysis Guide" (1976). In their words: while the practice of shadow pricing inputs may be appealing when unemployment of resources is widespread, there are a number of practical and theoretical problems associated with the use of this technique .. unless the project area suffers from consistently high unemployment rates over a long period of time, a project's operating costs should be estimated on the basis that it will function in a fully employed economy. This

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78 procedure should be followed even if a project is undertaken in times of severe unemployment, unless we have good reason to believe that this unemployment will persist in the future. The consensus on this matter also reflects the assumption that mass unemployment is unlikely to be a characteristic condition of the economy in the late century. (p. 19) Discounting Program benefits and costs are likely to occur over a period of time; therefore, future effects must be discounted to reflect their present value to society. Because people prefer goods received in the present to goods received in the future, costs and benefits realized in future years must be discounted to reflect their reduced value to society. Program effects are discounted by (1) computing total benefits and total costs for each year and (2) multiplying each future year's total cost and total benefit by the discount factor 1/(l+i)j, where i is the social discount rate per year, and j is the index of the year in which the cost or benefit will occur. This factor reflects society's preference for benefits realized sooner so that the further in the future the benefit is realized, and j grows larger, the smaller the benefit's present value. The size of the discount rate determines the value of future costs and benefits and,

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thus, the net-present-value calculation. The greater the discount rate, the smaller the present value of costs and benefits. 79 Therefore, a good deal of care needs to be taken in choosing the discount rate. The "social11 discount rate is assumed to reflect society's time preference tor money. For example, if society is indifferent between whether it has $100 million today or $106 million next year, the social rate of time preference is 6 percent per annum (Mishan, 1972: 118). The correct social rate of time preference, according to Baumel (1968), should measure "the opportunity cost of postponement of receipt of any benefit yielded by a public investment" (p. 788). Although no definitive method for determining the social rate of discount exists, Baumel provides some basic guidelines which are widely accepted. He contends that the appropriate rate of discount for public projects is one which measures the social opportunity cost of moving the resources employed by the program from the private sector to the public sector (Baumel, 1968: 789). He recommends that the social discount rate be calculated by determining the return that would have been earned if the program's

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80 resources would have been left for corporate use during the period in question. Furthermore, he argues that any rate different from the opportunity cost rate would misallocate resources and reduce social welfare. In Baumel's words: the correct discount rate for the evaluation of a government project is the percentage rate of return that the resources utilized would otherwise provide in the private sector. That is the correct discount rate is the opportunity cost in terms of the potential rate of return in alternative uses on the resources that would be utilized by the project. Any discount rate that is clearly above or clearly below the opportunity cost rate is indefensible because either of these will lead to decisions that reduce the general welfare. (1968, p. 275) Once the rate of return that would have been earned by the corporation is determined, two other issues need to be taken into account: risk and taxes (Baumel, 1968). It has been argued that public investments incur no risk and, therefore, the risk component in private cost of capital figures should be ignored in the social rate of discount calculation. However, Baumel (1968) contends that all investments should be evaluated at their expected earnings and, therefore, the risk factor should be included in the social discount rate calculation. Baumel says, from the social point of view the "law of large numbers" argument cuts both ways --it says that risk in either public or private projects is

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81 irrelevant for the returns society can expect. Take the example of our corporation earning a 16 per cent rate of return, which in the absence of a risk premium would be reduced to 10 per cent. The expected return on its investment is then in fact 16 per cent which, as we have seen, is virtually certain from the viewpoint of society. Then, clearly, the social opportunity cost of a transfer of resources from the corporate to the public sector is 16 and not per cent, and that is all there is to be said on the subject. (p. 796) An adjustment should, however, be made to take account of the taxes paid by the corporation. The opportunity cost of transferring funds from corporation to public use can be calculated by (1) determining the returns which could have been obtained if the resources had been left in the private sector and (2) adjusting for taxes (Baumel, 1968: 790). For example, if the corporation must return r percent of its gross earning to its stockholders, and the corporation pays 50 percent of its earnings in taxes, the corporation must in fact earn 2r on its investment in order to pay stockholders an r rate of return. Therefore, a corporation which pays r percent to its stockholders and a tax rate such that the fraction 1/k remains after taxes, has an opportunity cost rate for resources of k times r percent (Baumel, 1968: 279).

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Net-Present-Value Calculation The accepted measure of a program's impact on social welfare is net-present-value. After all costs and benefits are quantified and discounted to their present value, the present value of total costs is subtracted from the present value of benefits to calculate the program's net-present-value. Traditionally, a net-present-value figure of greater than zero indicated that society's total welfare is increased. However, because many program effects are not included in the calculation due to the difficulty 82 of quantifying them in monetary terms, the net-present-value calculation can only partly indicate a program's impact on social welfare. The net-present-value calculation, therefore, identifies whether the value of the program's desirable effects which could be quantified in dollars and cents is greater than the value of its undesirable effects that could be quantified in dollars cents. Sensitivity Analysis The final step in calculating the program's net-present-value is the sensitivity analysis. Many of the values used in the calculation are estimates

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83 and, therefore, are not known with''Certainty (e.g., the social discount rate, shadow prices). Because these estimates can significantly affect the magnitude of the net-present-value calculation, their influence on the outcome of the analysis must be determined, and sensitivity analysis serves this purpose. It allows the impact of uncertain values on the net-present-value figure to be assessed. To perform the sensitivity analysis, high and low estimates for uncertain values are substituted into the net-present-value calculation to see if the recalculation will affect the decision concerning the program's desirability (Shepard & Thompson, 1979: 539.) If the final decision is not affected by making different assumptions about these quantities, the decision can be used with relative but if the decision would be drastically altered, considerably more caution should be used about making recommendations based on the net-present-value figure (Shepard & Thompson, 1979: 539). By examining the sensitivity of the benefit-cost findings to changes in the study's major assumptions and estimates, decisions can be base.d on the results of the analysis with far greater confidence (Mathematica, 1982: 156).

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Display Non-Measured Effects 84 For sound funding decision to be made based on a program's impact on welfare, decisionmakers must be aware of all program effects. However, some costs and benefits will probably not lend themselves to being measured in monetary terms (e.g., distributional effects, lives saved, increased well-being and health). Consequently, they are likely to be left out of the net-present-value calculation. Rather than leave pertinent information out of the decisionmaking process, non-measured effects should be displayed in the manner suggested by Haveman and Weisbrod (1983): given the importance of unmeasured benefits, it is essential that they be handled appropriately in cost-benefit analysis. One reasonable way of dealing with these effects is to describe their nature as explicitly as possible and, where feasible, to describe them in non-monetary, though quantitative, units. Such indicators at least provide information on the importance of the impact, even though its monetary value is still beyond measurement. (p. 189) Analysis Report The final step in program evaluation requires that the findings of the analysis be compiled into a report. This report can be presented to decisionmakers and any other interested party and

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is used to inform them of the assumptions, limitations, and outcome of the analysis. The analysis report should include: 1. a summary of the results of the analysis; 2. an introduction describing the situation which led to the program analysis; 3. the program definition; 4. the constraints considered in conducting the analysis; 85 s. a list of assumptions made in performing the analysis, and information on how benefits and costs were estimated; 6. a description of the distributional effects and their quantitative indicators; 7. a conclusion discussing the results of the analysis and how they might be interpreted (Canada Treasury Board Secretariat, 1976) This type of "supplemented" benefit-cost analysis promises to be a useful approach for identifying and presenting the social impact of child abuse and neglect prevention programs.

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CHAPTER V SUMMARY OF PRIOR COST ANALYSES OF CHILD MALTREATMENT PREVENTION PROGRAMS Pleas for public support of child abuse and neglect prevention programs regularly include the claim that preventing is cost-effectiveness. However, a review of the literature reveals that many such claims are not based on the results of actual cost studies. In fact, a 1984 literature search shows that very few economic analyses of child maltreatment prevention programs have been performed. Furthermore, most of these studies do not evaluate a program's impact on society as a whole; rather, they tend to limit their view of program effects (particularly costs) to the funding source. A review of these analyses is helpful for developing an evaluation system for child maltreatment prevention programs because they provide insight into approaches taken by other analysts. The three analyses discussed in this chapter are (1) "Self-Referral Demonstration Program Collaborative Research Effort" performed by Louis F. Cicchinelli, Robert A. Keller, and Phil E. Fox of the Denver Research Institute,

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87 (2) Kay Armstrong's study described in her article, "Economic Analysis of a Child Abuse and Neglect Treatment Program," and (3) the analysis discussed in Nancy T. Greenspan's paper "Funding for and Cost-Benefit Analysis of Services for High-Risk Families and Infants." These studies serve to provide information on both preparatory steps necessary before the analysis can be performed and specific details on how the analysis might be performed. Each analysis is described with particular attention to (1) the type of analysis chosen, (2) program effects and how they were measured, (3) the costs identified and how they were quantified, (4). how cost savings were treated in the analysis, (5) how volunteers' time, if employed, was valued, (6) the discount rate employed, and (7) the indirect effects identified in the analysis. Denver Research Institute Study In 1979, the National Center on Child Abuse and Neglect (NCCAN) funded five demonstration projects to examine ways public child protection service (CPS) agencies can encourage and manage voluntary self-referrals by parents with child abuse and neglect problems (Cicchinelli, Keller, & Fox, 1982: viii). In addition, the NCCAN funded a "collaborative research

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effort" conducted by the Denver Research Institute. This study is particularly informative because a copy of its final report is available from the Denver Research Institute. Consequently, a more detailed description of the analysis was obtained. As part of the program evaluation, three separate analyses (process, cost, and impact) were conducted. Process Analysis 88 The object of the process analysis was to collect information on program characteristics, activities, and clients in order to understand how program outcomes were achieved. In addition, the information collected by the process analysis served to provide immediate feedback to project personnel about what they were doing as seen from an independent, outside viewpoint (Cicchinellij Keller, & Fox, 1982: 24). This data was collected by (1) review of program documentation, (2) direct observation of program and (3) with the program. interview with persons associated Program documentation (e.g., proposals, status reports, internal memos, and reports ) was gathered and used to describe the characteristics

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89 of the program, its history, and its development. The research team's impressions of program operations was obtained from their attendance at staff meetings, observation of intake procedures, and from following staff through their daily case management activities (Cicchinelli, Keller, & Fox, 1982: 24-25). Interviews with program staff and persons in community agencies working with the project were structured to obtain information concerning key issues that could not be obtained by the other two methods. The information obtained by the process analysis was then compiled into case studies reports which answered the following questions concerning program history, goals, organizational structure, staffing, case management, and clientele: -Why was the program started and by whom? -Was the program new or a continuation or expansion of an existing program? -If expanded, what was the nature of the previous program? -What were the program goals? -How did they change over the program period? -What was the program's treatment philosophy? Was tpe program part of or independent of a larger organization? To what extent did the program interface with other agencies? (e.g., CPS) -What was the program management structure? -Who was responsible for policy decisions? Who was responsible for daily management? -How was the program financed? -What was the program staffing pattern?

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90 -What was the educational background and experience of the staff? -How did a case enter a program? -What was the daily average caseload? -How long was a case maintained? -How were cases assigned to specific staff members? -How were service needs determined? -What direct services were provided? -What referral services were available? -How was it decided to terminate or refer control of a case? -Were preventative cases handled differently than repeat incident cases? -What was the intended target population? (Cicchinelli, Keller, & Fox, 1982: 25-26). Cost Analysis The goal of the cost analysis was "to determine how much and on what project tasks money was spent" (Cicchinelli, Keller & Fox, 1982: 26). Specific data to be obtained were (1) the programs' financial resources, (2) program costs associated with both the start-up and operational phases, and (3) the estimated costs of alternative and service strategies. In addition, knowledge gained from the cost analysis was expected to answer the question "can self-referral programs be considered cost effective?" (Cicchinelli, Keller, & Fox, 1982: 27). The cost analysis shows that the program's total financial resources consisted of federal funds from the NCCAN and in-kind contributions. The amount

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91 of the federal funds received was determined from a review of NCCAN awards, and the amount received from in-kind contributions was quantified by program directors. In-kind contributions included cost-sharing provided by donations from community groups, salaries paid by either local or state governments, volunteer time (estimated at local wage rates) and office supplies and expenses (Cicchinelli, Keller, & Fox, 1982, p. 97). Costs attributable to the program's start-up phase were those costs incurred beginning the date of the NCCAN awards and ending thirty days after the receipt of the program's first client. The thirty days extension was added to the start-up phase because some programs accepted a few clients before all aspects of the program were completely operational. The costs of the program's operational phase included the monthly costs over the first year the program was fully operational. Major cost categories included (1) client intake, (2) project administration including supervision and staff (3) promotion of the program, and (4) direct services to clients. These broad categories were established after determining the amount of time staff spent on different

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92 activities. However, because staff workers did not keep regular records of their time, the evaluation team estimated how their time was spent from forms they provided staff workers to record their time for two, two-week periods (Cicchinelli, Keller, & Fox, 1982: 100) As a final step in the cost analysis, the evaluation team estimated the cost of alternative services. This was accomplished by comparing the cost of serving project cases with the cost of serving cases in child protection service (CPS) agencies. Costs associated with cases handled by CPS agencies were obtained from data collected on (1) the average length of time each case was open in CPS, (2) the average amount of worker contact per case, and (3) the average cost of serving CPS cases (Cicchinelli, Keller, & Fox, 1982, p. 29). Impact Analysis The impact analysis was designed to determine the program's effect on three populations: (1) clients served (2) the potentially abusing and neglecting population, and (3) existing child protection agencies (Cicchinelli, Keller, & Fox, 1982: 29). The program's

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93 impact on clients served was determined for both involved families and involved adults. The program's impact.on involved families was determined by the change in family environment, change in family stress level, and incidence of maltreatment in open cases. To determine the change in family environment, at the time of termination, caseworkers' provided a subjective assessment of the overall change in the family environment with particular emphasis on the safety of the children in the home. Change in family stress level was measured by comparing the pre-and posttreatment stress level as gauged by the existence of specific factors like recent marital change, financial difficulty, employment problems, etc. The third measure of the program's impact on involved families was the extent of recidivism or first occurrence of maltreatment. This was determined by the proportion of total program cases that were transferred to CPS (Cicchinelli, Keller, & Fox, 1982: 109-14). The programs' impact on involved adults was ascertained from a comparison of program workers' ratings of the condition of adult members of the families at admission and termination and the client's expressed level of satisfaction with the program.

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94 Next, program impact on the population was calculated. Impact on the at-risk population was identified by the extent program strategies were successful in encouraging parental self-referral of actual or potential child abuse and neglect and was calculated by the percentage increase in the number of self-referred cases. Because over 70 percent of the cases served by the demonstration programs had no evidence of prior child abuse or neglect, cases served by the demonstration programs were assumed to be different from self-referred cases served by traditional CPS agencies and, thereby, new cases. When the number of self-referred cases was recalculated including demonstration program cases, self-referred cases increases by more than 10 percent (Cicchinelli, Keller, & Fox, 1982: 125). Therefore, it was concluded that the demonstration programs were successful in encouraging self-referral. The third factor considered by the impact analysis was the programs' effect on existing protection agencies. Evaluators concluded that "the creation of self-referral projects can be expected to increase CPS caseloads and costs, to some extent, in the very short-run;" however, they added that in order

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95 to assess the programs' effect on CPS agencies, the impact "must be considered in a more general context and over a longer time period" (Cicchinelli, Keller, & Fox, 1982: 127). A reduction in the incidence of child maltreatment was anticipated to take place in the long-run because the demonstration programs were believed to be providing a primary prevention function for the local CPS agency. Therefore, a shift in CPS caseload from traditional secondary prevention (i,e., preventing further maltreatment after the first occurrence is identified) to primary prevention (i.e., preventing the first occurrence) might occur over time (Cicchinelli, Keller, & Fox, 1982: 129). If this shift occurs, the incidence of actual child abuse and neglect could be dramatically reduced which, in turn, would reduce the costs of existing protection agencies. Because the most costly aspects of child protection are out of home placements and court involvement (Cicchinelli, Keller, & Fox, 1982: 129), data was collected from CPS agencies to determine the average number of placements in CPS agencies, their duration, and their cost. A comparison between the number of out of home placements in traditional CPS cases and placements in the demonstration programs

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96 indicated that significant costs due to averted placements would occur. Since none of the cases opened by the demonstration projects involved the' court system, additional cost savings were likely to occur due to the primary prevention approach. Although the study only addressed cost savings associated with averted placements and court involvement, evaluators stated that a variety of additional factors should be included in a full-scale cost-effectiveness or costbenefit analysis. The Armstrong Analysis In her article, 11Economic Analysis of a Child Abuse and Neglect Treatment Program," Kay A. Armstrong describes how the cost-effectiveness analysis of the Family Support Center in Yeadon, PA was conducted. Like the Denver Research Institute study, a process analysis, an outcome analysis, and a cost analysis were performed. However, while the Denver Research Institute study reported the results of these analyses, it did not compare program benefits and costs. Armstrong's analysis, on the other hand, combines portions of the information supplied by all three analyses to compare costs and benefits using cost-

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97 effectiveness analysis. Armstrong explains that she chose the costeffectiveness approach rather than benefit-cost analysis because it does not require benefits to be stated in monetary terms. Because she found the outcomes of the Family Support Center program difficult to express in monetary terms (i.e., avoidance of physical, emotional, and sexual abuse and neglect and cessation of the cycle of poor parenting), she felt that cost-effectiveness analysis was the more appropriate method (Armstrong, 1983: 5-6). Costs and benefits in the study were calculated using a modified version of the five-step format for cost-effectiveness analysis outline by D. S. Shepard and M. s. Thompson (1979): (1) define the program, (2) compute net costs, (3) compute net effects, (4) perform sensitivity analysis, and (5) apply decision rules. How each step was applied to the Family Support Center's child abuse and neglect treatment program is summarized below.

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98 Step !-Define the Program Armstrong's description of the program specified (1) the time span of the analysis (one year-October 1, 1978 to September 30, 1979), (2) the number of children and families treated during this period (130 preschoolers and 83 families), (3) specific program goals, and (4) how the program's success in attaining these goals was to be measured. Program goals consisted of (1) preventing physical abuse and neglect, (2) avoiding foster home care, and (3) reducing developmental delays of the children. How successful the program was at attaining these goals was measured by (1) maltreatment accidents or injuries requiring medical care, (2) maltreatment injuries requiring in-patient hospital care, (3) placement in I out-of-home care such as foster home, and {4) developmental delays requiring special education. Step 2-Compute Net Costs The program's net cost was calculated by subtracting cost savings (cost of avoided treatment) from gross costs (total expenditures). The program's gross costs consisted of the cost of program staff, administration, facilities, and supplies for one year,

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99 and monetary savings represented the costs avoided because the treatment programs was in operation. Therefore, monetary savings were calculated by estimating the number of times the four outcomes were likely to occur in one year's time with no intervention (i.e., if the program did not exist). An estimate of how often the four outcomes were likely to occur without intervention was made using estimates and probabilities obtain from nonintervention studies of similar at-risk populations (Armstrong, 1983: 6-7). Once the number of undesirable outcomes expected to occur in a one year period was estimated, the cost associated with each of the outcomes was determined using cost estimates based on "experts' opinions, local figures, and published studies" (Armstrong, 1983: 7). When multiplied by the number of undesirable occurrences, the sum of these costs was used to represent the potential cost savings of preventing child maltreatment in a group of children over a one year period. Once the potential cost savings were estimated, the cost of the outcome variables that were not avoided by children in the program were subtracted to obtain the program's actual cost savings.

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100 Because these cost estimates. were obtained from: studies conducted at different times, it was necessary to remove the affect of tnflation. Therefore, Armstrong converted all cost estimates to 1979 dollars using the U.S. Department of Labor's Consumer Price Index. In addition, because "future savings are not worth as much at the present time" (Armstrong, 1983: 9), costs and savings expected to occur in the future (e.g., foster care and special education) were discounted to their present value. Armstrong used a 10 percent rate of discount and states that this was the appropriate rate because'"it was estimated that the funding source would accept a 10% rate of return for its investment, after removing the effects of inflation" (p. 7). Step Net Effects In this step, the program's outcomes were e,xpressed in a measure tl:tat allows for nonmonetary comparisons with other types of programs (Armstrong, 1983: 9) Armstrong determined that this meas,ure should be the number of ''additional healthy years of life" saved by the program, and it was estimated as the differences between the of healthy years

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expected for those receiving services and those receiving no services. 101 First, Armstrong estimated the potential number of additional healthy years saved by the program by determining the number of healthy year that would be lost due to child maltreatment if no intervention took place (i.e., out-patient care, in-patient care, out-ofhome placements, and special education). The number of adverse outcomes expected without intervention--as calculated in step 2--were multiplied by estimates of the portion of a healthy life year lost when these outcomes occur. For example, an accident requiring outpatient care occurs in 49 percent of maltreatment cases and equates to a loss of .02 of a year, and inpatient hospital care occurs 15 of the time and equates to the loss of .10 of a year. The life years affected by foster care and special education were quantified on the basis of a one-to-one relationship with the actual number of years involved. Next, outcomes expected to occur in future years were discounted to their present value. The same discount rate, 10 percent, was used to discount benefits as was used to discount costs in step 2. According to Armstrong, other discount rates could have

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102 been used, but "analysts have made the assumption that money and health effects remain constant and can be discounted at the same rate" (Armstrong, 1983, pp. 10). Finally, in order to compute net benefits, the number of healthy life years lost from outcomes that were not prevented within the program population was calculated and discounted to its present value. Once this was done, the present value of the actual number of healthy life years lost was subtracted from the present value of the potential healthy life years lost to arrive at the net number of benefits. Step 4-Perform Sensitivity Analysis In order to determine the impact of uncertain values on the outcome of the analysis, Armstrong varied the discount rate and other estimates she used to calculate costs and benefits within the sensitivity analysis. For example, the sensitivity analysis showed that if a 4 percent or a 16 percent discount rate was used, the results of the analysis would change (Armstrong, 1983, p. 10). In addition, estimates used to quantify the loss of healthy life years were not exact and were varied in the sensitivity analysis. Although Armstrong measured the impact of an accident

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103 requiring outpatient care as two percent of a year (i.e., one week), she realized this estimate might be low. For example, an accident causing a broken bone could also required only outpatient care; however, a broken bone equates to the loss of 15 percent of a year (or 2 months) (Armstrong, 1983, p. 11). As a final note, Armstrong explained that the. outcome of her evaluation should not be seen as precise because some benefits were excluded from the costeffectiveness computation. Because they were difficult to measure, indirect effects such as (1) training received by volunteers, (2) consultation and information received by other professionals and community organizations, (3) dissemination of materials on the program, (4) reduction in family stresses, (5) improved parenting skills, and (6) reduced social isolation were not included in the calculation of benefits. Step 5-Apply Decision Rules The output of a cost-effectiveness analysis is usually a ratio such as cost per healthy life year saved. This ratio allows the most cost-effective program or programs to be chosen among programs that

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104 can be 'evaluated in terms of healthy life years saved. However, Armstrong did not calculate a ratio but formulated four decision rules for the funding source to base its funding decision: 1. If net costs are greater than zero and the number of healthy years saved is less than zero, the program should not be funded. 2. If net costs are greater than zero and the number of healthy years saved is greater than zero, the program might be considered depending on the funding source's limitations. 3. If the program results in a monetary savings or zero costs (i.e., costs are less than or equal to zero) and the number of health life years saved is greater than zero, the program might be considered. 4. If the program results in monetary savings or zero costs and a positive number of healthy life years is saved, the program generally should be funded. Greenspan's Analysis Only a brief description of Greenspan's benefit-cost analysis of two cases from a high-risk parenting intervention program in Prince Georges County, Maryland was available. Consequently, very few details of how the analysis was performed could be obtained. However, it is a particularly valuable study for two reasons: (1) it is the only benefit-cost analysis obtained and (2) it focuses on the long-term

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105 benefits that society might receive from early intervention in cases of child abuse and neglect. Because the Clinical Infant Development Program was only five years old at the time of the analysis, long-term outcome data was not available. Greenspan, therefore, devised five scenarios that might result after intervention. They ranged from "a worst case of almost total dependence on government support to the best case of being total self-support requiring no intervention services" (Greenspan, 1983: 121). Probabilities indicating with the likelihood of each scenario occurring with and without intervention were then attached to each scenario, and cost differences and net expected benefits were derived for each case. Greenspan states that her findings "strongly suggest that early intervention for high-risk infants is very cost-effective" (p. 111), and she adds that her cost savings estimates are conservative. Maltreated children could create much higher costs for society throughout their lives than those hypothesized in her scenarios if serious social problems result. In Greenspan's words: Should any hypothesized scenario contain serious social problems such as robbery, homicide, or drug abuse, costs escalate quickly. For instance, it has been estimated that by curing a heroin addict,

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106 the present value of the benefit to society of uncommitted thefts due.to heroin addiction is $332,000. When added to the $56,000 benefit to society form future earning, the total benefit is $388,000. Calculations show that including heroin addiction in one scenario increases the average expected net benefit by 72 percent, showing how conservative the above estimates are. Court and correctional facility cost for serious crimes are even greater, especially when considering the harm to the victim. In 1981, the construction costs alone of a maximum security cell in a federal prison has been estimated at $75,000. (p. 121) Conclusion The three studies reviewed in this chapter provide information on both useful techniques for performing an economic analysis of child abuse and neglect prevention programs as well as methods to avoid. First, the Denver Research Institute study and Armstrong's study appear to have considered program costs to be monetary outlays of the program. Although a cost study that identifies the amount of benefits it receives for every dollar it spends is useful to a funding source, an economic analysis designed to determine a program's net social benefit must include all costs regardless of who incurs them. Secondly, these studies did not compute program costs and benefits on the same basis. Although only those impacts directly involving the funding agency

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107 were included in the computation of program costs, program benefits and were not confined to the funding source. That is, costs were confined to the monetary outlays of the program, but benefit included impacts such as avoided court proceedings, foster care, deviant behavior, and special education which affected many other agencies and individuals. Consequently, the comparison of benefits and costs obtained in these studies may be somewhat erroneous. If costs are restricted to outlays made by the funding source, benefits must be confined to the funding source as well. Likewise, if costs are viewed in terms of social costs, benefits must be also. Greenspan's analysis provides insight into the long term social impacts of child maltreatment prevention and how they can be approached in the analysis. Furthermore, it shows that many effects associated with prevention of child maltreatment can be quantified in dollars and cents. This and other approaches taken in the analyses summarized will be combined with the information provided in the previous chapters in the next and final chapter which offers suggestions for_the economic analysis of the CAP Volunteers prevention program.

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VI CONCLUSIONS AND RECOMMENDATIONS TO CAP VOLUNTEERS, INC. This final chapter on two areas: the need to determine whether prevention strategies are successful in preventing child abuse and neglect; and benefits and costs to be included in the benefit-cost analysis of CAP's prevention program. The first section of the chapter outlines the common primary prevention approaches, methodological problems with many evaluation techniques, and suggestions for future direction in program evaluation. The second portion of the chapter pertains to the CAP.prevention program and how the ideas presented in this paper can be applied to the analysis of its prevention program. In this section, a history of the CAP organization is provided, and program benefits and costs are discussed. Measuring Effectiveness of .Prevention Strategies Before a strong argument can be made in favor

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109 of full-fledged support for child abuse and neglect prevention, the success different approaches have in actually preventing occurrences of child maltreatment must be determined. However, the degree to which alternative strategies are successful in preventing child abuse and neglect not yet been established, and, according to the authors of a 1985 article which discusses methodological in the area of child maltreatment, "we will go no further in our goal of eradicating child abuse until evaluation of prevention programs is taken as seriously as the ideas that formulate the programs" (Rosenberg & Reppucci, 1985: 583) Primary Prevention Strategies The focus of primary prevention strategies can be categorized into three main areas: (1) enhancing the competency of parents, (2) preventing the onset of abusive behavior, and (3) targeting high-risk groups (Rosenberg & Reppucci, 1985: p. 577). Programs which take the first approach are based on the philosophy that enhancing competencies will prevent maltreatment, and they usually incorporate parenting skills, child development information, and coping abilities to reduce

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110 stress in their programs. However, Rosenberg and (Rosenberg & Reppucci, 1985) report that very little is known about the effectiveness of this approach: to be a viable strategy for child abuse prevention, parent educators must focus serious attention on program evaluation because these programs have not yet demonstrated that those individuals whose parenting knowledge and skill are strengthened become less vulnerable to the likelihood of abusing their children. (p. 579) Programs of the second type focus on preventing the onset of abusive behavior and typically involve media campaigns; information, crisis, and referral services; and efforts at the neighborhood and community levels to empower social networks in the ability to provide support and feedback to families (Rosenberg & Reppucci, 1985: 579). This community-wide approach rests on the assumption that increased understanding of the problem and where and how to reach for help are the bases of any effort to prevent abuse. Although consumer satisfaction is genera.lly positive and programs with a community-wide focus report large numbers of well-attended activities, very little is known about the effects of increased public awareness and related services on the incidence of child abuse (Rosenberg & Reppucci, 1985: 581).

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111 The third type of child abuse and neglect prevention technique.targets selected groups who, according to causation theory, show a higher probability of abusing children compared with the general public (i.e., low socioeqonomic status, single and teenage parenthood, isolation from support systems, and complicated pregnancies). Programs of this type typically provide services aimed at encouraging early bonding between parent and child following delivery or provide lay health visitors in the home before and after delivery to encourage healthy pregnancies and parenting. Unlike programs using the other two approaches, several of the programs included in this group have evaluated their effectiveness by comparing program outcomes with the outcomes of control groups, and their findings indicate a range of significant preventive effects (Rosenberg & Reppucci, 1985: 581). Problems With Currently Used Evaluation Methods From their review of primary prevention activities, Mindy s. Rosenberg and N. Dickon Reppucci (1985) identified three problems with the methods frequently used to evaluate the effectiveness of child maltreatment prevention programs. First, the majority

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112 of child abuse and neglect prevention programs lack appropriate comparison groups. Many programs assess program effectiveness using preand post test result; however, Rosenberg and Reppucci (1985) state that that this approach is "weak and uninformative in contrast to designs using one or more control groups" (p. 582). Furthermore, they contend that evaluations that do not compare their program's results with a control "seriously undermine the quality of the conclusions or interpretations that can be made about program impact" (p. 582). The second problem involves the choice of outcome measures. They found that most programs "had very little outcome data beyond the initial description of indicators for successful program implementation (e.g., number of participants, numbers of activities, and service delivery interviews) (p. 582). However, the most disturbing problem Rosenberg and Reppucci found was the failure to document the program's actual success at preventing incidents of maltreatment. Rosenberg and Reppucci state: most important and glaring methodological -weakness involves the failure to document proximal programmatic objectives (i.e., criterion test of new skills, knowledge, attitudes, and behavior of the target population) and distal prevention goals (i.e., decreased incidence of abuse). For example,

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113 'most parent education programs demonstrate shortterm changes in attitude and knowledge but do not assess behavioral changes. (p. 582) According to Rosenberg and Reppucci, many service providers fail to assess their programs' success at obtaining their short-term obje.ctive of training parents, and, moreover, do not test whether success at their short-term goal guarantees that their long-term goal of preventing incidents of child abuse and neglect is attained. Recommended Evaluation Techniques Methods which Rosenberg and Reppucci (1985) recommend for gathering data on short-and long-term behavior changes include (1) adding a pretest videotaped parent-child interaction and pretest observations of parent-as-teacher in the day care setting to compare with parent-child videotapes and observations later in the program; (2) coding both parental behavior and children's response in the videotapes and day care settings; (3) charting the use of formal and informal support systems over the program time period; and (4) documenting suspected or founded cases of child abuse (p. 583). In addition to Rosenberg and Reppucci's concern

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114 with proving the worth of prevention strategies, other professionals have voiced the need for improvement with the manner in which long-term effects. of child maltreatment is determined (Steele, 1975). That is, while theory suggests that child abuse and neglect contributes to violent and antisocial behavior, and professionals have witnessed this occurrence, the relationship between child maltreatment and criminal behavior has not been substantiated. In the past, spot-checks were conducted on a particular segment of society (i.e., juvenile delinquent.s and members of the prison populai ton) to determine whethe.r abuse and/ or neglect was a part of their childhood experiences. Although this method showed that many troubled youth and hardened criminals had been maltreated as children, longitudinal studies must be performed to truly substantiate the link between child maltreatment and antisocial behavior. Data collected by longitudinal studies promises to be more accurate and reliable than information from spot-checks because data are collected by following abuse victims through adolescence and adulthood to determine the actual consequence of maltreatment.

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Benefit-Cost Analysis of CAP's Prevention Program Organizational History 115 CAP Volunteers was founded in 1971 and became affiliated with the Denver Department of Social Services (DDSS) in 1974. At that time, it was known as Eastside Social Services Volunteers and served only Northeast Denver. The original purpose of the organization was to utilize and manage volunteers who worked with public assistance clients as an extension of DOSS's social work staff. Programs had a broad focus, and volunteers extended the role of social workers in cases involving families, children, and the elderly. However, the organization began to focus primarily on child maltreatment with the passage of legislation requiring the reporting of child abuse and neglect in 1975. At that time, DDSS was assigned the responsibility of legal and treatment processes for families who had abused and/or neglected their children. With DDSS's new focus on child maltreatment, the number of volunteers in the volunteer organization grew dramatically, and in April 1978, the organization's name was changed to Denver Social Services Volunteers, Inc.

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116 In the summer of 1981, however, DDSS's funding was severely reduced, and for the first time in their history, 69 full time staff positions including half of the volunteer programs' staff were layed off. DDSS made further cutbacks in March of 1982. Consequently, board members of the volunteer organization met and decided to seek funding from private sources in order to continue providing what they believed to be credible and important services unavailable elsewhere in the community. The Prevention Program In July 1983, the organization changed its name to Child Abuse Prevention (CAP) Volunteers, Inc. and relocated the following year to its present offices at 1649 Downing Street, Denver, CO. CAP currently provides support services to families and children with child abuse and neglect problems through three program areas: Parent-Aide, Child-Aide and Specialized ChildAide. Although program services previously focused on families where a founded report of child maltreatment had occurred, during the summer of 1983, funds were sought and obtained to establish a "prevention" program.

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117 The prevention program was intended to prevent the onset of physical abuse and/or serious neglect of children. It had been estimated that approximatley 800 parents would contact the DDSS hotline in 1983 requesting help, and DDSS socialworkers caseloads would not allow them to intervene in all these cases. Therefore, CAP proposed to provide parent-aides to 200 of the parents who report themselves to the Family Crisis Center in a category of reporting known as "parents requesting help; fear of hurting child." Clients for the prevention program were to be obtained from referrals by DDSS, Denver General Hospital, and Denver Visiting Nurse Service when the potential for child abuse and neglect existed, but cases were not opened. The program is targeted toward families in the low end of the abuse/neglect spectrum, and suitable cases for referral were described as (1) ones that involve displaced homemakers; (2) parents who fear abusing their child but do not have a high-risk profile; (3) families suffering temporary disruptions; (4) parents over 17 who lack parenting experience; (5) mentally limited parents who need parenting guidance; (6) isolated incidents of abuse or neglect caused by situational crisis; or (7) medical problem families who

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need support. Cases would not be admitted to prevention program if they involved severe abuse or neglect; high-risk for abuse; severe mental illness; alcohol or drug abuse; or aggressive and violent behavior. Program Philosophy 118 CAP's prevention program employs a strategy similar to the first approach discussed by Rosenberg and Reppucci (i.e., that enhancing the competency of parents will prevent child abuse and neglect}. CAP's philosophy hin'ges on the belief that parents will be better able to meet the needs of their children as their environmental and social needs are satisfied. Environmental needs include housing, education, employment, child care, health care, and school attendance; emotional needs pertain to parent characteristics such as childhood history of maltreatment, low self-esteem, social isolation, inability to seek help in a crisis, lack of trust, inability to maintain relationships, depression, and unrealistic expectations of their children. Parent-aides work with parents in a one-to-one relationship to provide a nurturing role model for the parent as well as to teach and develop parenting

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119 skills. Duties performed by the parent-aide include (1) focusing on the needs of the parent, (2) providing support and companionship to the parent, (3) assisting the client in developing own interests and resources, (4) maintaining consistent contact with client (initially 6-10 hours per week) (5) being available by phone any hour of the day, (6) maintaining consistent contact with the Volunteer Manager, (7) arranging for care of children in times of crisis if necessary, and (8) participating in activities with the parent which balance socializing/recreation and support/growth activities. The Benefit-Cost Analysis Much of the literature concerning economic analysis of child abuse and neglect prevention programs associates child maltreatment prevention programs with health related programs and, consequently, argues that cost-effectiveness analysis should be used instead of benefit-cost analysis because it does not require program benefits to be measured in monetary terms. However, child maltreatment is not solely a health problem. It also creates many social problems which can be assessed in dollars and cents, and, therefore,

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120 the supplemented benefit-cost approach can be successfully used to demonstrate the net social benefit resulting from child maltreatment prevention. Rosenberg and Reppucci suggest that funding sources require service providers to undertake program evaluation; however, it is in service providers' best interest to demonstrate the worth of their programs and solicit program evaluations on their own. Administrators of CAP Volunteers, Inc. are in a position to establish whether the prevention strategy they employ is effective and whether their program produces more social benefits than costs. In order for CAP to demonstrate the desirability of their services and to make a contribution to the knowledge in the area of child maltreatment prevention, administrators would (1) assess the effectiveness CAP's prevention program has in preventing child abuse and neglect and (2} use benefit-cost analysis to determine if the program's social benefits exceed its costs. As discussed in Chapter IV, the analysis report should be supplemented with information pertaining to program effects excluded from the net-benefit calculation.

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121 Program Benefits CAP's prevention program appears to have two goals: (1) to prevent child abuse and neglect and (2) to avoid DDSS involvement in cases served by CAP. Given this set of, goals, outcomes would be measured by (1) the number of incidents of abuse avoided, (2) the number of incidents of neglect avoided, and (3) the amount of DDSS intervention avoided in CAP cases. At minimum, these measures require that CAP determine the frequency of abuse and/ot neglect that takes place while families are receiving services from the program. Ideally, however, long-term follo'w-up would be conducted because programs cannot fully recognize their potential until populations have passed through their period of greatest risk (Rosenberg & Reppucci, 1985). Determining the amount of abuse and neglect which takes place while families participating in CAP's program would not be difficult-to obtain since volunteers work closely with families and, in many would be aware of incidents of abuse and/or neglect. Furthermore, volunteers have a legal obligation to report incidents of maltreatment to child protection agencies. Therefore, volunteers' responsibilities-should include record keeping of known

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122 incidents of abuse and/or neglect. Also, records should be kept on the number of cases referred to DDSS due to lack of success in the program. Although this would create additional work for program volunteers and staff, this data is essential to program evaluation. Currently, CAP's program effectiveness is determined from preand posttreatment questionaires administered by parent-aids to assess by changes in factors such as parents' selfesteem, reduced isolation, and increased parenting skills. These factors are certainly important and have been cited in causative theories of child abuse and neglect as causes of chiid maltreatment. However, whether the CAP program prevents maltreatment is not assured if these factors are improved. If CAP is to establish the effectiveness of its prevention program, therefore, the extent to which its program is successful in preventing child maltreatment must be established. In addition to CAP program outcomes, the amount of maltreatment that would occur without intervention must also be obtained. This data can be collected either by matching CAP's client population to non-intervention studies previously performed or by establishing control groups to

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determine the amount of maltreatment that occurs without intervention. 123 Other outcomes to be considered when identifying program benefits include cost savings associated with the avoidance of DDSS intervention, court costs, and out-of-home placement costs. Also the cost savings associated with the impact on other social problems such as juvenile delinquency, domestic teenage pregnancy, and criminal and antisocial behavior shbuld be calculated. Indirect benefits to volunteers must also be considered in the analysis. These benefits might include (1) personal growth and satisfaction from learning to work with neglectful parents1 (2) opportunities to gain employable skills and knowledge which may be later applied to paid work; and (3) tax benefits from working for a private, non-profit, tax-exempt organization. Program Costs Costs CAP is likely to incur fall in the following categories; however, because CAP administers other programs in addition to the prevention program, CAP's total costs will need to be proportioned to identify only those costs caused by the prevention program.

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124 (1) Salaries. Salaries of employees assigned to the prevention program alone, and the appropriate portion of salaries of shared employees should be included. For example, one Volunteer Manager is assigned solely to the prevention program, while the Executive Director, Program Director, and clerical worker might spend only a portion of their time working on matters pertaining to the prevention program. How to proportion employees' salaries might depend on the portion of their time spent on the prevention program. This information can probably be obtained through observation and discussion with CAP personnel. (2) Payroll Taxes must be proportioned in the same manner. (3) Employee Benefits. Employee benefits are costs of the program and should also be assigned by the proportion of time devoted to the prevention program. (4) Staff Travel. (5) General Office. (6) Marketing and Promotion. (7) Volunteer Training. (8) Schools and Conferences. (9) Program (10) Program Development and Evaluation.

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125 (11) Rent, utilities and maintanence. Because CAP administers several protective service programs housed in the same location, these costs must be properly allocated to the prevention program. The allocation might be based on the portion of CAP personnel directly involved with the prevention program or the number of volunteers working in the program. (12) Set-up costs. (13) Volunteers' time. Although the funding source does not pay volunteers a salary, whether or not volunteer time and other in-kind donations have an opportunity cost to society must be considered. Both arguments in favor of including a cost for volunteer time in the analysis and arguments against have been given. The argument against contends that volunteer time imposes no opportunity cost to society if the time volunteered is in addition to the volunteers' job. That is, if the time spent volunteering would not have otherwise been spent at a job, it is assumed that society has not given up any productive output. One argument in favor of including volunteer time in the calculation of costs reasons that volunteer time has an opportunity cost because volunteers would donate their time elsewhere if they were not

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126 volunteeri-ng to the particular program being examined. Another argument claims that volunteer time should not be valued at its opportunity cost but at the cost of duplicating the services'provided by volunteers. Those recommending this approach suggest that the appropriate wage rates to use be based on local wage rates for comparable services or based on the level of education and training of each volunteer. Conclusion A great deal of progress has been made in the area of child abuse and prevention since the 1960s when c. Henry Kempe coined the term "battered child syndrome.n But the goal of preventing this life destructive activity requires continued work. The long-term effects of child maltreatment must be identified, the effectiveness of prevention strategies must be tested, and the net-benefit society receives from prevention programs must be determined for members of the public and policymakers to realize the grave need to prevent child abuse and neglect. Much of this work will need to be done by however, service providers also have an essential part to play. They are often given the

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127 responsibility of obtaining necessary funding to continue prevention programs, and they are in a position to test the effectiveness of prevention strategies and the social impact of prevention programs. Therefore, collaborative efforts between academic and service. providers is necessary to continue the progress toward the goal of preventing child abuse and neglect.

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SELECTED BIBLIOGRAPHY Ackley, Dana C. nA Brief Overview of Child Abuse." in Patterns of Family Violence. Ed. Margaret Elbow. New York: Family Services Association of America, 1980, 13-16. Anderson, Lee G. and Russell F. Settle. Benefit-Cost Analysis: A Practical Guide. Lexington, MA: D. c. Heath, 1977. Armstrong, Kay A. "Economic Analysis of a Child Abuse and Neglect. Treatment Program.n Child Welfare, 62 (Jan.-Feb. 1983), 3-13. Association For Protecting Children. "Reports of Child maltreatment Increase Again." Protecting Children, 2 (Spring 1985). Baumol, William J. "On the Social Rate of Discount." American Economic Review, (Sept 1968), 788-802. Baumol, William J. Economic Theory and Operations Analysis. Englewood Cliffs, NJ: Prentice-Hall, 1977. Begus, Sarah and Pamela Armstrong. "Daddy's Right: Incestuous Assault.n in Politics, and Public Policy: A Feminist Dialogue on Women and the State. Ed. Irene Diamond. New York: Longman Publishing, 1983, pp. 236-49. Belsky, J. ''Child Maltreatment: An Ecological Integration.n American Psychologist, 35 (1980), 320-35. Blaug, Mark. Economic Theory in Retrospect. 3rd ed. Cambridge, England: Cambridge University Press, 1983. Bourne, Richard. "Child Abuse and Neglect: An Overview.n in Critical Perspectives on Child Abuse. Ed. Richard Bourne and Eli H. Newberger. Lexington, MA: Lexington Books, 1979. Canada Treasury Board Secretariat. Benefit-Cost Analysis Guide.. Ottawa, Canada: Information Canada, 1976. Cantwell, Hengrika B. Standards of Child Neglect. Denver: Denver Department of Social Services, 1978.

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Cicchinelli, Louis F., Robert. and Phil E. Fox. "Self-Referral Demonstration Program Collaborative Research Effort." Denver, CO: Denver Research Institute, 1982. 129 Children's Defense Fund. A Children's Defense Budget: An Analysis of the President's FY 1985 Budget and Children. Washington, DC: By the Author, 122 C Street, N.W., 1984. Clarke, Jean Illsley. Self Esteem: A Family Affair. Minneapolis: Winston Press, 1978. Currie, John Martin, John A. Murphy and Andrew Schmitz. "The Concept of Economic Surplus And Its Use In Economic Analysis." The.Economic Journal, (December 1971), Curtis, George C. "Violence Breeds-Violence--Perhaps?" Indiana State Medical Journal, 1.4 (Oct. 1963), 386-87. Dembits, Nanette. "Preventing Youth Crime by Pre.venting Child American Bar Association Journal, 65 (June 1979), Dobb, Marice. Welfare Economics and the Economics of Socialism: Toward a Commonsense Critique. Cambridge: Cambridge University Press, 1969. Freeman, A. Myrick, III. Intermediate Microeconomic Harper & 1983. AnalYsis. New York: Garbarino, James and Joan Vondra. "Intervention in Child Maltreatment.n Paper presented at the 91st Annual Convention of the American Psychological Association, Anaheim, CA, August 26-30, 1983. Graaff, J. de v. Theoretical Welfare Economics. Cambridge: Cambridge University Press, 1967. Gray, Jane D., et al. "Prediction and Prevention of Child Abuse .. Seminars in Perinatology. 3 (1979), 85-90. Greenspan, Nancy T. "Funding For And Cost-Benefit Analysis of Services For High-Risk Families and Infants," in Minimizing High-Risk Parenting: A

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130 Review of WhatIs Known and Consideration of Appropriate Preventive Intervention. Ed. Valerie J. Sasserath. Skielman, NJ: Johnson and Johnson Baby Products, 1983. Gunn, Albert E. "Cost Effectiveness? It's Time to Blow the Whistle." Critical Care Medicine. 6 (1978), 352-53. Haeuser, Adrienne. Hearings Before the House of Representatives Subcommittee on Select Education of the Committee on .Education and Labor to Reauthorize the Child Abuse Prevention and. Treatment and Adoption Reform Act. Washington, DC, March. 9 and 12, 1981. Harberger, A. "Three Basic Postulates For Applied Welfare Economics: An Interpretive Essay." Index to the Journal of Economic Literature. (Sept. 1971), 785-97. Haveman, Robert H. and Burton A. Weisbrod. "Defining Benefits of Public Programs: Some Guidance for Policy Analys.is." Policy Analysis. (1975), 169-9 6. Haveman, Robert H. "Policy Analysis and the Congress: An Economist's View," in Public Expenditure and Policy Analysis. Ed. Robert H. Haveman and Julius Margolis. Boston: Houghton Mefflin, 1983. Hoekelman, Robert A. "Introduction" and "Summary Comments" in Minimizing Parenting: A Review of What Is Known and Consideration of Appropriate Preventive Ed. Valerie J. Sasserath. Skillman, NJ: Johnson & Johnson Baby Products, Hunt, E. K. History of Economic Thought: A Critical Perspective. Belmont, CA: Wadsworth Publishing, 1979. Hunter, Rosemary and Nancy Kilstrom. "Breaking the Cycle in Abusive American Journal of Psychiatry. 136 (1979), 1320-22. Kempe, c. Henry. "Cost Analysis of the Child Protection Team." Pediatrics, 61 (1978), 328-29.

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131 Landsdown, Elizabeth. Hearings before the House-, of Representatives Subcommittee on Select Education of the Committee on Education and Labor to Reauthorize the child Abuse Prevention and Treatment and Adoption Reform Act. Washington, DC, March 9 and 12, 1981. Levin, Henry M. "Cost Analysis." inNew Techniques for Evaluation. Ed. Nick L. Smith. Beverly Hills: Sage Publications, 1981, 13-70. Mansfieid, Edwin. Micro-Economics: Theory & Applications. New York: w. W. Norton, 1970. Me Kean, Roland. "Use of Shadow Prices." Ed. Samuel s. Chase, Jr. Washington, DC: The Brookings Institute, 1968, Miller, K. and E. Fein. "A Parent Aide Keeping, Outcomes, and Child Welfare. 64 (Jul-Aug 1985) Mishan, E. J. Economics For.Social Decisions: Elements of Cost-Benefit Analysis . New York: Praeger, 1973. Mishan, E. J. Cost-Benefit Analysis. 2nd ed. New York: Praeger, 1976. Newberger, Eli H. and Carolyn Moore Newberger. "Prevention of Child Abuse: _Theory, Myth, practice." Paper presented at the Biennial Meeting of the Society for Research in Child Development, Boston, MA, April.2-5, 1981. Prest, A. and R. Turvey. "Cost-Benefit Analysis: A Survey." Economic Journal. (1965), 683-735. Randall, Alan. Resource Economics: An Approach to Natural Resource and Environmental Policy. Columbus, OH: Grid Publishing, 1981. Rosenberg, Mindy s. and N. Dickon Reppucci. "Primary Prevention of Child Abuse." Journal of Consulting and Clinical' Psychology, 53 (1985), 576-85. Ryan, Gail. The lay Person's Role in the Treatment of Child Abuse and Neglect. Denver, CO: The C.

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Henry Kempe National Center for Prevention of Child Abuse and Neglect, 1981. Satir, Virginia. Peoplemaking. Palo Alto, CA: Science and Behavior Books, 1972. 132 Shepard, Donald s. and Mark S. Thompson. "First Principles of Cost-Effectiveness Analysis in Health. n Public He'alth Reports, 94 (1979), 535-43. Singer-Chapel, Esthr M. and Robert A. Aitchison. "Behavior Therapy Treatment For Child Abuse." Paper presented at .the 59th Annual Meeting of the Western Psychological Association, San Diego, CA, April s-a, 1979. Snyder, E. "Child Protective Services: Gatekeeper to Foster Care and Permanence Planning." Proceedings of the Fifth National Conference on Child Abuse and Neglect.' Milwaukee, April 5-8, 1981. Steele, Brandt F. "Child Abuse: Its Impact on Society." The Pharos of Alpha bmega.Alpha, 33 (April 1970), Steele, Brandt F. "Child Abuse: Its Impact on Society." Indiana State Medical Journal, 68 (March 1975), 191-94. Stiener, Richard. Managing the Human Service Organization: From Survival to Achievement. Beverly Hills: Sage Publishing, 1977. Stokey Edith and Richard Zeckhauser. A Primer for .Policy analysis. New York: W. w. Norton, 1978. Thorton, Craig; David Long; and Charles Mallar. Technical Report Q: A Comparative Evaluation of the Benefits and Costs of Job Corps After FortyEight Months of Postprogram Observation. New Jersey: MATHEMATICA POLICY RESEARCH INC., 1982. Tramontana, M. s.D. and K. J. Authier. "Evaluation of Parent Education Programs." Journal of Clinical Child Psychology, 3, (Spring 1980) 40-3.

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Weinstein, Milton C. and William B. Stason. "Foundations of Cost-Effectiveness Analysis For Health and Medical Practices." New England Journal of Medicine, 296 (Mar 1977), 732-39. 133 Watkins, H.D. and M.R. Bradbard. "Child Maltreatment: An Overview with Suggestions for Intervention and Research." Family Relations, 31 (July 1982), 323-33. Young, Leontine. Wednesday's Children. New York: McGraw Hill, 1974.