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Invited Commentary
Health Policy
June 14, 2019

Prevention of Child Maltreatment as an Unexpected Benefit of Social Policies

Author Affiliations
  • 1Division of Child Protection and Family Health, Department of Pediatrics, University of Utah, Salt Lake City
JAMA Netw Open. 2019;2(6):e195521. doi:10.1001/jamanetworkopen.2019.5521

In 2016, 74 million children lived in the United States. In that same year, 3.5 million children—1 in 22—experienced either an investigation or an alternative response from a state child welfare agency based on a report of suspected child maltreatment.1 Rates of child welfare involvement in US households increase year after year despite our best prevention efforts. Three-quarters of these cases involve child neglect, the form of maltreatment most resistant to targeted prevention and most vulnerable to repeated referrals to the child welfare system.2

According to the article by Brown et al,3 a promising reversal of this trend may be an unexpected benefit of recent Medicaid expansion. Brown and colleagues use the inconsistent adoption of the Affordable Care Act across states as a natural experiment to explore how policies that improve parental access to health care are associated with reduced rates of maltreatment among children younger than 6 years. The authors suggest that increased financial stability in households and improved mental health of adults, both of which have been described in association with Medicaid expansion, may contribute to an unintentional but welcome reduction in maltreatment of young children. In a thoughtfully constructed analysis, the authors found that, between 2013 and 2016, rates of child neglect decreased in the 31 states that expanded Medicaid on or after January 1, 2014, whereas rates of child neglect increased in the 19 states that did not expand Medicaid. By use of a model adjusted for social conditions and public policies associated with parental stress, financial hardship, and child maltreatment, Brown and colleagues3 report that, from a baseline of 3944 cases per 100 000 children, Medicaid expansion was associated with a relative reduction in child neglect of 422 cases per 100 000 children younger than 6 years. This could yield a potential reduction of more than 10% of child neglect cases in this population.

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