CDC trauma report: Spend now to help kids or pay later in hospital and prison costs

The root causes of incarceration, addiction, homelessness, suicide and poverty often begin with psychological trauma inflicted during childhood.

New data is clear on that, which begs the question:

How is society supposed to react? 

“At some point, when you know so much, isn’t there a moral imperative?” said Mary Triggiano, deputy chief judge in Milwaukee County Circuit Court and an advocate of trauma-responsive practices in social work and criminal justice.

The answer, which public health researchers have publicized in recent weeks with renewed intensity, would amount to a wholesale restructuring of how the nation allocates its spending.

Do taxpayers pay for jails and hospital beds after the crisis hits? Or does society invest in prevention? 

Invest today in child care subsidies and day care, the thinking goes, and that will lead to a proportionate drop in taxpayer-funded jail beds down the road. Invest today in in-home health care visits by nurses and social workers in the belief that taxpayers in the future will cough up less for public medical care and emergency mental health services.

The logic of inverted spending is common among those who treat and research trauma and all its destructive aftereffects. But leaders in the U.S. trauma-responsive movement renewed their arguments in the wake of a comprehensive new report that lays bare levels of trauma that are epidemic across the American population.

The new study, issued by the U.S. Centers for Disease Control and Prevention, found that nearly one in six Americans are exposed to potentially traumatizing levels of violence and abuse growing up. Surveying 144,000 Americans in 25 states, including Wisconsin, the CDC found that no ethnicity or geography is immune — neither urban, rural or suburban. CDC officials called the findings conservative. 

What's more, data show that trauma in one generation is passed down with statistical probability to the next. Sometimes that's due to conditioned behavior. Sometimes that's because chronic stress builds up toxins within the body and potentially can even mutate genetic codes, which are passed down in the DNA to children.

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The logic is to break the generational cycle as early as possible, said Melissa Merrick, lead author on the CDC study.

“We as a society think that things that happen in the past stay in the past," Merrick said in an interview. "But brain science and epigenetics (an emerging medical field) actually mean that things that happen in the past stay with us across our lifetimes and across generations.”

The inverted economics of trauma 

A radical shift in spending priorities might sound utopian in a politically divided nation that barely manages to compromise on routine budget legislation.

But the economic impact of trauma has metrics of its own. The CDC estimates the economic burden resulting just from child abuse and neglect in the United States at $124 billion per year. Like the other CDC trauma study, Merrick said, “that’s a really conservative estimate.”

The CDC’s Division of Violence Prevention just issued its own separate report on the social impact of trauma, also citing the generational dynamic. "Toxic stress during childhood can harm the most basic levels of the nervous, endocrine, and immune systems, and that such exposures can even alter the physical structure of DNA," the CDC reported.

The Sycamore Institute, a public policy research center in Tennessee, estimated that childhood trauma exposure "led to an estimated $5.2 billion in direct medical costs and lost productivity from employees missing work" in the state in 2017.

Driving mental health spending higher

In one of its findings, the CDC trauma report estimates that instances of depression in the general population would fall 44% if American children grew up in homes without abuse, alcoholism, mental illness, drugs or domestic partner violence.

On the topic of depression, Merrick points to data from Aetna Behavioral Health, showing that the amount of money companies spend on the mental health of their employees is increasing twice as fast as all other medical expenses. Benefits consulting firm Willis Towers Watson reports that people suffering from depression submit an average of $14,967 per year in claims, compared with $5,929 a year for the total population.

After Merrick completed a nine-year tenure at the CDC and put the finishing touches on the most recent CDC trauma report, she moved to Chicago as chief executive of Prevent Child Abuse America, a national nonprofit.

Here's a short list of measures that Merrick and the CDC call preventive and practical:

Don't leave your child unattended 

Invest in high-quality child care, child care subsidies and preschool enrichment programs. This is a major issue in Milwaukee, where the Greater Milwaukee Foundation earlier this year documented a crippling shortage of child care centers in the metro region. Milwaukee has so few child care centers that only one in five prekindergarten kids last year lived in a neighborhood within reasonable proximity to a licensed facility — and that's by a conservative count.

There's a nurse at the door

Early childhood home visitation programs pay for nurses or social workers to advise young families in their home setting. The idea is to work with overburdened families who are at-risk for child maltreatment and neglect. They're meant to advise on parent-child interaction and coordination of services and referrals.

One of the nation’s largest home visiting programs is run by Merrick’s agency, called the Healthy Families America program. It sponsors home visits for 70,000 families in 38 states.

Max out existing tax breaks

Promote earned income tax credits and child tax credits. They're regarded as crucial economic supports for struggling families but are vastly underused because they're enmeshed in the labyrinthian and bewildering U.S. tax code.

Sometimes called EITCs, the earned income tax credit can plow refunds directly to low-income individuals and families who qualify in the form of a refund check when used as part of annual federal tax filings. “Data show EITCs lifted 5.7 million people out of poverty in 2017, including about 3 million children. EITC has kept more children living above the poverty line than any other tax credit program,” according to a statement from Prevent Child Abuse America.

“By increasing income for working families, EITCs can reduce parental stress and depression, which are two key risk factors for child abuse and neglect,” Merrick said.

There's a role for the workplace

Family-friendly work policies such as on-site child care, flexible work schedules and paid leave to care for a sick child or relative increase maternal employment and contribute to safe and stable homes.

But they also can reduce employee absenteeism and increase productivity, Merrick said 

This recommendation is mostly targeted to private-sector employers although North Carolina this year extended paid parental leave to state employees, a move supported by Merrick’s agency.

Change 'social norms'

The prevalence and social costs of trauma are new and still little recognized. The CDC wants to change “social norms” so society recognizes the toxic impact of violence and chronic stress. 

This would require public education campaigns and public service advertising. “Public education campaigns are one way to shift social norms and reframe the way people think and talk," the CDC wrote.