Cost-Effectiveness Analysis of the SEEK (A Safe Environment for Every Kid) Child Maltreatment Prevention Program

Background: SEEK (a Safe Environment for Every Kid) is a pediatric primary care-based maltreatment prevention program with demonstrated effectiveness. Cost-related assessments of prevention programs are important to determine optimal allocation of limited prevention dollars. Methods: SEEK program costs were calculated. Families in 8 pediatric practices exposed to SEEK and 10 pediatric practices not exposed to SEEK were compared. Rates of psychological aggression and physical assault were calculated using data from a subset of recruited parents who completed the Parent Child Conflict Tactics Scale 12 months following recruitment. Logistic regression was used to generate estimated rates, adjusting for age, race, income, marital status, and education. Lifetime medical, mental health, and social service costs were estimated using published data. Results: To implement the SEEK program in all 18 practices, it would cost approximately $180,540 per year, or $2.05 per child per year. If all families attended practices using SEEK, 1852 fewer children would have experienced any instance of psychological aggression or physical assault. The cost of SEEK was $244 per case of psychological maltreatment or physical assault averted. Conclusions: The cost per child to implement SEEK across 18 practices with 102 providers was quite reasonable. Costs per case of physical assault and psychological aggression averted are significantly lower than the short or long-term costs to provide medical and mental health care to maltreatment victims. Expansion of the SEEK model of pediatric primary care has the potential to decrease medical, mental health, and social service costs associated with maltreatment.