Cash prescription program linked to fewer child abuse investigations

A new peer-reviewed study published in JAMA Pediatrics Provides rigorous, population-level evidence that Michigan State University’s RX Kids program, the nation’s first community-wide prenatal and infant cash prescription program, is associated with a substantial reduction in child maltreatment diagnoses among infants.

After the launch of RX Kids in January 2024, abuse diagnoses among Flint infants in the first six months of life dropped from 21.7% to 15.5%. Charges increased in 21 similar comparison cities during the same time period. RX Kids led to a 7 percentage point drop in abuse investigations in Flint, or a relative reduction of 32%.

Our research compared what happened in Flint before and after the launch of RX Kids with what we saw in a control group, and the results are clear. During RX Kids’ first year, infants in Flint experienced fewer investigations for abuse. “These results show that providing quick economic support to families can make a real difference and should challenge us to rethink how we can proactively support families.”

Dr. Sumit Agarwal, lead author, physician and health economist at the University of Michigan, assistant professor in the UM Medical School and School of Public Health

Aggarwal is a poverty solutions associate and member of the UM Institute for Healthcare Policy and Innovation.

Along with research collaborators from three institutions, the study’s authors found steady declines in several categories of child welfare involvement, including neglect-related and non-neglect-related investigations as well as certified cases. Overall, researchers estimate that the program prevented approximately 57 infants from experiencing a child welfare check in its first year alone, demonstrating how economic support during pregnancy and early infancy can improve a child’s well-being.

Several pathways may explain these results. Previous research on RX Kids has documented a reduction in food and housing difficulties and a significant reduction in postpartum expulsions. These changes are closely linked to reductions in parenting stress and improvements in maternal mental health, which are key factors influencing child safety and well-being.

Additionally, the program is associated with improvements in birth outcomes, including a reduction in low birth weight and preterm birth, both of which are risk factors for later maltreatment.

“These findings, now published JAMA Pediatrics“Underscoring the powerful role economic stability plays in protecting children,” said Dr. Mona Hanna, RX Kids director and associate dean of public health at Michigan State University. By relying on families and investing in them during the earliest, most vulnerable times of life, we are not only improving health outcomes; We are preventing trauma before it starts. “This is what community-driven public health looks like.”

Many families face significant economic hardship during pregnancy and infancy, as mothers drop out of the workforce and expenses increase due to medical costs and basic infant supplies. Reducing this financial stress can play an important role in preventing losses before they occur.

“As a child welfare researcher, decades of evidence show that poverty is one of the strongest drivers of child maltreatment risk,” said Will Schneider, associate professor of social work and faculty director of the Children and Family Research Center at the University of Illinois. “What the RX Kids findings make clear is the flip side of that truth: When families get relief during the economic shock of pregnancy and early infancy, fewer children are harmed. That’s what real prevention looks like.”

RX Kids, a maternal and child health program, provides a one-time $1,500 cash infusion mid-pregnancy and $500 per month during infancy. This assistance helps cover essentials like diapers, formula, rent, and transportation to prenatal care. The program has demonstrated improvements in family financial stability, healthy mothers and infants, and meaningful economic benefits, with millions of dollars flowing directly into local businesses and communities. RX Kids is led by Michigan State University and administered by GiveDirectly, with support from the State of Michigan and a growing family of funders through public-private partnerships.