Prospectus

RITE is a nonprofit in formation. It is not yet incorporated and has not applied for tax-exempt status.

RITE plans to operate as a fiscally sponsored project of an established 501(c)(3) organization while it incorporates as a nonprofit corporation and applies to the IRS for recognition under section 501(c)(3) as a scientific and educational organization. This prospectus describes plans and commitments, not current operations.

RITE measures what psychological trauma costs people and economies, publishes what it finds, and builds the public data infrastructure needed to improve care and inform prevention policy.

As RITE uses the term, the trauma economy is the set of economic consequences of psychological trauma: the costs borne by individuals, households, employers, payers and governments, and the institutions that absorb, transfer or benefit from those costs. It is distinct from economic trauma, which refers to financial shocks experienced as traumatic events.

Adverse childhood experiences, first measured at scale in the CDC–Kaiser ACE Study [1], are common. Among U.S. adults surveyed between 2011 and 2020, 63.9 percent reported at least one and 17.3 percent reported four or more. Four or more were reported by 24.1 percent of adults in households earning under $15,000, against 15.3 percent of those earning $50,000 or more, and by 25.8 percent of adults who were unemployed and 28.8 percent of those unable to work [2]. These are cross-sectional associations. Explaining their direction and mechanism is part of RITE's agenda.

The link runs both ways. Poverty raises the risk of childhood adversity: a $1 rise in the minimum wage was associated with 9.6 percent fewer child neglect reports [7], and more generous state earned income tax credits with fewer neglect reports [8]. Trauma, in turn, lowers income later in life. Children with court-documented abuse or neglect, followed to an average age of 41, had less education, lower earnings and fewer assets than matched controls, and were 14 percentage points less likely to be employed [9]. Hardship and trauma form a loop: each raises the odds of the other. RITE's agenda centers on the least-counted arc of that loop, from trauma to work, earnings and public costs.

The economic burden is large however it is measured. The 2019 burden of health conditions associated with adverse childhood experiences among U.S. adults was estimated at $14.1 trillion, of which $183 billion was direct medical spending and the rest the dollar value of lost healthy life-years [3]. The excess annual cost of post-traumatic stress disorder in the United States was estimated at $232.2 billion for 2018, $189.5 billion of it in the civilian population, with direct health care and unemployment the largest civilian costs [4]. Across North America, costs attributable to adverse childhood experiences were estimated at $748 billion a year [5].

These estimates share a limitation. They are built from population surveys and attributable-fraction methods, and they rarely draw on what happens inside treatment. Clinical outcomes data sits in proprietary systems, where it is either unused or used to manage claims, and it mostly describes people who were able to get care. Much of the population that carries the heaviest burden is missing from it.

Untreated trauma concentrates where resources are scarcest, deepens that scarcity, and compounds across health, work, family and the justice system. Existing data describes the problem from the outside. Clinical outcomes data, de-identified and governed as a public trust, could show what treatment does over time, for whom, at what cost, and with what economic return.

Human-capital economics already estimates returns to early investment; Heckman and colleagues put the annual social return to the Perry Preschool program at 7 to 10 percent [6]. That literature rarely measures trauma exposure, its severity or its treatment directly. RITE asks what trauma and its treatment do to the same outcomes, held to the same econometric standards.

What is the cost of trauma?

A standing, versioned estimate of the annual cost of psychological trauma in the United States, broken down by component (direct medical care, lost productivity, disability, caregiving, criminal justice, education) and by who bears it (individuals, employers, private payers, Medicaid and Medicare, state and local government). The first version will synthesize existing estimates and reconcile their methods in the open. Later versions will add original estimates from linked data and, in time, from clinical outcomes data.

The Trauma Index

A documented, reproducible measure of population trauma burden that combines prevalence, severity, treatment coverage and cost into a single series tracked over time.

• Version 0. A methodology paper defining the index from published indicators, with weights, sources and limitations stated.
• Version 1. An annual series, with peer review of the method and open code.
• Longer term. Use by researchers, state agencies and payers. Adoption as an official statistic is an aspiration RITE does not control.

Stage 1. Synthesis and public data

Systematic review and meta-analysis of research linking adverse childhood experiences, post-traumatic stress and trauma exposure to economic outcomes, with re-analysis of public datasets that carry adversity measures and economic variables: the BRFSS ACE module, NSDUH, MEPS, NLSY97, PSID and Add Health. Review protocols will be registered with PROSPERO and analysis plans posted to the Open Science Framework before results are produced.

Stage 2. Linked administrative data

Government, health and insurance datasets obtained under data use agreements, and collaboration with university research groups that hold ethics-approved clinical cohorts. Methods include cohort designs, cost-of-illness and attributable-fraction methods, quasi-experimental designs where credible, and microsimulation of lifetime costs.

Stage 3. Clinical outcomes data in public trust

De-identified, session-level outcomes, such as standardized symptom measures, treatment modality, attendance and discharge status, donated by clinical software platforms. These data show what happens inside treatment over time and allow symptom change to be linked to functional and economic outcomes.

Who can donate

Government agencies, health systems and payers, and enterprises such as employers and clinical software companies can all donate data. Each follows the same path: a written donation agreement, records mapped to a data specification RITE will publish, de-identification by Expert Determination before anything leaves the donor, and a one-way transfer. Every donor receives the same terms: credit as a data source, public results at release like everyone else, and no payment, early access or say over findings.

Closed analytics

All analysis of donated clinical data runs inside RITE's own secured environment. The data never leaves that environment, is never sent to outside AI services, and is never used to train anyone else's models. Statistical and machine-learning models that RITE builds are documented, tested for bias and reported with their limitations. Results are released only in aggregate, after small-cell suppression and a review of re-identification risk.

De-identification

The HIPAA Safe Harbor method removes dates finer than the year, which destroys the session-by-session timing that outcomes research depends on. RITE therefore accepts only data de-identified by Expert Determination, in which a qualified statistician certifies that re-identification risk is very small while relative timing is kept. RITE does not accept Limited Data Sets, which keep exact dates and ZIP codes and remain protected health information. Each donor de-identifies before transfer, using a vendor chosen with counsel.

Independence

• The board will have a majority of independent directors with no financial relationship to the founder, to intuitiveSuite, Inc., or to any data partner.
• The board, not the executive director, approves the research agenda, data partnerships and any related-party transaction.
• Data partners have no seat on the board by right, no approval over questions, methods or findings, and no advance access to results.

Data principles

1. 01Donated, never sold. Data enters by donation under a written agreement and never leaves by sale or license.
2. 02De-identified before transfer. Partners de-identify data by Expert Determination before it reaches RITE. RITE accepts no identifiable data, including Limited Data Sets.
3. 03Closed analytics. Analysis runs inside RITE's secured environment. Data is not sent to outside AI services or used to train outside models.
4. 04No individual decisions. RITE's models and findings are never used to make decisions about anyone's care, coverage or employment.
5. 05Independent findings. Data partners have no influence over questions, methods, results or publication.
6. 06Aggregate release only. Public outputs are aggregate, with small-cell suppression and re-identification risk review.
7. 07Bias stated. Clinical data over-represents people with access to care. Every analysis that uses it reports that selection.
8. 08Open methods. Protocols are registered, code is published and limitations are stated.
9. 09Right to withdraw. A partner may stop future donations at any time.
10. 10Security. Encryption at rest and in transit, role-based access, access logging, annual third-party security review and an incident response plan. RITE’s secured environment will be built to meet SOC 2 Type II and HITRUST certification requirements, with independent audits.

Research ethics

RITE will engage an independent institutional review board and seek a determination for every study, including studies that use de-identified data. Data use agreements will prohibit re-identification and contact with individuals, and will require data to be returned or destroyed when a project ends.

Ian Noël, RITE's founder, is also the founder and CEO of intuitiveSuite, Inc., a company that makes clinical documentation software, including intuitiveEMDR. intuitiveSuite is expected to be RITE's first data partner. No agreement has been signed. This relationship will be disclosed in every RITE publication, grant application and data agreement, and any agreement will follow these terms:

• Data flows one way, by donation. RITE pays nothing for data, from intuitiveSuite or any other partner.
• RITE never sells or licenses data and shares no revenue with any data partner.
• intuitiveSuite receives no influence over findings, no preferential access and no endorsement. Factual acknowledgment of data sources is the only recognition any partner receives.
• Any transaction between RITE and a company in which the founder has an interest requires review and approval by the independent directors, with the founder recused.
• Any compensation for the founder at RITE is set by the independent directors.
• Ian Noël’s roles at intuitiveSuite, including any board seat, and any equity he holds are disclosed every year. He takes no part in RITE decisions involving intuitiveSuite or in intuitiveSuite board decisions involving RITE, and RITE’s independent directors negotiate and approve any agreement with the company.
• Donated data is recorded as a contribution at fair value and reported as such, like any other in-kind gift.

RITE will seek support from foundations, research funders and individual donors. Until it holds its own tax exemption, grants will be received through a fiscal sponsor.

RITE accepts no gift, grant or in-kind contribution that carries influence over its research questions, methods, findings or publication. Donated data is itself a contribution: it is recorded at fair value, reported like any other, and governed by the same rule.

Contributions from data partners, and from payers whose coverage decisions RITE's research could affect, are accepted only as unrestricted support, approved by the independent directors, and disclosed in every publication that draws on them.

• Working papers, published first on this site and posted to SSRN or medRxiv, with code and data appendices where agreements permit.
• Peer-reviewed articles in health economics, public health and traumatic stress journals.
• Policy briefs for state agencies, payers and legislators, each tied to a published paper.
• Annual products: the cost-of-trauma estimate and the Trauma Index.

See Publications→ for the publication standards.

• Recruit advisors in health or labor economics, epidemiology, data governance and privacy, and nonprofit governance.
• Secure a fiscal sponsor.
• Register the first systematic review protocol.
• Adopt a data governance charter and conflict-of-interest policy.
• Incorporate, seat a majority-independent board and apply for tax-exempt status.