FRANKFORT, Ky. - Some children's advocates in Kentucky are convinced that more low-income kids would do better in school if that is also where they received physical, dental, and mental health care.

Terry Brooks, executive director of Kentucky Youth Advocates, says the group's new study reveals Kentucky's patchwork of school-based health services varies in quality and investment. It indicates most school districts spend less than one percent of their budgets on onsite health services and few meet the nationally recommended nurse-to-student ratio.

"No one is suggesting that schools suddenly cut teachers or reduce technological support in order to have a school nurse. Instead, what we're looking at is, how can we reconfigure existing resources?"

The research, done during the 2008-2009 school year, found the average Kentucky school district provides one nurse for 1,254 students. The National Association of School Nurses recommends a ratio of one nurse to 750 students.

As Kentucky educators wrestle with improving student test scores, Brooks says connecting mind to body is a key to student performance.

"We know that, while curriculum is important and teaching methods are important, it's also important to have kids who are physically and mentally healthy and well, to maximize their learning."

The Foundation for a Healthy Kentucky commissioned the study from Kentucky Youth Advocates and the University of Louisville. Foundation Executive Director Susan Zepeda says its concern was that Kentucky lacked a complete picture of the quality of school health care services and how they are paid for. The challenges cited in the research present some unique opportunities, says Zepeda.

"There may be a hospital; there may be a Community Health Center. There may be a business that wants to, if you will, 'adopt a school' and help make access to health care stronger in their community, recognizing that link between health and learning."

According to Brooks, some school district health services are supported through philanthropy, while others rely on collaborations with local health departments. As Kentucky moves to provide Medicaid services through a managed-care approach, the move could be a catalyst in ensuring that all 174 school districts have consistent quality and access, says Brooks.

"And this is the time for the governor and for other state officials to embrace this idea and make sure that they are thoughtful as we move into this new way of doing business with Medicaid."

The report, "A Picture of Health: A Report of Kentucky School Districts' Health Services," can be viewed at www.kyyouth.org. It also notes that the health-related services offered at schools are very basic overall, generally lacking in the areas of mental health, substance abuse and dental health.



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The need for child care and early learning is critical, especially in rural Arkansas. One nonprofit is working to fill those gaps by giving providers a chance to get more education.

The Career Pathways Program with Save the Children partners with universities to grow the workforce of child care and preschool providers.

Joyce Taylor, Eastern Arkansas parent-family community engagement coordinator for Save the Children, had more than 20 years' experience with Head Start and said the program gave her the opportunity to pursue a bachelor's degree. It also provides her with resources she can use, in the classroom and with families.

"In particular, we have a family with a child that is autistic," Taylor noted. "Mom is working with the child at home. So I have things that I can share with that family, so she can continue to work with her child."

More than 153,000 openings for child care workers are projected over the next decade, largely driven by the need to replace those who have left the field or retired, according to the Bureau of Labor Statistics.

Taylor pointed out some children have challenging behaviors, and may have a lot of things going on at home. It is her job to help them thrive in preschool.

"Because we're the first start, when they come into Head Start, that's their first opportunity to be in a learning environment," Taylor explained. "It's up to us to do everything that we can do, to help make that first experience successful."

Karen Harrison, managing director of career in education workforce development for Save the Children, said rural areas have access to fewer resources compared to urban areas, so the program focuses on addressing the specific gaps in rural communities. She added the Pathways program aims to reduce barriers to obtaining a higher-ed credential or degree.

"All of our pathways come with incentives," Harrison emphasized. "We either pay all or partial of their tuition; we pay stipends, for books, supplies and materials. We also give 'barrier reduction' stipends. We know that child care for participants themselves can be an issue; transportation, technology needs."

Harrison added the pathway begins with a Child Development Associate credential, followed by an associate degree, and ultimately a bachelor's degree. In the process, they improve the career opportunities for workers, as well as the quality of early learning.

A persistent child care worker shortage across New Hampshire is leaving families with few options.

The state is currently short more than 7,000 child care positions but low wages and burnout are driving workers from the field and forcing some centers to close.

Shannon Tremblay, director of the New Hampshire Child Care Advisory Council, said workers are struggling to care for their own families with wages barely above the federal poverty line.

"No one wants to come in for a low wage," Tremblay pointed out. "No one wants to come in making $15 an hour, working long hours in a stressful environment."

Tremblay argued greater state investment will create long-term benefits for both parents and children, some of whom may have disabilities or behavioral issues which could be identified earlier by trained child care staff.

Last year, state lawmakers invested more than $60 million in child care services, including $15 million for the creation of child care workforce grants and investments in the state's Family Resource Centers.

Tremblay emphasized the end of career and technical education programs in New Hampshire high schools broke the pipeline of workers entering the field, putting greater pressure on current staff to do it all.

"Our providers are the case manager, the cook, the plumber," Tremblay observed. "They want to provide that high-quality care and right now it's just, they can't do it."

Tremblay stressed pandemic-era funding to support the child care industry will run out in September, so state lawmakers need to act. She added the state could increase wages so the burden does not fall on New Hampshire families, who currently spend roughly $24,000 a year on care for two children under age five.

The child welfare system in Pennsylvania faces a staffing crisis affecting children and families throughout the system.

The Child Welfare Resource Center said about 30 counties report caseworker vacancy rates of 30% or higher

Terry Clark, president and CEO of the Pennsylvania Council of Children, Youth and Family Services, at a state Senate hearing on child welfare, challenged the Departments of Education and Human Services to work together to develop a STEM-focused model for human services. It could offer young people opportunities for training, apprenticeships and careers in child welfare, juvenile justice and behavioral health.

"We spend a lot of time focusing on colleges and universities," Clark noted. "But we believe we might want to back this up a little bit, and start looking at middle schools and high schools. Try to reinvigorate, get younger students motivated and trying to come into this field."

Clark pointed out some agencies have asked supervisors and even people from other departments to take on casework responsibilities. A recent Philadelphia study found Community Umbrella Agencies had an average 45% turnover rate, with vacancies ranging from 21-60 positions.

Clark observed private providers face workforce challenges similar to the county child welfare agencies. He emphasized counties are beginning to explore more contractual relationships with private providers for needed work.

"Counties are starting to put out RFPs, calls for private providers to help supplement their workforce," Clark stressed. "That means they're asking private providers to take on roles and functions that, in the past, were primarily done by counties themselves."

Clark argued competitive wages are seen as crucial to attract and retain child welfare workers, and county funding often falls short. He added student loan forgiveness and fellowship programs may be promising ways to bring new people into the field, but lawmakers would have to agree.

"There have been House bills and different Senate bills that have been introduced, or at least in draft form over the years," Clark acknowledged. "We hope that there's continued discussion about those, because if we can get some movement on those, we think those will really help."

He told legislators the turnover trends will not change significantly without increased investment in workers.