HARRISBURG, Pa. - The number of children in the nation with no health insurance increased from 2016 to 2018, but a new report shows that in Pennsylvania the insurance rate stayed about the same.

The report, from the Georgetown University Center for Children and Families, found that nearly 4.5% of children in the Keystone State lacked health insurance last year, while nationally the uninsured rate rose to more than 5%.

Kari King, president and chief executive of Pennsylvania Partnerships for Children, said that while the report showed the state is doing better than the national average, it also indicates where improvements can be made.

"Our uninsured rate for children under age 6 is actually higher than school-age children," she said, "and typically across the country you see the opposite."

King said attacks on the Affordable Care Act and delays in funding the Children's Health Insurance Program on the federal level have made expanding coverage more difficult.

Joan Alker, executive director of the Georgetown Center, said a combination of actions and inaction by the Trump administration have made health insurance harder to get and have kept families from enrolling their children.

"That's really a failure of leadership," she said. "It has not been a priority of this administration to cover children; in fact, they did not even acknowledge until very recently that the uninsured rate was going in the wrong direction."

She said she believes reducing red tape and increasing outreach to inform families of available options would help reverse the trend.

King said the anti-immigrant rhetoric coming out of Washington also is having an impact. She said 40% of uninsured children in Pennsylvania live in just five counties.

"We think at least in part it's due to the higher percentage of Hispanic families that are living there," she said. "That goes back to the chilling effect and their hesitancy to seek assistance and supports when needed."

Pennsylvania Partnerships just released its "State of Children's Health Care in Pennsylvania" report, detailing health-insurance disparities across the state. It's online at papartnerships.org.

The Georgetown report is online at ccf.georgetown.edu, and a state-specific data hub is at kidshealthcarereport.ccf.georgetown.edu.

A screening tool developed by medical providers is an effective way to spot signs of child abuse, and experts are raising awareness about it today.

The TEN-4 rule stands for "Torso, Ears and Neck," an easy-to-remember prompt to examine high-risk bruising on young children that should be considered as a red flag for abuse.

Tamara Brown, director of the Health Access Nurturing Development Services (HANDS) program at Family and Children's Place Jefferson County, said the home visitation program that provides resources for new or expectant parents includes education on the TEN-4 rule to help people spot any potential signs of abuse of their child or neighbors' and friends' children.

"We work with children under the age of two and prenatal families," she said, "and what we are hoping is that we can really provide a lot of support for those most vulnerable populations. Children under two are the highest-risk group for death through child abuse."

Kentucky's rate of child abuse decreased in 2022, but the number of reported abuse and neglect cases in the state still surpasses the national average, according to federal data. Around a dozen Kentucky kids out of every 1,000 experienced some form of maltreatment during 2022.

For more information on the rule, visit faceitabuse.org/ten4rule.

Dr. Melissa Currie, professor and endowed chair for pediatric forensic medicine at the University of Louisville School of Medicine, explained that bruising - particularly on babies - isn't normal. It can be a sign of something serious: If not abuse, then a bleeding disorder or even cancer.

"It does not necessarily mean that it's abuse," Currie noted. "That said, the rule helps us determine high-risk bruising with enough specificity that if a child screens positive, they definitely need medical workup, and they need it right away."

Barry Dunn, president and CEO of Kosair for Kids, the group that created the TEN-4 Day observance, said all Kentuckians have a role to play in preventing child abuse and neglect.

"We are proud of the progress that we've made. That drop is big," he said. "We've gone from worst in the nation to 14th worst. We're not going to plant a flag with that advancement, but it is a data point."

If you suspect a child is being abused or neglected, contact the statewide Child Abuse Hotline at 877-597-2331 to make a report.

On the heels of warnings from federal health officials about parent burnout, school-linked programs in Minnesota are overhauling their approach so that families don't feel isolated. The Surgeon General's office says 33% of parents nationwide report high levels of stress in the past month compared with 20% of other adults, noting the lingering effects of the pandemic and any financial hardships, as well as a household having to navigate technology and social media.

Keem Anderson, associate director of the statewide Ignite Afterschool initiative, said it's something they've noticed.

"We've been seeing parents struggling with their mental health, right? Having to pick up a couple extra jobs because of the economy," Anderson explained.

He said those added stressors, worsened by the pandemic, are negatively impacting parent engagement with a child's academic life, including out-of-school programs. To improve connections, Anderson said they're rethinking how they ensure parents feel supported, such as addressing transportation gaps or giving them opportunities to volunteer. Ignite Afterschool plans to hold listening sessions on this topic in the near future.

The Children's Defense Fund's Freedom Schools effort - which offers educational and cultural enrichment for kids and their families - partners with a dozen schools in Minnesota.

Paris Timmons, assistant director of Extended & Experiential Learning and Academic Recovery, and executive director of Freedom Schools, leads this program for Hopkins Public Schools, and said part of the approach is figuring out how to communicate with parents in an ever-changing world.

"It's really hard to build a relationship via words on a screen versus a phone call, versus an in-person meeting," she said.

Timmons suggested her team and other support programs need to be more intentional about speaking with parents so they're aware of what's happening in and out of school. That might look like following up a text or email with that phone call or face-to-face meeting. Freedom Schools has prioritized weekly parent empowerment sessions, so that key messaging doesn't get lost in the shuffle.

September has been National Kinship Care Month, and more than 80% of Kentucky kinship families say they need help with groceries, followed by clothing, school supplies and other basic needs, according to a new report.

Because of budget constraints, the state placed a moratorium on its Kinship Care Program that previously allotted monthly payments of $300 per child to kinship caregivers stepping in as an alternative to foster care.

Shannon Moody, chief policy and strategy officer for Kentucky Youth Advocates, said a growing number of these families are navigating an often confusing child-welfare system.

"There are estimates that we've got about 55,000 children being cared for by relatives or close family friends in some sort of kinship care setting, whether that's child protective service-involved or not," she said, "and we do believe there are probably more than that."

Child care and mental health care were also listed as top priorities in the survey, by Kentucky Youth Advocates and the Kinship Families Coalition of Kentucky.

Norma Hatfield, president of the coalition, has spent the past decade raising two grandkids. She said most caregivers, especially grandparents, aren't financially equipped to suddenly take on full-time caring for children.

"Kentucky has done a lot to try to provide more support, but the needs are still there," she said. "It costs to raise children today, and that doesn't change."

Moody pointed to Senate Bill 151, signed into law by Gov. Andy Beshear earlier this year, as a sign of progress on policies aimed at improving the lives of kinship families. The law allows relatives or close friends, known as "fictive kin," to apply for certification as a foster home, and allows kids a say in where they live after they've been removed from their home.

However, Moody said more work is needed to expand community resources "to ensure that we are providing really comprehensive supports, including counseling and mediation services, in order for the that triad - the birth parent, the grandparent or other relative and the child - to get what they need."

The report also calls for more investments in peer support groups, using opioid settlement money to increase resources for kinship families, and better training for state and foster-care agencies and community mental-health providers on the unique needs of kinship families.

Resources for kinship families in the state are online at kinshipky.org.