COLUMBUS, Ohio -- With myriad public health and economic challenges looming, a new report offers local leaders in Ohio pre-pandemic data on child well-being to help guide the path forward.

New 2020 Kids Count County Profiles released yesterday by the Children's Defense Fund Ohio feature research on financial security, health, safety and education -- all of which is timely and relevant, said CDF Ohio Kids Count Project Director Kim Eckhart.

"It's a time when, more than ever, we need to focus on the needs of children and families in our communities," said Eckhart. "And setting these benchmarks really allows us to have child well-being as the key performance indicator of an economic recovery."

The report shows before COVID-19, Ohio showed slight progress in the areas of poverty, median income and unemployment.

Eckhart noted areas that need more work include child abuse and neglect and children in foster care - demonstrating the need to support programs that protect some of the state's most vulnerable residents.

In the area of health, babies born with low birthweight also continue to be a challenge for Ohio. Eckhart said mothers and infants could be better supported by extending pregnancy-related Medicaid coverage, from the current 60 days after delivery, to twelve months.

"A mother's health is so intimately related to a baby's health," said Eckhart. "And so, continuous eligibility for a year can tie into the measures of infant mortality and babies born with a low birth weight."

Eckhart said the county profiles can be used help to ensure kids are kept at the forefront of policy discussions. She added families are living with challenges they've never experienced before.

"Right now, housing is also an educational institution," said Eckhart. "And so, what are leaders' plans to prevent housing instability and to increase access to internet service? So, thinking about funding for utility assistance, funding for rental assistance."

Summit County was cited in the report as an example of local leaders elevating the needs of children. Eckhart said county leaders there are leveraging CARES Act funding to support rent and utility assistance, food banks and small business grants.

Child-abuse prevention specialists in South Dakota and elsewhere say a new study underscores the need to protect kids from traumatic situations to avoid long-term physical health issues. International researchers have found a 14% increase in heart failure among adults who experienced one form of childhood maltreatment.

Those with three to five types of maltreatment had a 43% increased risk.

Brooke Jones, a child-abuse pediatrician based in Sioux Falls, said these events place stressors on the body.

"If you've heard of the term 'fight or flight' - if you're having constant adversity in your childhood, you might be in a constant flight stage, meaning that you don't have any down regulation or you're not getting out of that constant stress environment," Jones said.

And that constant stress can leave its mark in multiple ways, including cardiovascular disease, as these kids transition to adulthood. Jones said parents or caregivers can reduce the impact by providing a nurturing environment as the child grows.

She said it can involve simple things, such as reading to them or finding ways to let them know they are in a safe space.

Shakira Suglia, director of epidemiology at Emory University, chaired a 2017 American Heart Association report that tied adverse childhood experiences to adult health risks, including heart disease. She said the new study adds to evidence that the mental and physical health effect go hand-in-hand when peeling back the layers of trauma.

"There might be development of depression or anxiety disorders that may make someone more prone to then cope with substances," she said. "For example, the uptake of smoking is also another thing that people tend to use to cope with stress."

Suglia echoed calls for policymakers and community-level organizations to do anything that supports stronger family relationships, especially in situations where trauma has surfaced in a household. She said outside of the home, schools and care centers can be on alert for children who have dealt with trauma and should try to emphasize a welcoming environment in those settings.

Ohio's child-welfare system is plagued by a shortage of mental-health professionals. Experts said having consistent access to therapists, counselors, psychologists and psychiatrists could change the trajectory for kids who otherwise would be placed in institutions, increasingly lacking the space for them.

Theresa Lampl, CEO of The Ohio Council of Behavioral Health and Family Services Providers, said to offset the community consequences of lack of access to care, mental health should be viewed as a persistent health condition, and treated on par with heart health, diabetes or other chronic diseases. She said that requires creating value to attract more people to the profession.

"Really creating incentives for people to come in, because these jobs offer relatively low pay, yet require in many cases, bachelor's or master's degrees, in order to provide services," Lampl said.

She said the state could implement tuition-reimbursement programs, paid internships and loan-forgiveness opportunities to jump start the behavioral health workforce pipeline. According to state data, more than 2-million Ohioans live in communities without enough behavioral-health professionals.

Melissa Flick, protective services manager of South Central Ohio Job and Family Services, said the state's rural regions lack intensive behavioral health services that are more readily accessible in cities. She provided an example of a 12- year-old girl with a long history of trauma, and was hospitalized for several weeks.

"She's doing some self harming by ingesting different items," Flick said, "so whatever she can get her hands on, she will try to ingest to harm herself. And she is currently placed in an acute-care hospitalization type facility. Those types of facilities are supposed to be very short term."

The agency has exhausted every resource in the state, and those facilities are either completely full or they are unable to meet her specific needs. Flick believes better resources early on may have addressed the trauma to set the child on a path toward healing.

Nationwide, mental-health crises among young kids are on the rise. According to the CDC, mental health-related Emergency Department visits jumped by 24% for children ages 5 to 11 and 31% for 12 to 17-year-olds in 2020, compared with the year prior.

Ohio families are experiencing greater mental-health challenges coming out of the pandemic, and social services workers emphasized it makes it more difficult to place kids who need help in appropriate facilities.

According to a report published earlier this year by the Public Children Services Association of Ohio, 89% of counties experienced placements of youths whose needs were primarily behavioral health-related.

Deanna Nichols-Stika, executive director of Wayne County Children's Services, explained caseworkers had options for residential placement and could select the provider who best met the needs of a child a decade ago. Now, she noted, it is now rare to find basic long-term housing and care.

"It is not uncommon for us to make over 40 phone calls to different providers in the state of Ohio, just looking for an available bed," Nichols-Stika pointed out. "Not even having the opportunity to really look at available services matching the needs of the child."

According to an Ohio Council of Behavioral Health and Family Services Providers report, demand for behavioral-health treatment in the state spiked by 353% between 2013 and 2019, likely worsened by the pandemic. Agencies said the increased demand for youth mental-health services, in particular, is having a substantial impact on wait times.

Scott Boone, director of Knox County Job and Family Services, said families are struggling with increasingly complex, interconnecting issues compared to previous generations. As a result, kids are dealing with trauma and resulting behavioral and mental-health issues traditional foster homes and even therapeutic foster care, are not equipped to manage.

"We're finding that a lot of kids are developing these types of behaviors where they're self harming, and they're running away," Boone observed. "They've been exposed to every kind of abuse that you can think of."

Boone cited a recent example of trying to place a teenage girl who had been in a detention facility. He recalled staff worked desperately with the local probation department and contacts throughout the state for nearly three months trying to find placement.

"And we were turned down by over 100 providers until finally we found a location in Cincinnati," Boone recounted. "You can imagine that the cost of that is around $400 a day."

Nichols-Stika added despite the challenges, there is a collaborative spirit among people working to stabilize and care for children coming out of the worst circumstances.

"There is such a passion for this, of people in this profession, child welfare, behavioral health, mental health, to help people," Nichols-Stika explained. "That's why we got into this profession. We just need additional resources to help us do better."