FARGO, N.D. - A new report confirms that vulnerable families in North Dakota are experiencing more struggles as the pandemic drags on. Households with children say housing payments and health coverage are becoming increasingly out of reach.

This week's report from the Annie E. Casey Foundation looked at all states, using weekly census survey data to get a better sense of what families are experiencing. Fifteen percent of North Dakota households said they're worried they won't be able to cover their rent or mortgage payments in the near future. One in eight households said they can't afford health insurance for their kids.

Leslie Boissiere, vice president for external affairs at the Casey Foundation, said it all adds up to an overwhelming sense of pressure.

"They're also struggling with their mental and their physical health," she said. "Twelve percent of families don't have health insurance, one in three has postponed getting needed medical care, and one in five have experienced depression since the pandemic."

The number of North Dakota households that report feeling down or depressed is one in seven. In addition to boosting mental-health services, the report recommended guaranteeing COVID-19 vaccines be available at no cost, boosting investments in education and ensuring schools are more equitably funded.

Also in North Dakota, 6% of households with children said they didn't have enough food to eat. Xanna Burg, who coordinates the Kids Count program for North and South Dakota and Montana, said that need more than likely runs deeper, since the survey data only covers short periods of time.

"So really, we think that hunger is something that families are struggling with in North Dakota," she said, "even though the snapshot of data in this report maybe indicates a lower percentage."

Burg said these problems of overall family instability stand to have long-term effects on a child's development, but she says that can be mitigated through short-term responses by policymakers, including a new COVID relief package being debated in Congress.

The flu, COVID and RSV are rapidly spreading in Kentucky, and health experts say that's a problem for hospitals, schools and the state's vulnerable residents.

So far, more than 20 school districts have temporarily halted classes due to RSV. At Norton Children's Hospital, pediatrician Dr. Robert Blair said respiratory viruses spread primarily by airborne droplets from coughing and sneezing. He explained that premature babies and young children with congenital heart disease, reactive airway disease or asthma are particular susceptible to RSV. They can wind up in the hospital on a ventilator, so he encouraged families to do everything they can to stop the spread of the virus.

"We need to pay attention to people who are sick, and isolate them and support them, and encourage them to mask and take care of themselves, and get medical care," he said. "And these little babies that are very, very high risk need to not be exposed to people with colds."

The American Academy of Pediatrics and Children's Hospital Association have asked President Joe Biden to declare a federal emergency to provide more support to combat the nationwide surge in pediatric hospitalizations driven by RSV and the flu.

Blair said normally, newborns' immune systems come into contact with RSV, but he pointed out that babies born during pandemic lockdowns didn't have that exposure.

"And so here they are, two or two-and-a-half or three years old, and they're catching these virus infections for the very first time," he said, "and their immune systems have not really been primed well."

Kelly Taulbee, director of communications and development with Kentucky Voices for Health, added that COVID precautions can help stop the spread of all viruses.

"Emphasis on hand washing, social distancing, covering your cough. Staying home when you're sick, even if it just seems like mild cold-like symptoms," she said. "As we've seen a lot of those precautions lapsing - those public health policies that were in place during the pandemic, early on - we've seen a resurgence of all of these diseases, and RSV is among them."

There currently is no Food and Drug Administration-approved vaccine for RSV, although clinical trials are ongoing. However, Taulbee said flu shots are easily accessible in every county and are effective at preventing illness, especially among young children, people 65 and older or those at risk for serious complications.

CORRECTION: Monthly amounts of the expanded Child Tax Credits were $250 (ages 0 to 5) to $300 (ages 6 to 17). An earlier version of this story had the incorrect amounts.. (12:40 p.m. MDT, Nov. 30, 2022)

A group of U.S. House members said Congress should not pass corporate tax breaks unless it also expands tax credits for families.

Rep. Pramila Jayapal, D-Wash., penned a letter, signed by 57 other Democratic House members, to House Speaker Nancy Pelosi and Senate Majority Leader Chuck Schumer, opposing tax cuts for businesses if an expansion of the Child Tax Credit and Earned Income Tax Credit isn't also included.

An expanded Child Tax Credit during the pandemic expired last year, after helping pull millions of families out of poverty.

April Messenger, director of family engagement and advocacy for the Washington State Association of Head Start and ECEAP, argued Congress should consider the greater good.

"When you think about the big businesses getting tax breaks, where's the relief for the families who are struggling day to day to put food on their tables?" Messenger asked. "We have to think about everybody, on both ends of the spectrum."

When it was in effect, the expanded Child Tax Credit provided monthly payments of $250 to $300 per child to families, depending on the child's age. Without the expanded program, an estimated 324,000 kids in Washington state are missing out the full Child Tax Credit. Opponents in Congress say the program contributed to inflation.

Inflation is now one major factor squeezing families. But Messenger, who works with low-income families, said an expanded tax credit would help. She pointed out families used the money not for frivolous things, but to pay off debt and for basic needs. In some cases, she added, it meant families not having to choose between rent and child care.

"Just that little bit of knowing that there was some hope at the end of the month, or coming in the mailbox, really gave people an inspiration to do things like plan ahead and make some financial decisions to help get themselves out of poverty," Messenger explained.

The expanded Child Tax Credit has become a priority for some Democrats as Congress enters its end-of-year negotiations and before Republicans take control of the House in 2023.

National Adoption Month comes to an end today, but in Tennessee, more than 9,000 children are in foster care and waiting for new families through adoption.

A nonprofit organization is working to equip children and change their experience and outcomes.

Carmen Brown, communications and marketing manager for Tennessee Kids Belong, said it starts with a family recruitment initiative, called the "I Belong Project." Children are the topics of videos presented to an online community interested in adoption. Brown pointed out 30 children were featured during the 30 days of November.

"But we also share these throughout the year," Brown explained. "Through our 'I Belong Project,' we have actually filmed over 700 children in the state of Tennessee, and we have a 55% rate of adoption if we film the child."

Brown added Tennessee Kids Belong is part of America's Kids Belong, a national nonprofit focused on three key areas of the adoption process: family recruitment, community engagement and coalition building.

At the start of the pandemic, Brown noted the number of children being placed into foster care went down, in part because fewer issues of neglect or abuse were spotted by caring adults when kids were not in school or daycare, or at doctor visits. But she emphasized the numbers are on the increase again.

Brown added their goal is to have more homes waiting for kids, than kids waiting for homes.

"We are always focused on the approximately 400 children that are eligible for adoption," Brown stressed. "Out of those 10,000, about 300 to 400 are always eligible for permanent placement. And that is where we are rallying families to open their homes and to adopt the children that need to be placed with a family."

Brown stated some misconceptions around adoption include the idea some children are not adoptable, or adoptive parents have to be "perfect." She added they never expect perfection from parents and children just need a loving home.

"We encourage anyone who has a pull at their heartstrings, anyone who has an extra bedroom, anyone who has a love of animals and can also give that love to a child," Brown said. "Anybody can be a foster parent and provide a safe and loving environment."

Brown noted there is also an app, called "Foster Friendly." It is free and lists more 450 businesses in Tennessee offering discounts on goods and services to foster families.