HELENA, Mont. -- Troubling trends in Montana may have made the pandemic harder for children, a new report shows.

The latest Annie E. Casey's KIDS COUNT report ranks states based on 2019 data in four categories: economic wellbeing, education, health, and family and community. Montana ranks 22nd overall.

Xanna Burg, KIDS COUNT coordinator at the Montana Budget and Policy Center, said families have been struggling to afford housing, which became harder during the pandemic.

Burg added another concerning trend is the recent rise in Montana children without health insurance, up to about 15,000 in 2019.

"That was before the pandemic, and it's concerning because so many families, their health insurance is tied to their employment," Burg explained. "And so we're concerned that this number may have increased as a result of some of the job loss that we saw in the last year."

Burg argued Montana should support Medicaid and improve outreach in order to enroll more children in the program.

Leslie Boissiere, vice president of external affairs for the Foundation, said Congress passed pandemic relief quickly, including an expansion of the Child Tax Credit within the American Rescue Plan Act.

She explained the policy is expected to pull as many as half of the children living in poverty out of it, but noted it's only temporary.

"We are excited and grateful that lawmakers passed the expansion," Boissiere stated. "And we're calling on them to make that expansion permanent. We'd like to ensure that we don't have the largest ever, one year reduction in the number of children who live in poverty followed immediately by the largest ever one-year increase."

Burg noted Native American children in Montana face greater hardships than their white counterparts, including higher rates of poverty. She emphasized policymakers should look at the pandemic recovery as a chance to reimagine how we support children and families, instead of returning to the way it was before COVID-19.

"So when making decisions and creating supports for families, how can we think about specifically supporting Native children and other children of color in our state so that we don't see these disparities continue in the data?" Burg asked.

A bill in the Pennsylvania General Assembly would amend the state Constitution to allow more adult victims of childhood sexual abuse to sue their abusers.

Senate Bill 1 would open a two-year retroactive window for lawsuits by victims of sexual abuse who were otherwise time-barred from bringing claims.

Terry Clark president and CEO of the Pennsylvania Council of Children, Youth and Family Services, said in 2019, the state extended the civil statute of limitations for child sexual-abuse victims to file suit, from age 30 to age 55. Clark pointed out the bill would also allow legal action against organizations the Council works with to support victims.

"And this really is where our concern is, because it relates to a person being able to sue institutions," Clark explained. "Those institutions aren't just folks like the Catholic churches or Boy Scouts of America. It's also foster-care providers, adoption providers, residential treatment providers."

The bill, sponsored by Sen. Daniel Laughlin R-Erie, also includes new, stricter voter ID requirements. Clark noted the proposed amendments would have to pass in two consecutive legislative sessions, before they would be put on the ballot for voters statewide.

Clark added there are concerns opening a two-year window for sexual-abuse claims, referred to as the "look-back time," may prompt some fraudulent claims. The Council recommended legislators consider a shorter time window of one year instead of two.

"But also establishing parameters around potential defendants," Clark urged. "That would mean including some type of language that limits the scope to who the perpetrator is; the individual causing the harm being more the individual, versus being the institution itself."

Clark emphasized his group would also back requiring some level of fact-finding before a claim is filed, including evaluation by a licensed mental-health professional certifying there is a reasonable basis to believe sexual abuse occurred.

"One of the other things is really looking at creating a victim's compensation fund," Clark noted. "That's a fund that would really help victims and their families through that time. That's the emotional, physical, and traumatic time, it helps ease the financial impact of the services that they might need to heal."

Other suggestions would be mandatory, structured settlements with specific dollar amounts, and including language in the bill to cap attorney fees, to ensure most of the money in a sexual-abuse settlement goes to meeting the needs of the survivor.

Many of California's 13.5 million children and teens have not bounced back after the pandemic, especially children of color, according to the just-released 2023 California County Scorecard of Children's Well-Being. The report showcases data from all 58 counties and shows wide disparities in indicators of health, education and more.

Kelly Hardy, senior managing director of health and research at Children Now, said anti-poverty measures during COVID helped a lot, but they were just temporary.

"Thirty-eight percent are in families making less than two times the poverty level, which is around $60,000 a year for a family of four," she said, "so, that's a pretty low bar."

The data show the state has more than 170,000 homeless students, and that the shortage of state-funded child care continues. The report found that in 2017, 2019 and 2021, only one in four working families had access to a space in a licensed child-care facility.

Susannah Kniffen, Children Now's senior managing director of child welfare and government relations, said kids in foster care had alarmingly low scores for access to healthcare and academic achievement.

"These kids are facing distinct challenges that other students aren't," she said, "and they need a very targeted approach to their education if we're ever going to change the numbers, which are fairly dismal."

Vince Stewart, vice president for policy and programs at Children Now, said in terms of education, kids appear to be losing ground as they get older.

"Forty-two percent of third graders met or exceeded standards and reading, 31% of fifth graders met or exceeded standards in science, in 29% of eighth graders met or exceeded standards in math," he said. "And then 11th graders, it's only 27% who are deemed ready for college-level math."

The report does show some bright spots. California children have high rates of health insurance and a high proportion of babies are born at normal birth weight.

Dental hygienists are trying to raise awareness about the importance of oral hygiene, noting dental pain is one of the most common reasons for school absenteeism among children.

Studies show children with dental pain are three times more likely to miss school. In addition, a child or teenager with noticeable dental disorders, such as blackened teeth or tooth loss, can take a negative toll on their self-esteem.

Betty A. Kabel, director of dental outreach for North Florida Medical Centers, sees it all too often, noting for too long, people have treated oral hygiene as a secondary issue instead of a primary concern.

"If a child has a broken arm, they would not be walking around with a broken arm," Kabel pointed out. "Your tooth, if it's an infection, or it's abscess, it's broken, there is a problem, so it's not OK for a kid to be in tooth pain."

Student health is among the top causes for chronic absenteeism, which includes dental pain, vision problems or mental health, according to the Healthy Schools Campaign.

Kabel argued there needs to be more awareness and expanded access for dental care, especially in rural areas.

Kabel stated she hears first-hand from the children she treats who feel embarrassed, and find it difficult to concentrate due to severe pain. She warned there are worse outcomes for untreated dental problems.

"Children die from tooth infections," Kabel stressed. "The infection is right there next to their brain, it's in their bloodstream, so it's a matter of life and death, when you're walking around with an infection in your mouth. "

Florida is among the top states in the nation with individuals living in Dental Health Professional Shortage Areas, and Kabel noted her organization tries to fill the gaps by working with parents and caregivers to try to treat kids who end up in their school nurse's office with severe pain.

She added there are not a lot of providers who see children, so they do their best to get kids into the ones who do provide care to kids.