CAMP HILL, Pa. - Pennsylvania's child welfare and behavioral health services are in crisis, with a worker shortage exacerbated by the pandemic, a new report reveals.

Between low wages and emotionally demanding work, advocates say real solutions are needed to ensure these agencies are able to help at-risk children.

The Pennsylvania Council of Children, Youth & Family Services' report includes a survey into the struggles facing many child-serving behavioral health providers.

Of the 51 agencies that responded, one in four said it has more than 30 vacant positions. Council President and CEO Terry Clark said the shortage has a ripple effect.

"Whether it's individual therapy, whether it's a child coming into a particular residential treatment facility, and they don't have staff, they're waiting somewhere," said Clark. "As a result, we're seeing kids that aren't getting their needs met. They're not able to start to address some of the underlying causes of their trauma."

More than half of respondents said they were forced to delay expanding programs as a result of being understaffed. The report recommends allowing providers to receive the maximum allowable reimbursement rate from the state for their services.

Nancy Kukovich is president and CEO of Adelphoi, which offers behavioral health care for children and teens, including 14 group homes in the state.

She said the company has 30 to 40 current job openings, even after raising the starting pay to $18 an hour. Kukovich said one recommendation from the report she sees as critical is student loan forgiveness.

"It just kills me that I am hiring people to work at Adelphoi, I expect them to have college educations," said Kukovich. "And yet, I'm not paying them enough for them to send their kids to college. I mean, that's just on its face wrong."

The report also recommends providers compile data from exit interviews to learn more about why staff members leave, and develop plans based on the results to recruit and retain employees.

New Hampshire ranks second in the country on measures of child well-being, according to the new 2022 Kids Count Data Book from the Annie E. Casey Foundation.

The Granite State scores well for economic well-being, education, health, and family and community factors. However, researchers also found rising rates of attempted suicide nationally, especially for students of color or LGBTQ youths.

In New Hampshire, said Emma Sevigny, children's behavioral health policy coordinator with New Futures, a health advocacy nonprofit in Concord, said the new 988 mental-health hotline is paired with local crisis-intervention services.

"And with it, we have a rapid response team that's available to give support to kids in their communities," she said, "so if we can improve that system and ensure that there is sustainable funding for it, that's a huge step in the right direction."

The report ranked New Hampshire fourth in education, but it drops to seventh for the number of 3- and 4-year-olds not attending preschool. Sevigny said she would like to see more subsidies to help parents afford preschool.

Leslie Boissiere, vice president for external affairs at the Annie E. Casey Foundation, said she'd like to see Congress renew the extended Child Tax Credit that boosted the bottom line for low-income families during the pandemic, but was allowed to expire.

"It's incredibly important that decisionmakers seize the opportunity and the lessons learned during the COVID-19 period, when more resources were provided to families, so that we can make sure that every child has their basic needs met," she said, "that fewer children live in poverty, and that the overall well-being of children in this country increases."

In the legislative session next year, state lawmakers will decide whether to reauthorize the expansion of Medicaid, a lifeline for many struggling families.

Massachusetts ranks first in the nation for children's well-being, according to the 2022 Kids Count Data Book from the Annie E. Casey Foundation.

Experts gave the Bay State high marks for combating poverty and boosting educational achievement. However, the report also found an increase of more than 50% in children ages 3 to 17 with anxiety or depression between 2016 and 2020, nearly double the national average.

Mary McGeown, executive director of the Massachusetts Society for the Prevention of Cruelty to Children, said the state faces a shortage of inpatient psychiatric beds.

"On any given day there are hundreds of kids who need inpatient care, who have gone to an emergency room seeking help," she said, "and they wait there days, weeks, and sometimes months for access to a bed."

Gov. Charlie Baker signed a comprehensive mental-health bill Wednesday that sets up a dashboard to manage psychiatric beds, invests in school-based behavioral health and more.

McGeown credited Massachusetts' top overall score to its success in getting almost all children covered by health insurance, as well as targeted supports to schools and low-income families during the pandemic.

Leslie Boissiere, vice president for external affairs at the Annie E. Casey Foundation, said the nation's recovery remains very uneven, with continued economic hardship, both in highly urban and rural areas.

"Enacting policies that we know can lift children out of poverty and also can secure the financial security of low-income families," she said. "Things like expansion of the Child Tax Credit. Putting resources in the hands of low-income families, so that they can provide for the basic needs of their children."

The report recommends expanding the Earned Income Tax Credit, which provides cash supports to low-income families.

Minnesota once again gets a high ranking among states for child well-being, but an annual report says the state's disparities remain a challenge, with marginalized families seeing lasting impacts from the pandemic.

This year's Annie E Casey Foundation Kids Count Data Book focuses on concerning mental health trends that have surfaced around the country. Nine percent of high schoolers overall reported attempting suicide in the most recent data year, along with 12% of Black students.

Deb Fitzpatrick, director of policy and research for Children's Defense Fund Minnesota, said these disparities are being seen within the state.

"This isn't just going to solve itself because the pandemic is in the rearview mirror for many people," she said. "We know that we had some challenges before the pandemic, and we're going to continue to see those going forward."

Fitzpatrick said issues such as economic stability and mental health go hand-in-hand, and in families that lost income during the pandemic, the children are likely to experience added stress. Overall, Minnesota ranked third in the report, and landed in the top ten for such categories as economic well-being, education and health.

State leaders did make some mental-health investments in the recent legislative session. But advocates have said more can be done to help kids, with a large surplus still available. The Casey Foundation's vice president for external affairs, Leslie Boissiere, added that federal policymakers could help by looking at past successes.

"The expansion of the Child Tax Credit lifted millions of children out of poverty," she said. "When policymakers enact policies that we know lift families out of poverty, then children do well."

The temporary expansion of the credit, which included monthly payments, expired at the start of the year. There have been calls to make it permanent, but partisan gridlock in Congress has prevented that from happening.