Montana ranks in the upper half of states for child wellbeing, according to an annual report. But mental health among young people remains a concern.

The KIDS COUNT Data Book ranks states based on four categories: economic well-being, education, health, and family and community. This year, it places the Treasure State at 20th.

Xanna Burg is KIDS COUNT coordinator with the Montana Budget and Policy Center. She noted that depression and anxiety are high among Montana children and teens.

"The reality here is that Montana youth have struggled with mental health for years," said Burg. "So this isn't a new topic. But the concerning piece and really, the urgency behind talking about this now, is that the trends really are getting worse."

The data was collected from 2020, the first year of the pandemic. The report, from the Annie E. Casey Foundation, finds mental health is a concern across the country, as kids felt the pressures from COVID-19.

Nationally, nearly 12% of children had anxiety or depression. In Montana, the number was 13.4%.

Burg said more counselors in schools is one way to addressing these growing numbers, although she noted that the solutions might look different in rural communities.

"Rural communities might not have the student population to fund a full-time counselor," said Burg. "So, ways to think about sharing staff among school systems, implementing telehealth or partnering with other community health services may be other ways to think about how this need is filled."

The number of children in poverty has improved, but Burg said it's still concerning that 34,000 Montana kids are living in families with incomes below the poverty line.

She said the federal government has offered supports, such as additional food assistance during the pandemic, but noted that this help is likely to expire soon.

"So, at a state level," said Burg, "thinking about how we're supporting families that are still struggling to afford things like healthy food, so that when kids show up to school, they're ready to learn and they're not thinking about being hungry."

As South Dakota voters prepare to consider a proposed Medicaid expansion, emerging research suggests giving these programs a bigger reach can lead to reduced rates of child maltreatment.

Through a grant from the Centers for Disease Control and Prevention, the findings were compiled by researchers at the Moore Center for the Prevention of Child Sexual Abuse at Johns Hopkins University.

Elizabeth Letourneau, director of the Center, said they looked at data in states with expanded programs, compared with states without. She reported on average, they found a 13%-16 % reduction in child neglect rates in expansion states.

"And financial instability is perhaps the most serious risk factor for neglect of children," Letourneau explained. "And so, there's less medical debt, there's less trying to figure out, 'Do I buy this prescription medicine or do I put food on the table for my family?' "

She pointed out they also found positive trends in reducing physical abuse. The Center cautioned the trend was not as statistically significant, but noted there is evidence of hope. Under the Affordable Care Act, the federal government provides funding to help states expand their Medicaid programs. Twelve states have yet to do so. The question will appear on South Dakota ballots in the November election.

Letourneau added while there are a variety of prevention programs to help families on an individual basis, broader policies should not be overlooked in seeking solutions.

"If those policies happen to have the impact of driving down and preventing violence against children, you're just going to get a much, much bigger bang for your buck," Letourneau contended.

The federal government covers 90% of Medicaid expansion costs, and extra incentives were added during the pandemic. There is opposition from some Republican policymakers, who still give pause at having to find room in the state budget for the remaining share. Except for Wyoming, all the states bordering South Dakota have expanded Medicaid.

The U.S. Department of Justice said the State of Nevada unnecessarily institutionalizes children with behavioral-health disabilities, and the problem is severe enough to violate the Americans with Disabilities Act.

The Justice Department announced its findings Tuesday, after an investigation found hundreds of children are stuck in hospitals or group homes when they should be living at home and getting community-based mental health services.

Dr. Tiffany Tyler-Garner, executive director of the Children's Advocacy Alliance, said the situation is troubling.

"Literally, the situation is so dire that they are surrendering their children to the child welfare system, in hopes of getting them mental-health services," Tyler-Garner observed.

The report showed in 2020 more than 1,700 children were admitted to the hospital for psychiatric care in Nevada and 480 ended up in residential facilities, often staying 9-12 months, and some were sent out of state. The problem is partly due to a severe lack of providers at all levels, exacerbated by low Medicaid reimbursement rates.

Tyler-Garner emphasized out-of-state placements are extremely traumatic for children and parents.

"That fragmentation that ensues as a result of it, can be crippling," Tyler-Garner stressed. "If you think about that journey of coming back together as a family. "

Gov. Steve Sisolak noted in a statement Nevada recently dedicated more than $80 million in federal funds from the American Rescue Plan to the public child behavioral-health system.

Tyler-Garner acknowledged the new investments is a good first step.

"The need is great," Tyler-Garner asserted. "Short-term pandemic or relief funding isn't going to cure it for us. Yeah, we need to find the money."

Sisolak has vowed to train more mental-health professionals and work with the Justice Department to remedy the situation. If the state does not show significant improvement over time, the federal government could file suit.

The 13th annual Pennsylvania State of Child Welfare report is out. Children advocates said the 2021 pandemic numbers showed some progress and highlighted ongoing areas of concern.

One major plus: The number of children and youth placed with family or trusted caregivers was the highest in five years, reaching more than 45%.

Rachael Miller, policy director for Pennsylvania Partnerships for Children, which publishes the report, said it also provides policy recommendations for support and community engagement to keep children with families.

"Placement with relatives or kin is critically important to a child's well-being and trauma reduction, and we need to work harder and more collaboratively to ensure that children have the opportunity to be placed with kin," Miller contended. "Every child has the right to be raised by someone they know, trust and have a relationship with, and tangible solutions exist to modifying practices that hinder that."

The report showed in 2021, more than 20,000 children were served in the foster care system, a decrease of more than 1,000 children from 2020 and the lowest rate in the last five years. On the other hand, child protective service reports increased 13% from 2020 -- though all are not substantiated -- and cases of repeat child abuse and neglect increased slightly, to reach another five-year high.

The report also found ongoing racial disparities. Black children are disproportionately placed in pre-adoptive homes and institutions, rather than kinship care. They are 4.5 times more likely to reenter foster care, and four times more likely to stay in foster care than white children.

Miller added one of the Partnership's specific advocacy initiatives focuses on researching policy changes which result in a more equitable system, and the way agencies gather information can make a big difference.

"Having the Department of Human Services, county agencies, and providers producing annual publicly available data that is disaggregated, specifically by race and ethnicity, and gender," Miller recommended. "But additionally looking at policies and procedures through a racial impact analysis."

Historically, the voices of the children and parents most effected have been excluded from policy debate and decision-making. The report makes the case the system needs youth and families of color with children in the foster care system to create better and more effective strategies as they are the population most affected.