A new report said South Dakota has made strides in the past decade to improve child well-being, but its authors say there are still plenty of challenges, and mental health is increasingly becoming one of them.

The Annie E. Casey Foundation's annual Kids Count Data Book puts South Dakota in the middle of the pack for child well-being, at 24th in the nation.

The report noted more than one in seven children around the state have experienced depression or anxiety.

Xanna Burg, Kids Count coordinator for South Dakota, said rates are higher for children of color, and there is another troubling statistic as well.

"In South Dakota, they have the second-highest rate in the nation of teen suicide," Burg reported. "Really concerning data around mental-health support."

The report backed a recommendation schools maintain a ratio of 250 students per counselor. Burg pointed out South Dakota's ratio is 363 to one. She emphasized for smaller districts which might have a harder time adding staff, solutions such as telehealth should be considered.

Earlier this year, the state announced it would use federal pandemic funding to add more regional behavioral health facilities.

The report also showed many South Dakota families still make poverty-level wages, and about 42,000 children live in families paying more than 30% of their income on housing.

Leslie Boissiere, vice president of external affairs for the Annie E. Casey Foundation, stressed it is important to not lose momentum in trying to improve the situation.

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

Analysts noted the federal Child Tax Credit, which was temporarily expanded last year and included monthly payments, helped lift kids out of poverty, but political gridlock has blocked a permanent expansion.

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.