BILLINGS, Mont. -- The number of Montana children without health coverage has gone up by 25%, according to a new report which said the increase came during stronger economic times.

The findings from the Georgetown University Center for Children and Families cover a three-year period, from 2016 to 2019.

Montana had an estimated 15,000 uninsured children last year, compared to 12,000 in 2016.

Xanna Burg, KIDS COUNT coordinator for Montana, said because the data is pre-pandemic, they don't know how many more families have lost coverage.

But she added there's real concern the number is growing.

"We do know that families are struggling," Burg emphasized. "You know people are losing their jobs and with it, the health insurance that came with those jobs."

The report cites constant changes to the Affordable Care Act and more red tape in various states as possible factors for rate spikes.

Montana has accepted a Medicaid expansion in recent years, but there have also been efforts to attach a work requirement for eligibility.

Joan Alker, executive director of the Georgetown Center for Children and Families, said while there have been attempts to dismantle the Affordable Care Act, including funding cuts for outreach and enrollment, that doesn't mean states shouldn't be doing all they can to help families qualify for assistance programs.

"States do have enormous power here," Alker explained. "However, they can't entirely outrun the federal context. We're going to have to see a renewed commitment at all levels of government, federal and state, to turn this situation around."

Meanwhile, Burg said one of the glaring concerns in Montana is that nearly 22% of American Indian children don't have coverage. She cites chronic underfunding of the Indian Health Service (IHS) program.

"The IHS has been severely underfunded for a long time," Burg contended. "It receives only half the amount per-person that Medicaid receives. "

Statewide, Montana's rate of uninsured children was more than 6% in 2019, higher than the national average of 5.7%.

The biannual Pro-Kid Scorecard from the Children Now Action Fund was released today.

In it, 12 state Assembly members and seven state Senators earned a 100% rating.

Kelly Hardy, senior managing director of health and research at the nonprofit Children Now, said the scoring reflects more than how lawmakers vote.

"They voted the right way on health and child welfare, child care, education," Hardy outlined. "They also supported kids in the budget, which is not always an easy thing to do when we've got budget deficits."

The lowest scores hovered around 48%, awarded to lawmakers who voted against certain bills but also voted for proposals like forced outing policies for LGBTQ+ students in schools.

Hardy noted the report is intended to inform voters as they head to the ballot box next month.

"Kids may not vote but we want to elect legislators who do their best to support kids," Hardy explained.

California ranks 35th in the nation for child well-being, according to the latest Annie E. Casey Foundation report and is just above the national average for per-pupil spending on K-12 education.

A screening tool developed by medical providers is an effective way to spot signs of child abuse, and experts are raising awareness about it today.

The TEN-4 rule stands for "Torso, Ears and Neck," an easy-to-remember prompt to examine high-risk bruising on young children that should be considered as a red flag for abuse.

Tamara Brown, director of the Health Access Nurturing Development Services (HANDS) program at Family and Children's Place Jefferson County, said the home visitation program that provides resources for new or expectant parents includes education on the TEN-4 rule to help people spot any potential signs of abuse of their child or neighbors' and friends' children.

"We work with children under the age of two and prenatal families," she said, "and what we are hoping is that we can really provide a lot of support for those most vulnerable populations. Children under two are the highest-risk group for death through child abuse."

Kentucky's rate of child abuse decreased in 2022, but the number of reported abuse and neglect cases in the state still surpasses the national average, according to federal data. Around a dozen Kentucky kids out of every 1,000 experienced some form of maltreatment during 2022.

For more information on the rule, visit faceitabuse.org/ten4rule.

Dr. Melissa Currie, professor and endowed chair for pediatric forensic medicine at the University of Louisville School of Medicine, explained that bruising - particularly on babies - isn't normal. It can be a sign of something serious: If not abuse, then a bleeding disorder or even cancer.

"It does not necessarily mean that it's abuse," Currie noted. "That said, the rule helps us determine high-risk bruising with enough specificity that if a child screens positive, they definitely need medical workup, and they need it right away."

Barry Dunn, president and CEO of Kosair for Kids, the group that created the TEN-4 Day observance, said all Kentuckians have a role to play in preventing child abuse and neglect.

"We are proud of the progress that we've made. That drop is big," he said. "We've gone from worst in the nation to 14th worst. We're not going to plant a flag with that advancement, but it is a data point."

If you suspect a child is being abused or neglected, contact the statewide Child Abuse Hotline at 877-597-2331 to make a report.

On the heels of warnings from federal health officials about parent burnout, school-linked programs in Minnesota are overhauling their approach so that families don't feel isolated. The Surgeon General's office says 33% of parents nationwide report high levels of stress in the past month compared with 20% of other adults, noting the lingering effects of the pandemic and any financial hardships, as well as a household having to navigate technology and social media.

Keem Anderson, associate director of the statewide Ignite Afterschool initiative, said it's something they've noticed.

"We've been seeing parents struggling with their mental health, right? Having to pick up a couple extra jobs because of the economy," Anderson explained.

He said those added stressors, worsened by the pandemic, are negatively impacting parent engagement with a child's academic life, including out-of-school programs. To improve connections, Anderson said they're rethinking how they ensure parents feel supported, such as addressing transportation gaps or giving them opportunities to volunteer. Ignite Afterschool plans to hold listening sessions on this topic in the near future.

The Children's Defense Fund's Freedom Schools effort - which offers educational and cultural enrichment for kids and their families - partners with a dozen schools in Minnesota.

Paris Timmons, assistant director of Extended & Experiential Learning and Academic Recovery, and executive director of Freedom Schools, leads this program for Hopkins Public Schools, and said part of the approach is figuring out how to communicate with parents in an ever-changing world.

"It's really hard to build a relationship via words on a screen versus a phone call, versus an in-person meeting," she said.

Timmons suggested her team and other support programs need to be more intentional about speaking with parents so they're aware of what's happening in and out of school. That might look like following up a text or email with that phone call or face-to-face meeting. Freedom Schools has prioritized weekly parent empowerment sessions, so that key messaging doesn't get lost in the shuffle.