FRANKFORT, Ky. - April is Child Abuse Prevention Month, and dentists can play a key role in spotting signs that something may be wrong in a child's life.

Dental hygienist Jennifer Hasch, dental director at Shawnee Christian Healthcare Center in Louisville, said that when poor oral health - infection or tooth decay - are going unaddressed by a parent or caregiver, that possibly could be a red flag for abuse or neglect.

"It has been a stressful year, so we know that there's likely a lot of child abuse happening that's not getting caught right now," she said, "and if they are coming to the dental office, I think it's an opportunity for us to intervene."

A virtual training on Friday aims to help oral-health professionals recognize signs of abuse. They can register for the training at kyoralhealthcoalition.org/event. A new online toolkit developed by The Kosair Charities Face It Movement and Delta Dental of Kentucky also has tips on how to help people in dental offices spot signs of child abuse. It's online at faceitabuse.org/health-professionals.

More than 20,000 Kentucky children were victims of child abuse or neglect in 2019, the highest rate in the nation. Because more than half of a child's injuries from abuse involve the head or neck, said Kara Farris, marketing and communications strategist for Delta Dental of Kentucky, dentists and hygienists are in a unique position to ask important questions.

"And the whole goal is to train them on what to ask, how to ask these questions without throwing any red flags to the child or to the parent."

According to the latest federal report in 2019, Kentucky had the highest rate of child victims of maltreatment for the third year in a row. Keith Inman, president of Kosair Charities, a group spearheading child-abuse awareness efforts statewide, said he believes the situation in Kentucky is a public-health crisis that requires the same level of resources and attention being given to the coronavirus.

"Unless more people know the warnings, it's going to continue," he said. "So, I want us to spend as much time and effort on this 'pandemic' as we have on the current pandemic."

Inman said the "TEN-4 rule" can help spot unusual bruising on kids. TEN-4 stands for bruises on the torso, ears and neck on any child four years of age or younger, or bruising anywhere on an infant who is not yet taking steps.

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.

September has been National Kinship Care Month, and more than 80% of Kentucky kinship families say they need help with groceries, followed by clothing, school supplies and other basic needs, according to a new report.

Because of budget constraints, the state placed a moratorium on its Kinship Care Program that previously allotted monthly payments of $300 per child to kinship caregivers stepping in as an alternative to foster care.

Shannon Moody, chief policy and strategy officer for Kentucky Youth Advocates, said a growing number of these families are navigating an often confusing child-welfare system.

"There are estimates that we've got about 55,000 children being cared for by relatives or close family friends in some sort of kinship care setting, whether that's child protective service-involved or not," she said, "and we do believe there are probably more than that."

Child care and mental health care were also listed as top priorities in the survey, by Kentucky Youth Advocates and the Kinship Families Coalition of Kentucky.

Norma Hatfield, president of the coalition, has spent the past decade raising two grandkids. She said most caregivers, especially grandparents, aren't financially equipped to suddenly take on full-time caring for children.

"Kentucky has done a lot to try to provide more support, but the needs are still there," she said. "It costs to raise children today, and that doesn't change."

Moody pointed to Senate Bill 151, signed into law by Gov. Andy Beshear earlier this year, as a sign of progress on policies aimed at improving the lives of kinship families. The law allows relatives or close friends, known as "fictive kin," to apply for certification as a foster home, and allows kids a say in where they live after they've been removed from their home.

However, Moody said more work is needed to expand community resources "to ensure that we are providing really comprehensive supports, including counseling and mediation services, in order for the that triad - the birth parent, the grandparent or other relative and the child - to get what they need."

The report also calls for more investments in peer support groups, using opioid settlement money to increase resources for kinship families, and better training for state and foster-care agencies and community mental-health providers on the unique needs of kinship families.

Resources for kinship families in the state are online at kinshipky.org.