Roughly 200,000 children in the U.S. have lost a caregiver to COVID-19. In South Dakota, mental-health experts say these cases can have added complications as kids grieve, and a range of support is needed for a strong emotional recovery.

Nikki Eining is therapist with Avera Behavioral Health and board member for the Center for the Prevention of Child Maltreatment. She said loss of a biological parent falls under the scope of Adverse Childhood Experiences.

Eining explained it can affect the child's development, because they lost a relationship that's difficult to replace.

"I might not be receiving that nurturing piece from that caregiver anymore," said Eining, "when I've developed that bond to that caregiver as an infant or a toddler, or even an early elementary-aged youth."

With social-distancing requirements, the child may have not had a chance to say goodbye, and those rules may have kept their support system at bay during the mourning phase.

Eining said that's why it's important for adults in their lives to help build new trusted relationships that offer a sense of bonding. That involvement can come from outside the home, including neighbors, teachers and coaches.

Maureen Murray, director of mental health and prevention services with Youth and Family Services in Rapid City, said her office has responded to a handful of these cases.

She said in situations where a child has to suddenly adapt to a new environment, that can extend the grieving even longer.

"A move, a different school system, loss of friends," said Murray, "even if the surviving parent is struggling with their own grief and is not there emotionally for the child."

She said it's dangerous to assume all kids are resilient, noting some will not show how much they're struggling emotionally.

Murray said providing safe spaces for them to talk when they are ready is important, while adding therapy, such as individual sessions or grief camps can help.

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.