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.

Many of California's 13.5 million children and teens have not bounced back after the pandemic, especially children of color, according to the just-released 2023 California County Scorecard of Children's Well-Being. The report showcases data from all 58 counties and shows wide disparities in indicators of health, education and more.

Kelly Hardy, senior managing director of health and research at Children Now, said anti-poverty measures during COVID helped a lot, but they were just temporary.

"Thirty-eight percent are in families making less than two times the poverty level, which is around $60,000 a year for a family of four," she said, "so, that's a pretty low bar."

The data show the state has more than 170,000 homeless students, and that the shortage of state-funded child care continues. The report found that in 2017, 2019 and 2021, only one in four working families had access to a space in a licensed child-care facility.

Susannah Kniffen, Children Now's senior managing director of child welfare and government relations, said kids in foster care had alarmingly low scores for access to healthcare and academic achievement.

"These kids are facing distinct challenges that other students aren't," she said, "and they need a very targeted approach to their education if we're ever going to change the numbers, which are fairly dismal."

Vince Stewart, vice president for policy and programs at Children Now, said in terms of education, kids appear to be losing ground as they get older.

"Forty-two percent of third graders met or exceeded standards and reading, 31% of fifth graders met or exceeded standards in science, in 29% of eighth graders met or exceeded standards in math," he said. "And then 11th graders, it's only 27% who are deemed ready for college-level math."

The report does show some bright spots. California children have high rates of health insurance and a high proportion of babies are born at normal birth weight.

Dental hygienists are trying to raise awareness about the importance of oral hygiene, noting dental pain is one of the most common reasons for school absenteeism among children.

Studies show children with dental pain are three times more likely to miss school. In addition, a child or teenager with noticeable dental disorders, such as blackened teeth or tooth loss, can take a negative toll on their self-esteem.

Betty A. Kabel, director of dental outreach for North Florida Medical Centers, sees it all too often, noting for too long, people have treated oral hygiene as a secondary issue instead of a primary concern.

"If a child has a broken arm, they would not be walking around with a broken arm," Kabel pointed out. "Your tooth, if it's an infection, or it's abscess, it's broken, there is a problem, so it's not OK for a kid to be in tooth pain."

Student health is among the top causes for chronic absenteeism, which includes dental pain, vision problems or mental health, according to the Healthy Schools Campaign.

Kabel argued there needs to be more awareness and expanded access for dental care, especially in rural areas.

Kabel stated she hears first-hand from the children she treats who feel embarrassed, and find it difficult to concentrate due to severe pain. She warned there are worse outcomes for untreated dental problems.

"Children die from tooth infections," Kabel stressed. "The infection is right there next to their brain, it's in their bloodstream, so it's a matter of life and death, when you're walking around with an infection in your mouth. "

Florida is among the top states in the nation with individuals living in Dental Health Professional Shortage Areas, and Kabel noted her organization tries to fill the gaps by working with parents and caregivers to try to treat kids who end up in their school nurse's office with severe pain.

She added there are not a lot of providers who see children, so they do their best to get kids into the ones who do provide care to kids.

Knowing how to approach the grief of others can be difficult, although things can get more complicated when addressing the grief of students in school settings.

Estimates indicate that nearly 7% of children in the U.S. will experience the death of a sibling or parent by the age of 18. Overcoming the cultural taboo around dealing with grief is especially important for teachers and other education personnel.

Gilly Cannon, director of the Children's Bereavement Services at Caring Matters in Gaithersburg, said it's important for educators and families to work together to support a grieving child at school.

"If schools were going to do three things," said Cannon, "they need to show that they care about the students, I want them to show that they can listen deeply without judging, and I'd want them to let the student know that school is a safe place for them to be present in, with their grief."

She said listening without judging involves being able to really hear the other person without needing to share your own experience, or making a judgment about the validity of the other person's feelings.

During these conversations people have to deal with their own impulse to want to fix things for the other person, or put a positive spin on the situation. Cannon recommended against both, and said people should begin by acknowledging what's happened.

"Let them know that you've heard that their person has died, and that you are very sad about that news," said Cannon. "So you're showing them that you are acknowledging it, you're aware of it, what you don't want to then do is to try and make them feel better."

Cannon said she believes that educators need to maintain the institutional awareness of the child's experience of loss, and ensure it travels with them during their school years.

"When a child is grieving," said Cannon, "you need to ensure that as they move from class to class and grade to grade and school to school, that you're passing on that information that this child has had a significant loss, because children revisit their grief as they grow. Their grief morphs and changes as they get older and they have milestones without that person."

Cannon also recommended that people avoid well intentioned clichés such as the idea of the deceased person "being in a better place" or that they wouldn't want to see them cry.

She says these kinds of clichés imply that a grieving person should feel better and hold back their tears, but the message communicated to the grieving person is that their feelings are not valid.

"You don't want to diminish any of their feelings," said Cannon. "You want them to be able to say how they're feeling. And also to know that there's no good or bad feelings, there's feelings. There's no judgment on how they're feeling."