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.

The need for child care and early learning is critical, especially in rural Arkansas. One nonprofit is working to fill those gaps by giving providers a chance to get more education.

The Career Pathways Program with Save the Children partners with universities to grow the workforce of child care and preschool providers.

Joyce Taylor, Eastern Arkansas parent-family community engagement coordinator for Save the Children, had more than 20 years' experience with Head Start and said the program gave her the opportunity to pursue a bachelor's degree. It also provides her with resources she can use, in the classroom and with families.

"In particular, we have a family with a child that is autistic," Taylor noted. "Mom is working with the child at home. So I have things that I can share with that family, so she can continue to work with her child."

More than 153,000 openings for child care workers are projected over the next decade, largely driven by the need to replace those who have left the field or retired, according to the Bureau of Labor Statistics.

Taylor pointed out some children have challenging behaviors, and may have a lot of things going on at home. It is her job to help them thrive in preschool.

"Because we're the first start, when they come into Head Start, that's their first opportunity to be in a learning environment," Taylor explained. "It's up to us to do everything that we can do, to help make that first experience successful."

Karen Harrison, managing director of career in education workforce development for Save the Children, said rural areas have access to fewer resources compared to urban areas, so the program focuses on addressing the specific gaps in rural communities. She added the Pathways program aims to reduce barriers to obtaining a higher-ed credential or degree.

"All of our pathways come with incentives," Harrison emphasized. "We either pay all or partial of their tuition; we pay stipends, for books, supplies and materials. We also give 'barrier reduction' stipends. We know that child care for participants themselves can be an issue; transportation, technology needs."

Harrison added the pathway begins with a Child Development Associate credential, followed by an associate degree, and ultimately a bachelor's degree. In the process, they improve the career opportunities for workers, as well as the quality of early learning.

A persistent child care worker shortage across New Hampshire is leaving families with few options.

The state is currently short more than 7,000 child care positions but low wages and burnout are driving workers from the field and forcing some centers to close.

Shannon Tremblay, director of the New Hampshire Child Care Advisory Council, said workers are struggling to care for their own families with wages barely above the federal poverty line.

"No one wants to come in for a low wage," Tremblay pointed out. "No one wants to come in making $15 an hour, working long hours in a stressful environment."

Tremblay argued greater state investment will create long-term benefits for both parents and children, some of whom may have disabilities or behavioral issues which could be identified earlier by trained child care staff.

Last year, state lawmakers invested more than $60 million in child care services, including $15 million for the creation of child care workforce grants and investments in the state's Family Resource Centers.

Tremblay emphasized the end of career and technical education programs in New Hampshire high schools broke the pipeline of workers entering the field, putting greater pressure on current staff to do it all.

"Our providers are the case manager, the cook, the plumber," Tremblay observed. "They want to provide that high-quality care and right now it's just, they can't do it."

Tremblay stressed pandemic-era funding to support the child care industry will run out in September, so state lawmakers need to act. She added the state could increase wages so the burden does not fall on New Hampshire families, who currently spend roughly $24,000 a year on care for two children under age five.

The child welfare system in Pennsylvania faces a staffing crisis affecting children and families throughout the system.

The Child Welfare Resource Center said about 30 counties report caseworker vacancy rates of 30% or higher

Terry Clark, president and CEO of the Pennsylvania Council of Children, Youth and Family Services, at a state Senate hearing on child welfare, challenged the Departments of Education and Human Services to work together to develop a STEM-focused model for human services. It could offer young people opportunities for training, apprenticeships and careers in child welfare, juvenile justice and behavioral health.

"We spend a lot of time focusing on colleges and universities," Clark noted. "But we believe we might want to back this up a little bit, and start looking at middle schools and high schools. Try to reinvigorate, get younger students motivated and trying to come into this field."

Clark pointed out some agencies have asked supervisors and even people from other departments to take on casework responsibilities. A recent Philadelphia study found Community Umbrella Agencies had an average 45% turnover rate, with vacancies ranging from 21-60 positions.

Clark observed private providers face workforce challenges similar to the county child welfare agencies. He emphasized counties are beginning to explore more contractual relationships with private providers for needed work.

"Counties are starting to put out RFPs, calls for private providers to help supplement their workforce," Clark stressed. "That means they're asking private providers to take on roles and functions that, in the past, were primarily done by counties themselves."

Clark argued competitive wages are seen as crucial to attract and retain child welfare workers, and county funding often falls short. He added student loan forgiveness and fellowship programs may be promising ways to bring new people into the field, but lawmakers would have to agree.

"There have been House bills and different Senate bills that have been introduced, or at least in draft form over the years," Clark acknowledged. "We hope that there's continued discussion about those, because if we can get some movement on those, we think those will really help."

He told legislators the turnover trends will not change significantly without increased investment in workers.