A grim reminder is out - that Arizona could be doing more to keep its youngest residents safe and healthy.

The state's 29th annual Child Fatality Report says a total of 863 Arizona children died last year - and almost half of those deaths were considered preventable.

They include fatalities from abuse and neglect, COVID-19, drowning, firearm injuries - as well as substance-related causes, and sudden unexpected infant deaths. And all increased last year compared to 2020.

Dr. Mary Rimsza - the medical director of the Child Fatality Review program of the Arizona Chapter of the American Academy of Pediatrics and chair of the review team - said it's unusual to see such a substantial increase, but this tragic information is useful.

"Frankly," said Rimsza, "a major purpose of us doing this report is to identify preventable deaths and to make recommendations on how future deaths can be prevented. That is our mission."

The report says Arizona's child mortality rate increased 4.7% from 2020 to 2021, and it's higher among boys than among girls.

In 2021, 31 children's deaths were attributed to COVID-19, compared to 12 in 2020.

Another category with an alarming increase was drowning - the rate jumped 108%. And in substance-related deaths, poisoning was the leading factor.

Of the 49 child poisoning fatalities Rimsza said 46 were opiate overdoses, and fentanyl was responsible for 44 of them.

"The deaths due to fentanyl and other opiate overdoses, most all the opiate deaths in children were due to fentanyl," said Rimsza. "It is a huge problem in our state. It is a very tragic event - oftentimes, it could be the first time a young person tried a drug."

Rimsza added that the message to Arizona families is that there are many steps families can take to prevent a tragedy - from ensuring safe sleep environments for infants, to making sure pool areas are supervised and well fenced, to storing firearms safely and securely.

The report contains a full list of recommendations.

As winter sets in, advocates are spotlighting the need for after-school programs to provide Indiana youth with safe spaces to build skills, stay engaged, and foster positive relationships.

Research shows participation in organized activities improves mental and physical health.

Tami Silverman - president and CEO of the Indiana Youth Institute - said the settings foster belonging, confidence, and resilience, reducing feelings of isolation, and promoting positive peer relationships.

"We know that social isolation is on the rise - and so, we're looking at that social isolation going up," said Silverman, "and also, the need for kids to belong. And say, 'What can we do about it? How do we counterbalance that?'"

Silverman said these activities can create safe spaces for youth to set goals, face challenges, and grow.

She added that they provide critical networks of supportive adults, especially for those lacking consistent guidance at home or school.

Silverman said physical activity through team sports improves fitness and lowers risks of obesity and related health issues.

Structured programs also help kids manage stress, avoid risky behaviors, and build a foundation for lifelong success.

Research links extracurricular participation to higher grades, better attendance, and greater college enrollment rates.

"Research, particularly from Child Trends, that talks about those activities build skills such as teamwork, communication, conflict resolution," said Silverman. "I mean, you can see how those skills could go right back into the classroom."

Advocates say addressing barriers like cost, transportation, and availability is essential to ensuring all children can participate.

They say more resources for youth programs can help Indiana create more inclusive and supportive environments.




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Incarcerated young people in Washington state can spend a longer time in detention if they do not have a place to go upon release.

Some of the reasons for longer stays for people under the age of 18 include youth who are experiencing homelessness or are in between homeless shelters.

Sara Zier, director of legal services for TeamChild, a Washington state based advocacy group for youth involved with the juvenile justice system, said overstaying in detention is devastating for the youth who experience it.

"They're facing layers of challenges," Zier pointed out. "Not only do they not have a safe place to sleep or to go home to or a family and supportive adults to meet their needs, but then they're held in detention where they're isolated and they don't have a chance of those things either."

Zier noted many barriers exist to ensuring young people have a place to go when they're released. She explained people do not have a right to determine where they reside until they're 18 years old. A U.S. Supreme Court decision earlier this year allows cities to pass laws punishing people experiencing homelessness, which could exacerbate the situation for young people in Washington.

Degale Cooper, CEO of YouthCare, an organization working to end youth homelessness in King County, said Black, Indigenous and people of color disproportionately experience homelessness in the county. Cooper acknowledged the city of Seattle and the state have policies in place to end youth homelessness, but funding remains an issue.

"Young people are homeless all over our state," Cooper emphasized. "If we don't have the financial resources to support organizations that can house these young people for either short periods of time or long periods of time, then the policy can't work."

State lawmakers passed a measure that went into effect in 2021 stating, "Any unaccompanied youth discharged from a publicly funded system of care will be discharged into safe and stable housing." However, the state has yet to achieve it. Zier stressed it is important to solve the issue of unaccompanied youth held in detention even though population-wise, it is a small number of people.

"From an equity perspective it's really important that our state stick to commitments we've made to house young people," Zier contended. "And also to give young people who are detained for offenses opportunities to engage in treatment, instead of being held in detention where their needs aren't met."

TeamChild offered some recommendations for addressing the issue of youth who are stuck in detention. It said the state should allow faster access to court for young people in detention and adjust the legal emancipation and minor guardianships to better serve people under age 18.

Young people in Pueblo can now avoid serious and long-lasting consequences when they are unable to pay fines or fees.

Chanell Hasty, program manager with the National League of Cities - which created the Cities Addressing Fines and Fees, or CAFFE program - said when young people cannot pay a fee, it goes into collections. That can make it much harder for them to become financially independent, contributing members of the community.

"Jobs today, they require that you have decent credit scores to get a job, so they may not be able to get a job. They may not be able to get housing because of a damaged credit score," she said. "It's just a negative economic spiral for this young person."

Unpaid fines and fees can quickly snowball, leading to increased fines, driver's license suspensions or even jail time. Through CAFFE, people can sign up for Pueblo's Financial Empowerment Center, get one-on-one financial literacy tutoring, get their court fines or fees reduced, and pay them off through community service. Pueblo is one of 14 cities selected to participate in the program, which is also open to adults.

A similar program run by the San Francisco Financial Justice Project, called AFTER, helps juvenile crime victims secure restitution costs. Struggling families are often left on the hook for these costs, which can push the entire family deeper into poverty. Without this program, Hasty said victims who have real medical bills to pay may never get the money they need.

"So a program like this allows for the victim to actually get financial restitution to pay whatever bills that result from the crime," she continued.

Researchers found that crime survivors generally receive little, if any, restitution.

One year after restitution was ordered, only 2% was paid, and more than 90% remained unpaid after five years. Municipal fines and fees also disproportionately burden low-income residents, especially residents of color.


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