Tennessee's "State of the Child" 2023 report shows some progress, but also highlights ongoing areas of concern. From the Tennessee Commission on Children and Youth, the report examines kids' health and mental health, education, family economics, child care and the state's child-welfare and youth-justice data.

Kylie Graves, director of policy and legislative affairs for the Tennessee Commission on Children and Youth, said a key finding is that, among children of all age groups, those younger than five are most likely to live in poverty. The proportion of those children living in poverty has increased to one in five.

"We did see in 2022 17.6% of children in Tennessee lived below the federal poverty line," Graves said. "That is still too high and too many of our kids, but it is closer to the national average than we've ever been. Nationally, that number was 16.3%."

Graves said the report showed between 2019 and 2021, the number of children in poverty declined. But between 2021 and 2022 among Tennessee kids younger than age five, it increased to 20%. However, the increase or decrease associated with the child poverty rate over the last couple of years was not due to pandemic assistance.

Richard Kennedy, executive director of the Tennessee Commission on Children and Youth, said the report highlights the continued decline in teen risk behaviors such as substance use, but mental health challenges have continued to increase. He pointed out that the Tennessee General Assembly has focused on increasing resources for access to mental health.

"We know that access to high-quality, easily accessible mental health services, especially those that are in school-based settings, can really provide those additional supports and services for young people, as they grow into adults that will help them be more successful, better citizens going forward," Kennedy explained.

Graves said the report finds progress in child welfare and neglect, including Tennessee's extended foster care, giving young people more time in the system and smoother entry into adulthood.

"In fiscal year 2023, 369 youths accepted extension of foster-care services; that's the second-largest number ever accepted," said Graves. "So, we're seeing that program expand, which just means that we're helping more and more kids bridge that transition that can be really challenging, and can be a cause of a lot of negative social behaviors."

Graves emphasized that Tennessee's rate of substance-exposed newborns is well below the national average, and the state has a successful "plan of safe care" program that helps keep mothers and babies together safely. Nearly 99% of these infants have such a plan, which is much higher than the national average of 70.4%, the report said.


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As Pennsylvania children return to school, health advocates stress the importance of keeping them insured.

The 2023 State of Children's Health in Pennsylvania report found more than 145,000 children are without health insurance.

Becky Ludwick, vice president of public policy at the Pennsylvania Partnerships for Children, said the back-to-school season is an ideal time to raise awareness among parents in Pennsylvania about free and low-cost public health insurance options. She added many children lost Medicaid coverage during unwinding but some have transitioned to the Children's Health Insurance Program.

"There's an increasing number of kids going without health insurance or have lost health insurance over the past year," Ludwick reported. "We just really want to take this time as kids are gearing up to get back into school again, to remind parents on what they can do to get their kids insured. So we're looking really at Medicaid and the Children's Health Insurance Program."

According to Children's Health Insurance Program guidelines, a family of three earning $60,000 annually can enroll in the program for an average monthly premium of $58 per child, with additional copays as needed. No family earns too much to apply.

Ludwick pointed out the American Academy of Pediatrics emphasizes the importance of back-to-school checkups, including routine vaccinations. She stressed enrollment in Medicaid and CHIP is open year-round and recommended parents contact the programs to ensure their children have comprehensive coverage for their health needs.

"We would encourage the families to reach out as quickly as possible on getting their child enrolled through Medicaid or CHIP," Ludwick stated. "In order to get that coverage, to make sure that they are then covered for their yearly physicals, immunization. That also covers mental health services and dental."

Ludwick pointed out recent measles outbreaks have highlighted declining vaccination rates, particularly for the MMR vaccine, which is putting communities at risk. Vaccination coverage among kindergartners in Pennsylvania has declined gradually, with the latest data showing a drop below 95% for the first time in six years.

Oregon aims to make social and emotional health care for young children more available with a new metric.

The Oregon Health Authority has adopted the Child-Level Social Emotional Health Metric, which will improve and incentivize care for kids from birth to age 5 who are on the state's Medicaid program. Oregon is the first state in the country to adopt such a measure.

Andi Walsh, senior health policy adviser for the Children's Institute in Oregon, said social-emotional health is the foundation for everyone's mental health.

"Building the ability to develop relationships, to experience and express emotions, to explore," Walsh outlined. "All of those are components of social-emotional health and all of those are the building blocks for positive mental and physical health later in childhood and adulthood."

Walsh pointed out the country's youth are experiencing a mental health crisis and Oregon is falling behind. A recent ranking from Mental Health America on access to care for youth placed Oregon third to last.

Karra Crane served on the parent advisory group for the Oregon Pediatric Improvement Partnership, which developed this metric. She has experience with a child who needs social-emotional health treatments. Crane shared her experience living in a small town, Roseburg, where waitlists for services can be years long.

"If you've never experienced it you can't imagine what it's like," Crane asserted. "Talking to people that are living it currently is a really good way to help make sure that you're not missing anything that you wouldn't know to look for because you aren't in that fight, essentially."

Walsh stressed the new metric will be especially impactful as the state bans suspension and expulsion from early care and education programs starting in July 2026. She added the goal of the metric is to get involved sooner with kids at risk of developing social-emotional challenges, which are often seen in child care settings and preschool.

"This metric is really meant to try and reach those kids much sooner in a preventative way," Walsh explained. "To start providing them with the services that we know will strengthen those skills and hopefully, theoretically, will prevent those kinds of issues moving forward."

Results of a poll by the Save the Children Action Network show voters of all backgrounds are struggling with the cost of living and want the government to do more to address such needs.

Iowa mirrored the national numbers. The poll showed a large, bipartisan majority of voters want help affording food and grocery prices, and child care costs.

Tiffany Welch, Iowa volunteer leader for Save the Children, said the issues are especially crucial in rural parts of the state and overall in Iowa, food banks and assistance programs are seeing record-breaking numbers of people in need.

"What that equals is one in six Iowa children are currently food insecure, and that is over 110,000 kids," Welch reported. "We are getting ready for back-to-school time but food insecurity is particularity a troublesome problem during the summer."

Gov. Kim Reynolds opted not to participate in a federal food subsidy program for kids this summer but instead make use of on-site food distribution sites. Child advocates have started a petition to encourage the state to participate in the SUN Bucks program next summer.

Christy Gleason, executive director of the Save the Children Action Network, said the group is calling on lawmakers to expand SNAP benefits and other policies affecting kids in the Farm Bill and observed the survey showed voters are making their decisions based on those issues, even during a time of intense polarization.

"Americans from across the political spectrum, from all walks of life, from all kinds of communities, want lawmakers to prioritize policies that help families afford high-quality child care and nutritious food," Gleason emphasized.

The latest Farm Bill, which has already been extended for a year, remains stalled in Congress.