In Your Neighborhood

The rite of spring in Rhode Island

Unveiling of the 2015 Rhode Island Kids Count Factbook is opening day for policy tussles around children and families

Image courtesy of Rhode Island Kids Count

Images from a collage of covers of the first 20 Rhode Island Kids Count Factbooks published as a poster in 2014

By Richard Asinof
Posted 4/13/15
The latest documentation of the well-being of Rhode Island’s children in the 2015 Rhode Island Kids Count Factbook creates an evidence-based challenge to the current status quo of Rhode Island’s economic future. More than serving as a launch point for selling Gov. Gina Raimondo’s plans to spark an economic comeback in Rhode Island, it points strongly to a need to repair and mend the state’s safety net for children and families – and the need to raise new revenues to do that, or else face a continued wave of economic decline.
What are the economic statistics in human capital that are being lost as a result of asthma and lead poisoning, as detailed in Anna Aizer’s recent research? What kinds of initiatives are planned by the Raimondo administration to underwrite the development of a healthy homes initiative in Rhode Island? If you want to reduce hospital costs, improve educational achievement, and economic attainment, why not invest state resources in healthy homes, and not a baseball stadium. What is the comparative ROI for both investments?
A coalition of diverse groups are beginning to come together to discuss collaboration on the diagnosis and treatment of toxic stress in Rhode Island. The group bridges numerous silos by bringing together not just doctors but nurses, not just hospitals but researchers and advocates, not just foundations and universities but pediatricians and community health practitioners.

WARWICK – The Rhode Island Kids Count annual Factbook turns 21 on Monday, April 13, with a gala celebration celebrating Rhode Island’s children at the Crowne Plaza.

It is very much a rite of spring in Rhode Island, with music provided not by Igor Stravinsky but by the 5th Grade Chorus at the Lillian Feinstein Elementary School at Sackett Street in Providence.

The keynote address was to be delivered by Christina Paxson, president of Brown University, and Gov. Gina Raimondo, Sen. Jack Reed, Rep. Jim Langevin, R.I. House Speaker Nicholas Mattiello and R.I. Senate President M. Teresa Paiva Weed were scheduled to speak after receiving an official presentation of the Kids Count Factbook.

The breadth and depth of the Factbook and its examination of the best available data statewide and in Rhode Island’s 39 cities and towns makes in the go-to source for children’s health and well-being.

The Factbook tracks 71 indicators across five large categories: family and community, economic well-being, health, safety and education.

It is, quite simply, the place where you can find accessible data snapshots about the current trends in Rhode Island related to children and families.

“I would say, that ever since Rhode Island Kids Count started, we knew having the best available data was a very important tool to informing positive public policies for children,” Elizabeth Burke Bryant, the executive director of Rhode Island Kids Count since its founding, told ConvergenceRI in an interview before the release. “Prior to [the Factbook], there was no central place to [go to] for a comprehensive picture of how children were doing in terms of health, education, economic well-being and safety.”

Having access to accurate, comprehensive data, she continued, “does lead to [positive] policy changes for children.”

What it means to be 21
As useful and valuable as The Factbook has become as a source of data, one of the continuing questions about the Kids Count Factbook is how effectively does it serve as a tool to get the information get translated into policy and legislative agendas and outcomes.

In the glass half-full cheering department, advocates can point to the potential to have full-day Kindergarten in all Rhode Island cities and towns next year, if the R.I. General Assembly moves forward. Advocates can also point to the renewed focus on obesity and nutrition, the continuing focus on maternal and infant health, and the leadership of Rhode Island in providing health insurance to its children and families.

Bryant cited numerous instances where putting together compelling data, such as the sounding of the alarm bells on childhood lead poisoning, has led to dramatic decreases in the number of children being poisoned by exposure to lead. The same was true around the issue of access by children to health insurance.

Bryant also cited changes that came about as a result of publishing data on out-of-school suspensions, which she said led to major policy changes in school systems such as Central Falls. “For several years, we were hearing anecdotal information,” Bryant told ConvergenceRI, “about the varied use of out-of-school suspension as a disciplinary tool.”

By quantifying the numbers, and putting the issue “much more on the front burner,” Bryant continued, it resulted in the school superintendent in Central Falls changing policies.

Frances Gallo, the outgoing superintendent of schools in Central Falls, will be receiving a presentation of the 2015 Rhode Island Kids Count Factbook.

The not-so-good news
In the glass half-empty section, the fact that the number of children without health insurance in 2013 was 5.4 percent, as high as it was in 2008, is a troubling indicator. Mattiello praised Elizabeth Burke Bryant, the executive director of Rhode Island Kids Count, as one of his favorite advocates in the state, in the annual celebration of children hosted by Rhode Island Kids Count on Nov. 24, 2014. Mattiello also pledged at that event to find the wherewithal to move the 5.4 percent of uninsured children to zero. [See link to ConvergenceRI article below.]

But the reality is that children and parents in the FY 2016 budget under Gov. Gina Raimondo, with some $91 million in scheduled cuts, will in all likelihood be taking a direct hit in Medicaid spending in benefits and services, despite Mattiello’s promise.

Mental health
And, not surprisingly, in mental health, the latest data shows an alarming increase in hospitalizations of children with a primary diagnosis of mental illness, some 2,737 hospitalizations in 2013, compared to 1,794 in 2003, a 53 percent increase.

As the Factbook stated: “Children most at risk for mental disorders are those with prenatal exposure to alcohol, tobacco and other drugs; children with low birthweight; those suffering from abuse and neglect; those exposed to toxic stress; children of parents with a mental disorder, and children living in poverty.”

Mental health problems, the Factbook continued, “whether arising from biological, environmental and/or psycho-social causes, affect the physical functioning of the brain.” One survey was reported to have found that 34 percent of Rhode Island children who needed mental health treatment or counseling in the previous year did not receive it.

“Mental health treatment systems tend to be fragmented and crisis driven with disproportionate spending on high-end hospital and residential care and often lack adequate investments in prevention and community-based services that would allow children to receive appropriate treatment levels in their own communities.”

Indeed, one of the new metrics added to the 2015 Factbook was tracking the birth of babies in Rhode Island that were born with exposure to alcohol or opioids [pain medication, what’s known as Neonatal Abstinence Syndrome, which has been on the rise in Rhode Island. Some 76 babies were diagnosed with NAS at birth in 2013, a rate of about 72 per 10,000 births, double the rate of 37.2 per 10,000 births in 2006. Some 90 percent of the babies born with NAS between 2009-2013 in Rhode Island were born to white mothers.

Toxic stress
The 2015 Rhode Island Kids Count Factbook states that “infancy is a time of great opportunity and vulnerability.” A child’s development, it continues, “can be compromised by ‘toxic stress’ and a variety of risk factors in infancy, including poverty, maternal depression, family chaos, exposure to violence, child maltreatment, and unsafe, low-quality child care.”

The new emphasis on “toxic stress” as a defining metric reflects efforts within Rhode Island’s health innovation ecosystem to attempt to better define how to treat and diagnose the prevalent disorder.

The Factbook continues: “Maternal marriage status, age, and education level at birth influence the likelihood that a child will live in poverty and predict many developmental vulnerabilities.”

Asthma and lead poisoning
The 2015 Rhode Island Kids Count Factbook also delves into the problems facing Rhode Island children as a result of asthma and lead poisoning, and drawing the direct correlation with the focus on creating healthier homes.

Nationally, asthma is the most common chronic condition among children, according to the Factbook. Asthma remains the third-ranked cause of hospitalization for children under age 15, and one of the leading causes of school absenteeism.

Further, racial and ethnic differences in asthma prevalence are believed to be correlated with poverty, exposure to indoor and outdoor air pollution, stress, acute exposure to violence, lack of access to preventive medical care, and genetic factors.

In Rhode Island, between the 2009-2010 and the 2012-2013 school years, 37 percent of children with asthma [some 6,744] were chronically absent in at least one of the school years, with chronic absenteeism defined as missing 10 percent or more days of school.

In Rhode Island, about 15 percent [1,607] of all asthma emergency department visits between 2009 and 2013 for children under the age of 18 resulted in a hospitalization.

The Rhode Island Kids Count Factbook repeated the statistic that has been trumpeted about Rhode Island’s high rate of poverty: some 21 percent, or 44,833 of Rhode Island’s children under the age of 18 lived in households with incomes below the federal poverty threshold, between 2011 and 3013.

Food, nutrition and obesity
Bryant raised the alarm regarding the epidemic of obesity in Rhode Island’s children, saying it was a critical health issue moving forward, because “children are going to be worse off than their parents.” Bryant claimed that the data provided “an absolute road map for policy changes and responses to these issues. “We have to find ways to get the data and track solutions,” she said. “Strategies need to be tested. We need to keep this on the front burner.”

Bryant also addressed the growing disparity in the gaps around race and ethnicity in children in Rhode Island.

“Everywhere you look, we need to close these gaps in order to move forward as a healthy state,” Bryant said. She pointed to the disparity of 4th grade reading competency, which was 79 percent for white students but only 59 percent for black students.

“I do believe that education is a critical part of the solution, but it’s not the only part. We need community partners to increase opportunities for children and families. We need community solutions to reduce chronic absenteeism. It’s not just what’s happening in the school building.”

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