Innovation Ecosystem

Putting women and children first

The latest edition of the Rhode Island KIDS Count Factbook reveals a crisis brewing in youth mental health services, with a growing need to support for community-based resources

Photo by Richard Asinof, from a screen shot of the Rhode Island KIDS COUNT website.

The latest edition of the Rhode Island KIDS COUNT Factbook is being released as a virtual gathering on Zoom on Monday, May 16.

By Richard Asinof
Posted 5/16/22
An interview with Elizabeth Burke Bryant, executive director of Rhode Island KIDS COUNT, on the verge of the release of the 28th annual edition of the Factbook.
How many candidates running for elected office in 2022 will proudly display their own copy of the Rhode Island KIDS COUNT Factbook? Will the R.I. General Assembly have the courage to raise reimbursement rates for Medicaid providers? What kind of coordination and sharing of data can occur between the KIDS COUNT Factbook, the Rhode Island Life Index, and local health equity zones? Will the R.I. Attorney General step in to help the Opioid Settlement Advisory Council navigate some bumpiness in how it is being set up?
The most recent mass shooting in Buffalo, in which a white teenager apparently shot 10 African Americans out of deep-seated racial hatred promoted by some right-wing commentators, raises accountability issues around what kind of messaging should broadcast by some large TV networks, such as Fox News. When does such incitement of violence cross the line? All the best data in the world cannot prevent the spread of hatred. As the song from “South Pacific” goes, “you have to be taught how to hate.”

PROVIDENCE – For 28 years, Elizabeth Burke Bryant has ushered in a spring-time celebration of children in Rhode Island, marked by the annual publication of Rhode Island KIDS COUNT Factbook, a data compendium that provides a travel guide – with the best available data – for all the things that you ever wanted to know about children and families in Rhode Island on their journey toward better health and well being.

More than a news story, more than an event, the annual Factbook celebration is closer to gestalt – where the entirety of the work is much more than the sum of its parts. Its publication is a moment when the walls and barriers and well-entrenched partisan divisions in Rhode Island come tumbling down – at least for 24 hours – to put the focus on kids.

Translated, the Factbook gives a powerful political voice to children – a voice not often heeded, because children do not vote, and because they don’t fill the coffers of candidates with donations.

In years past, the Factbook celebration brought together a crowd of politicians and advocates for breakfast at the Crowne Plaza, filling the room with “positive vibrations.” This year, the celebration will be a virtual gathering on Zoom, as the coronavirus pandemic continues to disrupt everything in our lives.

The “genius at work” with the Factbook has been its ability to keep the focus on the data, to promote its use as an “action tool” to create better policies for the future health of kids and families in Rhode Island. For nearly three decades, the Factbook breakfast celebration has been an annual “rite of spring,” similar to the way that osprey return to Rhode Island waters to build their nests and raise the next brood of chicks.

One of the “traditions” of the release of the Factbook has been an annual interview conducted by ConvergenceRI with Elizabeth Burke Bryant, the Rhode Island KIDS COUNT executive director.

In this year’s interview, Burke Bryant did not shy away from talking about some of the big problems facing Rhode Island, identifying the state’s failure to increase Medicaid reimbursement rates for providers – and the deleterious impact the low rates have had on staffing for community-based behavioral health and mental health services for children.

“We are very concerned about the workforce crisis for providers of community-based behavioral health services,” Burke Bryant told ConvergenceRI. “The Medicaid rates have not been increased in more than a decade. In some cases, for Early Intervention, for example, they haven’t been increased for 20 years.”

The low rates, Burke Bryant continued, are “leading to a significant staffing shortage for very, very critical behavioral health services, services for children with disabilities, and services for children within the child welfare system.”

She named both Early Intervention and First Connections, programs that identify and provide services for infants and toddlers with developmental delays and disabilities, which have been hurt by the low reimbursement rates.

“The issue of stagnant rates over many, many years is a major issue that needs to be addressed,” Burke Bryant said. “We are seeing really unprecedented staffing shortages, both because of an increased demand and need for services, and the difficulty that community-based programs are having in recruiting and retaining highly qualified staff.”

Without an increase in rates for so many years, Burke Bryant continued, “It [has become] a compensation issue. It is really a workforce issue in terms of staffing at health and human services and community-based programs.”

The question is:  Are the elected officials paying attention?

One on one
Here is the ConvergenceRI interview with Elizabeth Burke Bryant, the executive director of Rhode Island KIDS COUNT, talking about the findings in the latest Factbook.

ConvergenceRI: What are the important stories that the demographics tell us about children and families in 2022?
BURKE BRYANT: I would start with the fact that some of the initial data that we are seeing from the 2020 Census, Rhode Island’s child population decreased from 2010 to 2020. We were at 223,956 in 2010, and then in 2020, we are now down to 209,785. So, that is a 15 percent decrease from 2010 to 2020.

ConvergenceRI: What does that mean?
BURKE BRYANT: The child population is a trend that we watch carefully, because if it increases, you know that there will be a need for greater services, for more kids. But, if it decreases, it is telling you how our population numbers are shifting.

I do not have an exact reason for why [the children’s population is falling]. It is a trend that we started seeing back in 2000, because between 2000 and 2010, there was a decrease during that 10-year period as well. Back in 2000, there were 247,822 Rhode Island children.

ConvergenceRI: I noticed the data also seems to say that we have reached a turning point: minority children in Rhode Island are now the majority. Is that correct? The figures I saw in your executive summary were that minority children are at 53 percent.

ConvergenceRI: What does that mean?
BURKE BRYANT: It means that our state is increasingly diverse; our data is showing that. And, that the youngest children are the most diverse.

We have a figure in the Factbook that shows diversity by age. And so, we can see very clearly that, in the whole Rhode Island population, the younger children under six are [the most diverse].

ConvergenceRI: I have been reporting on the fact that there are a large number of Rhode Islanders who are currently on Medicaid [as a health insurance plan]. The latest numbers show that some 348,000 Rhode Islanders were enrolled in Medicaid as of March 31. That means that more than one-third of the entire state is receiving [health benefits] through Medicaid. For me, that has enormous implications. The Factbook covers just about everything when it comes to children and poverty, race, ethnicity, workforce, education and access to services. Do you cover the numbers of children and families and what health insurance plans they have?
BURKE BRYANT: Yes, we cover data on children with health insurance coverage, and we have the latest numbers for children enrolled in RIteCare.

ConvergenceRI: It may be a bit of a leading question. But, are we in danger of evolving into a two-tiered society, economically in Rhode Island.
BURKE BRYANT: [long pause]

ConvergenceRI: You can pass if that is not a question that you want to answer.
BURKE BRYANT: No, Medicaid is a really important program. And, it provides health insurance coverage for working families and for children, and health insurance is incredibly important in order to achieve positive health outcomes.

The numbers that you are seeing this year are higher because people stayed on Medicaid during the public health emergency. And, that was really important, because as we were dealing with COVID-19, it meant that children and families and adults that are on Medicaid weren’t losing coverage, just when this public health emergency was happening,

ConvergenceRI: If and when the public health emergency is ever declared over by the federal government, it means that, the guesstimates I have heard, is that as many as 50,000 people will be eliminated from the Medicaid rolls, when they start checking eligibility again. Have we paid enough attention for what that might mean in terms of disruption?
BURKE BRYANT: Yes, the whole country is really paying attention to that issue, that when the public health emergency ends, there will be an eligibility re-determination made for everyone on Medicaid.

And, I know that our state is planning for that, and our health plans are planning for that [as well], to try to ensure that we are reaching out to people on Medicaid, with information about this process that will happen after the public health emergency ends.

To let people know that it is coming, so that it is a smooth process. And, so that we don’t have people who are eligible for Medicaid lose coverage during this re-determination period.

ConvergenceRI: What would you say are the brightest spots in this year’s Factbook that you were able to find. What are the most positive trends that the data uncovered?
BURKE BRYANT: Is that for every issue, Richard? Or, just for health?

ConvergenceRI: Not just for health. I’ll let you define the range, however you want to define it. I am curious to learn what you see as the most important positive trends that you uncovered.
BURKE BRYANT: We are seeing some improvement in a few different indicators. We are continuing to see fewer youth held at the R.I. Training School and a declining number of youth referred to family court. So, those are very positive indicators.

Also, Rhode Island’s child and teen death rate was the lowest in the nation, for the latest available data that we have. The overall rate for children ages 1 to 19 was 15 per 100,000 children and teens, which was a further decrease from last year. And, that is why we are number-one best in the nation.

ConvergenceRI: Well, that is good news.
BURKE BRYANT: With the juvenile offenses [data] that I just talked to you about, the number of juvenile offenses referred to family court has fallen by 51 percent since 2012, from 5,780 to 2,858.

ConvergenceRI: Wow, that is a big jump, and once again, a very positive trend.
BURKE BRYANT: I just want to say that youth of color are disproportionately referred to family court. So, the good news is that there has been this incredibly significant decrease, [but] we still are reporting that youth of color are disproportionately referred to family court, compared to their representation in the youth population over all.

ConvergenceRI: In terms COVID, I recently did a long story about the cost trends analysis that Bailit Health conducted ,looking at the medical spend for Rhode Island in 2020. The consultants said that they needed to put an asterisk on almost all the numbers in regard to utilization, because the numbers were so out of whack with previous spending trends. I was wondering, when it comes to tracking data, do we need to look at the ways that COVID has changed everything in our lives, disrupted everything in our lives, including data collection?
BURKE BRYANT: Yes, certainly with indicators that we were tracking in 2020, such as school closures and distance learning, where COVID had an impact on things like attendance. That data has obviously improved for 2021, for the last school year.

But there are so many indicators where, for example, the number of calls to the hotline at DCYF, that dipped considerably when I was talking to you this time last year, because when schools were closed for different periods of time, children were isolated from caring adults in their lives, other than their parents, who might spot indications of possible child abuse and neglect. This year those numbers are on the way up.

The tracking of data by state departments has been challenging, just because of the various impacts of the pandemic, But, fortunately, we have worked in partnership with them, and bring the best available data to the Factbook.

ConvergenceRI. Moving forward, I know that you are loathe to add new categories and new trends, but I was wondering, coming out of COVID-19, whether there might be important new categories to consider, such as what we have learned from the pandemic, and how do we translate that into data learning points?
BURKE BRYANT: I think that there is a lot to be learned about how to overcome data challenges that we could put to good use going forward.

ConvergenceRI: Such as?
BURKE BRYANT: You were talking about where is the money going. But I guess, we could talk about a single identifier number for kids, so that when kids are in various different systems, you are able to know what program kids are enrolled in.

So, I think one continuing goal could be the synchronizing of data systems across state departments. It is still something we are working on as a state – and that many other states are working on as well.

ConvergenceRI: That is an excellent point. I must admit that one of the things that I always looked forward about the gathering that you had in the past the Crowne Plaza, it was such a great celebration of children in Rhode Island. Between the elementary school kids' choruses singing, and the different voices as speakers, it always served as an exclamation point, a really positive exclamation point, on the way that Rhode Island celebrated children in our lives.
BURKE BRYANT: Yes. Keep going.

ConvergenceRI: I miss that. I miss the opportunity to have those kinds of celebrations that puts the focus on kids, and not on adults talking about kids, if I said that properly.
BURKE BRYANT: Yes. You definitely said that very well.

ConvergenceRI: I look upon the Factbook celebration as a rite of spring, Do you ever see that there is a need to translate the Factbook into perhaps more bite-sized media presentations?
BURKE BRYANT: I want to address the first part of your question. This is the 28th annual Rhode Island KIDS COUNT Factbook that has been used by our partners across the state to show how kids are doing, how kids and their families are doing.

It puts all of the information in one place. And it really serves as a jumping off point for the kinds of policies and investments that kids need to thrive.

And, our team puts this together each year in partnership with state agencies who provide data, as well as the data we get from the Census Bureau, as well as many, many partners that are working on kids’ issues.

But it is the data and information that really is the foundation of a call to action for what the kids need. And, we were so excited over the years to be able to present this at a large breakfast event. We look forward to being able to do that again.

Because that does give a kind of energy, in person, coming together for kids, that really has always been a great gathering, and a great, action-oriented coming together for children.

We are releasing the Factbook again virtually this year, just because in terms of the size of the crowd that we gather together, we weren’t quite at the point of being able to host it in person. But hopefully that time is coming very soon, and we will be back doing that again next year.

For now, we are really delighted to have so many people gathering together on Zoom to hear our excellent keynote speakers: Miriam Calderone, chief policy officer for ZERO TO THREE; and our youth keynote, Ashanti Gonzalez, who is a senior at Juanita Sanchez High school in Providence and a member of the board of Young Voices.

And, we are also presenting a plaque to Chanda Womack, who is the executive director of ARISE, and really tremendous advocate and leader in our community, to recognize her work on behalf of children and families.

We are trying to emulate as much as possible the in-person gatherings that we had before, and we look forward to Monday’s release, to bring everybody together, for our virtual release, and look forward to going back in person next year.

ConvergenceRI: One of the things that is most impressive, Elizabeth, is the way that you have always created a great team around you. Could you talk a little bit about how important teamwork is these days, and the quality of the team at KIDS COUNT?
BURKE BRYANT: Rhode Island KIDS COUNT is fortunate to have an amazing team of staff who make it all happen.

ConvergenceRI: I often think that not enough credit goes to teamwork. This is clearly a labor of love by a team, with a tremendous amount of work that goes into it. Two more questions. What haven’t I talked about, should I have talked about, that you would like to talk about?
BURKE BRYANT: I think that there has been a real increase in children with mental health issues. It was a system that wasn’t what it needed to be before the pandemic.

And the pandemic has really exacerbated the number of children and youth with behavioral health issues. We know that there was a doubling of the calls to Kids’ Link RI hotline in the past two years. That is a huge jump, from a little over 4,000 to a little over 9,000 calls per year, and that is the latest data that we have in terms of being able to really compare, between March of 2020 and March 2022.

I think that is something that we are highlighting in our Factbook, because mental health is such an important [focus] for our children and their families. There a need for a seamless, comprehensive mental health/behavioral health system of care for children and youth. We need to really work urgently to be sure that the mental health needs of our children and youth are met.

We also need to a focus on prevention and early intervention of mental health issues, so that they can get the treatments that they need in their home and community before it escalates to be an emergency requiring hospitalization.

ConvergenceRI: You have been doing this work for nearly three decades now. It clearly provides you with a sense of renewal. Is that what keeps you young?
BURKE BRYANT: [laughing] What I would say is this work with our team is so important; we have an amazing group of child advocates at Rhode Island KIDS COUNT.

We really want it to be used as an action tool to make things better for kids and families.

We know the Factbook is used by people around the state that work for children; it is used by people in government; it used by elected officials; it is used by philanthropy. It has the latest available data and information about how children are doing.

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