Tuesday, August 7, 2018 4:22 am

Tennessee is making a marked improvement in several areas of child well-being, ranking 35th in the 2018 KIDS COUNT® Data Book released today by the Annie E. Casey Foundation. The state's overall ranking is composed of four domain ranks: economic well-being, education, health and family and community. Each domain is made up of four measures.

At 82nd, Cannon County ranks near the bottom of Tennessee counties in child well-being. Some of the county's strongest rankings include that there were no child and teen deaths in 2016 and it has a relatively low rate of poverty among children.

Though it is still a higher number than one would hope, Cannon County's 21.8 percent child poverty rate is better than most counties in Tennessee. The county's biggest challenges are a high rate of pregnancy among girls age 15 to 17, relatively high housing costs and low high school graduation rate. Additional strengths include a high median household income and a relatively low rate of substantiated cases of child abuse and neglect. Additional opportunities for improvement include low rates of proficiency among 3rd to 8th grade children on TNReady reading and math tests and a relatively high rate of children who are uninsured.

Policy/Practice/Program Options to Improve Outcomes.

Many of these policies have multiple models for delivery, including public-private partnership and non-profit leadership.

•Comprehensive sex education classes that include both encouragement of abstinence and information on birth control have been shown to reduce the number of teen pregnancies.

•Pro-active housing policy that helps ensure affordable housing is available for people to live where they work can improve negative outcomes related to high housing costs.

•Making high school students aware of the community college and technical school benefits available to them through Tennessee Promise can encourage on-time high school graduation.
•Increased access to pre-K can help both math and reading proficiency in later grades. Early assessment of reading skills coupled with appropriate interventions where needed can improve reading proficiency, while increasing STEM opportunities in elementary and middle schools can help improve 3rd to 8th grade math proficiency.

•Most uninsured children in Tennessee qualify for either TennCare or CoverKids, so high rates of uninsured children can be improved with outreach to make sure that families are aware of these insurance opportunities. According to Census Bureau estimates, Cannon County has almost 100 children who qualify for these health insurance programs but who nonetheless lack insurance.

Tennessee achieved its highest rank, 27th, in the health domain. Other rankings were 33rd in economic well-being, 35th in education and 38th in family and community. The state improved on one or more measures in all the domains except health.

The KIDS COUNT Data Book provides a picture of where Tennessee is and where it needs to focus more attention, and it provides data to inform changes states may want to make for improvements in the future. The Tennessee Commission on Children and Youth is the KIDS COUNT Tennessee state affiliate.

"Tennessee's early adoption of expanded TennCare and CoverKids for children has contributed to a strong ranking on its health domain over the years," said Rose Naccarato, Tennessee Commission on Children and Youth (TCCY) KIDS COUNT® director. "As other states have expanded Medicaid under the Affordable Care Act, this advantage has waned. Though most low-income children still have access to TennCare or CoverKids, their parents are often unaware because they themselves are not eligible."

Outreach to families with qualifying children can reduce the number who are uninsured. Further reductions occur when parents are also eligible for coverage. Accepting Medicaid expansion funds would help keep Tennessee among the top states for maintaining children's access to health care.

"One of Tennessee's lowest rankings continues to be for the percentage of babies born at a low birthweight," Naccarato said. "Over 9 percent of Tennessee babies are born weighing less than 5 pounds. Many risk factors for low birthweight are known, but they can be difficult to address." Among these risks is substance abuse during pregnancy.
Like many states, Tennessee is fighting an opioid addiction crisis. Between 2010 and 2015, the incidence of Neonatal Abstinence Syndrome (NAS) among enrollees in TennCare, the state's Medicaid program, increased from a rate of 11 per 1,000 live births to a rate of 24. NAS babies are more likely to be born prematurely and at a low birthweight. TennCare covers half of births in Tennessee and almost all NAS births. This year, Gov. Bill Haslam rolled out TN Together, a multifaceted approach across state agencies to end the opioid epidemic by focusing on prevention, treatment and law enforcement.

Reduction in the number of babies born at a low birthweight can occur when care is available for chronic physical and mental health and substance abuse conditions for women of childbearing age and outreach is improved to those who may qualify for SNAP, WIC and/or TennCare benefits. Additionally, nutrition programs that provide food for school-age children to take home can contribute to nutritionally sound diets for women in their childbearing years. TCCY leads the Home Visiting Leadership Alliance to support home visiting, an evidence-based program that can reduce instances of low birthweight and improve outcomes for children and families.

"The state has put particular focus on infant health and on improvements in early education," Naccarato said. "Over 60 percent of Tennessee three- and four-year-olds lack access to pre-K, and the programs that are available are inconsistent in terms of quality."

Tennesseans for Quality Early Education formed to push for consistent high quality in pre-K classrooms and coordinate with elementary schools so gains will be sustained. Its advocacy helped pass the Pre-K Quality Act in 2016, and the Tennessee Department of Education has followed up with efforts to strengthen early education. As programs improve, Tennessee needs to increase access to these important early educational opportunities. High quality pre-K has a solid $7 return on investment for every $1 spent.

One of Tennessee's best ranks is for timely high school graduation, with just 12 percent of students not graduating on time and a rank of 8th in the nation. Success in keeping children in school contributes to improvements in other measures. According to the Data Book, just 7 percent of Tennessee teens are neither working nor attending school, contributing to a higher economic well-being rank. Gov. Haslam's Drive to 55 initiative has helped support these outcomes by offering access to free community college and technical school to all high school graduates through Tennessee Promise.

These improvements also raised the family and community ranking, with fewer children living in families led by a person without a high school degree. The domain improvements are, however, offset by a lower rank in teen birth rate. Tennessee has enjoyed a 35 percent reduction in teen births since 2010, but other states have advanced more quickly.

In education, Tennessee's 4th- and 8th-graders saw improvement in reading and math, respectively, outpacing the national average. When many states were cutting school funding, Tennessee continued its steady increases through the Basic Education Program (BEP), though the state still ranks in the bottom 10 in per-child spending.

Counting kids accurately ensures that KIDS COUNT®

This year's Data Book focuses on the undercount of young children in the decennial Census, and the impact this can have in 2020. TCCY's analysis of state spending on children finds that, outside of the BEP, federal funds and their required matching and maintenance of effort dollars account for almost 90 percent of spending on children in Tennessee. Much of this spending is allocated based on either population counts in the census or on formulas that include those counts as a critical input.

An examination of earlier census undercounts finds that children under 5, as well as low-income children and children of color, are most likely to be missed. These children are often among Tennessee's most vulnerable. Failing to count them can have far-reaching effects on funding for programs and services they need and, ultimately, on their ability to thrive.

Much of the funding and planning for services that state, local and federal governments invest in is based on census data. For example, for the state to hire the right number of teachers leading the right number of classrooms, for health planners to identify where and how many vaccinations will be needed and for businesses to assess their chances of success in finding customers, the census needs to be accurate.

Census counts since 1980 have had increasing challenges in accurately counting children. In 2010, nationally, an estimated 4.6 percent of children under 5 were not counted, meaning, for the purpose of planning, they do not exist. That is almost 20,000 invisible Tennessee children, enough to fill almost 1,000 kindergarten classrooms.
"For Tennessee to continue its progress, it needs to be able to describe its problems and measure the impact of its solutions," Naccarato said. "To do so, it needs an accurate census, one in which all 'kids count.' For more than 60 years, TCCY has worked to be a voice for children who have no voice. When children are not counted, they are truly silenced.

State of the Child in Tennessee

While the national Data Book ranks Tennessee among the 50 states, TCCY runs annual data profiles of all 95 Tennessee counties, ranking them using the same four domains with measures similar to those in the national rankings. The Tennessee profiles include significant additional county-level data on the state of children and families. TCCY's annual State of the Child in Tennessee report was a policy and issue guide, released in March, in conjunction with the gubernatorial candidate forum held during Children's Advocacy Days. It explores Tennessee data on a range of issues and policies and includes questions for policymakers, candidates and elected officials.

The new county pages are being released in conjunction with the national data book so both state and county data and rankings are available at the same time. The book and the new profiles are available at https://www.tn.gov/tccy/kc/tccy-kcsoc.html.