As parents, caring adults and community leaders, we must create the conditions for healthy kids to thrive. This means recognizing and addressing the dangers children face when they live in unhealthy environments, reducing health-harming behaviors like smoking and substance use by children and around children, and building communities that make it easier for kids and families to make healthy choices about food and physical activity.

Unfortunately, Indiana comes in 35th for overall children’s health in the U.S. Recognizing this, a new statewide collaboration, the Alliance for a Healthier Indiana, is bringing together business and community leaders to address the health of our citizens. The Indiana Youth Institute is joining this important effort to support building a healthier state from the child up.

Growing up in an environment with trauma and abuse creates lasting negative effects on children’s health, including slowing a child’s social and cognitive growth, raising their likelihood for obesity, tobacco and drug use, and inflicting long term consequences to their health and life opportunities. By understanding the co-occurrence and impact of these Adverse Childhood Experiences (ACEs)*, we are better able to create positive interventions and conditions for change.

If we can reduce child and adult smoking rates, we can have a significant effect on Hoosier health. Indiana ranks 41st in the nation for the percentage of smokers, and an estimated 95 percent of adult smokers start smoking before age 21. More than 4,100 Hoosiers under age 18 become new daily smokers each year. In 2017, nine percent of Indiana high school students smoked cigarettes in the past month, and 14.9 percent of Indiana high school students used electronic vapor products. This is especially concerning, as teens who use e-cigarettes are more likely to subsequently take up cigarette smoking.

Governor Holcomb has challenged Indiana to lower its infant mortality rate, as Hoosier kids infants are 24 percent more likely to die before their first birthday than the national average. Smoking is a significant contributor to problems arising during pregnancy and in the child’s development and health. Almost 1 out of every 7 pregnant women in Indiana smokes during pregnancy, a rate that is 68 percent higher than the national average. Smoking while pregnant is associated with a higher risk of miscarriage, low birthweight, premature birth, some birth defects and Sudden Infant Death Syndrome (SIDS).

Our state’s struggle with opioid use disorder is also taking a tremendous toll on our babies and children. Newborns exposed to opioids in utero have a 60-80 percent likelihood of suffering from Neonatal Abstinence Syndrome, a condition which impacts the child’s long-term growth, behaviors, language abilities, cognitive development, and academic achievement. Last year, Indiana had one of the nation’s greatest percentage increases in the number of children being placed in foster care. The Indiana Department of Child Services reported a sizable increase in the number of substantiated cases of abuse or neglect, with over half of the removals due to parental substance abuse.

Parental overdoses have both an immediate as well as a cumulative impact on children in the home. Children double their likelihood of developing addictive disorders when they come from homes where one or more adults abuse alcohol or drugs. While we do not yet know precisely how many Indiana children are living with adults struggling with opioid use disorder, we do know that these children are suffering and that immediate interventions are needed.

The prevalence of substance use disorder has captured recent headlines, but Indiana’s struggle with obesity is a longstanding problem that we have yet to effectively address. Indiana is the 10th worst state for adult obesity rates, and 1 in 3 Indiana youth ages 10-17 are overweight or obese. According to Julie Burns, CEO of Jump IN for Healthy Kids, in central Indiana the obesity/overweight rate is 25 percent higher than the national average, and three times higher than the goal of 15 percent. Burns stresses the importance of focusing on young children, as habits around food and physical activity are developed by age 5.

Healthy kids grow up with greater chances to be healthy adults, and are more likely to become productive and successful citizens. Far too many Hoosier children face the issues caused by ACEs, smoking, opioid use, obesity and are lost due to infant mortality. We support and applaud the efforts of the Alliance for a Healthier Indiana. Local events to improve Hoosier health are taking place across the state, and we encourage everyone to find a way to contribute by going to www.healthierindiana.org. By collectively dedicating ourselves to these efforts, and by taking a multi-generational approach, we hope to increase the health and success of all Indiana residents.

We all benefit when the next generation is healthy, safe, well-educated and economically secure. Indiana can be a wonderful place to be a child, but when we look at overall child well-being, it ranks as the 28th state in the nation. A deeper look at the data shows the disproportionate challenges and barriers to success faced by some children.

The Indiana Youth Institute (IYI) recently published the 24th annual KIDS COUNT Data Book, part of a national effort to measure childhood well-being at the local, state and national levels using data in areas including health, education, economics, safety and family.

The 2018 Indiana KIDS COUNT Data Book shows improvements over last year in children’s health insurance coverage and teen pregnancy rates. Meanwhile, significant challenges remain in the areas of economics, safety and education. Furthermore, substantial inequities appear in most indicators when the data is disaggregated by race, place and income.

In his 2018 State of the State address, Gov. Eric Holcomb set the goal for Indiana to become the best state in the Midwest for infant mortality rates by 2024, challenging us to work together to improve conditions for infants. The governor rightly labeled our current infant mortality rate as “unacceptable.” Indiana is ranked 41st nationally, with our babies being 24 percent more likely to die before their first birthday than infants nationally.

Indiana’s black infants are twice as likely as white babies to die before their first birthday, with this disparity widening over the prior year. Tony Mason, CEO of the Indianapolis Urban League, says “There are many socio-economic and health factors that put black infants at a higher risk of infant mortality than white infants. On a state level we need to address the issues of food access and quality care.” Jeni O’Malley, director of public affairs for the Indiana Department of Health, highlights numerous programs aimed at infant health, including the new Liv pregnancy mobile app launched in November.

Child maltreatment is also rising with increasing substantiated cases of abuse and neglect, hotline reports and placements in foster care. Over the past five years, Indiana has seen a 58 percent increase in the number of children in foster care with 58 percent due to parent drug and/or alcohol abuse.

Leaders in government, education and community services all stress the importance of collective efforts, purposeful and consistent partnerships, to increase educational outcomes for all kids. Superintendent of Public Instruction Jennifer McCormick says “Math and reading growth and proficiency impact student success, which is why we have placed an important focus on these subjects in Indiana. Compared to our sister states, we have made great strides.” Yet students of color and those with low incomes and other risk factors, such as homelessness, have lower educational proficiency rates. As Gov. Holcomb states, “We need to move those kids who are at the back of the line—the most disadvantaged among us—to the front of the line,” beginning with increasing access to quality pre-K programs.

Clearly, the conditions necessary for children to thrive are complex. Children growing up in poverty are significantly more likely to experience stress and deprivation that hinders development and school readiness, health and other outcomes. Indiana’s child poverty rates decreased, with 19.5 percent of Hoosier children living in poverty as of 2016, down from 20.9 percent in 2015.

Jennifer Walthall, secretary of Indiana’s Family and Social Services Administration, says her agency believes a two-generation approach provides the best solutions for reducing child poverty because it” addresses the needs of both children and adults in their lives together.” Mason points to providing youth with access to quality education and employment skills as key to breaking the cycle of poverty. Access to such multi-faceted interventions is vital for children of color, as black Hoosier children are three times more likely to live in poverty than their white peers (42.2 percent vs. 13.9 percent).

To ensure all Hoosier children have the opportunity to reach their full potential and become productive and responsible adults, we must understand and work together to improve the conditions that support their success. Our goal with the 2018 KIDS COUNT Data Book is to spark conversations and action throughout the state. Whether working in a region, county, city, school district or neighborhood, the data can help further such efforts.

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(Tami Silverman is the president and CEO of the Indiana Youth Institute. She may be reached at iyi@iyi.org or on Twitter at @Tami_IYI)

ADDITIONAL RESOURCES:

The news offers daily reminders of the complex challenges our communities, state and country face in the opioid crisis. Governor Eric Holcomb made attacking the drug epidemic a pillar of his inaugural policy agenda. Indiana University has announced its Grand Challenge to respond to the addictions crisis, committing $50 million to finding solutions. Indiana’s social service, emergency service, criminal justice, health care, and public health providers are working to respond to the relentless array of ongoing, interconnected needs arising from the crisis. Collaborations among local, state and federal agencies are developing new cross-cutting partnerships and interventions. At the Indiana Youth Institute, we are concentrating on identifying and addressing the short- and long-term consequences of the opioid crisis on Hoosier children.

For the past three years the number of children in Indiana’s foster care system has increased steadily. Experts, including Mary Beth Bonaventura, director of the Indiana Department of Child services, agree these increases are directly linked to the opioid problem.

“We have more children in care than we’ve ever had in history, nationwide and in Indiana, Bonventura said. “With all cases counted, (we have) close to 29,000 kids in care in some way shape or form.”

In 2016, 52 percent of children DCS removed from a home were removed due to parental substance abuse. When substance abuse is included as a secondary cause, that rate rises to nearly 80 percent.

Who cares for the kids caught in this crisis? In Whitley County, 2 percent of children live with foster parents, and 6.2 percent of children live with their grandparents. Bonaventura states in Indiana nearly 51 percent of all DCS foster care placements are with relatives. A September 2017 Pew Charitable Trusts study shows parents of adult children who either struggle with substance use disorder, or have died from an overdose, are raising an increasing number of their grandchildren.

Child placements with relatives, also called kinship care, can be a formal placement from the state or an informal arrangement between the parents and the relative caregivers. In fact, the Pew research estimates that for every foster child formally placed with a relative as a primary caregiver, there are 20 more in informal kinship arrangements. Tina Cloer, president and CEO of Children’s Bureau, Inc., says “I get calls all the time from people all over the city and state who have now inherited their nieces and nephews, their grandchildren, their friends’ kids, because they’re struggling with addiction.”

About 39 percent of grandparents caring for grandchildren are older than 60, 21 percent live below the poverty line and 26 percent have a disability. Like all children in care, children in kinship care have been found to lack adequate access to primary care, immunization, vision, hearing and dental care services. Despite these challenges, the American Academy of Pediatrics stresses the benefits of kinship care, including increased stability and well-being, reduced trauma, and an increased likelihood that siblings will stay together.

We can help grandparents and family members caring for these young victims of our state’s addiction crisis. Kinship care is often unexpected and unplanned. Many families are unaware of available help. For instance, grandparents and families who become licensed foster families can access services and financial supports. Organizations such as Grandfamilies.org provide valuable information on applicable laws and resources. Cloer works with many faith-based and community groups that are reaching out to grandparents caring for their grandchildren with basic needs items such as diapers, formula and clothing. As employers, we can offer flexible schedules for those suddenly faced with caring for these children. Schools and youth organizations also need to be sensitive to kinship care arrangements.

Any comprehensive solution to Indiana’s opioid crisis must include the impacted children and family members. Most child welfare experts agree that an increased focus on the impacts on the youngest victims is warranted. While we look for policy and systems change at the state level, at the local level we can immediately step in to help families providing kinship care. Actions taken now can help prevent this crisis from lasting into the next generation.

For more information on the impact of opioids on children, see IYI’s Issue Brief on the opioid epidemic’s impact on Hoosierchildren.

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Tami Silverman is the president and CEO of the Indiana Youth Institute. She may be reached at iyi@iyi.org or on Twitter at @Tami_IYI. IYI’s mission is to promote the healthy development of Indiana children and youth by serving the people, institutions and communities that impact their well-being.
Download data on children in foster families and children living with grandparents.

syringe, pills, and spoon

Youth are the hidden victims of the opioid epidemic.

Nationally, the issue has grown so severe that in 2017, the Commission on Combatting Drug Abuse and the Opioid Crisis submitted a letter to the president requesting that the opioid crisis be declared a national emergency. In Indiana, there were 1,271 deaths from drug overdoses in 2016, a 33% increase from 2011. Drug overdoses have risen so sharply in Indiana that they now kill more Hoosiers than car crashes and gun homicides combined.

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