This article discusses mental health and suicide. If you or someone you know needs help, reach out to the National Suicide and Crisis Lifeline by calling 988.
Gov. Josh Stein addressed professionals from child care, health care, education, foster care, and more at the second annual State of the Child Summit on Tuesday. The annual event was hosted by NC Child and the NC Institute of Medicine.
“I expect that each of you do what you do for the same reason that I do what I do, which is our belief in the promise of North Carolina, that where you come from should never limit how far you can go, that our children and grandchildren should enjoy a better and brighter future than we”ve had,” Stein said.
Speakers pointed to several reports that rate North Carolina on child well-being compared to other states and compared to previous years: Annie E. Casey Foundation’s Kids Count Databook ranks the state 33rd in the nation in overall child well-being in 2024. A new report card from NC Child provides snapshots of progress and setbacks to children’s health and education, lifting up progress in teen birth declines and health insurance coverage, and challenges in youth mental health and birth outcomes.
Stein said his office is committed to investing in children, including addressing child care challenges, protecting Medicaid funding from federal cuts, and investing in children’s education, health, and safety.
“It all starts with our children,” he said. “They deserve our fiercest advocacy, our deepest investment, and our greatest efforts.”
Child care
Stein, along with other state officials and advocates, painted child care as a top issue that deserves its recent bipartisan support.
Stein said the industry’s broken business model is causing a shortage of child care teachers, which leads to less access and higher prices for families.
“It’s a vicious cycle that harms every North Carolinian, whether you have kids or not,” he said.
Stein lifted up his office’s new bipartisan Task Force on Child Care and Early Education, co-chaired by Lt. Gov. Rachel Hunt, a Democrat, and Sen. Jim Burgin, R-Harnett.
Hunt also shared remarks on her platform to expand child care efforts like Tri-Share and early childhood training centers at community colleges. Hunt started a tour of child care centers Thursday in Charlotte at LeafSpring School at Ballantyne.
“This is more than a family issue,” Hunt said. “It’s an economic one.”
A panel of experts broke down the roots of child care problems and outlined some potential solutions.
At play this legislative session are several bills to recruit child care teachers and add public funding to the system, as well as budget proposals from Stein and the state Senate. The proposals have similar investments ($88 million and $80 million, respectively) in the child care subsidy program, which helps low-income working families afford care. Stein’s plan also invests over $80 million in additional funding to expand NC Pre-K, and a total of $530 million in recurring funding for three new tax credits for working families. The Senate plan also directs $6 million in federal funding to start a three-county pilot to expand child care capacity.
Neither of the proposals include a subsidy floor rate, the top legislative priority of several advocacy groups. It would ensure programs participating in the subsidy program do not receive less than the state average rate, addressing funding disparities from county to county. The floor would cost about $217 million per year, according to the Division of Child Development and Early Education (DCDEE).
DCDEE Director Candace Witherspoon said increases in subsidy funding will help multiple issues of quality, access, and affordability.
“That is what’s going to help providers begin to start making ends meet, to be able to pay teachers more, to be able to maintain them,” Witherspoon said. “It’s a domino effect.”
Mereidth Archie, president of the NC Chamber Foundation, said members of the statewide Chamber of Commerce understand the importance of child care for their employees.
“They are seeing people dropping out of the workforce, not taking opportunities, scaling back,” Archie said. “And so they’re really digging into how that they can address this at their business sites.”
The foundation released a report in February that surfaced policy solutions, including many that partner with employers, from studying 28 other states’ approaches.
Research says the most effective early childhood policies address the adults that care for children, said Cynthia Osborne, founder and executive director of the national Prenatal-to-3 Policy Impact Center at Vanderbilt University, during a keynote address. The organization identifies research-backed policies that improve outcomes for young children.
“All the policies and programs that are effective really focus on caring for the caregivers so that they can do the job of caring for their children,” Osborne said.
Sarah Vanover, the policy and advocacy director of Kentucky Youth Advocates, talked about Kentucky’s innovative use of subsidy funding to help child care teachers afford child care for their own children, a policy that several states have since adopted and a House bill this session proposes as a pilot.
“We know right now that there are 6,000 kiddos in Kentucky that are getting free child care because they have a parent who works at least 20 hours a week in a child care program, and that’s 3,500 employees,” Vanover said.
Further compensation, benefits, and professional development for early childhood educators is needed, she said.
“We have to make sure that quality child care is in place, and so we have to give wages that are high enough, and we have to give educational training to make sure that our teachers are prepared,” she said.
Osborne called child care subsidies the most “pro-work policy,” and said the lack of those subsidies are “the most anti-work policy.”
About 15% of eligible families are receiving subsidies in North Carolina.
“The only way to make child care subsidies more effective is increasing the size of the pie,” Osborne said.
Mental health
Child mental health was raised throughout the day as students, elected officials, and advocates spoke about the need for school-based professional services and training.
Panelist Erika Taylor, faculty member and instructor in the Division of Behavioral Medicine at East Carolina University, pointed to the NC Child report card’s “F” on youth mental health as a result of several other challenges facing children.
According to the report card, 9.5% of high schoolers in 2023 had attempted suicide in the previous year.
Taylor pointed to other “Fs” on the report card, like those in housing stability and perinatal care, as reasons children are struggling. She also highlighted the adverse effects of high rates of screen time and online bullying.
“Pervasive kind of toxic stress that our students are encountering is leading to a lot of manifestation of forms of social anxiety, social disengagement, and isolation,” Taylor said.
Hutch Jones, mayor of Beulaville and director and clinician with Tar Heel Human Services PC, a mental health care provider in southeastern North Carolina, told the story of how Duplin County has improved its school-based mental health services and coordination across several sectors.
In 2021, one student’s case was a wake-up call for the community, Jones said.
“It all started out a few years ago when there was a call from a local emergency room being related to a student that had been in the ER for three weeks, and the school system didn’t realize they were there,” he said.
Community leaders in health and education started to work backwards to figure out “what were the symptoms that created this perfect storm.”
“There were all sorts of things … such as communication, lack of protocol, lack of infrastructure, lack of resources, lack of insurance, lack of awareness,” he said.
Jones said putting more licensed professionals for direct therapy services in schools has been the most important lever to improving students’ mental health outcomes.
“That’s where we get the most bang for our buck, but there’s also a lot of bang in getting to the folks that are there — administrators, teachers, counselors, social workers, nurses — to help identify kids,” Jones said.
Students and advocates said there is a need for more state funding for school psychologists, nurses, and other professionals. In 2024, there were 1,928 students for each school psychologist in North Carolina, nearly four times the 500:1 ratio recommended by the National Association of School Psychologists.
“(Students) are not able to get all the help that they deserve to have for their struggles,” said Avani Narayanan, a member of NC Child’s Youth Advisory Council.
Training for teachers and other school employees to identify children’s needs was another strategy lifted up. When asked what makes student panelists feel supported and safe, council member Ben McMiller said, “When people are actually equipped to help us out.”
Mental health challenges across ages have been exacerbated by the trauma of Hurricane Helene, said Paige Roten, president of the council. Roten said the Appalachian culture can, at times, keep people from seeking help.
“It’s definitely a barrier I feel like many people are facing as they’re having these emotions and these feelings, and they don’t know exactly where to go with them or how to handle them,” Roten said. Mental health resources are needed in the months and years to come, she said.
House Bill 578, which would require suicide prevention training for school personnel, passed the House health committee during the summit Tuesday. It heads to the House K-12 education committee next.
“Educating students, teachers and parents and guardians on what students are going through, what they might have the potential go through, is so so important,” Narayanan said. “Access to mental health resources in schools should be a normal thing. It should be as accessible as your books and your school supplies, because it’s just so important. You can’t learn without mental health and support.”
Protecting Medicaid
Medicaid expansion, which the legislature passed in December 2023, was highlighted as the biggest policy win in child well-being in recent years. North Carolina is one of the only states in the South that has expanded Medicaid.
Osborne said the program is one of the most important policies for positive early childhood outcomes.
“Medicaid is much more than health insurance,” Osborne said. “It’s actually one of the most important policies that exist in terms of stabilizing families economic resources. It is one of the few policies that actually improve birth outcomes and actually try to reduce some of the disparities of birth outcomes between women of color and white women, and it has one of the largest impacts on reducing child maltreatment.”
Stein said he has urged the state’s congressional delegation to vote against “any budget that cuts our state’s health care systems.”
The U.S. House passed a budget resolution in April that includes $880 billion in cuts over 10 years to the Department of Health and Human Services.
“It is a terrible choice for this country,” Stein said.
He said cutting Medicaid funding will lead to higher economic burden for the state.
“If we cut Medicaid, kids and their families are not going to stop getting sick,” Stein said. “Instead of going to their pediatrician and their primary care doctor, they’ll wait until they’re really sick and then in the emergency department, which is the most expensive way for us to pay for people’s health care.”
He said children and teenagers make up about a fifth of the state’s population, but about half of Medicaid beneficiaries.
“Our kids are our most fundamental investment,” he said. “When they succeed, we all succeed. So let’s strengthen their early years. Let’s prioritize their education. Let’s care for their physical and mental health. Let’s invest in them early so we set them up for success for the rest of their lives.”
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