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By Malissa Harris, Family Action Network Member Americorps VISTA Member Tax Time Intern at United Way of Central Ohio My three children have all attended Little Miracles EDC, a 5-star Step Up to Quality program. My goal is to tell my story of how high-quality child care can positively impact children’s academic success. This article will focus on my daughter, Lilian (6). Lilian began going to Little Miracles EDC when she was six weeks old. She experienced a nurturing and safe environment with learning experiences geared toward her needs. From birth to three, she had a chance to learn through hands-on and play-based activities with trusting adults. A trusting relationship with adults in the first three years of life is the foundation of social and emotional regulation. These relationships have helped her be able to connect with others, build positive friendships, and self-regulate her emotions. When she entered preschool, she was ready to learn because she could regulate her feelings. Mrs. Collier, her preschool teacher, was in tune with the needs of her students. Lilian was a child that needed to be challenged. She was able to meet all developmental milestones for math, science, language, and literacy skills for a preschooler. The combination of trusting adult relationships and a teacher who provides academic support in preschool has helped her succeed in kindergarten and first grade. She can demonstrate problem-solving, impulse control, and empathy. Academically, she has been in enrichment classes to challenge her to understand more. She did not struggle with learning to read. She wants to learn more and understand information over a first-grade level. What about the families who aren’t in quality centers? How can we solve teachers leaving the early childhood field? How can we ensure every child in Ohio gets to experience what Lilian did? The 2024-2025 state budget provided $30 million for child care infrastructure grants to increase infant and toddler child care capacity in communities with high infant mortality rates, $124 million for preschool (additional 11,525 children to be served), and perseveration of the Step Up to Quality system. While these investments will help children, they are not enough to ensure children have a brain-smart start. We want all children to enter kindergarten ready to learn. If we want Ohio's youngest citizens to be able to have access to quality early learning experiences, we have to create a system where we will pay the people who are helping build the foundation for academic success. We have to educate families on what quality looks like. We have to help other child care centers understand the importance of providing quality early learning experiences.

By Delaney Jones, Community Coordinator, Safe Babies of Cuyahoga County I have often heard the line of thinking within our child welfare systems that for young children, who are too young to self-protect, it feels better to err on the side of caution when assessing the potential need for removal. The thinking goes, if we’re assessing the safety of an infant or toddler in the home with their parent, and there are some clear safety concerns, and if the alternative is a proven-to-be-safe foster home, isn’t that obviously the better choice? But we must not forget the inescapable trauma inflicted on young children when we separate them from the only family they know. Trauma impacts the wiring of the brain during an extremely formative period in the development of the brain structure. Children undergo the extreme stress of separation and destabilization even when well cared for in the safest of foster homes. In some cases, this cannot be avoided because the trauma that the child would endure remaining in the current home outweighs the additional trauma caused by separation. And in those cases, there are ways to buffer the trauma of the removal and support the child in making some sense of what’s happening to them (yes, even with babies!) and in maintaining and building healthy attachment relationships. We should prioritize those steps to buffer the trauma of separation very highly, especially because these are children who are often too young to be able to communicate the stress that this experience is causing. Because babies can’t voice that to us, it can be easy for us to let those steps slip through the cracks or to view these steps as somewhat non-essential in a system where professionals are constantly bombarded with very pressing emergencies. Infancy and toddlerhood is an extremely formative period of development of a child’s brain and trauma experienced during this period can have a long-term, devastating impact on the way the child develops – but we can also spark a long-term positive impact on the development of the child by being very thoughtful and intentional about their needs and about the relationships that are important through their eyes. For infants and toddlers that are in vulnerable situations that lead them to the attention of our child welfare system, not only is it important that all professionals working with and around that child are knowledgeable about early development and trauma, but it is essential that we connect those kids with high-quality early childhood mental health services. The mental health of infants, toddlers, and young children is as important as their physical health. Make no mistake: mental health issues can and often do take root very early in life. Many people’s first long-term memories are from around the ages of 3- or 4-years old. Because of this, there is a common misconception that early experiences won’t be understood or remembered. The opposite is true – though adults may not be able to recall memories from infancy, the experiences during the first 0-3 years become baked into the wiring of the brain. With each interaction a baby has with a caregiver, they develop important neural pathways that shape their future social-emotional and cognitive functioning. The mental health of babies and toddlers is intertwined and dependent on the quality of their relationships with adult caregivers. Infant and early childhood mental health services can treat young children who have experienced painful or scary events. The therapist meets with the child and their caregiver(s) regularly to help the family and child heal from stressful experiences, understand feelings and behaviors, use play to promote connection and development, and get the child on track for healthy social-emotional development. It is critical we remember that the mental health trajectory of our future adults has its roots in early childhood and in relationships. This is especially critical for children who are involved in our child welfare system and for whom important relationships are causing stress or are being disrupted. The decisions we make can have a very long-term positive or negative impact on children. When we as professionals in these systems understand early mental health and the importance of early relationships, we can spark a healthy and successful future for children.

By Troy Hunter, Director of Research, Evaluation, and Performance, Groundwork Ohio Follow Troy on Twitter and LinkedIn Throughout Ohio, the availability of quality child care is a continuous concern for parents and caregivers. However, the challenges are even more disparate in the rural and Appalachian areas of the state, where access to reliable child care remains a significant and often unaddressed issue. The struggles faced by rural families, the broader impact on the economy when child care is not readily available, and the disproportionate challenges faced by families with children with disabilities emphasize a need for Ohio policymakers to act now. Child Care Access in Rural and Appalachian Ohio Ohio's region, consisting of 32 counties, houses over 110,000 children between the ages of birth and five. Alarmingly approximately 31,133, or one in three of these children live in poverty. What's even more concerning is that 75% of these young children living in poverty do not have access to quality, affordable child care, despite their economic status making them eligible for publicly funded child care. As a result, a significant 74% of low-income Appalachian children are not adequately prepared for kindergarten, setting them on an uneven educational path from the start. Additionally, rural Ohio families are more than twice as likely to experience a child care gap, a higher need than supply of child care, compared to their urban counterparts. This means that many rural Ohio families are struggling to find quality child care services for their children which impacts many individuals’ ability to work. These challenges contribute to the economic instability of working families and create disparities in access to quality early learning experiences. Equitable Access to Child Care One specific population of rural families is disproportionately impacted by this disparate access. Families raising children with disabilities already face unique challenges in accessing quality child care and support services. These challenges are exacerbated in rural and Appalachian areas, where the availability of specialized care is often limited. For parents of children with disabilities, the search for suitable child care is a complex and often stressful journey. In rural Ohio communities, options are often scarce, with a limited number of providers equipped to support children with diverse needs. Many parents have to choose between taking on full-time work, potentially miles away from home, and staying unemployed or underemployed to provide the care and support their child needs. Unfortunately, the lack of affordable and accessible child care facilities only deepens the disparities faced by these families. Erin Finley, a parent from a rural Ohio community, shares her personal experience: "It’s been a really stressful experience trying to find child care for my 2-year-old. In my county, there is one daycare facility and one licensed in-home provider. We do not qualify for Head Start or a child care subsidy. There are some private babysitters that I checked into, but they will not accommodate my schedule. Being a single parent who works full time (out of county) with a one-hour commute each way, really limits my options. I have also been on the waitlist for daycare centers in the county I work in since I was 6 months pregnant with my son. Luckily, I work for a company that allows flexibility while I find child care, but I imagine others would have been at risk of losing their job or being forced to take unpaid leave. I am not sure I will ever be in a position to buy a home or add additional children to our family, which is a sad reality." For parents like Erin, who work full-time and have long commutes, limited child care options and unaffordable alternatives pose a continuous source of stress. The Role of the 2023 Farm Bill The 2023 Farm Bill primarily focuses on agriculture and food policy. It presents an opportunity to address the disparities in child care access across the United States. Currently, the Agriculture Improvement Act of 2018 (2018 Farm Act) is in effect and will remain so until 2023. However, the upcoming bill could reauthorize this policy, and for the first time, allocate funds for rural development to improve the access and quality of child care services, particularly in Appalachian regions. Within this Farm Bill, there is an encouraging bipartisan initiative called the Expanding Childcare in Rural America (ECRA) Act of 2023. This effort is led by a group of U.S. Senators and Representatives, including Ohio Senator Sherrod Brown. The ECRA Act empowers the U.S. Department of Agriculture (USDA) to provide grants, loans, and technical assistance to enhance child care facilities in rural areas, improve child care access for working families, and provide a positive impact on rural communities and the workforce. The disparities in child care access in rural and Appalachian Ohio call for action. Ensuring that all families have equitable access to quality child care is not just a matter of convenience, but fundamental for the well-being and future success of children in these regions. In addressing these issues, policymakers and stakeholders can make a profound impact on the lives of families who deserve every opportunity to thrive. Call to Action: Here are some actions you can take: Check out Groundwork Ohio’s “Expanding Child Care in Rural Ohio” Factsheet Attend the “Harvesting Hope: Advancing Child Care Access in Rural & Appalachian” Webinar Review your county factsheet to see how Ohio Kids are doing in your area

By Dr. Andrea Weisberger, Director of Education and Early Childhood Mental Health, The Buckeye Ranch Early Childhood Leadership Fellowship Class of 2023 I never envisioned myself as someone who would enter the political world. When my supervisor suggested I apply for a fellowship with Groundwork Ohio, I didn’t pay much attention to what it was, just that it was an important advocacy group for early childhood mental health. Of course, my answer to her was “Absolutely.” I love advocating for my clients, so I thought this should be right up my alley. I went to my first Groundwork Ohio meeting and realized exactly what it actually was: all of a sudden, we were talking about politicians, legislative meetings, and how to best communicate your thoughts to lawmakers and legislative aides. This is NOT what I thought I was signing up for,” I thought to myself. In fact, minutes after leaving that meeting, I texted my friends who are very engaged in state and federal policies and asked, “Can I do this?” Being the wonderful friends that they are, they said “of course you can!” But I think the better question would have been, “Do I WANT to do this?” Fast forward a bit and I attended Groundwork Ohio Advocacy Day in March of 2023. It was a very nice experience meeting with other folks who have a similar goal: helping the lives of children and their families. On that day, I learned more about what I can do to help families in my community. I learned how to develop my “ask” and how to back it up with data and personal stories from the folks in our community. I enjoyed the experience enough that when Groundwork Ohio sent out a message that asked for volunteers to attend some meetings with lawmakers, I said I could help. Luckily, because of advocacy day, I felt better prepared and knew what to say. With the help of the Groundwork Ohio team, we spoke to three legislative aides about the need for more funding for quality and affordable child care. I was able to tell stories about what I saw as a school-based clinician and how the lack of quality child care centers impacted our K-12 education system on a financial level. Those meetings changed the entire trajectory of my work with my agency and profession. At one of those meetings, Emily, a legislative aide for Congressman Mike Carey (R-OH), showed so much care and commitment to mental health. In fact, at the end of our conversation, she asked for a tour of our facility to learn more about our work. I, of course, gladly accepted. I talked with the leadership at my agency who decided to take the tour idea and “run with it,” so to speak. First, we decided to invite team members from Google. Google is expanding in the Columbus, Ohio, area and has shown a commitment to being an important partner with other businesses in the area. In that effort, Google and Nationwide Children’s Hospital are partnering with us at The Ranch to build a psychiatric residential treatment facility with 48 beds. The project is a large undertaking and will fill a big need in our community as it will serve a significant area of mental health in Columbus. We wanted to invite those Google team members so they could further see how important our work is and to also see the location where the new building is they were helping to create. We also invited Grove City Mayor Richard “Ike” Stage, to weigh in on the conversation and represent Grove City. With the help from various areas in our organization, we were able to build an amazing event where stakeholders and policymakers could first tour our campus, and then have an open discussion with the teens in our care about mental health concerns in our community. Teammates from Google came and transformed our training room into a full conference space so we could have a meaningful conversation. It was also requested that we have students from our day treatment program and residents of our residential facility come and talk about their experiences with mental health. Leadership at our school and residential campus ensured our clients felt prepared to take on the challenge. The students did a beautiful job talking with lawmakers and stakeholders. Lawmakers showed such an interest in the teens, ensuring they felt heard, understood, and cared for. Rep. Carey even requested to speak with the adolescents afterward, listening to all their concerns and providing words of encouragement before they went back to treatment that day. I was struck by the pride on the students’ faces to have such important people actually listen to them and care about what they were saying. They truly felt connected with and cared for. The students will still talk with me about the experience and how much it meant to them. The day was such a wonderful success for everyone involved. I think it truly made a difference in continuing the conversations about mental health in our community. And the entire event was made possible because of the connections I made in my fellowship with Groundwork Ohio. So when a person may say, “I’m only one person, what does my opinion matter,” I would point out the butterfly effect that comes from one meeting, one speech, or even one sentence. What a person says or does can set in motion a chain of events that may have initially only impacted one person, but then reverberates out to hundreds and potentially thousands of people.

By: Becca Thomas, Managing Director, Communications, Groundwork Ohio Follow Becca on Twitter and LinkedIn Our team recently traveled to Charlotte, NC, to take part in the Alliance for Early Success’ CONNECT23 conference, a gathering of national early childhood advocates focused on advancing early childhood policy in individual states and on the federal level. The conference had a packed agenda that started for our team with a walking tour of the Brooklyn neighborhood in Charlotte, once a vibrant and thriving community of color in the city. We also heard from an incredible coalition of early childhood and maternal health experts who worked together in Minnesota to pass landmark legislation in support of their state’s youngest. The coalition was a masterclass in various groups coming together with an underlying goal and clear deliverables. The panel included a former state representative, a member of an indigenous group focused on early childhood issues for American Indians, a public health practitioner, and campaign and consulting strategists who all worked together to achieve their common goal. We were able to witness a unique plenary featuring the stars of the Refuge, a documentary that told the true story of a reformed white supremacist and former Ku Klux Klan member who joined forces with a Syrian refugee to form an organization to help others break away from hate organizations. The conversation was an incredible display of bridge building and what can happen when work is put in to find common ground. Breakout sessions throughout the day discussed child care advocacy in a post-pandemic world, building and sustaining effective coalitions, uplifting kinship care, supporting those in child care deserts, and how the climate crisis is affecting child care, among other topics. We came back together to discuss strategies for navigating a media ecosystem that feeds on misinformation and sensational headlines, and participated in a workshop aimed on focusing our storytelling and messaging so the messages we’re trying to get in front of policymakers and other advocates are received. It was an inspiring few days to be in the company of so many early childhood advocates and to feel support from a national partner. We came home with lots of ideas and look forward to putting them to use for Ohio’s children!

By Lisa DeGeeter, Esq, Director of Systems Advocacy and Policy Counsel, Ohio Domestic Violence Network The Ohio Domestic Violence Network (ODVN) recently released the fatality count at its annual Domestic Violence Awareness Month event on Oct. 11 in the Atrium of the Capitol. The count of domestic violence fatalities occurring between July 1, 2022, and June 30, 2023, was compiled from media reports and information provided by ODVN’s 76-member programs and cross-referenced with gun violence archives, court records, and other public information. We have collected 112 total intimate partner-related fatalities, and are continuing to find disturbing trends in the cases we review. This year’s report reviewed demographic and racial data; 40 percent of all deceased victims were people of color. While disturbing, this sadly makes sense to us because we know from our own research and national research that people of color experience intimate partner violence at higher rates than white people. Black women are almost three times as likely to experience death as a result from domestic violence than white women. Seventeen victims died by strangulation, traumatic brain injury, or a combination of both, a number that nearly doubled from last year’s report. The number of family annihilation cases also doubled from last year. In at least six cases, one parent murdered their child or children, the other parent, and other family members, such as a grandparent, who lived with them before taking their own life. We had also thought, or at least hoped, that last year's record numbers around child deaths were an aberration, but this year we tied that record. Twenty-two youth and children were killed, including five babies. Seventeen of the murdered children were killed by either their parents or stepparents. In one case, a father believed his seven-year-old son was not in a safe environment after a divorce with the child’s mother, but “no one in the domestic court and child welfare system would listen to his concerns” until it was too late. Another theme in this year’s report is the prevalence of teen dating violence. At least four of the young lives lost were victims of teen dating violence. The cases also show that for the third year in a row, no law enforcement officers were killed in responding, although two officers were shot and survived. In five other cases, a third party intervened and the perpetrator died, including a case where a father shot his daughter’s abusive ex-boyfriend when the man tried to break into their house. People can feel powerless in the face of this volume of violence and be left wondering what they can do. We were overwhelmed when we realized how many of the cases in this year’s report were in some way involved with the justice system. Fifty-two percent of the killers in this year's report had prior contact with the criminal justice system; 65 percent of the victims had made reports to law enforcement, filed charges, sought protection orders, or raised their concerns in domestic relations courts. Yet the responses they received were not enough to save their lives. This is why we are grateful to representatives Jeff LaRe (R-Violet Twp.) and Kevin Miller (R-Newark) for sponsoring House Bill 111, which would increase penalties for felony domestic violence and create a presumption for jail time for those offenses. We are also grateful to Senators Nathan Manning (R-North Ridgeville) and Nickie Antonio (D-Lakewood) for sponsoring Senate Bill 100, which would prohibit installing tracking devices on someone’s property without their consent. Since more than a dozen Ohio children were killed by a parent last year, we are opposing House Bill 14, which would make equal parenting time more important than child safety. No one on staff can remember working on another bill that has the potential to threaten so many children’s lives. When we report this information, we try to be comprehensive and include the deaths of people who cause harm because those lives lost also matter. This is why we are supportive of House Bill 231, which would improve suicide prevention efforts, including funding the 9-8-8 crisis line. When we added up all the deaths from murder-suicides in this year's report, we realized that this kind of service had the potential to save 49 of the 112 lives lost. We know this information is not easy to hear, but it is necessary to understand these links and risks and enhance child safety and family well-being.

New 2023 Ohio Prental-to-3 Policy Roadmap Released and You’re in the Driver’s Seat By: Lynanne Gutierrez, Chief Operating & Policy Officer at Groundwork Ohio Follow Lynanne on Twitter and LinkedIn As we continue to build a movement focused on the unique needs of Ohio’s youngest children, Groundwork Ohio is committed to providing an impact on policies that work for young kids. One of the ways our team drives change is by providing accurate data and expert insights to provide a comprehensive view of gaps and opportunities in our great state. In addition to providing unique data analysis, we have access to a robust national network of experts who provide context for how our state is performing and investing, or not, in policies that improve the lives of babies and their families. Today, we joined thousands of state lawmakers, advocates, researchers, and practitioners at the 2023 National Prenatal-to-3 Research to Policy Summit to hear which states are driving improvements for children and their families. The Prenatal-to-3 Policy Impact Center hosts the Summit annually to share a national and state landscape of progress. Under the trusted, expert leadership of Dr. Cynthia Osborne, Ohio has an updated policy roadmap to help inform our work. Beyond the research, Dr. Osborne and her team have acted on it by traveling to Ohio, spending time with our communities, and meeting with policymakers alongside us to provide targeted support to policy efforts focused on pregnant women, infants, and toddlers. As you review where Ohio stands, join us in acting on this new knowledge. Getting Involved Whether you’re a parent, practitioner, or policymaker, it is each of your actions that will build the movement for Ohio’s youngest children—you’re in the driver’s seat of our state roadmap! What additional context and connections do you need to impact change and amplify your voice? Join our ever-growing coalition at the Groundwork Ohio Momentum Institute on November 2nd so that we can support your turning knowledge into action. Ways to Act Right Now REGISTER for the Groundwork Ohio Momentum Institute on Thursday, November 2. Here you will network with committed community leaders and learn new skills so that you can take research to action and become a more effective advocate for Ohio’s youngest children as we build a movement together. INVESTIGATE Groundwork’s Ohio Early Childhood Data Dashboard to help identify where disparities in outcomes could be improved through evidence-based policies shared in the 2023 Ohio Roadmap. LEARN more about how Groundwork Ohio makes an impact. Thanks for acting for Ohio’s youngest children. Email me directly at lgutierrez@groundworkohio.org or engage with me on LinkedIn or Twitter to keep the conversation going.

By Caitlin Feasby, Statewide Coordinator, Ohio Infant-Toddler Court Team Follow Caitlin on LinkedIn Established by President Ronald Reagan in October 1988, Pregnancy and Infant Loss Awareness month was enshrined as a national observation of the millions of families each year who experience the loss of a pregnancy or newborn infant under age one. It is difficult to think of a more harrowing topic, as pregnancy and giving birth should be an unmatched time of celebration, joy, and dreams for the future. The inherent injustice associated with life lost too soon is not only devastating, but a form of grief distinct from any other. In setting aside the month of October to bring awareness to this issue, we acknowledge this type of loss exists at a unique intersection of physical health, mental health, and social and environmental conditions. More than 35 years after its establishment, we continue to observe Pregnancy and Infant Loss Awareness month knowing this experience touches far too many families. Grief resulting from pregnancy and infant loss is often encumbered with powerful feelings of personal failure, guilt, or shame. These ingredients create a recipe for social stigma that leads many women and families to suffer in silence, emotionally alienated from others. This month is an opportunity to recognize the millions of Ohioans who carry this pain that is both invisible and impossible to fully comprehend. Observance is important and recognition essential. At Groundwork Ohio, we encourage our readers to align recognition for these losses with indignation. In one of the world's wealthiest countries with some of the most advanced medical care available, we must acknowledge the reality that our systems are failing families and babies. Ohio ranks 41st worst of all 50 states and D.C. in infant mortality rates, an abhorrent position telling us that our state infrastructure is falling far short of providing adequate structure for new life. We also know this issue does not impact all Ohioans equally. Those living in rural or Appalachian areas often have a more difficult time accessing timely prenatal care or well-child visits compared to those who live in healthcare-rich areas of the state. Data shows staggering racial disparities in pregnancy and infant health outcomes, as Black babies under age one are dying at nearly 3 times the rate of white babies in Ohio. According to the Health Policy Institute of Ohio, access to quality healthcare services explains only 20 percent of poor pregnancy and infant health outcomes, and 30 percent are related to behaviors such as smoking or eating poorly. A whopping 50 percent are attributed to infrastructure issues such as housing, transportation, education, and employment. Systemic racism continues to perpetuate higher rates of poverty, substandard housing, and lower educational attainment in Black and other communities of color throughout the state. Pregnant moms and newborn babies need responsive policies and practices that close these gaps, for the health of Ohio's citizens and the future stability of our state. The health, social, and environmental conditions pregnant mothers and infants face prolong this revolving door of potentially avoidable outcomes. Yet, with such varied causes across a multitude of systems, implementing solutions is incredibly complex. In response to racial disparities in infant mortality rates, Governor Mike DeWine established the Ohio Eliminating Racial Disparities in Infant Mortality Task Force, in which Groundwork Ohio President and CEO, Shannon Jones, was a part. The full summary of the task force findings and recommendations can be found HERE. Ohio House Bill 7, the Strong Foundations Act, is a current piece of legislation targeting maternal and infant mortality rates among other important issues impacting infants, children, and families. Get up-to-date and learn more about Groundwork Ohio's advocacy on issues addressed by HB 7. If you or someone you know is experiencing the loss of a pregnancy or an infant, please consider these free resources: Postpartum Support International Bereaved Parents of the USA Share: Pregnancy and infant Loss Support The Compassionate Friends Any hospice organization (whether within or outside your area) is available to provide free 1:1 support and/or resources to any grieving individual, regardless of whether or not you utilized that organizations hospice services.

By Jona Ison, Business Development and Communications Coordinator, Goodwill of South Central Ohio As the 2023-24 school year approached, Chelsea Seymour began thinking of re-entering the workforce. The Chillicothe resident knew she’d have some time during the day for the first time in a while – four of her five children would be in school. When she learned Goodwill of South Central Ohio was having a hiring event for an up-and-coming child care center, it seemed like the perfect opportunity, and Seymour was hired as an assistant teacher in the toddler room. “It’s really flexible being able to bring him while I work, and he leaves when I do,” Seymour said. Helping people re-enter the workforce was a key aspect of why Goodwill’s board and leadership team decided to pursue opening a child care center. CEO Marvin Jones and Board Chair Jim Hill attended an event in the Fall of 2022 put on by the Chillicothe-Ross Chamber of Commerce and Pickaway-Ross Career and Technology Center, where they heard from the state chamber about the huge need for child care across the state and its impact on the workforce. “We also knew some of our employees who recently had a baby had a difficult time finding child care so they could return to work,” Jones said. “Even when child care is available, it’s also often unaffordable. Our goal with opening a child care center is to address both of these barriers to employment.” A January report from the Department of Labor revealed Ross County families with a median household income of $60,417 spend 12 percent of their income to send an infant or toddler to a child care center each year. This means the nearly 13 percent of Ross County families living in poverty may be spending an even larger share of income on child care. Opening a center was a dream come true for Goodwill Missions Coordinator Cana Horner who had long dreamed of adding child care to Goodwill’s list of mission services. The center received its state license in September and began providing services the following week. As the first Goodwill organization in the state to open a child care center, other Goodwills are eying the venture with great interest. “It’s just amazing. We’re going to be looking at doing this in other counties,” Jones said. “It’s been a great initiative. I’m really, really proud we were able to do this.” A huge help during the process was the Corporation for Ohio Appalachian Development (COAD) which consulted on every step of the process and assisted with paying for some things like background checks, cribs, and cots. COAD will continue to be an important partner, providing training and continued assistance as Goodwill explores opening additional centers. Child care Administrative Assistant Denise Murphy and Lead Preschool Teacher Stacey Caressi both commented on the resources available to staff and children at the new center. Murphy has worked for 13 years in child care at three different child care centers and Caressi has worked at four different centers and has two children attending the center. “The staff and management have been great from the top all the way. I can’t express how much that means,” Caressi said, noting it’s been a great work environment. “Everyone is down to help. It’s like we became instant best friends.” Currently, the center, located on Western Avenue in Chillicothe, is licensed to service 44 children at one time and accepts both private and subsidized pay. Jones anticipates expanding the center into the rest of the building in 2024, which would increase that number to about 100. “Everything has been going great since opening Sept. 18. It is a new adventure each day, and we are learning right along with the kids,” said child care Administrator Mary Anne Queen. “I love that the building has the sound of little ones all day long. One thing I have seen from day one is that each child brings a learning opportunity for my staff and me.”

By Caitlin Feasby, Statewide Coordinator, Ohio Infant-Toddler Court Team Follow Caitlin on LinkedIn As the statewide coordinator of the Safe Babies Court Team (SBCT), I was invited to represent Groundwork Ohio at the 17th Annual Cross Sites conference hosted by ZERO TO THREE in National Harbor, MD. Joined by colleagues representing Children's Defense Fund-Ohio (CDF-Ohio) and Educational Service Center of Northeast Ohio (ESCNEO), and along with community coordinators and court staff in Lucas, Scioto, and Cuyahoga Counties, Cross Sites offered an opportunity for us to join together as thought partners and strategic leaders to promote the SBCT approach statewide. While in National Harbor, Cross Sites allowed the Ohio team to connect with one another while simultaneously building invaluable relationships with professionals engaging with this work from coast to coast. Each day was filled with information from visionary plenary speakers, structured breakout sessions, and ample networking opportunities all designed to support education and engagement. ZERO TO THREE’s Safe Babies approach places families and local communities at the center of all efforts. This was reflected in the structure of Cross Sites with continuous representation of families who have interacted with and navigated the child welfare system, courageously sharing their lived experiences publicly. As attendees, it was impossible not to see the distinctive gaps in the structure of child welfare systems in the face of so many personal stories from parent leaders. As one parent leader shared, while navigating the system and witnessing its shortcomings first-hand, she never would have guessed there would be so many people gathered in one place united by a goal to change it. Just as each of the three Safe Babies sites in Ohio are unique based on local community needs, challenges, strengths, and child welfare practices, each community across the country represented at Cross Sites is also unique in the same ways. This makes the work of building and expanding Safe Babies Court Teams dependent on buy-in and support at the local level, starting first with judicial leadership and local organizations. In leaving Maryland, we brought enrichment and invigoration back to Ohio. SBCT is still young with plenty of room for growth in the coming years under the financial support of the federal HRSA grant. While we expect to navigate future challenges in changing systems, Groundwork Ohio is confident in the resiliency and dedication of the Ohio team. The partnerships, professionals, and supportive leaders at local and statewide organizations are committed to expanding this work to enhance the child welfare experience for infants ages 0-3 and their families. For more information about Safe Babies Court Teams, click here.

By Patrick Caniglia, Policy and Research Fellow, Appalachian Children Coalition The Issue After years of hard work, a long-awaited need for Appalachian Ohio finally appeared to be filled. A former residential unit for adults with developmental disabilities located in Gallipolis, the county seat of Gallia County, had just finished its renovations. Over several months, the residential unit was transformed into a cutting-edge crisis stabilization center for youth. In July 2022, a ribbon-cutting ceremony celebrated the timely opening of the facility. Over one year later, however, it has yet to welcome any kids through its doors. Spearheaded by Hopewell Health Centers’ Clinical Officer David Schenkleberg and Robin Harris, executive director of the Galia/Jackson/Meigs Alcohol, Drug Addiction, and Mental Health (ADAMH) Board, the crisis stabilization center addresses one of the most important needs in the region. Without a place designated to treat, de-escalate, and teach youth to learn the skills they need to help cope and prevent future crisis scenarios from arising, medical hospitals will be left to face behavioral health crises without adequate equipment or training. “Hospitals only help for maybe two, three days,” Harris said. “After the kids are discharged, nothing changes for them.” The story of this open but empty crisis stabilization center disproves the Field of Dreams philosophy, “If you build it, they will come.” Gallia County’s beautifully constructed but unopen crisis stabilization center is a snapshot of the greatest barrier to Appalachian Ohio’s at-risk youth: a lack of behavioral health workers. The Behavioral Health Workforce in Appalachian Ohio Why, after years of tireless efforts from regional leaders such as Robin Harris and David Schenkelberg, is there still such a need for behavioral health workers across the state, and specifically, within the Appalachian region? The answer cuts far deeper than one may think. For starters, the demand for behavioral health workers is at an all-time high. Rates of youth crisis cases have risen significantly while workforce numbers have struggled to catch up. Nearly 50 percent of the Appalachian region’s adolescents meet diagnostic criteria for a mental illness and fewer than half receive treatment. Nationally, between March and October of 2020, emergency department visits for youth with mental health conditions rose 24 percent for children ages 5-11 and 31 percent for adolescents ages 12-17. The same study also indicates that suicide attempts among girls ages 12-17 saw a 50.6 percent increase in February-March 2021 versus February-March 2019. Children in rural areas disproportionately contributed to these rising statistics, as rural youth are more likely to visit the emergency department for cases of self-harm. As the demand increases for behavioral health workers, barriers prevent the supply of workers from keeping up. These roadblocks for progress include, but are not limited to: Low agency reimbursement rates for behavioral health services, leading to low pay for service providers. Lengthy educational tracks for full behavioral health professional licensure. High burnout rates due to compassion fatigue and high caseloads. Each year, between 30 percent and 60 percent of therapists leave their profession. Lack of child care access for behavioral health professionals and clientele alike. Stigma of working with at-risk populations. These factors all combine to become concentrated within the Appalachian Ohio region. In the United States, there are about 497 individuals per each behavioral health professional. In Ohio, the ratio is 645:1, respectively. In Appalachian Ohio, the gap widens even further at 1,010:1. This disparity results in youth being left without critical care. Behavioral Health Workforce Solutions Solving the behavioral health workforce issue within Appalachian Ohio will take multiple initiatives, such as addressing workforce recruitment, retention, and child care. Robin Harris, of the Galia-Jackson-Meigs ADAMH Board, believes that more expansive outreach is one component needed to better fill the labor demand. “We need to get creative with recruiting,” she stated enthusiastically. Harris feels that the key to filling direct care positions in the region begins with looking into a crop of untapped, nontraditional workers. She specifically noted individuals from faith communities and individuals in recovery from substance use as some of her best and most motivated direct care employees from her time running a crisis stabilization unit herself. Outreach to those communities can connect these critical roles with prospective employees dedicated to the work and/or looking for a change in career trajectory. Other solutions target traditional populations through innovative approaches. For example, the Appalachian Children Coalition’s (ACC) Workforce Hub recently launched a high school internship program working to provide young students with the opportunity to experience the behavioral health workforce environment for the first time. These paid internships can help break the stigma of working in behavioral health by giving students a glimpse into the many, diverse responsibilities of social workers, counselors, case managers, administrators, nonprofit leaders, and more. The ACC also provides personalized coaching services for both young people and displaced workers interested in exploring careers in behavioral health. Another innovative recruitment and retention strategy in behavioral health is streamlining licensure requirements to enhance access to training and licensure opportunities. To become a licensed independent social worker in Ohio, one must graduate from a four-year undergraduate program, obtain a Master of Social Work degree from an accredited university, and log 3,000 hours of post-graduate supervised practice. This track typically takes at least eight years to complete. Through streamlining licensure processes, more individuals will have access to pursuing careers in behavioral health. This approach may also help incentivize displaced workers and midlife career changers already interested in pursuing a career in behavioral health to take action. Otherwise, the process to achieve licensure may be too expensive and time-consuming for many to tackle. Lastly, child care access is hurting workforce development in the region. If individuals cannot access child care, or if it costs more than they can afford, then they cannot work outside of the home. Appalachian Ohio is riddled with child care deserts, meaning that there is a significant lack of access to child care facilities in comparison to more affluent, urban areas. Organizations such as the Corporation for Ohio Appalachian Development (COAD) and Groundwork Ohio are working to reduce this disparity at the regional and state levels, respectively. Increasing access to child care not only assists low-earning behavioral health workers, but it helps their clients, as well. Addressing workforce issues from both the workers’ and clients’ sides will lead to stronger Appalachian communities. Uplifting Our Appalachian Youth As we ended our conversation, ADAMH Board Director Robin Harris retained a sense of optimism despite the great obstacles at hand. “We are close,” Harris said. “We need to ensure the kids would get medical care. The biggest hurdle is direct care staff.” Through leveraging unique outreach strategies and being a part of greater collaboration throughout the region, Harris is confident that Gallipolis’ crisis stabilization center will begin operating within the calendar year. Bolstering the behavioral health workforce is a critical response to ensure that Appalachian Ohio children get the care they need to survive and thrive. Through collaboration and creativity, Appalachian youth can finally receive greater access to the treatment that will help improve their outcomes. The results will be well worth the wait. About the Appalachian Children Coalition The Appalachian Children Coalition is an alliance of behavioral health, education, and social service professionals from the Appalachian region seeking public and private solutions to our region’s most acute needs. Every child deserves equal access to support services to help them grow into happy, productive adults. To contact the Appalachian Children Coalition, please email info@appchildren.org. With questions or comments regarding this blog post, you can reach out to Patrick Caniglia at pcaniglia@appchildren.org. We look forward to hearing from and working alongside you.

By Erin Ryan and Kezia Ofosu Atta, Policy Assistant, Groundwork Ohio Follow Kezia on LinkedIn Infant mortality is an issue that has garnered more attention in recent years. You may be surprised to learn that Ohio has one of the worst infant mortality rates in the country at 6.7 infant deaths (under age 1) per 1,000 births. Along racial lines, this rate is even worse. Per 1,000 live births, Black infants in Ohio had the highest infant mortality rate at 13.6, Hispanics at 5.2, Asian/Pacific Islanders at 4.1, and non-Hispanic at 6.8. The rate for white babies is 5.1. The disparities are evident even with the technological advancements available, and regardless of racial identity, we should not be losing infants at this rate. Celebrating the Wins and Amplifying the Needs for More Progress There have been some concrete policy wins to support infant vitality efforts in the state, such as the passage of increased funding for Home Visiting within the state operating budget. However, crucial progress still needs to be made to ensure every child can thrive, particularly in addressing racial disparities in outcomes facing Black babies. Groundwork Ohio is one of many organizations across our state that have been advancing the work to address infant and maternal mortality. At the regional level, there are collaborative efforts that convene community members, parents and caregivers, local government leaders, and health care professionals to drive forward community-focused work. As a collective group, these leading regional organizations – specifically CelebrateOne (representing Franklin County), Cradle Cincinnati (representing Hamilton County), First Year Cleveland (representing Cuyahoga County), and the Ohio Collaborative to Prevent Infant Mortality (OCPIM) – united to organize the state’s first-ever Infant Vitality Advocacy Day on September 13th. The event brought together passionate advocates, health care professionals, and community leaders in the maternal and infant health space to advocate with legislators the need to advance policy initiatives that strengthen health outcomes for moms and babies. Ahead of Advocacy Day, the group hosted a legislative reception to celebrate the accomplishments of advocates and legislators to provide a strong foundation for mothers and babies by addressing maternal and infant mortality and improving conditions for families to thrive. Members of our team had the opportunity to attend this reception, joining in the celebration of the progress that has been achieved. The next day, these leaders from Cleveland, Columbus, and Cincinnati came to the Capitol to attend legislative meetings where they promoted a shared agenda to their lawmakers.With a focus on raising awareness and advancing policy priorities, Advocacy Day attendees shared their personal and professional experiences working to promote stronger maternal and infant health outcomes. They advocated for progress on legislation that will strengthen infant vitality, including Ohio House Bill 7 – The Strong Foundations Act. Infant Vitality Supports in Ohio House Bill 7 Infant vitality support, which is also a provision in Ohio House Bill 7, will be pivotal in reducing infant mortality. Ohio House Bill 7, aimed at promoting and supporting strong foundations for Ohio mothers and babies in their first 1,000 days to address maternal and infant mortality, lies in the Ohio House of Representatives, awaiting floor votes for potential passage. The bill, also known as the Strong Foundations Act, was introduced by Representatives Andrea White (R) of Kettering and Latyna Humphrey (D) of Columbus, to promote the well-being of Ohio’s mothers and children by funding services that could prevent incidents that could lead to death. If passed, the bill will appropriate $1 million in Fiscal Years 2024 and 2025 to fund Centering Pregnancy Services and other evidence-based and evidence-informed group pregnancy education programs and target outreach to areas with gaps in such services. The provision will also appropriate $1 million in the same fiscal year to establish a community-based grant program to expand access to infant vitality support. Therefore, we applaud First Year Cleveland and their partners in their advocacy efforts to ensure that infant vitality is a priority in the Ohio legislature.