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10/29/2021 Caldwell, Valverde: Federal funds should be used to bolster desperately needed services to children
STATE HOUSE – Rep. Justine Caldwell and Sen. Bridget Valverde join children’s health and welfare advocates in strongly supporting funding within the proposed supplemental budget (2021-H 6494) to address crises affecting children’s mental and physical health, child care and supports.

The proposal would dedicate $38.5 million from the state’s $1.13 billion in American Rescue Plan Act (ARPA) funds to bolstering pediatric care, child care and early intervention and the Department of Children, Youth and Families (DCYF), all of which already have been vastly overburdened by the strains of the pandemic.

The American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry (AACAP) and Children’s Hospital Association last week declared a national emergency in children’s mental health, pointing to the challenges of the pandemic coupled with challenges that previously existed.

Representative Caldwell (D-Dist. 30, East Greenwich, West Greenwich) and Senator Valverde (D-Dist. 35, North Kingstown, East Greenwich, Narragansett, South Kingstown), both of whom are the mothers of young children, said the critical level of need demands immediate attention and resources, and is precisely the sort of necessity that should be addressed with ARPA funds.

“The pandemic has been very hard on children, isolating them and cutting many off from resources that protect them and help them grow, while also severely curtailing the availability of supports that were already in limited supply. Some kids have lost family or friends, some have not had even the most basic needs met or have suffered abuse, and virtually all have lost important social connections and opportunities to learn,” said Representative Caldwell. “Our service providers — pediatricians, pediatric mental health providers, development specialists, DCYF — were under-supported even before the pandemic, and now they are immensely overwhelmed by the surge in demand. More than ever, Rhode Island’s kids desperately need these services so they can move forward and have genuine opportunities to grow and thrive.”

Said Senator Valverde, “As the pandemic stretches on through its second year, a significant portion of every kid’s childhood has been consumed by it. It has completely denied many children critical services, such as Early Intervention, because they have aged out while the pandemic limited their access. This is a crisis that will be passed on to our schools, which will be supporting kids who haven’t had what they needed earlier in their development. We need to invest in getting Rhode Island children the services they need as soon as possible, because their ability to achieve throughout their lives will be deeply affected by these years. They deserve the opportunity to heal and thrive, and our state’s future depends on their success.”

Senator Valverde and Representative Caldwell pointed to testimony on the proposal provided by the Rhode Island chapter of the American Academy of Pediatrics, which highlighted its declaration of a mental health emergency for children. According to AAP, between March and October 2020, the percentage of emergency department visits for children with mental health emergencies rose by 24 percent for children ages 5-11 and 31 percent for children ages 12-17. The group also cited federal Centers for Disease Control data indicating an increase of more than 50 percent in suspected suicide attempt visits to emergency departments among girls ages 12-17 in early 2021 compared to the same period in 2019.

“Rhode Island’s children and their families continue to suffer greatly during this prolonged pandemic and have now reached a crisis state. Infants, children and teens are all experiencing a lack of sufficient resources to meet their physical and mental health needs and are facing ongoing trauma. Families are drowning. The state has the money to begin to mitigate this crisis, and it must act now to use designated rescue funds to rescue our children and families,” said Allison Brindle, president of the Rhode Island AAP chapter.

Testimony from AAP is below, followed by its statement declaring a mental health state of emergency among children. For more information, contact RI AAP President Allison Brindle at (352) 262-9412, AAP Vice President Peter Pogacar at (401) 207-6162 or Pat Flanagan, AAP past president at (401) 248-5507.

 Amercian Academy of Pediatrics
Dedicated to the Health of All Children
Rhode Island Chapter  

Senate Finance Committee 

October 27, 2021 

Dear Chairman Pearson and Members of the Committee, 

The Rhode Island Chapter of the American Academy of Pediatrics (RIAAP) would like to offer full support of the Governor’s Supplemental Request to Amend FY2022 Appropriations Act (2021-H- 6494) as it relates to childcare and childhood health.  The RIAAP represents 200 pediatricians practicing in primary and subspecialty care across the state. We have seen in real time that the trauma and economic instability of the pandemic has impacted all children, and it has disproportionately impacted children in poverty.  The dedicated pediatric relief funds is a needed start to helping children and families begin the recovery process from the devastation of the COVID pandemic:    
  • The Early Intervention (EI) system is in crisis.  Infants and children under three years with identified developmental impairments or medical diagnoses placing them at risk for developmental delay or impairment do not have adequate access to these critical services.  COVID has exacerbated this crisis; of the 9 EI centers in RI, 3 (Groden Center, Meeting Street, and Community Care Alliance) are closed to new referrals. Because of these centers closing to referrals, the access to EI services to children across the state, but specifically in the four core cities of Central Falls, Pawtucket, Providence, and Woonsocket, has decreased considerably.  Some children have never had their intake evaluation, and still others aged out of the program without the needed supports to transition into the school system for services.
  • Quality early child-care and education is another sector hit hard by COVID and is critical to child health. The workforce has been decimated by COVID.  Child-care providers are small business owners, and are led disproportionately by women and minorities.  In RI, the median wage for a child care educator is $12.11 per hour.  Funding is needed to increase the wage to $15 per hour, which would meet the new goal for minimum wage before mandatory increases go into effect. This in turn prevents programs from hiking tuition to cover minimum wage increases scheduled for 2022, 2023, and 2024. Quality early child care is essential to rebuilding the workforce; parents can’t go to work if they can’t find affordable, high quality care for their children.
  • DCYF is in need of funding support to pay and retain its workforce. DCYF is a critical partner in protecting children.  The pandemic brought unprecedented stressors into households that resulted in increases in domestic violence, abuse, anxiety and depression.  Analysis completed by the National Commission on COVID-19 and Criminal Justice and reported on in March 2021 indicated an increase in all domestic violence incidents by over 8%. Given that many victims do not report their abuse, this is likely an underestimation.  DCYF needs workers who are engaged in their difficult work and needs to be able to retain these skilled workers to provide consistency and continuity to the children and families they serve.
  • Support for pediatric practices is critical.  Medicaid payment in RI is among the lowest in the nation and generally pays 40-70% Medicare rates. This has been a longstanding strain on pediatric practices.  As COVID has impacted children and families, more than HALF of all children in RI are insured by Medicaid.  Practices have needed to extend hours, devote more time and resources to outreach to catch up on missed visits, immunizations and screenings, and increase behavioral health supports and resources,  all while losing support staff.  In a recent survey of RI AAP members (September 2021), nearly 75% of respondents reported worry about the financial impact of the pandemic on their practice and 50% of respondents reported high staff turnover. We are excited with the anticipation of being able to offer COVID vaccine to children in our practices, but need additional resources to counsel and provide the vaccine. Children have never been in more need for quality pediatric healthcare; our pediatric practices have never been more strained. 
We ask for immediate action by the Rhode Island legislative bodies to approve this supplemental budget, and today we specifically ask that the Senate Finance Committee support the proposed supplemental budget with dedicated funding to: childcare workers and childcare startups, DCYF, Early Intervention, and pediatricians; we are all partners and collaborators in caring for the children of Rhode Island. These funds are labelled as rescue dollars.  The pandemic has taken so much away from children’s life and health services; they are in dire need of rescue and this relief.   


Allison W. Brindle, MD, FAAP 
General Pediatrician, Hasbro Children’s Hospital President, RIAAP 

Peter Pogacar, MD FAAP East Greenwich Pediatrics  Vice- President, RIAAP 

Gregory Fox, MD, FAAP Pediatric Associates, Inc.  Immediate Past President, RIAAP 

Patricia Flanagan, MD, FAAP Hasbro Children’s Hospital Past President, RIAAP 

Elizabeth B. Lange, MD FAAP Waterman Pediatrics Coastal Lifespan Past President, RIAAP 
President, RI Medical Society 

Amercian Academy of Pediatrics
Dedicated to the Health of All Children
Rhode Island Chapter  

The mental health of children and teens is in crisis and today pediatricians, child psychiatrists and children's hospitals are joining together to declare a national state of emergency, and the Rhode Island chapter of the American Academy of Pediatrics extends this emergency declaration to our own state.. Young people have endured unprecedented challenges throughout this pandemic, and it has taken a serious toll on their mental health – which was of growing concern even before COVID-19. We must act now to end this crisis and we need policymakers to join us. 
State of child/adolescent mental health: Why we must act: 
  • Young people are facing challenges like never before as they've struggled with physical isolation, ongoing uncertainty, fear and grief associated with the pandemic. 
  • Their mental health is suffering, and they are experiencing increasing rates of depression, anxiety, trauma, loneliness, and suicidality. 
  • We've seen sharp increases in the number of emergency room visits for mental health emergencies and suspected suicide attempts. We're also seeing dramatic increases in eating disorders.
  • We know that COVID-19 has disproportionately impacted communities of color, and so we must ensure that all children have to these critical mental health services. 
  • The mental health challenges facing young people today are alarming and widespread, which is why we are making this emergency declaration. When it comes to supporting children's health, we must treat the brain as a vital a part of the body. 
Key stats on children's mental health: 
  • The numbers paint an alarming picture:
    • Suicide has been the second leading cause of death for youth ages 10-24 in the U.S. but the COVID-19 pandemic has worsened this crisis. 
    • Between March and October 2020, the percentage of emergency department visits for children with mental health emergencies rose by 24 percent for children ages 5-11 and 31 percent for children ages 12-17.
    • The CDC also found a more than 50 percent increase in suspected suicide attempt visits to emergency departments among girls ages 12-17 in early 2021 compared to the same period in 2019.
    • More than 140,000 U.S. children have experienced the death of a primary or secondary caregiver during the COVID-19 pandemic, with children of color disproportionately impacted. 
What we are calling for: 
  • There is no time to waste. This is a health emergency that requires emergency action. 
  • We must act now and meet children's mental health needs wherever they are: at school, at the doctor’s office, or in the community.
  • Pediatricians, child and adolescent psychiatrists and children's hospitals call on policymakers at all levels of government to join us and prioritize the mental health of young people. 
  • Now more than ever, children and families need access to evidence-based services that support their mental health needs. Investing in children's mental health means investing in our country's future. 
  • Without action, it is clear this crisis will endure far beyond the pandemic and will have long-lasting impacts on the health and well-being of our patients. 
  • Today's declaration is an urgent call for policymakers to recognize the state of children's mental health as a national emergency and to take bold, comprehensive action to address it. The time to act is now. 

For more information, contact:
Meredyth R. Whitty, Publicist
State House Room 20
Providence, RI 02903
(401) 222-1923