Community Insights: The Impact of COVID-19 on Children and Youth in the Tulsa Area United Way Region

COMMUNITY INSIGHTS Transforming data into insights, insights into investments and investments into action for a thriving community

The Impact of COVID-19 on Children and Youth in the Tulsa Area United Way Region

Prepared by Tulsa Area United Way in parnership with Healthy Minds Policy Initiative Sponsored by Blue Cross Blue Shield of Oklahoma October 2023

Executive Summary

While the COVID-19 pandemic is officially over in the United States, this historic event continues to impact children and youth in the Tulsa Area United Way’s six-county service region (Tulsa Area). This report covers impact in four areas: physical health, safety and well-being, mental health, and academics. Facing unprecedented levels of demand for services, Tulsa Area United Way (TAUW) partner nonprofits stepped up to the challenge posed by the pandemic and implemented expanded and innovative service models to adapt to the changing environment of need.

Physical Health Physical health declined due to illness and lack of resources to meet basic needs during the pandemic. By March of 2023, more than 49,000 positive cases of COVID-19 were reported among children and youth in the Tulsa Area, for an overall rate of approximately 200 cases per 1,000 children. Highest rates of infection were reported among children of color – reflecting both pre-existing inequities and pandemic-related conditions that disproportionately increased risk and exposure. Seven Tulsa Area children have died from the virus.

In addition to connecting community members to basic needs and other human service resources, TAUWsupported 211 Eastern Oklahoma (211EOK) served as the hub for providing reliable and factual information about COVID-19 infection rates and testing resources during the pandemic. During 2021, 211EOK experienced a 75% increase in calls over pre-pandemic 2019, handling over 300,000 requests for resources.

The pandemic eroded the economic well-being of communities across the nation and locally. Declining family resources due to reduced working hours and job loss during the pandemic have been replaced by high costs for food and basic needs, and a lack of affordable housing. Food insecurity among families with children tripled as families nationwide experienced record levels of need for basic necessities. Oklahoma has the highest rate of extreme child food insecurity in the nation. One in eight Oklahomans, and specifically one in five Oklahoma children, face hunger; Black and Hispanic/Latino children are at increased risk. Nearly 50,000 children in the Tulsa Area live with food insecurity.

TAUW Collaborations partner Hunger Free Oklahoma spearheaded local efforts to ensure that children who relied on school meals had access to meals during school closures by connecting school districts to the Food Bank of Eastern Oklahoma and providing information about meal waivers. Hunger Free Oklahoma also launched Tulsa Kitchens Unite to provide meals to entire families in the Tulsa area.

Safety and Well-being COVID-19 spawned conditions that drove child and youth well-being to decline with fewer opportunities to identify those in need. Oklahoma ranks fifth worst among states in overall child wellness, and tenth highest in Adverse Childhood Experiences (ACEs). Experts believe that elevated parental stress levels, reduced access to protective factors, and fewer opportunities for mandatory reporters (e.g., school teachers, day care workers, medical professionals) to observe signs of maltreatment caused increases in unreported child abuse and neglect during the pandemic.

In response to elevated stress levels during the pandemic, TAUW partner nonprofit Parent Child Center of Tulsa developed several new programs including enhanced parenting groups that help at-risk parents and caregivers improve their parenting skills and trauma-informed training for early learning professionals that enable them to identify and respond to trauma behaviors in children. These new programs continue today as families recover from pandemic and post-pandemic stressors.

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Mental Health The ongoing mental health crisis among children and youth in Oklahoma accelerated during the pandemic.

An estimated 27,500 Tulsa area youth aged 6 to 17 have a mental health disorder. In 2020, eight Tulsa Area children under 18 died by suicide. An estimated 5,400 Tulsa Area youth attempted suicide in 2021.

The pandemic revealed gaps in the mental health continuum of care for Oklahoma’s children in the form of insufficient availability of child and adolescent psychiatrists, insurance barriers, and limited access to home and community-based intensive service for complex needs. During FY 2020, more than 91,000 children received Medicaid or state-funded mental health services, however, it is estimated that over half of Oklahoma youth experiencing a major depressive episode did not receive needed mental health services.

TAUW partner nonprofit Family & Childrens’ Services (F&CS) staff provided additional crisis response services to help clients cope with the rising number and severity of mental health issues in the school environment. F&CS’ on-site, school-based services have provided mental health services that children otherwise would have not received. The services have improved childhood outcomes by providing immediate response to mental health and behavioral health issues, aiding in trauma reduction, helping children focus on learning, and empowering students to build connections to caring adults.

Academic Achievement Oklahoma students experienced some of the highest levels of learning loss during the pandemic. Unprecedented changes to educational formats and routines contributed to academic challenges nationwide. During the 2020-21 school year, Oklahoma’s proficiency levels on the National Assessment of Educational Progress (NAEP) fell to 24% in fourth grade reading and 16% in eighth grade math, positioning the state as third-lowest in reading and secondlowest in math.

As a group, the more than 50 public school districts within the Tulsa Area United Way six-county region experienced declines on the Oklahoma School Testing Program (OSTP) Assessment during the pandemic, with third grade reading proficiency levels falling to 22% and eighth grade math levels dropping to 12%. These staggering statistics indicate that 78% of area third graders are not reading at grade level and 88% of area eighth graders lack proficiency in grade-appropriate math concepts.

In general, students with the fewest resources and the greatest educational needs prior to the pandemic experienced the greatest learning loss, generating even wider gaps for these children to overcome. Many of these students represent underserved populations – Black, Hispanic / Latino, and Native American students, English Learners, students with disabilities, and lower income students.

In response to COVID-19’s impact on the learning environment, new virtual opportunities were created. More than 400 Tulsa Area children and youth attended virtual classes at TAUW partner nonprofit YMCA (Y) every day while schools were operating virtually. The Y provided tutors and delivered school supplies, soccer balls, and other resources to help kids learn and play at home in an effort to minimize learning losses during the pandemic.

Exploring the depths of the impact of COVID-19 on children and youth in the Tulsa Area offers important guideposts to understanding the evolving picture of resources, those available and still lacking, across our community. As needs multiplied during the pandemic, so did the resolve of Tulsa Area United Way’s partner nonprofit organizations, showing exceptional perseverance in the face of the unprecedented rise in demand for services.

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WELCOME Welcome to the first edition of Tulsa Area United Way’s Community Insights: Transforming data into insights, insights into investments and investments into action for a thriving community.

Community Insights is a series of reports and briefs designed to inform about pressing community needs and the essential work of Tulsa Area United Way (TAUW) Partner Nonprofits and investments. Each report and data brief focuses on key human service-related issues affecting the Tulsa area. Collaboration with community partners and subject matter experts enrich this exploration to create impactful data and examples of TAUW Partner Nonprofits going above and beyond to help Tulsa Area residents access needed services to reach their goals.

We appreciate the tremendous generosity of the businesses and residents of the Tulsa Area who give to the Tulsa Area United Way every year. We couldn’t support the amazing work of our Partner Nonprofits without those contributions. We hope that this report series offers you a clearer understanding of why investing in TAUW is so vital to the well-being of our community.

We chose to focus this first report of the Community Insights series on the impact of COVID-19 on children and youth of the Tulsa Area. While the pandemic has impacted each of us in different ways, children and youth have been especially vulnerable. Thank you for staying informed about the struggles faced by many children and youth of our community and about the efforts of TAUW Partner Nonprofits to help our young people navigate and thrive through these challenging times. And again, thank you for donating to the Tulsa Area United Way, helping mobilize the work of our outstanding Nonprofit Partners!

Brent Sadler Chief Officer, Organizational Development and Transformation

Six counties One million residents

Tulsa Area United Way Six-County Region

Approximately 250,000 children and youth under 18 Nearly 70 nonprofit partners and 160 partner programs Investments to support expanding education, improving health and safety, and strengthening financial stability

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PHYSICAL HEALTH

Overview

As of March 2023, a total of 322,583 positive cases of COVID-19 were reported in the six-county Tulsa Area United Way region (Tulsa Area) since the beginning of the pandemic.1 Fifteen percent of those cases were children, a proportion lower than their 24% share of the total population. Before the widespread availability of the COVID-19 vaccine, children were still less likely to have a reported case of the virus. Infected young people are more likely than adults to experience asymptomatic or mild cases, which frequently go unreported.2 As with adults, children with underlying medical conditions, such as obesity, diabetes, cardiac, lung and neurologic disorders, and medical complexity, are more susceptible to severe illness. Fortunately, from the pandemic’s start, children experienced relatively few fatalities compared to other age groups.

Although children and youth tend to experience relatively mild direct physical symptoms, many have suffered indirect consequences from the pandemic, including conditions affecting physical health: stress, inadequate nutrition, and abuse.3 Particularly impacted

Tulsa Area Children and Youth Underrepresented in COVID-19 Cases Youth Share of COVID-19 Cases

15%

are children and youth who entered the pandemic economically and socially marginalized due to historical inequalities, including children and youth of color, with lower income status, in foster care, in the child welfare system, and with disabilities.4

COVID-19 Infections and Fatalities

From the onset of the virus in March 2020 through March 2023, a total of 49,319 positive cases of COVID-19 were reported among children and youth, ages birth through 17, in the Tulsa Area, yielding a cumulative rate of 202.1 per 1,000 population.5 This rate is lower than rates at the state level, at 215.2, and the national level, at 226.6 per 1,000.6 The highest reported area infection rate for children was found in Okmulgee County at 246.1; the lowest rate, Tulsa County, at 196.0 per 1,000.7 COVID-19 disproportionately affects particular groups of people for various reasons, including inequities in social determinants of health, the presence of preexisting medical conditions, essential work status, and lack of access to health care. Populations of color in the United States and worldwide have experienced greater incidence and mortality rates from COVID-19 than the White population.8 Across the Tulsa Area, children of color have experienced the highest rates of reported infection:

Infected young people are more likely to experience asymptomatic or mild cases, which frequently go unreported.

TAUW Partner Nonprofit Highlight: Youth Share of Population

24%

Youth Services of Tulsa Youth Services of Tulsa provided Health Navigation services to over 500 homeless youth to help them access needed services during the first two years of the pandemic.

Learn more at yst.org

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Nearly 50,000 Positive COVID-19 Cases Among Children and Youth Across the Tulsa Area Cumulative Positive COVID-19 Cases Among Children 0-17

Area

Cases

Per 1,000 Youth

TAUW 6-county Area

49,319

202.1

Tulsa County

32,813

196.0

Creek County

3,410

205.9

Okmulgee County

2,151

246.1

Osage County

2,082

216.4

Rogers County

4,574

206.8

Wagoner County

4,289

219.2

Oklahoma

206,888

215.2

United States

16,673,166

226.6

Native American, at 209.0 cases per 1,000 youth, and Black children, at 179.3. Rates among Asian/Pacific Islander, White, and Hispanic / Latino children range from 145 to 162 per 1,000.9 Such inequities align with health disparities that existed pre-COVID but also reflect conditions that cause increased levels of risk and exposure to the virus for people of color.

These conditions include disproportionate representation in:

• neighborhoods that are densely populated with concentrated poverty; • communities that offer limited access to health promoting resources such as full-service grocery stores, health services, high-quality education, and public transportation;

TAUW Partner Nonprofit Highlight:

211 Eastern Oklahoma (211EOK)

Morton Comprehensive Health Services

211EOK provided essential information about infection

As the go-to organization for vaccinating safety net front-line staff and the homeless population, Morton Comprehensive Health Services vaccinated over 16,000 individuals for COVID-19 in 2021.

Morton tested over 2,000 children for the COVID-19 virus as referred by the Tulsa Health Department at its testing sites.

Learn more at mortonhealth.com

rates to thousands of community members during the pandemic, testing resources, and changing restrictions, in addition to traditional human service resources.

During 2021, 211EOK connected people to needed resources over 300,000 times, a more than 75% increase from pre-pandemic 2019.

Learn more at 211eok.org

• jails and prisons, which became breeding grounds for infections; and • jobs in non-healthcare service industries considered essential that are often low-wage and do not offer paid sick leave, resulting in little opportunity to self-isolate.10 Due to these and other inequitable systems and conditions, people of color generally had poorer health status and health outcomes than Whites before COVID arrived. COVID didn’t create new health disparities; it exacerbated those that already existed.

Although difficult to diagnose, “long COVID,” a condition roughly defined as the persistence or development of symptoms for weeks or months after infection, is estimated to afflict about a quarter of children diagnosed with COVID-19.11 Researchers have learned that those with more acute cases of infection are more likely to develop long COVID.12 The condition may manifest in children and youth as extreme fatigue, sleep disorders, respiratory difficulties, headache, cognitive difficulties, anxiety, depression, fever, gastrointestinal symptoms, and loss of smell and taste.13 Additionally, a recent CDC study found that young people who have had long COVID are more likely than those who have not to experience serious lung, heart, and kidney problems.14

Children and Youth of Color Disproportionately Infected

by COVID-19 Youth COVID-19 Cases by Race and Ethnicity per 1,000 Youth, TAUW Area 209.0

Native American

179.3

Black Asian / Pacific Islander White Hispanic / Latino

162.0 149.9 144.7

COVID didn’t create new health disparities; it exacerbated those that already existed.

Nationally, for the total population, COVID-19 has become the third leading cause of death, with an age-adjusted mortality rate of 94.7 per 100,000 population.15 Disaggregating by race, however, shows considerable inequities. COVID-19 is the leading cause of death among Native American and Hispanic / Latino individuals, with age-adjusted death rates of 180.0 and 153.8, respectively. Although rarely fatal among children and youth, 2,153 children under 18 from across the U.S., 29 from Oklahoma, and seven from the Tulsa Area, have died from the virus since its inception.16

Indirect Physical Impacts of COVID-19

In addition to the direct physical effects of the virus, children and youth suffered other kinds of harm due to COVID-19. For many families, the virus exacerbated financial strain, food insecurity, abuse, and toxic stress. Children of color, living in poverty, or experiencing homelessness are disproportionately at risk for financial difficulties and food insecurity.17 (Learn more about COVID’s impact on toxic stress and child abuse in the next section of this report.)

The pandemic eroded the economic well-being of communities and families throughout the Tulsa Area in multiple ways. In the early days of the pandemic, families everywhere struggled with job loss, reduced wages and hours, lack of childcare options, and food shortages. More recently, families are contending with inflated costs of food and other basic needs, the risk of eviction, and housing shortages. Families face record levels of demand for basic necessities.

Food insecurity, defined by Feeding America as “the lack of access to sufficient food because of limited financial resources,”18 among families with children has reportedly tripled across the nation during the

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TAUW area youth deaths from COVID-19 11

Oklahoma Children and Youth Experience High Levels of"Food Insecurity" and "Very Low Food Security" Child Food Insecurity

22.5%

pandemic.19 Oklahoma has been hit particularly hard.

According to Feeding America, one in eight Oklahomans, and specifically one in five Oklahoma children, face hunger; Black and Hispanic / Latino children are at increased risk of hunger because of a range of deeply rooted systemic inequities.20 Nearly 50,000 children in the Tulsa Area live with food insecurity.21 Oklahoma ranked seventh nationally in child food insecurity in 2021, with an estimated 22.5% of children experiencing food insecurity.22 Very low food security is a subset of food insecurity, defined as “a more severe range of food insecurity that involves reduced food intake and disrupted eating patterns.” At a projected rate of 8.4%, Oklahoma ranks first in very low food security for children. No state in the nation has a greater share of children facing extreme food

Food insecurity among families with children has tripled across the nation during the pandemic. Nearly 50,000 children in the Tulsa Area live with food insecurity.

No state in the nation has a greater share of children facing extreme food insecurity than Oklahoma.

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Very Low Child Food Security

8.4%

insecurity than Oklahoma. Children who grow up with food insecurity are more likely than others to develop health conditions, struggle academically, experience developmental challenges, and have multiple social and behavioral problems.23 School closings exacerbated hardship for children already at risk for hunger and malnutrition by eliminating access to daily in-person school breakfast and lunch. Those participating in the School Lunch Program, which provides free or reduced-cost meals to children with household incomes below 185% of the federal poverty level, consume more than a third of their daily calories from meals provided at school.24 When schools are closed, participating children eat less food overall and specifically, consume less nutritious food.

Fortunately, numerous collaborative efforts among local school districts and local and statewide organizations, including Hunger Free Oklahoma, a TAUW Collaborations Partner, were immediately launched to ensure that area children continued to have access to meals during COVID-related school closures.

Many TAUW-funded nonprofit basic needs organizations saw massive surges in requests for food and other basic needs items during the pandemic and took steps to creatively meet the growing demand. TAUW Partner Nonprofits that have not traditionally served as basic needs providers reported growing requests from clients during the pandemic for help with food, rent, utilities, and other necessities.

TAUW Partner Nonprofit Highlight:

Hunger Free Oklahoma

YWCA Tulsa

TAUW Collaborations Partner Hunger Free Oklahoma

In response to COVID, YWCA Tulsa has embedded a

served a crucial role in spearheading the successful

focus on health equity in all programs, launching and

implementation of local efforts to ensure that

doubling membership in its Community Investment

children continued to have access to meals during

Program by increasing access to fitness centers for

school closures, including:

residents living in underserved areas.

YWCA was a partner in the City of Tulsa’s survey of COVID-19 impacts on historically underrepresented communities and is also working with the Tulsa Health Department to offer free translation and interpretation services to health providers and social service agencies addressing impacts of COVID. Learn more at ywcatulsa.org

– connecting school districts with the Food Bank of Eastern Oklahoma to ensure adequate coverage of meals and minimize gaps in service; – communicating information about meal waivers from Oklahoma State Department of Education to school districts; – coordinating messaging to the public about meal site information; and – launching Tulsa Kitchens Unite that provided meals to entire families in the Tulsa area.

Learn more at hungerfreeok.org

Caring Community Friends

across the community with social distancing and

Caring Community Friends has always provided

other modifications for safety. The Book and Snack

groceries, financial help, and other resources to area

Mobile included the Recreation Road Show allowing

families in need, but they creatively adjusted their

kids to play games, socialize, and have fun safely.

programs to ensure safety during the pandemic.

Executive Director Camille Teale states, “Book and

Unprecedented numbers of individuals and families

Snack Mobile was a lifeline for many children and

visited Caring Community Friends seeking food, rent,

families who had their summer vacation plans

mortgage, utility, and other resources due to inflation

cancelled due to the pandemic. It was often the only

and economic uncertainty related to the pandemic.

thing they looked forward to every week.”

Nearly three times as many people received food and other services in 2021 as in pre-pandemic 2019. The

The Christmas Star program continued during

Nonprofit modified its grocery service to offer drive-

the pandemic thanks to help from 50 community

through and delivery options when the pandemic

volunteers who delivered turkeys and gifts to families’

required families to shelter in place and avoid

doorsteps. Every child received a riding toy – either a

physical contact.

bicycle, tricycle, or push toy.

Made possible beginning in 2018 through a Tulsa

Learn more at caringcommunityfriends.org

Area United Way Social Innovations Grant, the Book and Snack Mobile delivered books, snacks, fresh fruit, popsicles, and games to different neighborhoods 13

Taking Action: Recommendations from State and Local Partners Morton Comprehensive Health Services 25 • Telehealth option: Advancement of resources and technology for continuing option of Telehealth to increase access to both physical and behavioral health care for all Tulsa Area residents.

• Collaboration: Optimize resources and expertise by elevating the Tulsa Area practice of collaboration among partners from diverse sectors – health care, universities, health departments, governmental entities, communities, nonprofit organizations, funders, and businesses – to address health and wellness in addition to social drivers of poor health outcomes.

• Emergency Preparedness: Continued support of the Tulsa Area Emergency Management Agency (TAEMA) to ensure community disaster preparedness and response plans are ready to activate when needed. TAEMA works with several community partners in these efforts including the Tulsa Health Department, Tulsa area hospitals, community organizations, EMSA, law enforcement, fire departments, and the Tulsa Area Chapter of the Red Cross.

Hunger Free Oklahoma (HFO) 26 • Increase SNAP Participation: Help eligible families stretch their grocery budget by enrolling in the Supplemental Nutrition Assistance Program.

- HFO offers a statewide SNAP application assistance hotline.

- Supporting outreach and referral materials, training on SNAP application assistance, and technical assistance are available for TAUW service area partners through the Tulsa Community Partner Program (TCPP).

- Advocate for Congress to ensure SNAP benefits reflect the cost of a balanced, nutritious diet.

• Offer Breakfast After the Bell: Offering school breakfast through non-traditional service models increases participation, boosts nutrition, and improves academic performance.

- HFO can help area schools explore options and implement programming.

• Expand Summer and After School Meals: Hosting Afterschool or Summer Meal sites for children and teens helps fill meal gaps for kids during out of school hours.

- Contact HFO to learn more about how to be a site or sponsor.

- Advocate for expanded service options for meal sites, including non-congregate service models.

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SAFETY & WELL-BEING

Impact of Trauma

The topic of child well-being is wide-reaching and can refer to many different areas such as physical, emotional, educational, or financial well-being. In this report, we approach the topic using the framework of Adverse Childhood Experiences (ACEs), focusing on the traumatic impact of the pandemic on children’s development and wellness. Research on ACEs shows that toxic stress associated with traumatic events can impair children’s development, potentially leading to lifelong health impacts.27 Based on data gathered during the pandemic, the United Health Foundation ranks Oklahoma as the fifth worst state in overall child wellness, as measured by social and economic factors, physical environment, clinical care, behaviors, and health outcomes.28 We know that within this ranking lies a wide range of outcomes in child wellness. Not all children fare equally. Racial inequities related to child well-being are deep, systemic, and persistent nationally and across the state. Generations

United Health Foundation ranks Oklahoma as the fifth worst state in overall child wellness. of inequities and deeply entrenched discriminatory practices and policies related to accessing resources continue to impede the path towards well-being and success for disproportionate numbers of young people of color.29 COVID-19 didn’t create these inequities nor the poor status of child well-being, but it undeniably intensified both. Child well-being is shaped by a state’s wealth and resources, but also by policy and investment decisions made by state officials, lawmakers, and community leaders.

Adverse Childhood Experiences

Although low or moderate levels of stress are normal and can help children develop the capacity to handle challenging situations, high levels of stress can take a toll on children’s well-being. The presence of recurring high levels of stress hormones can be especially

Childhood Trauma, Social Conditions, and Historical Trauma Can Generate Negative Health Outcomes Mechanism by which Adverse Childhood Experiences Influence Health and Well-being Throughout the Lifespan 32

Death

Early Death Disease, Disability, & Social Problems Adoption of Health Risk Behavior Social, Emotional, & Cognitive Impairment Disrupted Neurodevelopment Adverse Childhood Experiences Social Conditions / Local Context Generational Embodiment / Historical Trauma

Conception

17

Oklahoma Ranks in Top 10 for High Numbers of Adverse Childhood Experiences

Adverse Childhood Experiences Examples:

Oklahoma Children with 2+ ACEs

• Witnessing violence in the home or community

• Experiencing violence, abuse or neglect • Family member attempt or die by suicide • Household member with substance use disorders

18.3%

• Household member with mental health conditions • Family instability due to parental separation or incarceration

detrimental to children’s health and developing brains.30 Extensive research on Adverse Childhood Experiences finds that toxic stress associated with traumatic events can impair children’s physical, mental, and behavioral development, potentially resulting in lifelong health impacts.31 Although any traumatic event or adverse condition may trigger harmful levels of stress, ACEs clinical research and assessments often measure the presence of several key types of events including experiencing or witnessing violence, abuse or neglect, having a household member with mental health disorders or substance use conditions, and family instability.33 More recent studies include social, environmental, and generational factors known to affect children and youth adversely, such as poverty, racism, crime and historical trauma.34 The greater the number of traumatic experiences during childhood, the greater

COVID-19 didn’t create these inequities nor the poor status of child well-being, but it undeniably intensified both.

Child well-being is shaped by a state’s wealth and resources, but also by policy and investment decisions made by state officials, lawmakers, and community leaders.

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the likelihood of unhealthy risk behaviors and adverse physical and behavioral health outcomes throughout life.

Prior to the pandemic, research consistently showed that Oklahoma residents collectively had one of the highest ACE scores in the nation, measured by the share of the population experiencing two or more adverse childhood experiences.35 The latest data from United Health Rankings’ 2022 Health of Women and Children Report indicate that, at 18.3%, Oklahoma has the 10th highest rate in the nation of children experiencing two or more ACEs.36 The pandemic amplified stress levels alongside reduced access to resources to help children process and cope with it in healthy ways, only adding to the intensity of adversities experienced by Oklahoma children.

With the potential to counteract harmful effects of ACEs, Protective and Compensatory Experiences (PACEs) are positive childhood experiences in the form of supportive relationships and adequate resources.37 These types of experiences help build resilience in children and youth.

ACEs do not impact all populations equally.

Researchers find a disproportionate prevalence of adverse childhood experiences among populations that have been historically oppressed or neglected.38 Individuals and families that are Black, Native American, Hispanic / Latino, unemployed, have lower income, have lower education levels, have disabilities, identify as LGBTQ, or are in other ways marginalized tend to be excessively impacted by ACEs. Similarly, children

in families struggling financially, challenged by mental health or substance use disorders or domestic violence, may have fewer opportunities to benefit from protective and compensatory experiences than other children.

Pandemic-related stress and adversity haven’t affected all children in the same way. Children of parents or caregivers who struggle with unmet needs or have difficulty modeling healthy coping strategies themselves tend to be more adversely impacted by the pandemic.39 Families strained by pre-existing and unresolved stressors such as limited financial resources, domestic violence, substance abuse, and mental or physical health challenges are often less likely to have access to resources to help them effectively manage additional adversity. This inequity has the potential to develop new health conditions that disproportionately impact marginalized 40 communities.

Child Abuse and Neglect

As a primary form of Adverse Childhood Experiences, we can drill down to observe trends in child abuse and

TAUW Partner Nonprofit Highlight: Parent Child Center of Tulsa The Parent Child Center of Tulsa (PCCT) has taken steps to intervene in pandemic-related increases in risk factors for child abuse and neglect by offering parenting groups for at-risk parents and caregivers to enhance their parenting skills before abuse or neglect happens, expanding staff training on additional treatment modalities, and providing trauma-informed training to childcare and early learning professionals to enable them to identify and respond to trauma behaviors in children in their care.

PCCT was nominated to participate in the first Child

neglect. Research shows child maltreatment (general term for all forms of child abuse and neglect) increases during natural disasters, including pandemics, due to elevated stress levels and reduced access to protective factors.41 Many experts believe that the COVID-19 pandemic created a confluence of factors contributing to increased levels of child maltreatment.42 Every aspect of the pandemic added a new layer of stress to families, especially those already dealing with strained financial resources, housing insecurity, and mental or physical health challenges. The addition of actual or anticipated family illness or death, job and income loss, school and childcare closures, and social isolation generated heightened stress levels within families. Heightened stress levels can trigger child maltreatment and other forms of domestic violence. 44 Coinciding with these increased stressors was the social isolation of at-home schooling, restricted gatherings, and limited in-person healthcare visits, resulting in diminished access to trusted adults and fewer opportunities for mandatory reporters of suspected child maltreatment, like teachers and

In response to growing financial strain and increased stress, anxiety, and depression among clients, PCCT has become certified through the National Family Support Network as a Family Resource Center. A Family Resource Navigator has been hired to offer enhanced referral and education services to help families access and apply for assistance. Several new services have been added to support families, including HealthySteps, which embeds pediatric specialists in clinics, a Fatherhood Initiative to strengthen father-child relationships, and socialemotional learning support in schools to reduce child stress.

Learn more at parentchildcenter.org

Parent Psychotherapy (CPP) Agency Mentorship Program, a SAMHSA funded initiative, due to their successful implementation of the program, low turnover rate, and knowledge and experience of staff.

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Reported and Substantiated Cases, Rates of Child Abuse and Neglect Increasing in Tulsa Area Prior to COVID-19 25,000

20

20,000

16

15,000

12

10,000

8

5,000

4

0

'02

'03

'04

'05

'06

'07

'08

'09

'10

Cases Reported

20

'11

'12

'13

'14

'15

Cases Substantiated

'16

'17

'18 Rate

'19

'20

'21

'22

0

Confirmed Cases per 1,000 Children

Number of Cases

Tulsa Area Child Abuse and Neglect Trends

Research shows increased child maltreatment during natural disasters, including pandemics, due to elevated stress levels and reduced access to protective factors. healthcare providers, to observe signs of abuse and neglect.45 Coupled with heightened stress and social isolation, the stage was set for increased incidents of unreported child abuse and neglect.

Prior to the pandemic, numbers of both reported and substantiated cases of child abuse and neglect in the Tulsa Area United Way region (Tulsa Area) were on the rise, reaching highs of 21,752 reported cases in FY2019 and 4,313 substantiated cases in FY2020.46 Since the beginning of the pandemic, the numbers have declined or fluctuated. The latest data reveal 21,421 reported cases of child abuse and neglect and 3,601 substantiated cases in the Tulsa Area in FY 2021. Substantiated child abuse and neglect rates also increased in the Tulsa Area prior to the pandemic to a high of 17.9 per 1,000 children in FY2020.

Since then, the rate has declined to 14.6 substantiated cases per 1,000 children, 80% higher than the national rate of 8.1 per 1,000.47 According to local experts, these lower numbers of reported cases mask an actual upsurge in unreported child abuse and neglect in the Tulsa Area during the pandemic due to social isolation, heightened stress levels, and limited access to mandatory reporters.48

TAUW Partner Nonprofit Highlight: Child Abuse Network

Taking Action: Recommendations from State and Local Partners Look Out, Reach Out Campaign 49 • Watch for signs of abuse and neglect: The Look Out Reach Out collaborative campaign of Tulsa Area United Way, Family & Children’s Services, Parent Child Center of Tulsa, Child Abuse Network, and Tulsa CASA encourages the general public to report signs of abuse or neglect, especially during times when children have limited contact with typical abuse and neglect reporters.

Oklahoma State University Extension PACEs for Children: Overcoming Adversity & Building Resilience 50 • Promotion of the science of Protective and Compensatory Experiences (PACEs): PACEs are positive experiences in the form of supportive relationships and resources that can counteract the harmful effects of adverse childhood experiences and build resilience in children and youth. The top 10 PACEs include: – Parent/caregiver unconditional love; – Spending time with a good friend; – Volunteering or helping others; – Being active in a social group; – Having a mentor outside of the family; – Living in a clean, safe home with enough food; – Having opportunities to learn; – Having a hobby; – Being active or playing sports; and – Having routines and fair rules at home.

Child Abuse Network’s Multidisciplinary Child Abuse Team served 1,933 Tulsa County children who were reportedly victims of abuse or neglect in 2021 through forensic interviews and medical evaluations – a 20% increase over number of children served in 2019.

Learn more at childabusenetwork.org

According to local experts, these lower numbers of reported cases mask an actual upsurge in unreported child abuse and neglect in the Tulsa Area during the pandemic due to social isolation, heightened stress levels, and limited access to mandatory reporters.

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MENTAL HEALTH

This Section contributed by Vy Dinh, Community Systems Analyst, Healthy Minds Policy Initiative.

Children’s Mental Health Pre-Pandemic

Oklahoma children and youth were already struggling with poor mental health and substance use prior to the pandemic. Before 2020, young people in Oklahoma consistently had higher rates of major depressive episodes, binge drinking, misuse of pain medications, and heroin and methamphetamine use compared to national estimates.51 Responses to the 2019 Youth Risk Behavior Survey (YRBS) showed that 38.6% of Oklahoma high school students reported persistent sadness or hopelessness.53 Since 2009, there has been a significant increase in Oklahoma youth who have seriously considered, planned, or attempted suicide.

Pandemic Worsened Children’s Mental Health

The onset of the COVID-19 pandemic further accelerated the ongoing crisis in mental health among children and youth in Oklahoma, particularly among vulnerable populations. Disruptions resulting from the pandemic, such as school closures, have been linked to increased feelings of anxiety, depression and distress among youth.54 According to the National Survey of Children’s Health, the percentage of Oklahoma children aged 3 to 17 ever diagnosed with or reported to experience anxiety or depression by a doctor or health care provider, increased by 15% from 10.5% in

27,500 TAUW area youth aged 6-17 estimated to have mental health disorder

Youth Suicide Indicators Increasing Leading Up to Pandemic Suicide Indictors among Oklahoma High Schoolers 25% 20% 15% 10% 5% 0% 2011 Attempted suicide in past year

2013

2015

2017

2019

Made a plan to Considered suicide attempt suicide in in past year past year

Oklahoma Youth Report Higher Rates of Poor Mental Health and Substance Use Than National Average Pre-Pandemic Behavioral Health Indicators Among Youths Aged 12 to 17 Years Old, 2018 - 2019 52

United States

Oklahoma

with major depressive episodes in the past year

15.10%

17.00%

binge drinking in the past month

4.78%

4.97%

misusing pain relivers in the past year

1.93%

2.96%

using heroin in the past year

0.02%

0.03%

using methamphetamine in the past year

0.17%

0.20%

Percent of youths:

23

Increasing Incidence of Mental Health Challenges Among Youth During Pandemic Oklahoma Children Aged 3 to 17 Diagnosed or Reported Anxiety or Depression

Oklahoma Students Struggling with High or Moderate Psychological Distress

60.1% 12.1%

51.8%

2020

2017-18

10.5%

2016

2016 to 12.1% in 2020.55 Additionally, the mental health of certain youth populations, such as those from rural communities, lower-income households, and youth of color, have been disproportionately affected.56 Based on a national prevalence rate of 16%, an estimated 27,500 Tulsa area youth aged 6 to 17 have a mental health disorder.57 This rise in anxiety and depression is simultaneously caused by increased risk factors and loss of protective factors.58 As a result of the pandemic, many families faced economic and food insecurity, with as many as 49% of households with children in the U.S. reporting

a loss of employment income.59 As previously mentioned, children from lower-income households have been especially vulnerable to negative mental health outcomes. The implementation of social distancing measures made it difficult for children to access school and community-based supports. During the early days of the pandemic, many children lost their only reliable source of daily nutrition through school meals. Experts note that losses in cognitive and social development due to pandemic-related disruptions also affected children’s mental well-being. Other challenges to children’s mental health include increased grief and loss of loved ones due to COVID-19 mortality.

TAUW Partner Nonprofit Highlight:

and analysis, helped secure tens of millions of dollars

Healthy Minds Policy Initiative

health care system, and initiated more than a dozen

in competitive funding for Oklahoma’s behavioral

TAUW Collaborations Partner, Healthy Minds Policy

community-based partnerships committed to ending

Initiative (Healthy Minds) is Oklahoma’s premier

untreated mental illness and substance use. Healthy

think tank focused on mental health issues. With

Minds’ policy recommendations receive bipartisan

a foundation in data and research, Healthy Minds

support from legislators, including recently passed

collaborates with state and local leaders to develop,

bills establishing mental health crisis protocols in

elevate, and implement policy and community

schools and expanding access to treatment via

solutions that help ensure all Oklahomans have the

telehealth.

mental health treatment and prevention services they need, when and where they need them.

Since its founding in 2019, Healthy Minds has published more than 50 pieces of original research 24

2021-22

Learn more at healthymindspolicy.org/children

TAUW Partner Nonprofit Highlight: Family & Children's Services Family & Children’s Services (F&CS) offers over 60 programs which restore children’s well-being, heal victims of abuse, strengthen individuals and families, and provide hope and recovery for adults suffering from mental illness and addictions, which include TAUW funded Children’s Center for Counseling and Mental Health and Child Abuse and Trauma Services (CATS). F&CS programs buffer the damaging effects of poverty, trauma, adversity, and toxic stress by creating protective environments that generate new synapses in the brain.

COVID-19 accelerated a crisis in children’s mental health care. Stressors unique to the COVID era (e.g., family deaths, financial hardship, fewer social supports due to ‘Safer-at-Home’ orders, virtual schooling) compounded already high levels of childhood trauma. CEO, Gail Lapidus, states, “without treatment, COVID plus ACEs-related risks set the stage for potential long-lasting mental health crises with generational consequences.”

As the impact of the pandemic on mental health continues, F&CS is seeing increases both in the severity of the conditions clients are struggling with and in the demand for treatment. A 15% increase in requests for assistance in 2021 coincided with increases in suicide, PTSD, crisis calls, and emergency department usage for mental health crises. As the weight of the pandemic crisis lifts, F&CS predict a long-term impact on children’s mental

learning brought with them the pandemic’s negative effects on mental health, behavior, development, and learning. Public schools report that the pandemic negatively impacted student socio-emotional and behavioral development. F&CS’ on-site, school-based services have improved outcomes by providing immediate response to mental health and behavioral health issues, aiding in trauma reduction, helping children focus on learning, and empowering students to build connections to caring adults. Positive results linked to F&CS’ impact include improvements in school attendance and high school graduation, and a more positive school environment.

Lingering mental health effects gave rise to a 9% increase in number of requests for child trauma services through CATS in 2022. Children are presenting with increased symptom severity related to trauma, increased depression, anxiety, PTSD and suicidality.

In addition to traditional services, CATS families continue to request help with basic needs and medications. FC&S provides aid via the F&CS COVID Help Line, COPES COVID Emotional Support Line, food boxes, age-specific activity bags, website resources such as parenting tips, and referrals to other community resources. Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) grant-funded iPads allowed F&CS to provide technology to families who could not otherwise access telehealth from home.

Learn more at fcsok.org.

health.

Providing therapy and counseling services to 7,500 children in 2022, F&CS’ Children’s Center for Counseling and Mental Health staff have provided crisis response to help clients cope with the rising number and severity of mental health issues in the school environment since the beginning of the pandemic. Many students returning to in-person

25

5,400

14 to 17 attempted suicide in 2021 – 11.7% of youth, compared to 8.9% nationally.63

TAUW area youth – 11.7% of youth – attempted suicide in 2021

Data from the Oklahoma Prevention Needs Assessment (OPNA) collected during the pandemic indicate 60.1% of student respondents were struggling with high or moderate psychological distress during the prior 30 days, compared to 51.8% in pre-pandemic 2017-18.60 In 2020, 38 children under 18 died by suicide in Oklahoma, eight of whom lived in the Tulsa Area United Way region (Tulsa Area).61 Rates of youth suicide in Oklahoma and the Tulsa Area, at 4.0 and 3.3 per 100,000 youth, respectively, exceed the national rate of 2.3.62 An estimated 5,400 Tulsa Area youth aged

Since 2016, Oklahoma has made strides in reducing rates of overdose death. However, the onset of the COVID-19 pandemic reversed these positive trends and overdose deaths are again on the rise. In 2020, six children under 18 died of unintentional overdose.64 Although overall drug overdose deaths have since leveled off both nationally and within the state, use of certain substances continues to be an issue among children.65 It is worth noting that the capacity for robust survey data collection was severely limited during the early months of the pandemic. Therefore, 2020 prevalence values may be underestimated. Even as the world returns to normal, the effects of the pandemic will

8

TAUW area youth under 18 died by suicide in 2020

More than 26,000 Tulsa Area Youth Received Medicaid or State-Funded Mental Health Services During FY 2020 Number of Children 17 and Under Who Have Received Services Funded by Oklahoma Department of Mental Health and Substance Abuse Services 69

Total Number of Treatment Admissions

Number of Treatment Admissions with Serious Emotional Disturbance

Creek County

1,763

1,217

Okmulgee County

903

474

Osage County

1,077

797

Rogers County

2,235

1,620

Tulsa County

18,818

12,240

Wagoner County

1,764

1,097

Oklahoma State

91,573

45,242

Region

26

continue to persist. Experts suspect there will be long-lasting, compounding consequences that could negatively affect education, workforce development, and healthcare systems.66

Gaps in Children’s Mental Health Treatment System

The pandemic revealed gaps in the children’s mental health treatment system within Oklahoma. During FY 2020, Oklahoma Department of Mental Health and Substance Abuse Services reported more than 91,000 children receiving Medicaid or state-funded mental health services in Oklahoma, almost 50% of whom were identified as having a serious emotional disturbance.67 It is estimated that as many as 57% of Oklahoma youth aged 12 to 17 experiencing a major depressive episode did not receive mental health services.68 Although increased telehealth usage helped increase treatment access to students, gaps in Oklahoma’s mental health continuum of care persist. As of late 2022, only six of Oklahoma’s 77 counties have at least

Gaps in Children's Mental Health Treatment Systems in the Tulsa Area Led to Increased Overutilization of Emergency Departments Increase in Children's ER Visits for Mental Health Crises, 2019-2021

+84%

+104%

St. Francis Health System

Ascension St. John

27

one child and adolescent psychiatrist – Tulsa County is one of the six.70 Families often experience long wait periods for professional evaluation and initiation of treatment that can worsen symptoms and increase the likelihood of crises. Insurance barriers and the limited availability of home and community-based intensive services for children with complex needs also hamper access to appropriate services. The lack of intensive care for children contributes to the overwhelming demand for inpatient facilities, hospitals, and child

Taking Action: Recommendations from State and Local Partners Family & Children’s Services (F&CS) 78 • Promote children’s mental health: The best way to promote children’s mental health is to build up their strengths, help to protect them from risks, and give them tools to succeed in life. Promoting a child’s mental health means helping them feel secure, relate well with others, and foster their growth at home and at school. We can do this by helping build a child’s confidence and competence – the foundation of strong self-esteem. This can be achieved by providing a child with a safe and secure home; warmth and love; respect; caring and trusting relationships with family, friends, and adults in the community; opportunities to talk about experiences and feelings; time to play, learn, and succeed; encouragement and praise and consistent and fair expectations with clear consequences for misbehavior.

• Adequate and appropriate mental health resources: The most important takeaway from the COVID mental health crisis is the need to build capacity to support children’s emotional health. Severe consequences of mental illness may often be prevented through early intervention. Given that half of all mental illnesses appear by age 14 and three-quarters by age 24, early and effective intervention can

protective services, which can be avoided in most cases.71 These gaps have thus led to increasing overutilization of emergency room visits from children with suicidal thoughts and other psychiatric conditions, compared to pre-pandemic.72 A record 1,300 kids in mental health distress flooded Tulsa County emergency rooms during 2021, resulting in increases in children’s emergency room visits for mental health crises of 84% for St. Francis Health System and 104% for Ascension St. John since 2019.73

have profound lifelong benefits. Strong and supportive environments, including mental healthcare, social and emotional learning, and trauma-informed care, contribute to children and youth in the Tulsa Area being better equipped to succeed in school, work, and life.

• School-based services: Access to mental health services in school leads to a tenfold increase in mental health or substance abuse treatment. Prevention and early intervention in schools prevent behavioral issues from developing into deeper problems which may lead to suspension and dropping out.

• Address inequities: Health and well-being are rooted in broader social and environmental conditions; for instance, poverty, trauma, unemployment, food insecurity, and housing instability. These conditions shape peoples' lives, the conditions in which mental illness and other health problems develop, and access to resources. Systemic root causes of health disparities must be addressed in order to successfully manage our community’s youth mental health crisis.

29

Integration of Mental Health Multi-Tiered Support Systems (MTSS) in Local Schools Enables More Effective Service Delivery

Treatment for few

Tier 3

Intervention for some

Tier 2

• Small group therapies • Family programs • Substance use education

Prevention for all

Tier 1

• Universal screenings • Classroom-wide curriculum

Healthy Minds Policy Initiative 74 The need to address children’s mental health is more evident now than ever before. We need to ensure that children are protected from risk factors and have access to mental health care when and where they need it and at the required level of care.

• School-based, community-linked services and supports: As students have largely returned to school, it is important to develop and integrate mental health multi-tiered support systems (MTSS) in local schools to effectively meet the needs of students and their families. Evidence-based practices are systematically layered to offer protective services to all students and provide more intensive services for select students based on need in partnership with community-based organizations. By adopting MTSS, schools can reduce problem behaviors, bullying, illegal substance use, and teacher burnout, and increase emotional regulation and prosocial behavior. MTSS increases the likelihood that appropriate services are provided early on to students to reduce the occurrence of educational

30

• Crisis services • Intensive inpatient

and behavioral challenges.75 Currently, only 19% of Oklahoma students attend a school set up to provide appropriate mental health support.76 In 2021, Tulsa Public Schools was one of only 14 Oklahoma school districts that are funded to implement a district-wide MTSS. • Integrated behavioral health in primary care: Communities must invest in children’s mental health capacity during routine medical care. Integrating behavioral health into family practice and pediatrician offices will help to address Oklahoma’s current behavioral health workforce shortages.77 Pediatric primary care providers need access to mental health training and consultation from mental health professionals to effectively offer prevention education to families effectively, screen young patients, and treat mild to moderate mental health challenges or refer them to specialty care.

• Intensive home- and community-based treatment services: More intensive home and community-based services in the Tulsa Area are needed to increase the number of children

and youth accessing mental health services, especially among those young people with more complex needs, and avoid restrictive settings such as emergency rooms and inpatient and residential settings. Individualized intensive

TAUW Partner Nonprofit Highlight: Okmulgee-Okfuskee County Youth Services Okmulgee-Okfuskee County Youth Services’ Behavioral Health/CARS program provided counseling services to 250 clients in 2022. Increased levels of need for youth mental health services during the pandemic has created new opportunities for collaboration and referral.

Learn more at okamyskids.org

services help to ensure that children, youth and their families experience stabilization and are at less risk for another crisis episode.

Youth Services of Creek County Through education and counseling services of Youth Services of Creek County, 1,200 students learned life, coping, and social skills in 2022.

Virtual tele-therapy implemented during the pandemic continues to be offered along with in-person services to meet the growing demand due to higher levels of anxiety, depression and suicidal ideation among Creek County students.

Learn more at yscc.net

The Tristesse Grief Center

Mental Health Association Oklahoma

The Tristesse Grief Center responded to the desperate

The reach of the Mental Health Association

need for youth grief services created by the pandemic

Oklahoma’s Youth Mental Health Program has

by expanding its Healing Hearts Club, a school-based

expanded each year since prior to the pandemic.

service centered around student bereavement support

In 2022, nearly 15,000 students from area school

that incorporates school resources, the student’s own

districts received mental health education, a 400%

support system, strengths, and coping mechanisms.

increase over 2019.

The Grief Center has added individual grief counseling at school sites to address increased demand. A

Learn more at mhaok.org

Certified Healing Hearts Club Group Facilitator training program was recently launched to grow capacity for grief groups in Tulsa area schools.

Learn more at thegriefcenter.org

31

ACADEMIC ACHIEVEMENT

Overview

Prior to the pandemic, Oklahoma’s educational outcomes were poor. The Annie E. Casey 2022 Kids Count Data Book, which presents data primarily from before the onset of COVID-19, ranks the state 45th of 50 states in an analysis of key indicators in the education domain.79 The pandemic compounded those already unsatisfactory outcomes. Remote or hybrid learning, lack of classroom structure and consistency, lowered rigor and accountability, lack of internet access, teacher shortages, student illness, and deaths of family members all contributed to academic challenges during recent years. Along with the direct academic impact, the transition to remote learning for many students also meant limited access to consistent nutritious meals, social isolation, loss of connection to trusted adults, and disruption to mental health and other social supports typically provided at school.

COVID-19, but the pandemic exacerbated the inequities.

Although schools have returned to pre-pandemic formats, disparities in the impact of COVID-19 across the nation have continued and deepened. Generally, Black and Hispanic / Latino students and those from lower-income families attended school remotely for longer periods. They were less likely than other students to have internet access, a reliable computer or device, and other essential tools for learning, resulting in deeper academic lags.81 Researchers find that, if not addressed, students who started with fewer academic resources are likely to exit pandemic times with the greatest levels of learning loss, generating even wider gaps in educational and economic opportunities.

Standardized Assessment Results

The academic impact hasn’t been experienced equally across all student groups.80 Disparities in academic opportunities and outcomes were recognized before

One meaningful way to measure the academic impact is by comparing assessment scores before and since the onset of COVID-19. Reading and math assessments are important measures of young people’s ability to become successful citizens and effective participants in the economy.

The Annie E. Casey 2022 Kids Count Data Book ranks Oklahoma 45th of 50 states in an analysis of key indicators in the education domain.

Although standardized assessments are conducted at various points during elementary and secondary school, third and fourth grades are critical times to measure reading proficiency, and eighth grade is a key milestone for math. Through third grade, students are learning to

TAUW Partner Nonprofit Highlight:

Produce and grocery deliveries and virtual “cook-

Global Gardens Global Gardens empowers low-income students and families through gardening and education.

While schools were in remote learning during the pandemic, Global Gardens staff delivered gardens to all of their after-school program participants, giving them something to nurture and care for. To foster a sense of connection and kindness in their neighborhoods, they encouraged their after-school students to create signs and small gifts for their neighbors.

alongs,” implemented during the pandemic to encourage remote engagement among their Food Farm families, have become permanent wintertime opportunities due to immense popularity.

Executive Director, Maryann Donahue, believes that all of these activities helped to mitigate some of the trauma that their students and families experienced during the pandemic, by providing them with a safe space to express themselves and have fun.

Learn more at global-gardens.org

33

National Assessment of Educational Progress Performance Level Definitions 85

Oklahoma School Testing Program Assessment Performance Level Definitions 86

NAEP Advanced: This higher level signifies superior performance.

Advanced: Students demonstrate superior performance on challenging subject matter.

NAEP Proficient: This level represents solid academic performance for each grade assessed.

Students reaching this level have demonstrated competency over challenging material, including subject-matter knowledge, application of such knowledge to real-world situations, and analytical skills appropriate to the subject matter.

Proficient: Students demonstrate mastery over appropriate grade-level subject matter and readiness for the next grade level.

NAEP Basic: This level denotes partial mastery of prerequisite knowledge and skills that are fundamental for performance at the proficient level.

Below Basic: Students have not performed at least at the Basic level.

read, and beginning in fourth grade they primarily are reading to learn.82 If grade-appropriate reading mastery is not achieved by the end of third grade, students are more likely to struggle to comprehend reading materials for other subjects in later grades, curbing their potential for academic success. In adulthood, reading difficulty and the lack of post-secondary education or training can prohibit higher earnings potential and a secure economic trajectory. Further, eighth grade math is a gateway to more complex math concepts and skills.83 Difficulty with eighth grade math may indicate underdevelopment of foundational tools necessary to master more advanced math coursework.

Math proficiency is becoming increasingly crucial for various career paths as it is a building block for developing analytical and critical thinking skills.84

Researchers find that, if not addressed, students who started with fewer academic resources are likely to exit pandemic times with the greatest levels of learning loss, generating even wider gaps in educational and economic opportunities.

34

Basic: Students demonstrate partial mastery of the essential knowledge and skills appropriate to their grade level.

National Assessment of Educational Progress The National Assessment of Educational Progress (NAEP), commonly known as “The Nation’s Report Card,” is a federally mandated assessment of basic subject proficiency of a large-scale representative sample of elementary and secondary school students in the United States and administered by the National Center for Education Statistics.87 Because the NAEP is conducted nationwide, results can be compared across regions and states and are used to inform education policy.

Aggregate outcomes on NAEP assessments are reported in two ways: 1. Scale Scores: The NAEP Scale Score reflects the average score on an assessment using a scale of zero to 500 for fourth grade reading and eighth grade math.

Higher proficiency in a subject yields a higher score.

Scale scores are grouped into performance standards or achievement levels by specified cut scores.

2. Achievement Levels: NAEP Achievement Levels describe proficiency in a subject: NAEP Basic, NAEP Proficient, or NAEP Advanced. The percentage of a student group scoring within each of these

Scores in either the NAEP Proficient or Advanced categories indicate readiness for more challenging material.

Findings from NAEP research show an inverse relationship between reading level and amount of learning loss during the pandemic, resulting in widened gaps in outcomes.

NAEP Fourth Grade Reading The NAEP measures early reading proficiency in fourth grade. Once students enter fourth grade and continue their academic journey, they are expected to be able to apply their reading skills to learn other subjects.

and from 29% to 24% in Oklahoma.89 Only two states had lower proficiency rates. Strategic interventions are needed to ensure that all Oklahoma students have the resources to read proficiently and excel academically throughout their educational journey.

The 2022 national average scale score of 216 on the NAEP Fourth Grade Reading Assessment reflects a three-point decline from pre-pandemic 2019.88 Both years’ scores fall in the Basic achievement level.

While every state averaged either lower or had no significant change from 2019, Oklahoma’s eight-point loss was one of the largest of all states. Oklahoma’s 2022 scale score of 208 matches the cut score for the Basic level and positions the state third from the bottom in fourth grade reading proficiency.

Findings from NAEP research show an inverse relationship between reading level and the amount of learning loss during the pandemic, resulting in widened gaps in outcomes.

achievement levels reflects the aggregate outcomes of the group.

Achievement levels on the NAEP Fourth Grade Reading Assessment declined during the pandemic. The share of scores falling in the proficient or advanced levels declined nationally from 35% in 2019 to 32% in 2022,

NAEP Eighth Grade Mathematics Nationwide, NAEP average eighth grade math scale scores remained at the Basic achievement level, falling from 281 in 2019 to 273 in 2022.90 While every state’s scale score either declined or remained unchanged, Oklahoma experienced the greatest decline of all states in eighth grade math with a 13-point loss for a 2022 scale score of 264, just reaching the Basic achievement level and shifting the state from a position of 10th-lowest to third-lowest scale score.

Nationally and in Oklahoma Reading and Math Proficency Levels Declined Sharply During Pandemic NAEP 8th Grade Math Proficiency Rates

NAEP 4th Grade Reading Proficiency Rates 40% 30%

40% 35%

30%

32%

34%

29% 24%

20%

10%

26%

20%

25%

16%

10%

0%

0% U.S.

Oklahoma 2019

2022

U.S.

Oklahoma 2019

2022

35

Reading and Math Proficiency Levels Dropped Markedly During Pandemic Across the TAUW Area TAUW Six-County Area 3rd Grade OSTP English Language Arts Scores

TAUW Six-County Area 8th Grade OSTP Math Scores

50% 48%

40% 30%

34% 29%

50% 48%

40%

22%

30% 20%

10%

10%

30% 22%

20% 12%

0%

0% Proficient or Advanced

Basic 2019

Below Basic 2021

NAEP eighth grade math scores in the proficient and advanced levels dropped from pre-pandemic 2019 to 2022, from 34% to 26% nationally and from 25% to 16% in Oklahoma.91 The state tied for the second lowest proficiency level in 2022. Oklahoma’s public school system has left eight out of 10 students unprepared for complex math concepts and skills. Widespread interventions are needed to ensure Oklahoma students have the resources to pursue more advanced math coursework.

Oklahoma School Testing Program Assessments The Oklahoma School Testing Program (OSTP) assessments are state-mandated, criterionreferenced standardized tests administered to assess student proficiency in particular subject areas 92 and to help school districts identify strengths and gaps in instruction and curriculum.93 OSTP Third Grade English Language Arts The OSTP Third Grade English Language Arts (ELA) test assesses proficiency in the reading and writing process, critical reading and writing, vocabulary, language, and research.94 The percentage of scores falling in the proficient or advanced levels for third grade ELA among the more than 50 public school districts within the six-county Tulsa Area United Way

36

68%

60%

37% 29%

20%

70%

Proficient or Advanced

Basic 2019

Below Basic 2021

region (Tulsa Area) dropped during the pandemic by 15 percentage points from 37% in 2019 to 22% in 2021.95 This means that Tulsa Area schools are producing about eight out of 10 third graders who are not reading at grade level, and are striving to learn and advance without this critical skill for academic success. Oklahoma must ensure that all Tulsa Area public school students have the resources necessary to thrive academically, including a firm base of reading proficiency.

OSTP Eighth Grade Mathematics Eighth grade math proficiency, as measured by the OSTP, also declined during the pandemic in the Tulsa Area. The share of scores falling in the proficient or advanced categories dropped by 10 percentage points from 22% in 2019 to 12% in 2021.96 About nine out of 10 Tulsa Area public school students are not sufficiently equipped with the foundational math skills necessary to succeed in higher-level mathematics courses. Oklahoma must target interventions and resources to ensure that every Tulsa Area student has the foundational skills necessary to advance to higherlevel math coursework.

Oklahoma experienced the greatest decline of all states in eighth grade math.

Disparities

Researchers find that the pandemic’s impact on academic outcomes is not distributed equally. National data indicate that students with the fewest opportunities and the greatest educational needs prior to the pandemic have experienced the largest share of learning loss from COVID-19, generating even wider gaps in outcomes and opportunities.97 Many of these students represent historically marginalized and underserved populations – Black, Hispanic / Latino, and Native American students, English Learners, students with disabilities, and lowerincome students.

Disparities in testing outcomes existed before COVID-19 among Oklahoma and Tulsa Area students.

Those disparities persisted and, in some cases, widened during the pandemic. Research by NAEP on student learning during the pandemic found that among students who attended school remotely during the 2022 school year, those performing higher on the assessments were significantly more likely to have: full-time access to a computer or tablet, a quiet space to study, and access to their teacher for help on a weekly basis.98 Additionally, higher-performing

TAUW Partner Nonprofit Highlight: YMCA While routinely providing a variety of services to children and families in need, the YMCA (Y) adapted and innovated to meet extreme demand during the pandemic.

The Y shifted from offering secondary or tertiary services to becoming first responders of food needs in the community. They provided meals on-site and provided meal delivery.

students were significantly more likely than others to have access to live video lessons with their teacher almost daily. Access to resources and attributes of the remote learning environment played pivotal roles in these outcomes.

While disaggregation by student characteristics reveals a loss in proficiency in fourth grade reading from 2019 to 2022 for nearly every group in the state, measurable disparities emerge.99 Compared to the overall 17% loss in reading proficiency across the state, the 26% loss for Oklahoma’s Hispanic / Latino students indicates that this population group experienced the greatest obstruction to reading progress due to the pandemic.

Similarly, disaggregated outcomes for the eighthgrade math assessment reveal a substantial loss of proficiency during the pandemic for all student groups in the state.100 While Oklahoma’s overall math proficiency rate declined by 38% from 2019 to 2022, the 63% loss among Hispanic / Latino students reveals the group experiencing the greatest harm to math advancement due to the pandemic.

Access to resources and attributes of the remote learning environment clearly played pivotal roles in these outcomes.

virtually. The Y provided tutors to assist students. Staff also delivered school supplies, soccer balls, and other resources to help kids learn and play at home.

CEO, Ricki Wimmer, reports that Y staff reported more cases of child abuse than ever during the pandemic.

They partnered with Family & Children’s Services to offer group sessions and provide other resources to help both Y participants and staff cope with mental health challenges intensified by the pandemic.

Learn more at ymcatulsa.org

Beyond the normal scope of services, more than 400 Tulsa Area children and youth attended virtual classes at the Y every day while schools were operating 37

Oklahoma's Hispanic/Latino Student Population Experienced Greatest COVID-19 Learning Loss Oklahoma 4th Graders Scoring Proficient or Advanced on NAEP Reading Test 50% 40% 30% 20%

42% 37%

35% 29%

29%

22% 13%

Total

White

31%

27%

24%

10% 0%

32% 32%

26%

14%

11%

Black

20%

19%

17% 9%

Native American

Hispanic / Latino

Multi-race

2019

2022

Lower income

Higher income

9%

English Learner

Non-English Learner

Oklahoma 8th Graders Scoring Proficient or Advanced on NAEP Math Test 50% 40%

39%

30% 20% 10% 0%

31%

29%

26% 21%

20%

16%

19%

16%

12% 7%

Total

White

Black

Native American

Hispanic / Latino

As with NAEP results for the state, analysis of OSTP disaggregated data shows substantial academic loss during COVID-19 for Tulsa Area students across all student groups. Inequities are evident, however, in the scale of impact.

The Tulsa Area experienced a 41% decline in third grade ELA (reading) proficiency from 2019 to 2021.101 Reading progress for every subgroup was disrupted by the pandemic. The greatest decline in proficient and advanced scores emerged among students for whom English is not the first language. Tulsa Area students who are English Learners experienced a 61% loss in reading proficiency during the pandemic.

17%

16% 10%

7%

5%

2019

38

27%

24%

Multi-race

Lower income

6% N/A

Higher income

English Learner

Non-English Learner

2022

The pandemic disrupted eighth grade math progress in the Tulsa Area, evidenced by the overall 45% decrease in scores in the proficient and advanced categories from 2019 to 2021.102 Again, disparities emerge in the extent of harm. The disruptions of the pandemic led to a 78% decline in proficiency rates among Black Tulsa Area students, followed by a 67% decline among English Learners.

These patterns of disparate degrees of learning loss reinforce the observation that those with the greatest opportunity gaps and the least access to academic resources before COVID-19 were often the most intensely harmed by the pandemic. If not addressed,

TAUW Area English Learners and Black Students Had Greatest Learning Loss From Pandemic TAUW Six-County Area 3rd Graders Scoring Proficient or Advanced on OSTP English Language Arts Test

50% 46%

40% 30%

41%

37%

35% 29%

20%

23%

22%

22%

15%

10%

25% 19% 10%

8%

0%

Total

White

Black

18% 13%

Native American

Asian

2019

2021

Hispanic / Latino

7%

Lower income

English Learner

TAUW Six-County Area 8th Graders Scoring Proficient or Advanced on OSTP Math Test 50% 43%

40% 30% 20%

29% 22%

20%

17%

10% 0%

12%

Total

9%

White

16%

16% 8%

2%

Black

Native American 2019

this inequity will continue to generate even wider gaps in educational and economic opportunities and outcomes if not addressed.

ImpactTulsa's Child Equity Index

Research shows that variances in academic performance among different population groups do not equate to differences in intelligence or capacity to learn; instead, they largely reflect systemic inequities in access and opportunities to excel.103 The Child Equity Index (CEI), a data-driven tool and resource developed in Tulsa by local collective impact organization and partner nonprofit, ImpactTulsa, in partnership with Tulsa Public Schools, shows that student outcomes

Asian

14% 6%

6%

Hispanic / Latino

Lower income

6%

2%

English Learner

2021

reflect much more than the capacity to learn. This research finds that a complex, interrelated set of structural and systemic factors based both within and outside the educational system, deeply impact student outcomes. The model uses more than 40 indicators from six domains to measure the effects of geographically-based conditions on student outcomes. The six domains are: student-level factors;

Access to resources and attributes of the remote learning environment clearly played pivotal roles in these outcomes.

39

Child Equity Index: Overall Contribution of Neighborhood Indicators to Academic Outcomes

Significantly Above Median Slightly Below Median

40

Slightly Above Median Significantly Below Median

Child Equity Index: A Complex, Interrelated Set of Structural and Systemic Factors Based Both Within and Outside of the Educational System Deeply Impact Student Outcomes

1

STUDENT LEVEL DOMAIN

Gender

Economic Disadvantage

Race / Ethnicity

Homeless

ELL

Special Alert (i.e. medical)

Student Mobility

EBL

Attended Pre-K

Suspensions

2

NEIGHBORHOOD HEALTH

Built Environment Score

ER Visits

Life Expectancy

Infant Mortality Rate

Mental Health / Substance Abuse Visits

Teen Pregnancy

3

Low Birth Weight

NEIGHBORHOOD SOCIO-ECON STATUS

% of population with Less than a High School Education

Unemployment Rate

% of Pop below 100% FPL

Housing Cost Burdened

% of Pop below 200% FPL

Receipt of SNAP

4

NEIGHBORHOOD SAFETY

Violent Crime

(aggravated assault, homicide, rape, robbery)

Gun- related Mortality Arrests

Narcotics Crime

5

NEIGHBORHOOD CUSTODIANSHIP

Nuisance / 311 Complaints Negative Land Use Built Environment Nuisance

6

NEIGHBORHOOD ACCESS

Walkscore

Industrial / Oil Land Site

Transit

Highway

Grocery Stores

Parks, Trails, Schools

Vehicle Access

(Food Stamps)

Housing Quality and Condition

ImpactTulsa Theory of Action If we use our data expertise: to convene and connect critical partners to boldly share our community's stories Then we: build our collaborators' capacity to disrupt systems of inequity and effect stronger cradle to career outcomes in the Tulsa Area.

neighborhood health; neighborhood socioeconomic status; neighborhood safety; neighborhood pride and custodianship; and neighborhood access.

A deeper understanding of the different factors impacting students in particular neighborhoods informs educators on strategically targeting interventions and resources, opening up opportunities and overcoming barriers to student success.

Pre-Kindergarten Enrollment

Because barriers to opportunities begin at a young age, so must interventions. One such impactful intervention is high-quality pre-K. A well-implemented, high-quality pre-K experience using an evidencebased curriculum has been linked to kindergarten readiness and improved overall academic outcomes in later grades, fewer behavior problems, higher levels of educational attainment, greater career success, and higher lifetime earnings.104 These outcomes ultimately 41

generate a better-educated workforce and a stronger economy overall.

Because long-term gains derived from high-quality pre-K experiences are greatest for low-income children and dual-language learners, the diminished access to pre-K during COVID-19 was especially detrimental to those children.105 As the first state to implement universal public pre-K for all 4-year-olds, Oklahoma is recognized nationally as a leader in early childhood education.106 Before the pandemic, pre-K enrollment was on an upward trajectory. However, amidst the move to remote and hybrid learning, the closure of many private early childhood centers, and job loss or shift to remote

Taking Action: Recommendations from State and Local Partners Community Action Project (CAP) Tulsa 111 •Two-Generation Approach: The combination of high-quality educational opportunities for young children with strong evidence-based education, workforce readiness, and parenting programming for families has a deep and lasting impact.

•Access to high-quality early childhood education: All kids should have access to highquality early childhood education to ensure future academic achievement.

• System Alignment: Alignment and coordination of services with other organizations to fully meet the needs of children and their families.

ImpactTulsa 112 •Theory of Action that all children in Tulsa receive every opportunity to succeed, from cradle to career: • Amplify Community Stories • Use Data to Drive Systems Change and strategically convene partners to increase

42

work for many parents during COVID-19, public pre-K enrollment fell sharply across the state during the pandemic.107 In the Tulsa Area, public pre-K enrollment dropped by 19% between the 2019-20 and 202021 school years.108 The greatest pre-K enrollment shrinkages in the Tulsa Area were found among Multiracial, Hispanic/Latino, and Black students – all groups characterized by lower than average income levels.

National trends indicate that the steepest declines in pre-K enrollment occurred among low-income families – the student group known to benefit most from pre-K.109 Although not yet back to pre-pandemic levels, enrollment data indicate total pre-K enrollment increased in the 2021-22 school year.110

access of resources, ownership and accountability • Center youth and community to make impactful decisions • Strategically build capacity for systems change to address disparities: Evidencebased, data-informed strategies and collaborative action are necessary to pinpoint policies, practices, and resources to alleviate dsparities and ensure that all students have the opportunity to excel academically. Insights from the Child Equity Index and other resources can inform the systemic interventions needed to help close opportunity gaps and overcome barriers to student success.

• Broaden search for solutions: Direct investments in schools are critical, but limitations and inequities in opportunities for student success are not restricted to the educational environment. We will also find important solutions in our housing, health care, economic, human service, criminal justice, and transportation systems.

TAUW Partner Nonprofit Highlight:

A well-implemented, high-quality pre-K experience using an evidence-based curriculum has been linked to kindergarten readiness and to improved overall academic outcomes in later grades, fewer behavior problems, higher levels of educational attainment, greater career success, and higher lifetime earnings.

CAP Tulsa Community Action Project (CAP) Tulsa’s Two Generation (2Gen) approach supports low-income families with early childhood education, parenting

ImpactTulsa ImpactTulsa is a collective impact organization that uses data to drive systemic change by convening community sectors through the shared vision that all children in Tulsa receive every opportunity to succeed, from cradle to career.

Learn more at impacttulsa.org

Program teaches families how to have important conversations in English with their child’s teacher, doctors, and others which was critical during the pandemic for distance learning and telehealth. With

skills, and economic empowerment.

the successful implementation of this offering, virtual

Executive Director Karen Kiely reports that COVID-19

flexible options for families.

created new challenges for serving children and families. “The pandemic caused disruptions in social and emotional development for our children, and it’s still evident in classrooms three years later,” she said. “So, we continue to provide targeted training for teachers to build their toolbox so they can help these kids cope with the trauma they experienced during COVID. As a result, we have seen an increase in socioemotional learning outcomes. Also, teachers feel more confident when dealing with challenging behaviors and can focus their energy on creating classroom environments that are both highly engaging and fun.”

ESL classes will continue to be offered to provide more

CAP Tulsa also assisted families to address financial struggles that were worsened by the pandemic.

Emergency Assistance of more than $1 million has been distributed to families since the start of the pandemic to buy food and diapers, and pay rent, utilities, and medical bills. In addition, Family Advancement services have been expanded to integrate a proven housing stability counseling program.

Learn more at captulsa.org

To meet other challenges created by the pandemic, CAP Tulsa shifted its English as a Second Language (ESL) Program to a virtual platform in 2020. The ESL

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FINAL THOUGHTS Tulsa Area United Way’s Partner Nonprofits and our Innovations and Collaborations partners have been critical to empowering families to weather the storm of the pandemic. They maximized their efforts, shifted ways of doing business to meet clients where they were, and added services, resources and specialized staff to meet clients’ emerging needs. They recognized disparities and strategized to more effectively target resources to those most in need. They stepped out of their lanes to provide more than their usual services; they saw the need, adapted, and served. Out of necessity, they responded to the immediate crisis of the pandemic.

While the COVID-19 pandemic is officially over, its impact on young people will continue to reverberate into the future. The long-term effects depend largely on how we as a community choose to move forward and confront the challenges that surfaced.

The pandemic illuminated pre-existing problems in many systems and structures that directly affect the well-being of children and youth – physical and mental health care, education, child welfare, and compensation – and caused those problems to worsen. Now is the time to learn from this experience, think proactively, and take steps to continue to help our youth heal, reduce the likelihood of harm in future crises, and eliminate barriers to success for all youth. Being informed about the pandemic’s overall and disparate impacts felt by particular groups of youth is a key step.

Identifying and strategizing to fill gaps in services and resources can guide recovery plans and ensure we’re better prepared for the next emergency. Uncovering the root causes of disparities exacerbated by the pandemic can inform efforts to uproot them.

The Tulsa Area United Way and our Partner Nonprofits have played pivotal roles in building and supporting the human services safety net for the Tulsa Area for generations. Countless individuals and families have relied on this safety net for groceries and housing assistance, educational and training opportunities, physical and mental health care, mentorship and youth development, advocacy and counseling, and protection and recreation, to name a few. Our Partner Nonprofits display excellence in serving community members in need, and they eagerly strategize creatively and act courageously to adapt to changing needs and resources, as we saw with COVID-19.

We at Tulsa Area United Way are honored to serve as stewards of investments from businesses and individuals who want to support the crucial work of these organizations to help ensure that every community member has the opportunity to thrive. Learn more at tauw.org.

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REFERENCES 1. Oklahoma State Department of Health. (2023). Oklahoma Statistics on Health Available for Everyone (OK2SHARE). https://www.health.state.ok.us/ 2. Organisation for Economic Co-operation and Development. (2020, August 11). Combatting COVID-19’s effect on children. https://www.oecd.org/coronavirus/policy-responses/combatting-covid-19-s-effect-on-children2e1f3b2f/; Centers for Disease Control and Prevention. (2023, February 10). COVID-19: Information for pediatric healthcare providers. https://www.cdc.gov/coronavirus/2019-ncov/hcp/pediatric-hcp.html#severity-underlyingmedical-conditions 3. Organisation for Economic Co-operation and Development (2020) 4. Jones, K. (2021, August). The initial impact of COVID-19 on children and youth (birth to 24 years): Literature review in brief. Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health & Human Services. https://aspe.hhs.gov/sites/default/files/documents/188979bb1b0d0bf669db0188cc4c94b0/impactof- covid-19-on-children-and-youth.pdf 5. Oklahoma State Department of Health, OK2SHARE 6. Centers for Disease Control and Prevention. (2023). COVID Data Tracker: Demographic trends of COVID-19 cases and deaths in the US reported to CDC. https://covid.cdc.gov/covid-data-tracker/#demographics; Oklahoma State Department of Health, OK2SHARE 7. Oklahoma State Department of Health, OK2SHARE 8. Sonu, S., Marvin, D., & Moore, C. (2021, May 15). The intersection and dynamics between COVID-19, health disparities, and adverse childhood experiences. Journal of Child and Adolescent Trauma, 14(4), 517-526. https:// www.ncbi.nlm.nih.gov/pmc/articles/PMC8122187/ 9. Oklahoma State Department of Health, OK2SHARE 10. Sonu et al. (2021) 11. Lopez-Leon, S., Wegman-Ostrosky, T., Cipatli Ayuzo del Valle, N., Perelman, C., Sepulveda, R., Rebolledo, P., Cuapio, A., Villapol, S. (2022). Long-COVID in children and adolescents: A systematic review and metaanalyses. Scientific Reports 12, 9950. https://www.nature.com/articles/s41598-022-13495-5; Christensen, J. (2023, January 15). Long Covid can be debilitating, even for healthy kids. CNN Health. https://www.cnn. com/2023/01/14/health/long-covid-children/index.html 12. Hall, S. (2022, August 25). Long COVID in children appears less common than early fears suggested.

Scientific American. https://www.scientificamerican.com/article/long-covid-in-children-appears-less-commonthan-early- fears-suggested/ 13. Sweeney, K. (2022, September 8). Long COVID in kids: A path to recovery. Children’s Hospital Los Angeles. https://www.chla.org/blog/covid-19/long-covid-kids-path-recovery 14. Hall (2022) 15. Centers for Disease Control and Prevention. (2023). CDC WONDER: Underlying cause of death, 2018-2021. http://wonder.cdc.gov/ucd-icd10-expanded.html 16. Centers for Disease Control and Prevention, COVID Data Tracker; Oklahoma State Department of Health, OK2SHARE 17. Organisation for Economic Co-operation and Development (2020); Jones (2021) 18. Feeding America. (2021, March). The impact of the Coronavirus on local food insecurity in 2020 and 2021. https://www.feedingamerica.org/sites/default/files/2021-03/Local%20Projections%20Brief_3.31.2021.pdf

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19. Jones (2021) 20. Feeding America. (2023). Facts about child hunger in America. [Fact sheet]. https://www.feedingamerica.org/hunger-in-america/child-hunger-facts 21. Feeding America. (2023). Map the Meal Gap: Food insecurity among children (<18 years) population in Oklahoma. https://map.feedingamerica.org/county/2020/child/oklahoma 22. Feeding America (2021) 23. Feeding America, Facts about child hunger 24. Organisation for Economic Co-operation and Development (2020) 25. Morton Comprehensive Health Services. (2023). Unpublished information.

26. Hunger Free Oklahoma. (2023). Unpublished information.

27. Sonu et al. (2021); Wisconsin Department of Health Services. Resilient Wisconsin: Trauma and toxic stress. https://dhs.wisconsin.gov/resilient/trauma-toxic-stress.htm 28. United Health Foundation. America’s health rankings: 2022 Health of women and children report: Oklahoma. https://www.americashealthrankings.org/learn/reports/2022-health-of-women-and-children-report/statesummaries-oklahoma 29. The Annie E. Casey Foundation. (2022). 2022 Kids count data book. https://assets.aecf.org/m/resourcedoc/ aecf- 2022kidscountdatabook-2022.pdf 30. Organisation for Economic Co-operation and Development (2020); Jones (2021); Administration for Children and Families. Toxic stress. U.S. Department of Health & Human Services. https://www.acf.hhs.gov/traumatoolkit/toxic-stress 31. Sonu et al. (2021); Wisconsin Department of Health Services, Resilient Wisconsin 32. Centers for Disease Control and Prevention. (2021). Violence prevention: About the CDC-Kaiser ACE study. https://www.cdc.gov/violenceprevention/aces/about.html 33. Centers for Disease Control and Prevention. (2022). Violence prevention: Fast facts: Preventing adverse childhood experiences. https://www.cdc.gov/violenceprevention/aces/fastfact.html#:~:text=Adverse%20 childhood%20experiences%2C% 20or%20ACEs,in%20the%20home%20or%20community 34. Sonu et al. (2021) 35. United Health Foundation. (2019). America’s health rankings: 2019 Health of women and children report. https://www.americashealthrankings.org/learn/reports/2019-health-of-women-and-children-report; United Health Foundation. (2019). 2019 America’s health rankings annual report. https://www.americashealthrankings. org/learn/reports/2019-annual-report 36. United Health Foundation. (2022). America’s health rankings: 2022 Health of women and children report: Oklahoma. https://www.americashealthrankings.org/learn/reports/2022-health-of-women-and-children- report/ state-summaries-oklahoma 37. Ratliff, E., Morris, A. S., and Hays-Grudo, J. (2020, May). PACEs for children: Overcoming adversity and building resilience. Oklahoma State University Extension. https://extension.okstate.edu/fact-sheets/paces-forchildren- overcoming-adversity-and-building-resilience.html 38. Sonu et al. (2021) 39. Center on the Developing Child. (2021). PBS NewsHour Q&A: Childhood trauma and COVID-19. Harvard University. https://developingchild.harvard.edu/resources/pbs-newshour-qa-childhood-trauma-and-covid-19/ 40 Sonu et al. (2021)

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41. Sonu et al. (2021) 42. Office for Civil Rights. (2021). Education in a pandemic: The disparate impacts of COVID-19 on America’s students. U.S. Department of Education. https://www2.ed.gov/about/offices/list/ocr/docs/20210608-impactsof- covid19.pdf; Jones (2021) 43. Merrick, M. T. PCA America 2021 annual report. Prevent Child Abuse America. https://preventchildabuse. org/resources/2021-annual-report/ 44. Center on the Developing Child. Protecting our children: COVID-19’s impact on early childhood and ACEs. Harvard University. https://developingchild.harvard.edu/resources/protecting-our-children-covid-19s-impact-onearly- childhood-and-aces/ 45. Sonu et al. (2021) 46. Oklahoma Human Services. Annual reports: Statistical tables. https://oklahoma.gov/okdhs/library.html 47. Children’s Bureau. (2023). Child maltreatment 2021. U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families. https://www.acf.hhs. gov/cb/report/child-maltreatment-2021 48. Killman, C. (2021, March 31). Child abuse, neglect reports decline statewide during pandemic. Tulsa World. https://tulsaworld.com/news/local/child-abuse-neglect-reports-decline-statewide-during- pandemic/article_ fd8da7dc-916c-11eb-96b1-9bc77caa80a8.html 49. Family & Children’s Services, Child Abuse Network, The Parent Child Center of Tulsa, Tulsa Area United Way, & Tulsa CASA, Inc. Look Out Reach Out. https://lookoutreachout.net/ 50. Ratliff et al. (2020) 51. Substance Abuse and Mental Health Services Administration. (2020, December 15). 2018-2019 National Survey on Drug Use and Health: model-based prevalence estimates (50 states and District of Columbia). U.S. Department of Health & Human Services. https://www.samhsa.gov/data/report/2018-2019-nsduh-stateprevalence-estimates 52. Substance Abuse and Mental Health Services Administration (2020) 53. Centers for Disease Control and Prevention. (2020, August 20). 2019 Youth Risk Behavior Survey. https:// www.cdc.gov/healthyyouth/data/yrbs/data.htm 54. Viner, R., Russell, S., Saulle, R., Croker, H., Stansfield, C., Packer, J., Nicholls, D., Goddings, A. L., Bonell, C., Hudson, L., Hope, S., Ward, J., Schwalbe, N., Morgan, A., & Minozzi, S. (2022). School closures during social lockdown and mental health, health behaviors, and well-being among children and adolescents during the first COVID-19 wave: A systematic review. JAMA Pediatrics, 176(4), 400–409. https://doi.org/10.1001/ jamapediatrics.2021.5840 55. The Annie E. Casey Foundation. Child Trends’ analysis of the Department of Health and Human Services 2016 and 2020 National Survey of Children’s Health. (2022, August 8). 2022 Kids Count Data Book. https://www. aecf.org/resources/2022-kids-count-data-book 56. Elharake, J. A., Akbar, F., Malik, A. A., Gilliam, W., & Omer, S. B. (2022). Mental health impact of COVID-19 among children and college students: A systematic review. Child Psychiatry and Human Development, 1–13.

Advance online publication. https://doi.org/10.1007/s10578-021-01297-1 57. Whitney, D. G., & Peterson, M. D. (2019, February 11). U.S. national and state-level prevalence of mental health disorders and disparities of mental health care use in children. JAMA Pediatrics, 173(4), 389-391. https:// jamanetwork.com/journals/jamapediatrics/fullarticle/2724377

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58. Sánchez-Guarnido, A. J., Huertas, P., Garcia-Solier, R., Solano, M., Díez, B., León, M., & Herruzo-Cabrera, J. (2021). Risk factors for relapse in people with severe mental disorders during the COVID-19 pandemic: A multicenter retrospective study. Healthcare (Basel, Switzerland), 10(1), 64. https://doi.org/10.3390/ healthcare10010064 59. Drake, P. & Rudowitz, R. (2022, April 21). Tracking social determinants of health during the COVID-19 pandemic. KFF. https://www.kff.org/coronavirus-covid-19/issue-brief/tracking-social-determinants-of-healthduring-the- covid-19-pandemic/ 60. Oklahoma Department of Mental Health and Substance Abuse Services. 2019-2020 Oklahoma Prevention Needs Assessment. https://oklahoma.gov/odmhsas/prevention/schools/opna.html 61. Oklahoma State Department of Health, OK2SHARE 62. Oklahoma State Department of Health, OK2SHARE; Centers for Disease Control and Prevention, CDC WONDER 63. Center for Disease Control and Prevention. High School Youth Risk Behavior Survey, 2017. U.S. Department of Health & Human Services. https://nccd.cdc.gov/Youthonline/App/Default.aspx 64. Oklahoma State Department of Health, OK2SHARE 65. Layman, H. M., Thorisdottir, I. E., Halldorsdottir, T., Sigfusdottir, I. D., Allegrante, J. P., & Kristjansson, A. L. (2022). Substance use among youth during the COVID-19 pandemic: A systematic review. Current Psychiatry Reports, 24(6), 307–324. https://doi.org/10.1007/s11920-022-01338-z 66. Borel, M., Xie, L., Kapera, O., Mihalcea, A., Kahn, J., & Messiah, S. E. (2022). Long-term physical, mental and social health effects of COVID-19 in the pediatric population: A scoping review. World Journal of Pediatrics: WJP, 18(3), 149–159. https://doi.org/10.1007/s12519-022-00515-7 67. Oklahoma Department of Mental Health and Substance Abuse Services. ODMHSAS Online Query System (OOnQueS). http://www.odmhsas.org/eda/query.htm 68. Substance Abuse and Mental Health Services Administration (2020) 69. Oklahoma Department of Mental Health and Substance Abuse Services, ODMHSAS Online Query System 70. Healthy Minds Policy Initiative. (2022, February 22). Prevention and early intervention: The state of children’s mental health system. https://www.healthymindspolicy.org/research/children/ 71. Oklahoma Department of Mental Health and Substance Abuse Services, ODMHSAS Online Query System 72. Healthy Minds Policy Initiative. (2021, September 29). The impact of COVID-19 on children’s mental health. https://www.healthymindspolicy.org/research/the-impact-of-covid-19-on-childrens-mental-health 73. Healthy Minds Policy Initiative (2021) 74. Healthy Minds Policy Initiative website. https://www.healthymindspolicy.org/ 75. Office of Special Education. (2016, June). ESSU technical assistance: Role of the school nurse: Students with special needs. Colorado Department of Education. https://www.cde.state.co.us/cdesped/ta_roleofschoolnurse; Swain-Bradway, J., Johnson, S. L., Bradshaw, C., & McIntosh, K. (2017, November). What are the economic costs of implementing SWPBIS in comparison to the benefits from reducing suspensions? U.S. Department of Education, Office of Special Education Programs. https://www.gadoe.org/Curriculum-Instruction-andAssessment/Special- Education-Services/Documents/PBIS/2017- 18/Economic%20Costs%20of%20 Implementing%20SWPBIS%20%20in%20Comparison%20to%20the%20Benefits% 20from%20Reducing%20 Suspensions.pdf 76. Healthy Minds Policy Initiative. (2021, March 1). Healthy Minds children’s Multi-Tiered System of Supports project. https://www.healthymindspolicy.org/research/connecting-mental-health-and-oklahoma-schools

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77. Healthy Minds Policy Initiative. (2020, December 15). Behavioral health workforce series: Oklahoma’s greatest needs and opportunities. https://www.healthymindspolicy.org/research/workforce 78. Family & Children’s Services. (2023). Unpublished information. 79 The Annie E. Casey Foundation (2022) 80. Dorn, E., Hancock, B., Sarakatsannis, J., & Viruleg, E. (2020, December 8). COVID-19 and learning loss – disparities grow and students need help. McKinsey and Company. https://www.mckinsey.com/industries/publicand-social- sector/our-insights/covid-19-and-learning-loss-disparities-grow-and-students-need-help 81. Dorn, E. (2020); Silver, D., Saavedra, A., & Polikoff, M. (2022, August 16). Brown Center Chalkboard: Low parent interest in COVID-recovery interventions should worry educators and policymakers alike. Brookings. https://www.brookings.edu/blog/brown-center-chalkboard/2022/08/16/low-parent-interest-in-covid-recoveryinterventions-should-worry-educators-and-policymakers- alike/?utm_campaign=Brown%20Center%20on%20 Education%20Policy&utm_medium=email&utm_content=2230 05276&utm_source=hs_email; Goldhaber, D., Kane, T., McEachin, A., Morton E., Patterson, T., & Staiger, D. (2022, May) The consequences of remote and hybrid instruction during the pandemic. Center for Education Policy Research, Harvard University. https://cepr.harvard. edu/files/cepr/files/5-4.pdf?m=1651690491 82. The Children’s Reading Foundation. (2023). Third grade reading success matters. https://www. readingfoundation.org/third-grade-reading- matters#:~:text=Reading%20is%20essential%20for%20 learning&text=Through%20third%20grade%20children%20 are,the%20beginning%20of%20their%20education 83. Sanchez, R. (2022, October 24). ‘Nation’s Report Card’ shows new evidence of Covid-19’s devastating impact on US children’s education. CNN. https://www.cnn.com/2022/10/24/us/student-test-scores-nations-report-card 84. ImpactTulsa. (2020). Pathways to opportunity: 2019 Community impact report. https://www.impacttulsa. org/reports/ 85. National Center for Education Statistics. (2021, December 9). National Assessment of Educational Progress (NAEP): Scale scores and NAEP achievement levels. U.S. Department of Education, Institute of Education Sciences. https://nces.ed.gov/nationsreportcard/guides/scores_achv.aspx#achievement 86. Cognia & Oklahoma State Department of Education. (2021). Oklahoma School Testing Program / College and Career-Readiness Assessment grades 3–8, 11: 2020–21 Technical report. https://sde.ok.gov/sites/default/files/ documents/files/2020-21%20OSTP_CCR%20Tech%20Report.pdf 87. National Center for Education Statistics. (2023, April 13). National Assessment of Educational Progress (NAEP): About NAEP. U.S. Department of Education, Institute of Education Sciences. https://nces.ed.gov/ nationsreportcard/about/ 88. National Center for Education Statistics. NAEP Report Card: 2022 NAEP Reading Assessment. U.S. Department of Education, Institute of Education Sciences. https://www.nationsreportcard.gov/highlights/ reading/2022/ 89. National Center for Education Statistics, NAEP Report Card: 2022 NAEP Reading Assessment 90. National Center for Education Statistics. NAEP Report Card: 2022 NAEP Mathematics Assessment. U.S. Department of Education, Institute of Education Sciences. https://www.nationsreportcard.gov/highlights/ mathematics/2022/ 91. National Center for Education Statistics, NAEP Report Card: 2022 NAEP Mathematics Assessment 92. Cognia et al. (2021) 93. Oklahoma State Department of Education. Oklahoma School Testing Program: Parent portal toolkit. https:// sde.ok.gov/oklahoma-school-testing-program-ostp-families 94. Oklahoma State Department of Education. Oklahoma School Testing Program: Test blueprint English language arts grade 3. https://sde.ok.gov/ela-assessment

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95. Oklahoma State Department of Education. Oklahoma School Report Card: Oklahoma Data Matrix. https:// escmatrix.com/ok-2021/#home 96. Oklahoma State Department of Education, Oklahoma School Report Card 97. Office for Civil Rights. (2021, June 9). Education in a pandemic: The disparate impacts of COVID-19 on America’s students. U.S. Department of Education. https://www2.ed.gov/about/offices/list/ocr/docs/20210608impacts-of- covid19.pdf 98. National Center for Education Statistics, NAEP Report Card: 2022 NAEP Reading Assessment; National Center for Education Statistics, NAEP Report Card: 2022 NAEP Mathematics Assessment 99. National Center for Education Statistics, NAEP Report Card: 2022 NAEP Reading Assessment 100. National Center for Education Statistics, NAEP Report Card: 2022 NAEP Mathematics Assessment 101 Oklahoma State Department of Education, Oklahoma School Report Card 102. Oklahoma State Department of Education, Oklahoma School Report Card 103. ImpactTulsa (2020) 104. ImpactTulsa (2020); The Annie E. Casey Foundation (2022); National Education Association (2021, December 2). Issue explainer: Early childhood education. https://www.nea.org/advocating-for-change/actioncenter/our- issues/early-childhood-education 105. Loewenberg, A. (2022, June 20). Sooner the better: Oklahoma is a model for how states should provide pre-K. Washington Monthly. https://washingtonmonthly.com/2022/06/20/universal-prek-oklahoma-model/ 106. Loewenberg (2022) 107. Korth, R. (2021, September 9). Coronavirus pandemic causes lagging kindergarten and pre-k enrollments.

State Impact Oklahoma. https://stateimpact.npr.org/oklahoma/2021/09/09/coronavirus-pandemic-causeslagging- kindergarten-and-pre-k-enrollments/ 108. Oklahoma State Department of Education. OSDE Public Records: Student Count: Enrollment of Oklahoma State Public Schools. https://sde.ok.gov/public-records 109. Jones (2021) 110. Oklahoma State Department of Education. OSDE Public Records: Student Count: Enrollment of Oklahoma State Public Schools. https://sde.ok.gov/public-records 111. Community Action Project Tulsa. (2023). Unpublished information. 112 ImpactTulsa. (2023). Unpublished information.

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VISION Tulsa Area United Way envisions a

MISSION

community working together to ensure that all of its members flourish and thrive.

Tulsa Area United Way unites people and resources to improve lives and

Learn more about Tulsa Area United Way’s

strengthen communities.

goals, values, and processes at tauw.org.

REVIEWERS

AUTHORS

TULSA AREA UNITED WAY

Melanie Poulter

Brent Sadler

Chief Officer, Organizational Development and Transformation

Research and Data Director, Tulsa Area United Way

Vy Dinh

Alison Anthony

Community Systems Analyst, Healthy Minds Policy Initiative

DATA COMMITTEE

EDITORS

President and CEO

Teri Dreyer, Data Committee Chair Senior Manager of HR Operations, BOK Financial

Paula Lewis

Strategy & Enterprise Risk Lead, Williams

Mercedes Millberry Fowler Community Volunteer

SUBJECT MATTER EXPERTS Dr. Delia Kimbrel

Senior Director of Research and Policy, ImpactTulsa

Susan Savage

CEO, Morton Comprehensive Health Services

Gail Lapidus

CEO, Family & Children’s Services

Melanie Anderegg

President and CEO, Parent Child Center of Tulsa

Dr. Katie Black

Associate Director of Research and Innovation, CAP Tulsa

Annie Mitchell

Vice President, Community Investments, Tulsa Area United Way

Lauren Teague Collins

Director of Marketing and Communications, Tulsa Area United Way

Dr. Delia Kimbrel

Senior Director of Research and Policy, ImpactTulsa

PARTNER NONPROFIT HIGHLIGHTS Matthew Gleason

Grants and Marketing Communications Manager, Tulsa Area United Way

REPORT DESIGN Aaron Whisner

SPONSORSHIP Blue Cross Blue Shield of Oklahoma

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SPONSOR

REPORT CONTRIBUTORS Lead Contributor

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