The state’s overall ranking is composed of four domain ranks, economic well-being, education, health and family and community. Each domain is made up of four measures.
Tennessee achieved its highest rank, 27th, in the health domain. Other rankings were 33rd in economic wellbeing, 35th in education and 28th in family and community. The state improved on one or more measures in all the domains except health.
The Kids Count Data Book provides a picture of where Tennessee is and where it needs to focus more attention, and it provides data to inform changes states may want to make for improvements in the future. The Tennessee Commission on Children and Youth is the Kids Count Tennessee state affiliate.
“Tennessee’s early adoption of expanded TennCare and CoverKids for children has contributed to a strong ranking on its health domain over the years,” said Rose Naccarato, Tennessee Commission on Children and Youth Kids Count director. “As other states have expanded Medicaid under the Affordable Care Act, this advantage has waned. Though most low-income children still have access to TennCare of CoverKids, their parents are often unaware because they themselves are not eligible.”
Outreach to families with qualifying children can reduce the number who are uninsured. Further reductions happen when parents are also eligible for coverage. Accepting Medicaid expansion funds would help keep Tennessee among the top states for maintaining children’s access to health care.
“One of Tennessee’s lowest rankings continues to be for the percentage of babies born at a low birthweight,” said Naccarato. “Over 9 percent of Tennessee babies are born weighing less than 5 pounds. Many risk factors for low birthweight are known, but they can be difficult to address.”
Among the risks is substance abuse during pregnancy.
Like many states, Tennessee is fighting an opioid addiction crisis. Between 2010 and 2015, the incidence of Neonatal Abstinence Syndrome among enrollees in TennCare, the state’s Medicaid program, increased from a rate of 11 per 1,000 live births to a rate of 24. NAS babies are more likely to be born prematurely and at a low birthweight. TennCare covers half of births in Tennessee and almost all NAS births. This year, Gov. Bill Haslam rolled out Tennessee Together, a multifaceted approach across state agencies to end the opioid epidemic by focusing on prevention, treatment and law enforcement.
Reduction in the number of babies born at a low birthweight can happen when care is available for chronic physical and mental health and substance abuse conditions for women of childbearing age and outreach is improved to those who may qualify for SNAP, WIC and/or TennCare benefits. Additionally, nutrition programs that provide food for school-age children to take home can contribute to nutritionally sound diets for women in their childbearing years. TCCY leads the Home Visiting Leadership Alliance to support home visiting, an evidence-based program that can reduce instances of low birthweight and improve outcomes for children and families.
“The state has put particular focus on infant health and on improvements in early education,” said Naccarato. “Over 60 percent of Tennessee 3-4 year olds lack access to pre-K, and the programs that are available are inconsistent in terms of quality.”
Tennesseans for Quality Early Education formed to push for consistent high quality in pre-K classrooms and coordinate with elementary schools so gains will be sustained. Its advocacy helped pass the Pre-K Quality Act in 2016, and the Tennessee Department of Education has followed up with efforts to strengthen early education.
One of Tennessee’s best ranks is for timely high school graduation, with just 12 percent of students not graduating on time and a rank of eighth in the nation. Success in keeping children in school contributes to improvements in other measures. According to the Data Book, just 7 percent of Tennessee teens are neither working nor attending school, contributing to a higher economic well-being rank. Haslam’s Drive to 55 initiative has helped support these outcomes by offering access to free community college and technical school to all high school graduates through Tennessee Promise.
The improvements also raised the family and community ranking, with fewer children living in families led by a person without a high school degree. The domain improvements are, however, offset by a lower rank in teen birth rate. Tennessee has enjoyed a 35 percent reduction in teen births since 2010, but other states have advanced more quickly.
In education, Tennessee’s fourth through eighth graders saw improvements in reading and math, respectively, which outpaced the national average.