Editor's note: This story was originally published on Nov. 4, 2021.

Results are in for the 2021 Community Health Needs Assessment parent survey conducted by Cook Children’s Center for Children’s Health and one thing is clear—the mental health of children is top-of-mind for parents, particularly during the pandemic.

Half of all children ages 6 to 17 living in Cook Children’s eight-county service area have a parent who is concerned that the pandemic will have a negative impact on both their child’s education and mental health, according to the survey. The impact of COVID-19 was also noted by parents and guardians as one of the top three barriers to children receiving necessary health services, along with a lack of insurance coverage and the scarcity of needed services available in the area they live.

These barriers played a role in 137,000 children not getting needed medical care, more than 180,000 kids being deprived of needed dental care, and 63,120 kids going without needed mental health care. When compared to the same demographics from the 2015 and 2018 parent surveys, all of these numbers represent an increase in children not getting the health care they need.

The survey revealed that parents need support, too. More than 30,000 children have a caregiver not coping “very well” or not “well at all” with the day-to-day demands of parenting, and 24% of children live with someone who has a mental illness, or is suicidal or depressed.

“Parents of teens score lower when it comes to coping well with the demands of parenting than those with kids ages 6 to 11,” said Blair Williams, community health analyst at the Center for Children’s Health. “So the question becomes what do we do for parents to help them grapple with those daily parenting demands and the really tough topics that they face with their teens that are relatively new to us adults and changing almost every day.”

These results, along with many other survey data points, were shared Tuesday at the Virtual Children’s Health Summit presented by the Center for Children’s Health. Nearly 300 community members representing a number of area schools, health agencies and community organizations attended the summit.

“We recognize and acknowledge that Cook Children's isn't the only one working to improve the health of children and families in our communities,” said Becki Hale, director of Child Health Evaluation within the Center for Children’s Health. “We have such strong community partnerships and these issues around children's health are so complex that it can't just be one entity. It has to be all of us working together. We're so grateful that we have such a strong community that comes together to support one another to help families.”

Every three years the Center for Children’s Health surveys parents and guardians within its service area, including Denton, Hood, Johnson, Parker, Tarrant and Wise counties. This year the Center added Grayson and Collin counties into the surveyed region in preparation of meeting the needs of children served by the new Cook Children’s-Prosper, slated to open in late 2022. It also increased the child age range from 0 to 14 to 0 to 17.

A total of 5,715 surveys were collected from a sample of households across the surveyed region at large, not just Cook Children’s patients. Surveys were also collected from parents of special underserved populations via partners within community shelters and other local aid agencies. The results are weighted to represent the actual population of children living in the service area. That means data percentages are translated into the actual number of children within the population the percentage represents.

“We use this data to see how we might need to adjust our current programs to best address the needs we already know exist within our community because of what we see within Cook Children’s Health Care System,” Hale said. “Mental health is a good example. Because of what we are seeing in our health system data around self-harm and suicide, we’re particularly looking a little closer at what the survey reveals about mental health knowing that there may be some opportunity to adjust our programming to address that issue, especially within the adolescent and teen population. It’s another piece of the puzzle to help us figure out how to best support families and children.”

Parents reported that 19% of children ages 6 to 17 have been told by a health care provider they have anxiety, and 10% have been told they have depression. That’s higher than the national numbers of 13% and 6% respectively. In addition, Cook Children’s has recorded a record number of suicide attempts by children within the last 12 months.

“The survey reinforces what we have seen over the past year with skyrocketing numbers within our mental and behavioral health services,” said Rick W. Merrill, President and CEO of Cook Children’s Health Care System. “In 2022, we’ll dive deep into mental health access and behavioral health services. We owe it to the hurting children in our community to continue to make this a top priority.”

In addition to addressing mental health, the Center for Children’s Health will work with its community partners to explore new and innovative approaches for increasing access to food, personal health care providers, insurance, oral health care, parent support networks, injury prevention education, and opportunities for physical activity.

“The information we shared at the summit was just the tip of the iceberg,” said Chris Pedigo, senior vice president of system planning, health analytics and the Center for Children’s Health. “We’ll continue to dig deep into these issues to understand how to join with our community partners to best address these needs.”

Other notable findings include:

• 55,570 children are living in households that “sometimes” or “often” can not afford enough to eat.
• 57% of children ages 3 to 5 have a caregiver who is coping “very well” with daily parenting demands, which is lower than the national percentage of 63%; and 51% of children ages 6 to 17 have a caregiver who is coping “very well” with daily parenting demands, also lower than the national percentage of 61%.
• 70% of children ages 3 to 5 are ready for school according to their caregiver, which is slightly lower than the national percentage of 75%.
• 8 in 10 children have “excellent” or “very good” health.
• 9 in 10 children had continuous insurance coverage for 12 consecutive months prior to completing the survey.

In February, the Center for Children’s Health will release part two of its Community Health Needs Assessment, which will include a report of the “why” behind many of the survey results learned from parent focus groups and community leader interviews. That information will be combined with the parent survey results as well as the results of a community leaders survey to complete the Community Health Needs Assessment, which will be released in spring 2022.

What's under the microscope now is how mental health played a role in these unsettling crimes. While one involved a documented case of schizophrenia, the other is not so clear but may have been tied to depression or possibly a head injury. Yes, these are extreme examples of issues regarding mental health, but they are also reminders of what could go wrong if mental well-being is left unchecked.

It's long been reported that Texas is lagging when it comes to mental health spending. In fact, the state ranks 49th in the country for such spending per capita. At Cook Children's, The Center for Children's Health is working with local partners to expand awareness and access to mental health resources in one local county that especially needed help.

"We have seen higher rates of diagnosed mental illness, bullying at school, self-esteem issues and experience in trauma in 2015 than we did in 2009," said Courtney Barnard, Coordinator for Regional Outreach Services at Cook Children's. "The CCHAPS data tells us what is happening according to parents, but it does not tell us why it’s happening."

Barnard says it could be that kids are experiencing mental health issues and bullying more often or it could mean that parents are more aware of these problems and know what to look for and ask about. The latest numbers from CCHAPS will be the focus of the Denton County Child Health Summit on May 12, 2016, which will be presented by Cook Children's Center for Children's Health. There will also be discussion about the efforts and impact of the Wellness Alliance for Total Children's Health (WATCH) of Denton County. WATCH is a coalition of public and private organizations, born out of the CCHAPS data. The group offers mental health resources to kids, teens, parents and professionals as well as critical support to service providers.

"Moving the needle on children's health is a long-term process because it requires people and organizations to make changes in knowledge, skills, attitudes, beliefs and behaviors," Barnard said. 

About WATCH
The Wellness Alliance for Total Children’s Health (WATCH) of Denton County is a collaboration of both public and private organizations and individuals who are invested in the total wellness of Denton County’s children. WATCH currently works to increase awareness of and access to mental health services in Denton County. Visit www.watchdenton.org for more information.

Obesity? That's one.

Car accidents? That's a big risk too.

But would you guess the number one issue is asthma?

In Tarrant County, 19.5 percent of children suffer from asthma, according to data gathered in a survey sent to parents by The Center for Children's Health led by Cook Children's. The Community-wide Children's Health Assessment and Planning Survey (CCHAPS) was completed by more than 8,600 parents in Tarrant, Denton, Hood, Wise, Parker and Johnson counties.

"We questioned parents on everything from how often their child is buckled in properly to how many grocery stores in their neighborhood sell fresh fruits and vegetables," said Larry Tubb, senior vice president of the Center for Children’s Health. "The information we are gathering is extremely valuable when it comes to measuring the overall health of children in our region."

Overwhelmingly, parents in Tarrant County (and all of the surveyed counties) reported their children are dealing with asthma. In fact, children in this area ages 6-9 are three times more likely to have asthma than children living in other parts of Texas. While we don't know why the numbers are so high, we do know people with asthma have varying triggers, and what affects one person will not necessarily affect another. Those triggers include, but are not limited to, cigarette smoke, indoor and outdoor mold, pet dander, air pollution, dust mites, cockroaches, pollen, smoke and strong odors.

The second biggest health issue on parents minds is obesity, with 17.8 percent reporting concerns about their child's weight, activity level and access to healthy foods.

Accidental injuries rings in third. In Tarrant County, 11.9 percent of parents reported their children had been injured and required medical care. Those injuries range from car and ATV-related incidents to drowning, bicycle falls and crashes.

The fourth issue on the list is a lack of dental care for children. Parents reported 9.7 percent of children either didn't see a dentist regularly, didn't brush their teeth enough or some even reported their child didn't have their own toothbrush.

Finally, mental illness is the fifth biggest issue concerning parents in Tarrant County. Behavioral and emotional development is on the minds of 8.5 percent of respondents. Many reported their children have suffered sleep problems, self-esteem issues or have tried to harm themselves.

The survey used to gather this data is part of a Cook Children's initiative to improve the health and well-being of every child in our six-county region by 2020. This initiative launched in 2009 with the very first survey of its kind sent to parents. Since then, the surveys have been sent out every three years.

"The information provided by parents in our community is available on-line and being used by a host of organizations, including Cook Children’s, to build programs and services. There isn’t one perfect answer, but, together we are making solid progress in improving the health of the children in our community by putting the child and family at the center of our planning," said Tubb.

About The Center for Children's Health

The Center for Children's Health, led by Cook Children's, is home to the Community-wide Children's Health Assessment & Planning Survey (CCHAPS), Community Health Outreach and Community Health Research. The center's goal is to create aligned collaborations that will allow us to make our North Texas region one of the healthiest places to raise a child.