At the front of the line, a girl in a unicorn headband and sparkly pink skirt clutched a zip-close bag with her name on it. She pulled out a plastic tube with a small funnel attached. Next, Hillside superintendent Kevin Suchinski led the student to a spot marked off with red tape. Suchinski coached her how to carefully release — but not “spit” — about a half-teaspoon’s worth of saliva into the tube.

“You wait a second, you build up your saliva,” he told her. “You don’t talk, you think about pizza, hamburgers, French fries, ice cream. And you drop it right in there, OK?”

The results will come back within 24 hours. Any students who test positive are instructed to isolate, and the school nurse and administrative staff carry out contact tracing.

Hillside was among the first in Illinois to start regular testing. Now, almost half of Illinois’ 2 million students in grades K through 12 attend schools rolling out similar programs. The initiative is supported by federal funding the state health department.

Schools in other states — such as , , and — also offer regular testing; Los Angeles public schools have gone further by making it .

These measures stand in sharp contrast to the confusion in states where people are still fighting about wearing masks in the classroom and other anti-covid strategies, places where some schools have experienced outbreaks and even teacher deaths.

Within a few weeks of schools reopening, of students across the U.S. were sent home to quarantine. It’s a concern because options for K-12 students in quarantine are — with some schools offering virtual instruction and others providing little or no at-home options.

Suchinski hopes this investment in testing prevents virus detected at Hillside School from spreading into the wider community — and keeps kids learning.

“What we say to ourselves is: If we don’t do this program, we could be losing instruction because we’ve had to close down the school,” he said.

So far, the parents and guardians of two-thirds of all Hillside students have consented to testing. Suchinski said the school is working hard to get the remaining families on board by educating them about the importance — and benefit — of regular testing.

Every school that can manage it should consider testing students weekly — even twice a week, if possible, said . She’s an epidemiologist at the University of Illinois in Urbana-Champaign, which developed the Hillside and other Illinois schools are using. Smith pointed to several studies — including both and — that suggest rigorous testing and contact tracing are key to keeping the virus at bay in K-12 schools.

“If you’re lucky, you can get away without doing testing, [if] nobody comes to school with a raging infection and takes their mask off at lunchtime and infects everybody sitting at the table with them,” Smith said. “But relying on luck isn’t what we like to do.”

Julian Hernandez, a Hillside seventh grader, said he feels safer knowing that classmates infected with the virus will be prevented from spreading it to others.

“One of my friends — he got it a couple months ago while we was in school,” Julian recalled. “[He] and his brother had to go back home. … They were OK. They only had mild symptoms.”

Brandon Muñoz, who’s in the fifth grade, said he’s glad to get tested because he’s too young for the vaccine — and he really doesn’t want to go back to Zoom school.

“Because I wanna really meet more people and friends and just not stay on the computer for too long,” Brandon explained.

Suchinski, the superintendent, said Hillside also improved ventilation throughout the building, installing a new HVAC system and windows with screens in the cafeteria to bring more fresh air in the building.

Regular testing is an added , though not the only thing Hillside is relying on: About 90% of Hillside staff are vaccinated, Suchinski said, and students and staffers also wear masks.

Setting up a regular mass-testing program inside a K-12 school takes a good amount of coordination, which Suchinski can vouch for.

Last school year, Hillside school administrators facilitated the saliva sample collection without outside help. This year, the school tapped funding earmarked for to hire covid testers — who coordinate the collecting, transporting and processing of samples, and reporting results.

A couple of Hillside administrators help oversee the process on Mondays, and also facilitate testing for staff members, plus more frequent testing for a limited group of students: Athletes and children in band and extracurriculars test twice a week because they face greater risks of exposure to the virus from these activities.

Compared with a year ago, covid testing is now both more affordable and much less invasive, said Mara Aspinall, who studies biomedical testing at Arizona State University. There’s also more help to cover costs.

“The Biden administration has allocated $11 billion to different programs for testing,” Aspinall said. “There should be no school — public, private or charter — that can’t access that money for testing.”

Creating a mass testing program from scratch is a big lift. But more than half of all states have announced programs to help schools access the money and handle the logistics.

If every school tested every student once a week, the roughly $11 billion earmarked for testing would likely run out in a couple of months. (This assumes $20 to buy and process each test.) Put another way, if a quarter of all U.S. schools tested students weekly, the funds could last the rest of the school year, Aspinall said.

In its , updated Aug. 5, the Centers for Disease Control and Prevention does not make a firm recommendation for this surveillance testing.

Instead, the CDC advises schools that choose to offer testing to work with public health officials to determine a suitable approach, given rates of community transmission and other factors.

The agency previously recommended screening in all areas experiencing moderate to high levels of community transmission. As of Sept. 21, that included .

For school leaders looking to explore options, Aspinall suggests a resource she helped write, which is cited within the CDC guidance to schools: the Rockefeller Foundation’s .

This spring — when Hillside was operating at about half capacity and before the more contagious delta variant took over — the school identified 13 positive cases among students and staffers via its weekly testing program. The overall positivity rate of about half a percent made some wonder if all that testing was necessary.

But Suchinski said that by identifying the 13 positive cases, the school perhaps avoided more than a dozen potential outbreaks. Some of the positive cases were among people who weren’t showing symptoms but .

A couple of weeks into the new school year at Hillside, operating at full capacity, Suchinski said the excitement is palpable. Nowadays he’s balancing feelings of optimism with caution.

“It is great to hear kids laughing. It’s great to see kids on playgrounds,” Suchinski said.

“At the same time,” he added, “we know that we’re still fighting against the delta variant and we have to keep our guard up.”

This story is from a partnership that includes , , , and KHN.

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After all, who better to understand why herd immunity matters than a herdsman?

“Being a livestock producer, I’m well aware of vaccinations and vaccines,” he said. “That’s how we develop immunity in our animals. We’re always vaccinating the breeding stock to pass on immunity to the little ones.”

Boosting covid-19 vaccination rates in rural America is now less a problem of access and more an issue of trust. Only of people in Jo Daviess County, where Arnold lives, are fully vaccinated. Arnold said he doesn’t get why people are acting as if the pandemic were over. Scientists say those under-vaccinated parts of the country like Jo Daviess are at serious risk, especially as the highly contagious delta variant spreads rapidly.

It’s why farmers and ranchers need to speak openly about why they’ve chosen to be vaccinated, said , chief policy officer with the National Rural Health Association.

“One of the hardest things about the vaccination effort is that it really, at this point, is almost down to those one-on-one kinds of conversations,” she said.

Cochran-McClain’s association has teamed up with the National Farmers Union to try to get more farmers to promote the vaccine in their communities. They’ve created an for farmers with information and talking points for starting conversations.

Ryan Goodman, 32, is giving it a try. He’s a cattle rancher in Virginia and self-described “agriculture advocate.” On and , he’s known as “Beef Runner.”

Goodman, who lived in Colorado until recently, has been using his social media accounts to promote the vaccine, as part of a paid content partnership with the Colorado Department of Public Health and Environment.

The agency provides him with information about the vaccines to share online, and he responds to questions with support from the department’s public health experts.

He said he’s not sure he’s changed any minds, but he’s encouraged when skeptics return to chat more.

“I’m a fan of saying no one conversation changes someone’s mind, especially when you disagree on a topic that might be as hot or as political as vaccines,” Goodman said.

He’d like to see more farmers speak up, because in rural towns farmers have long roots, extending back generations — making them more trusted than even health experts, he said.

“Everybody looks at Joe down the road and thinks, ‘Hey, you know, what might be his experiences on this topic or this issue?'” Goodman said. “[And they] listen to what he or she may say.”

Larry Lieb farms 92 acres of soybeans and timber in central Illinois and also raises a few cows and pigs.

He said he wondered whether the vaccine could be safe, given how quickly it came to market — and he got it for only one reason.

“My daughter’s a respiratory therapist, and she told me I was gonna get it,” Lieb said. “Plain and simple.”

Unlike some of his relatives, Lieb said, he does not buy into conspiracy theories about the vaccine. But he said he avoids those conversations altogether.

“It’s their own personal choice,” he said. “On issues where they’re set in their ways, you know, it’s futile to try.”

The pandemic has had a huge economic impact on farmers, said Mike Stranz, vice president of advocacy for the National Farmers Union.

“There’s been so much upheaval in the agricultural economy and in our communities,” Stranz said. “We need to start moving past that, and vaccines are the way towards that [goal].”

Vaccination rates in rural communities, and an analysis from NPR and Johns Hopkins University in June found are cropping up in areas with dangerously low vaccination rates — especially in the South, Midwest and West.

Urban and rural areas have been seeing similar rates of new covid cases lately, according to from the University of Iowa. But some states — including Illinois, Missouri and Utah — are seeing higher rates in nonmetropolitan areas.

Recent polls suggest most unvaccinated people .

But Cochran-McClain said she hopes farmers don’t get discouraged, and she has this message for people like Lieb: “He may not feel like his voice is much, but we believe it’s very strong and important.”

Arnold said he believes the vaccine saves lives, but he doesn’t think it’s his job to try to convince his neighbors or friends. And, he said, he has limited capacity for new challenges.

“I’m already overworked and underpaid,” Arnold said. The vaccine rollout, so far, has coincided with some of the busiest times of the year for farmers.

If he gets into a conversation with someone about the vaccine, he said, he’ll express to them that he’s a livestock producer and understands how they work.

“But I don’t elaborate,” Arnold said. “Unless people are asking me. And usually they don’t.”

This story is part of a reporting partnership that includes , , and KHN.

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“When you get these losses, one after the other, you almost can’t get traction on normalcy,” said Noreen Leahy, an assistant superintendent at the school district.

To Leahy, the student suicides exposed a children’s mental health crisis brewing for years. She had observed a concerning uptick in depression, anxiety and suicidal ideation among students. Her school district had a team of mental health professionals, but Leahy said they couldn’t provide the kind of long-term care many students needed.

“Remember, psychologists and social workers and counselors in school districts are there to make sure kids are learning,” said Leahy. “We’re not hospital wards. We don’t do psychotherapy. So it’s very limited what we can do for these students.”

She said she saw an urgent need to connect students to mental health care quickly and easily, and the 2019 tragedies drove her to find a way.

Her vision ultimately led to the formation of a unique partnership between several Long Island school districts and the nearby children’s hospital, , part of the Northwell Health system. That partnership provides prompt access to mental health services for students and , creating a mental health safety net for children and families in the area that didn’t exist before.

At its heart is a new behavioral health center, which the hospital opened in January 2020. Students are evaluated by the center’s child psychiatrist and mental health counselor, who start and continue treatment until a child can be connected to long-term care in the community.

The concerning rise in mental health issues noticed by the Long Island school administrators mirrors national trends. meet the criteria for a mental health disorder, and the among teens has risen over the past decade, according to the Centers for Disease Control and Prevention.

Around the country, most kids who have mental health issues . There’s a shortage of providers who work with children and it can take months to get an appointment.

“The wait times on average to see a mental health specialist on an emergency basis is somewhere between two to three months, and for regular basis is up to 12 months, which is an unacceptable wait time,” said , a child and adolescent psychiatrist at Nationwide Children’s Hospital.

Without timely access to care, many kids end up with worsening symptoms and eventually land in a hospital emergency department, “as the fastest way to either avert [a mental health] crisis, or as the fastest way to get some kind of mental health evaluation,” Ramtekkar said.

“It sort of creates this ping-pong effect,” said Tina Smith, executive director of special education at Oceanside School District in Long Island.

It’s common to see students go to the ER only to be discharged soon after and return to school without a plan for follow-up care, she said. “And then the problems start to spiral again out of control,” Smith said, “and then they’re sent back to the hospital [ER].”

It was with these worries in mind that, after the student suicides in 2019, Leahy began raising her concerns with colleagues, school board members and other parents, including Gina-Marie Bounds, a hospital administrator at Cohen Children’s.

Bounds took the idea to the head of emergency child psychiatry and other hospital officials at Cohen’s and they got to work. Leahy spread the word to neighboring school districts, who were dealing with similar problems, and persuaded them to come on board. Several months later, the mental health center opened its doors.

This couldn’t have come at a better time, said Leahy. As many large hospitals around the country in their emergency departments, the new behavioral health center reports the opposite trend. The number of mental health visits to the emergency room by students from these school districts declined by at least 60% in 2020 compared with the previous year.

School administrators also say the health center has played a critical role in prevention by promoting the emotional well-being of students, families and school personnel. School and health center staffers meet twice a month via Zoom to check in and brainstorm ways to address emerging health and wellness concerns of staff members and families.

Getting Kids the Right Help at the Right Time

The goal of the new health center is to provide kids with care as soon as symptoms emerge.

The center is staffed by a child psychiatrist, a mental health counselor and a medical assistant. It’s located next to a pediatrician’s office and within a few miles of the school districts it serves.

When a child first arrives, the child is evaluated to determine whether they need to be hospitalized.

“Most kids don’t need that,” said Dr. Vera Feuer, Northwell Health’s associate vice president for school-based mental health, who helped create the center and now oversees it. “Most kids need outpatient care.”

And the center starts that care right away — medication and/or therapy, depending on what each child needs — to stabilize the child and prevent worsening of symptoms, and connect them to ongoing care with a provider in the community.

In January 2021, a local resident, Tara, found herself calling the health center to make an appointment for her 17-year-old sister, who had been struggling with irregular sleep patterns and panic attacks for months.

Tara had recently become her sister’s legal guardian. KHN is not using their last names and only using the sister’s middle name — Jasmine — to protect their privacy.

Jasmine said she felt suffocated during her panic attacks.

“It felt like I was running, like my heart got really fast, and like I was being put in a little tiny box,” she said.

Jasmine and Tara met with a mental health counselor at the behavioral health center. The follow-up sessions were helpful for Jasmine, who learned about the importance of speaking with a trusted friend or adult any time she felt triggered. And the clinic helped Jasmine get connected with a nearby psychologist whom she now sees for weekly therapy sessions, Tara said.

Removing Barriers for the Most Vulnerable

The new health center provides an important safety net for kids who might otherwise fall through the cracks, like 17-year-old Alyssa Gibaldi, who was refused care by other mental health providers because of a disability.

Alyssa attends Oceanside High School and is extremely social, said her mother, Jennifer.

“She’s like the mayor of the school; everybody knows her,” Jennifer said.

Alyssa has Down syndrome and the pandemic upped her anxiety. Last fall, she became catatonic and went into what Jennifer describes as a “zombie-like state.”

“She couldn’t talk. She couldn’t move. She couldn’t speak. She couldn’t feed herself,” Jennifer said.

On several occasions, Jennifer called 911. Alyssa was transported in an ambulance to the ER and hospitalized. After her neurologists ruled out seizures and other conditions, they suggested Alyssa see a psychiatrist.

But Jennifer said Alyssa was turned down repeatedly by providers saying they didn’t take her insurance or that they didn’t work with kids with disabilities.

That’s when Jennifer reached out to the school nurse, who referred the family to the new behavioral health center. The center’s child psychiatrist, Dr. Zoya Popivker, reviewed Alyssa’s medical records and prescribed medications for depression and anxiety.

Jennifer said they got the meds on a Saturday morning, “and by Saturday night, she was out of the catatonic state. Ever since then, she’s been coming back to us, like her personality came back.”

Alyssa continued to go to the behavioral health center for several months, until they were able to transition to a psychiatrist who works with kids with disabilities.

The Case for School-Hospital Partnerships

It makes sense for children’s hospitals to partner with schools because that’s where kids spend most of their day, said Ramtekkar, the psychiatrist at Nationwide Children’s Hospital.

School staffers often know their students well and can spot early signs. It’s why schools have been working to forge partnerships with nearby mental health care providers.

But such partnerships still depend on mental health care resources in the communities they serve. A found 70% of counties didn’t have a single practicing child psychiatrist.

Leahy, the assistant superintendent at Rockville Centre in Long Island, said sharing a behavioral health center across multiple school districts leads both to better collaboration and cost savings. The price her district pays for the services is less than the cost of one full-time staff member, and the state chips in to cover part of that.

Cohen Children’s will add a new behavioral health center this summer, expanding to 14 school districts. At that point, about 60,000 students in Long Island will have access to immediate mental health support should they need it.

This story is part of a reporting partnership that includes , and KHN. Nationwide Children’s Hospital, mentioned in this story, is a financial supporter of NPR.

If you or someone you know may be considering suicide, contact the at 1-800-273-8255 (en español: 1-888-628-9454; deaf and hard of hearing: dial 711, then 1-800-273-8255) or the by texting HOME to 741741.

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When someone dies while pregnant or within a year of childbirth in Illinois, that’s considered a maternal death.ÌýÌýis a maternal health researcher at the University of Illinois at Urbana-Champaign who serves on aÌýÌýthat’s trying to figure out what’s killing these mothers.

The group’sÌýÌýfound that about 75 women in Illinois die from pregnancy-related causes each year. Consistent with national trends, Black women are at greater risk than white women, and most of the deaths were preventable.

“It’s cause for alarm,” Tabb Dina said. “Our country is in a crisis in terms of unnecessary maternal deaths.”

In recent years, Illinois’ Maternal Mortality Review Committee has urged policy changes that would remove barriers to health care for pregnant and postpartum women. At the top of the list: Make sure low-income moms don’t lose Medicaid coverage after a baby is born. Some women lose coverage as soon as two months after giving birth.

In April, Illinois becameÌýÌýto be approved by the U.S. Department of Health and Human Services to extend Medicaid up to a full year after a pregnancy.

“This is tremendous,” Tabb Dina said. “One of the greatest risk factors for maternal deaths is lack of access to care: not being able to access the right providers and to be seen in a timely manner.”

Medicaid, the state and federal program mainly for low-income Americans, covers people with higher — but most states kick these women off the rolls 60 days after they give birth. As a result,ÌýÌýof women who’ve recently had a baby end up uninsured each year.

“Disruptions in Medicaid coverage results in higher costs and worse health outcomes,” HHS Secretary Xavier Becerra said in a press briefing in April, citing a federal report on the consequences of . “More than half of pregnant women in Medicaid experienced a coverage gap in the first six months of postpartum care.”

With the extension of Medicaid under the Affordable Care Act, mothers in Illinois with incomes up to about double the federal poverty level can keep their coverage for a year postpartum. Several other states — including New Jersey, Georgia and Virginia — areÌý.

Although the $1.9 trillion American Rescue Plan was passed to stimulate the economy amid the covid-19 pandemic, it also contains a less-noticed provision addressing the postpartum coverage. For the 12 states that never expanded Medicaid under the ACA, the law providesÌýÌýfor them to make Medicaid available to adults with incomes up to 138% of the federal poverty level ($12,880 for an individual, $21,960 for a family of three).

In addition, the stimulus package offers all statesÌýÌýfor extending postpartum Medicaid coverage beyond the 138% income limit. Starting in April 2022, states can file a state plan amendment to their Medicaid program — a process that hasÌýÌýto federal approval than the traditional route of applying for a federal waiver.

Maternal health experts say extending Medicaid coverage to a full year postpartum makes sense because pregnancy-related complications — physical and mental — aren’t limited to the first few months.

“Many [postpartum] health issues and health problems extend beyond the 60-day period that Medicaid is currently covering,” said Dr. Rachel Bervell, an obstetrician in Seattle and co-founder of theÌý, which aims to raise awareness about racial injustices in maternal health care.

A Ìýbased on data from nine states found nearly 20% of pregnancy-associated deaths happen between 43 days and one year postpartum.

Bervell clearly recalls learning about that statistic. “It was just so jarring,” she said. “It makes you worried about the 1 in 5 individuals we may be missing.”

Medicaid is theÌýÌýfor maternity care in the United States. Black women are overrepresented in the Medicaid population and are also overrepresented among those who get kicked off their plan after 60 days.

Chronic diseases — like diabetes and hypertension — areÌýÌýand less well-controlled among Black women, putting them at higher risk of pregnancy-related complications.

There are alsoÌýÌýto health care, such as inadequate housing, transportation and child care. Many of these barriers stem from racist and discriminatory policies,Ìý, linked to worse health outcomes. Black mothers are also more likely to beÌýÌýfor postpartum pain.

Racial disparities in maternal health outcomes are caused by racism, not race. So the problem can’t be solved, Bervell said, without addressing systemic racism in medicine and the broader society.

U.S. Rep. Robin Kelly (D-Ill.) said the racial disparities are unacceptable. She championed the state’s Medicaid change and is working onÌýÌýto improve maternal health data collection and establish national obstetric emergency protocols.

“When you look at educated Black women with money, they still die more than less-educated, less-wealthy white women,” she said.

Kelly said she first became aware of the issue several years ago, when she met the family ofÌý, a Black mother who died after the birth of her second child from obstetrical bleeding — one of the most common causes of maternal death in the U.S.

“I’ll never forget, her [older] son walked in and saw a picture of his mother on the screen. And he said, ‘There’s Mommy.’ And that just got to me,” Kelly said. “What a heartbreak.”

As the rate of maternal deaths in the U.S. has ticked upward, so has the incidence of “severe maternal morbidity,” according to the CDC. Each year, an estimatedÌýÌýexperience dangerous, even life-threatening health complications.

Jessica Davenport-Williams, a mother in Chicago, said that, after giving birth the first time, she hemorrhaged severely and had to receive blood transfusions. She was pregnant with her second daughter around the time Serena Williams and Beyoncé wereÌýÌýbecause of their own serious childbirth complications.

So she advocated for herself before her next delivery.

“I wanted to make sure that every physician was well aware of my history, that they documented information in my file that would be transferred to the hospital. And I was met with resistance,” she said. “They didn’t feel that it was necessary. I had to push for several appointments for that to happen.”

After her second daughter was born via cesarean section, Davenport-Williams hemorrhaged again.

“It became an emergency situation,” she said. “It just reminded me that I could have been one of those cases … that I [almost] didn’t make it.”

Davenport-Williams said her experience compelled her to become anÌý.

“I don’t know if I will see the change for myself, in my lifetime,” she said. “But I definitely don’t want my daughters to have the same story or experiences that many before them have had.”

While extending Medicaid coverage is an important first step, efforts to prevent maternal death can’t stop there, Tabb Dina said.

Health care providers need to be educated about racial inequities in medicine, she said. Screening all pregnant and postpartum women for mental illness and making sure they get treatment will also help save lives.

And more patients with experience need a seat at the table in policy discussions, she said.

“We need to understand the real lived stories of our ‘near misses,'” Tabb Dina said. “What were their barriers? What were their complications?”

And then ask: What more needs to change so no child has to grow up without a mother whose death could have been prevented?

This story comes from a reporting partnership with Ìý, Ìý²¹²Ô»åÌý.

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“I will be the first person ever to have every single person in the world as my friend,” he said on a recent Zoom call, his sandy-brown hair hanging down to his shoulder blades. From Kai, this kind of proclamation doesn’t feel like bragging, more like exuberant kindness.

But when Kai’s school recently invited him back, he refused. That’s because his worry list is long, topped by his fear of getting covid-19 and giving it to his 2-year-old sister, Alaina. She was born with a heart condition, Down syndrome and a fragile immune system. To her, the disease poses a mortal threat, and he is her protector, the only one who can make her giggle breathlessly.

Kai also worries about being separated from his mom, Rashida Humphrey-Wall. His biological father died in 2014, and she remains his rock, his mama bear and occasional taekwondo partner. He sometimes visits her bedside, in the middle of the night, just to check on her.

This pandemic has been stressful for millions of children like Kai. Some have lost a loved one to covid, and many families have lost jobs, their homes and even reliable access to food. If that stress isn’t buffered by caring adults, it can have lifelong consequences.

“Kids have had extended exposure to chaos, crisis and uncertainty,” said Dr. Matt Biel, a child psychiatrist at MedStar Georgetown University Hospital.

But there’s some good news for kids like Kai: Educators across the country say their top priority right now isn’t doubling down on math or reading — it’s helping students manage pandemic-driven stress.

“If kids don’t return to school and get a lot of attention paid to security, safety, predictability and reestablishing of strong, secure relationships, [they] are not gonna be able to make up ground academically,” Biel said.

Promoting Mental Wellness in the Classroom

To reestablish relationships in the classroom — and help kids cope with the stress and trauma of the past year — mental health experts say educators can start by building in time every day, for every student, in every classroom to share their feelings and learn the basics of naming and managing their emotions. Think morning circle time or, for older students, homeroom.

At Irene C. Hernandez Middle School in Chicago, teacher Lilian Sackett starts off each day by checking in with students, then diving into a short lesson on mindfulness and other social-emotional skills.

The school is in a predominantly Latino area that was hit hard by the pandemic, Sackett said. She teaches English as a second language, and she learned that many of her students’ families were dealing with a lot of stress related to job losses and illness — that’s on top of any trauma that may haveÌýpredatedÌýthe pandemic.

“We need to allow the students to share their experiences with the pandemic and to give them that safe space [to] talk about it,” Sackett said.

What’s more, she said, children can benefit a lot from just a few minutes each day of classwideÌýcalm. When she found out her students love Bob Ross and hisÌýÌýfrom the 1980s and ’90s, Sackett decided to work him into their morning routine.

“We watch five minutes of Bob Ross, and we watch the whole painting session within one week,” she explained. “When they’re having fun, they’re so excited — they’ll learn anything you throw at them.”

Sackett said her approach was informed by aÌý, provided by Chicago’s Ann & Robert H. Lurie Children’s Hospital, that focused on the impacts of trauma on children.

“They mentioned a bad grade is never about a lazy kid,” she said. If a child is struggling academically, they may be dealing with really tough circumstances at home. Sackett learned that teachers can help by creating a supportive environment that fosters resilience.

Sheyla Ramirez, an eighth grader at Sackett’s school, has benefited a lot from daily check-ins with her teacher. Last fall, her family came down with covid, and her baby sister ended up hospitalized before she recovered. Sheyla’s uncle had died after testing positive for the virus months earlier. She said it was a really stressful time, especially for her sister in third grade.

“My sister was like, ‘Oh, I don’t want to die,'” Sheyla remembered. “I didn’t know what to tell her because I was in shock, too.”

School staff members routinely checked in to see if she or her family needed anything, and they offered to connect Sheyla with a school counselor. But Sheyla said the short daily lessons in mindfulness at the start of each school day — and being able to share her feelings and concerns with her teacher — were enough to help her get through.

“They’ve been doing an excellent job,” said Sheyla’s mom, Amparo Ramirez. “I’ve been telling them, ‘I’m thankful for you being here.'”

When More Serious Help Is Needed

For many kids, a little morning circle time with a caring teacher, or an occasional chat with a school counselor is all they need. And the more schools invest in promoting mental health and equipping children with social-emotional skills, the fewer children will go on to develop more serious problems, said child psychiatrist Biel.

But there will always be children who need more intensive interventions, which could involve school social workers and psychologists, when available, or a referral to a mental health professional beyond the school.

Kai has been talking regularly with a therapist through his elementary school. And he said she has helped him come up with strategies to manage his stress at home.

“I would go in my room, lay on my bed, and either watch TV or play with my toys or do something like that,” Kai said. “And then I’ll come back out when I’m more calm and happy.”

As a solo parent, Kai’s mom, Humphrey-Wall, has also had a tough year. She admitted that looking after two kids, in addition to taking on a new job, during a pandemic has been stressful. “In the beginning, I think I had depression, anxiety … anything you can think of, I probably had it.”

Biel said that kind of stress can trickle down to children.

“All of the best evidence-based practices in the world are not going to have the desired effect if that child is living in a family that’s overwhelmed by stress,” he explained.

One of the best ways to address that is to also help caregivers, like Humphrey-Wall. And that’s exactly what Kai’s school has done. Through a partnership withÌý, Kai’s school arranged for Humphrey-Wall to meet with a clinical psychologist once a week for what they call “parent wellbeing sessions.”

Without it, she said, “I don’t know what I would have done, really.”

Partnerships between schools and mental health care providers can be expensive for districts and may not be an option in rural or under-resourced areas where there simply aren’t enough child-focused services.

Biel said he’s hopeful the rise in telehealth will help. But whatever the solution, he said, schools need support as they explore their options.

“Schools can’t beg, borrow and steal from what they already have to do this,” Biel said. “We need to support schools and school systems with more resources to make this possible.”

Federal Help for Schools

For districts that want to do more,ÌýÌýcould be a big help. The American Rescue Plan contains roughly $122 billion for K-12 schools, some of which can be used to hire more counselors, social workers and psychologists. And one U.S. senator has been pushing the Biden administration to emphasize mental health as it guides districts on how to spend that money.

“Not all schools and districts are equipped to work on these complex mental and behavioral health issues and meet the unique needs of today’s students,” Sen. Catherine Cortez MastoÌýÌýto the secretaries of the U.S. Departments of Education and Health and Human Services. “Many suffer from drastic shortages of counselors, social workers, and psychologists to work with students even under normal circumstances. They will need robust assistance from community-based service providers and the health care community.”

Cortez Masto said a recent spate ofÌý, Nevada, underscores just how urgent the needs are.

“This is a unique situation we’re in, hopefully a once-in-a-lifetime pandemic,” she said. “We don’t know the impact it’s going to have long term [on] our kids. But we know the short term. I’ve seen it here in southern Nevada and its devastating consequence here. So we’ve got to change that dynamic.”

In the U.S., where access to health care — especially for children’s mental health — is inequitable and inconsistent, the difficult work of identifying and tending to the mental and emotional health of this pandemic generation will fall largely on the shoulders of educators.

Programs like the one at Kai’s school, in Washington, D.C., could play a critical role in helping change that dynamic. Cortez Masto hopes the flood of federal relief dollars will help other districts create similar partnerships with child mental health providers, or find other solutions.

In the meantime, Kai and his mom are trying to figure out when Kai will return to in-person school. Humphrey-Wall said it would be good for her son to get out of the house, but Kai still fears bringing covid home. He’s talking it through with his school-based therapist, doing his best to give those worries a roundhouse kick:

“We all need to be free from this quarantine. I’m going crazy. I want to be free!” Kai shouted. He’s eager to get back to the business of making friends with the entire world.

If you or someone you know may be considering suicide, contact theÌýÌýat 1-800-273-8255 (en español: 1-888-628-9454; deaf and hard of hearing: dial 711, then 1-800-273-8255) or theÌýÌýby texting HOME to 741741.

This story is part of a reporting partnership that includes NPR, Illinois Public Media and Kaiser Health News.

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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Being an agricultural worker “is the most beautiful thing,” Saraí said in an interview in Spanish.

She moved to the U.S. from Mexico to find work that would allow her to better support her family. KHN agreed to identify Saraí by only her first name because she’s undocumented. Since the onset of the pandemic, she’s spent most of her time shepherding her three kids through their virtual school classes.

There have been tens of thousands of covid-19 cases and hundreds of deaths reported among U.S. farmworkers and meat plant workers. Because no official tracking system is in place, — based largely on media reports — are likely an undercount.

And yet, agricultural workers like Saraí struggle to access the most basic tool to fight the spread of the coronavirus: testing. Saraí, for example, has been tested only once since the start of the pandemic. The nearest testing site is the next town over, and without a car or a public transportation option, she had to borrow a friend’s vehicle to get there. She hasn’t gotten covid, but Saraí knows many others who’ve gotten sick. She said the pandemic has made the past year a sad and difficult one.

“Many farmworkers are both working and living in sometimes isolated rural regions of the country,” said , executive director of the California-based United Farm Workers Foundation.

Besides living far from testing sites, these workers often lack reliable information in their native language and have a of the health care system. And missing work to get a test, or to isolate or quarantine, could be financially devastating.

While the rollout of the coronavirus vaccines provides some hope for a better future, the virus is still spreading across the U.S., and efforts to expand access to testing and build trust with farmworkers are still needed, Tellefson Torres said.

She said these efforts will also be critical for ensuring that these hard-to-reach, vulnerable populations are vaccinated when the time comes.

Leverage Long-Standing Community Connections

Early on in the pandemic, , an anthropologist at the University of Illinois at Urbana-Champaign, was struck by how easy it was for him — a work-from-home professor — to get a test, compared with workers in nearby towns who were more vulnerable to catching the virus and developing a severe case of covid.

The university has its own for students and employees. The Urbana-Champaign campus is just 15 miles south of Rantoul, where virus outbreaks at a meat processing plant and a hotel housing migrant farmworkers were in Champaign County last year.

“We can walk down two flights of stairs, go out the back door and we can get testing,” Rosas said. “Whereas these people who are at the forefront — who work in the fields, who work in the plants — they lack that kind of access.”

Rosas is part of a team at that had set out to study what was causing the virus to spread in the agricultural community. They also decided to do something to address testing access.

“We want to both unearth inequalities, but also mitigate them,” Rosas said.

The researchers teamed up with medical professionals from clinics in the area to organize pop-up coronavirus testing events in Rantoul.

The events are advertised in English and Spanish. The group has tried to leverage long-standing community connections to bolster turnout, reaching out to churches and organizations that cater to the area’s immigrant and agricultural workforce.

Even with that outreach, they’ve been frustrated by low attendance. At an event held before Christmas outside a community center, for example, only 15 people came for a test. Four of those 15 tested positive — a very high rate.

Structural Barriers: Financial and Immigration Worries

Sofia Bolanos Robinette suspects the reason more people don’t turn out for coronavirus testing, even at convenient times and locations, is that a positive result can be financially devastating.

Bolanos Robinette has worked with farmworkers for the past 10 years, most recently as an advocate for students in the Illinois . She recently joined Rosas and the other University of Illinois anthropologists to study issues like barriers to testing.

She recalls helping last summer with a coronavirus testing effort aimed at farmworkers who travel to the region for seasonal work. tried to make it as easy as possible for the workers to attend by setting up a station during off-hours right outside the migrant housing area.

“But some of them said they didn’t even want to take the test, because, in the case they get back [a positive result], they will have to stop working,” Bolanos Robinette said. “And then that means, for them, they will not get any money for at least two weeks.”

That’s a big deal, she said, especially for farmworkers, who earn the bulk of their yearly income doing this seasonal work.

For low-wage farmworkers, “every penny counts,” said Tellefson Torres of the UFW Foundation. In the National Agricultural Workers Survey, one-third of farmworkers reported family incomes below the poverty line.

And they don’t have the same safety net that documented workers in the U.S. have.

“When you have to worry about putting food on your own table for your family, sometimes that is the focus, because there isn’t another option,” Tellefson Torres said.

For undocumented workers, she said, there are even more disincentives to get tested. They may worry it could jeopardize their efforts to obtain a visa — a common misperception. And after years of the Trump administration being more aggressive with immigration enforcement, Tellefson Torres said, there’s a huge lack of trust and a real fear of deportation.

Despite lower-than-ideal turnout at the pop-up events, University of Illinois anthropologist said attempts to host “a few small-scale testing events, irregularly scheduled and located in different sites” have made a difference for handfuls of people who might not otherwise have known they had the virus.

However, Moodie said, the U.S. needs a comprehensive strategy to address the virus and protect vulnerable workers. have been calling for such a strategy since the start of the pandemic.

So far, President Joe Biden has made that a priority of his administration. In published in January, Biden outlined a covid strategy focused on boosting the production and distribution of vaccines. His plan includes efforts to address supply shortfalls for testing materials, implement stronger worker safety guidelines, expand emergency paid leave and otherwise strengthen the social service safety net.

Vaccine Implications: Mistrust Breeds Skepticism

Building trust with farmworkers remains critical, Tellefson Torres said, not just to get more to show up for testing — but also to get them to show up for vaccination as soon as they are eligible.

At a recent virtual town hall hosted by the UFW Foundation, Tellefson Torres said she has heard from many farmworkers across the U.S. who are eager to get a vaccine. But others have reservations.

The biggest concern she’s heard has been about the potential cost, especially for the many workers who lack health insurance. Tellefson Torres said her organization is working to get the word out that covid for everyone.

Others, she said, worry about vaccine safety, asking questions like: “What is this vaccine? What does it contain? … What are you putting in my body?”

Vaccine safety is something Saraí — the farmworker in Illinois — worries about too. After finding some information online, she grew concerned about the possibility of adverse reactions, so, at least for now, she isn’t planning to be vaccinated.

However, Saraí said, if someone she trusts shows her evidence the vaccines are safe, she could change her mind.

In Illinois, food and agriculture workers are now eligible for the vaccines. Public health administrator Julie Pryde said the Champaign-Urbana Public Health District — which serves Champaign County, including Rantoul — plans to work with a federally supported migrant clinic to host mobile vaccination events targeting migrant and seasonal farmworkers.

Tellefson Torres said partnerships like that will be critical to ensure that agricultural workers, who have faced throughout the pandemic, have equitable access to the vaccines — their best hope of staying healthy.

“The norms that we have seen prior to the pandemic — of not prioritizing worker health or just basic safety-net needs — need to be addressed both by state, local, federal governments and employers,” she said. “We’re literally talking about a life-and-death situation here.”

This story was reported in collaboration with Side Effects Public Media, Harvest Public Media and the Midwest Center for Investigative Reporting — and is part of a reporting partnership that includes , and KHN.

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).