“I have some more,” Carey says to the 2 1/2 year old, picking up another ring. “Should we put it on? I’m gonna do it with you.” 

She takes Ryin’s hand and presses a finger to the tablet so a recorded voice says “More,” before adding the second ring to the cone. 

“More!” Carey calls out. “I got more. Yay!”

This activity is more than just a game. Ryin has autism and is nonverbal, so he also receives behavioral therapy. His attention often drifts as he and Carey interact.

But the tablet, once Ryin can use it himself, is a tool that may unlock his ability to communicate and learn when he starts preschool in the fall. It might even help him eventually speak.

“Right now it’s still pretty early on,” said his mother Deanna Szente, a delivery driver from Avon Lake, Ohio. “Because he’s two and a half, we’re having high hopes, but they are preparing him… if he does not.” 

Ryin’s therapies, tablet and the TouchChat program are all funded by Medicaid — and examples of how the government program, a major source of health care for low-income families, also supports children’s ability to learn and do well in school. 

Medicaid also covers such school-related items as eyeglasses, hearing aids, and microphones for teachers to use to communicate with children with hearing difficulties. 

Other devices and care, such as inhalers for asthma and dental coverage provided by Medicaid help make sure kids don’t miss school and hurting kids academically.

But Medicaid faces massive cuts starting in 2027 as part of President Donald Trump’s “Big Beautiful Bill.” Cuts to Medicaid and to the accompanying Children’s Health Insurance Program (CHIP) will likely total about a trillion dollars over the next 10 years, according to estimates.

Backers of Trump’s bill say it is much-needed welfare reform that will keep people on Medicaid who really need it, while kicking off those that don’t and can work to have insurance.They also stress that students with disabilities like Ryin are not targets of the cuts.

But how the cuts will affect Ryin and other young children is still unclear: The impact will vary by state, since each has its own version of Medicaid, with different rules for eligibility and benefits, and each state contributing different amounts of money. that a family of four qualifies in some states earning less than $45,300 a year, while other states allow annual income of more than $96,000.

As Medicaid dollars shrink and as rules shift and grow more complicated, child advocates worry students like Ryin are more likely to slip through the cracks and miss out on interventions that are crucial to their ability to learn. They also worry the Trump administration’s removal of some backstops that keep kids on Medicaid even as parents bounce on and off it create additional danger for children. 

All of which filters down to how well kids can do in the classroom.

“If the cuts are coming and if kids lose services, it can be very impactful on their learning,“ said Patricia Endley, president of the National Association of School Nurses.

Georgetown University’s Center for Children and Families researchers also raised concerns about students losing coverage and medical care that helps them in school. The center pointed to multiple studies showing or even if that reduces family stress and frees up income.

Other studies show students covered by Medicaid have higher graduation rates and adult earnings than those that go without health coverage, .

Elisabeth Burak, senior fellow at the Georgetown center, worries that as rules change and grow more confusing, parents might not enroll their children or let coverage expire.

“We know that a lot of these kids will roll on and off of coverage,” Burak said.

“They might have been enrolled for a little bit of time at some point during the year, but they dropped off because the mail didn’t reach them, or there was paperwork that their parents didn’t know about, or maybe their parent might have lost coverage and that somehow the renewal paperwork didn’t get to them,” she said.

Beyond just the common-sense idea that healthier kids do better in school or life, researchers and advocates identified several tangible ways student learning could be hurt if students lose coverage:

• Kids might miss out on early screening that catches disabilities before reaching school age. While Ryin might keep Medicaid because of his disability, being eligible for Medicaid allowed him to get checkups that identified his autism and allowed him to start treatment before preschool. 

Though school district preschools can catch students’ disabilities, church-based or private preschools might not. Parents may need private therapy for their children.

“We have a lot of preschoolers… who attend community preschool or no preschool, and who come to our place for help,” said Carey, Ryin’s speech therapist. “Parents notice something’s not clicking…and they come here.”

• Children might have to wait until school for vision tests and might not ever afford eyeglasses. In addition, students may not have hearing aids to absorb words and language patterns.

“They’re going to have difficulty learning those important speech sounds and strategies to be able to follow classroom conversations,” said Caroline Bergner, director of health care policy for Medicaid for the American Speech-Language-Hearing Association.  

•  Children may not have inhalers so they can deal with asthma in the classroom. Researchers have found asthma to be a – nearly 13 million school days a year nationally — and of students having to repeat grades.

That’s all on top of family disruptions and stress if kids keep Medicaid but parents lose it under the new rules.

Endsley also worries about students struggling if they lose dental care.

“You might say, ‘well, what does your teeth have to do with learning?’ ” she said. “Well, if you have an impacted tooth, or if you’re having tooth pain, you absolutely cannot learn… if you’re sick or if you have a chronic disease… Having access to daily medications keeps kids in school. It really is all interconnected.”

Defenders of the bill say opponents are being overly dramatic, noting that benefits for disabled children are not being directly cut. Well-publicized requirements that adults work in order to keep coverage don’t apply to parents since they don’t kick in until children turn 19. And they say the cuts make Medicaid sustainable by trimming people that don’t need it.

Others, including Cato Institute researcher Michael Cannon, argue that

“When Republicans propose that Medicaid grow at 3% annually instead of 4.5%, Democrats suddenly act like cutting waste means everyone will die,” he wrote.

Even child care advocates worried about the plan can’t say which children would lose coverage or how many and when.

They instead see risks in the confusion of shifting rules that states – and parents – will have to watch carefully.

A big reason is that Medicaid eligibility isn’t the same for children and adults, so children can still keep coverage even if parents start earning more money and lose their coverage. Parents may not realize that and let their children’s coverage lapse.

Endsley, who worked as a school nurse in Maine, said parents often don’t know how to apply for Medicaid for their kids.

“They’ll say, ‘Well, yeah, I just can’t figure it out’,” she said. “So sometimes a school nurse will help them navigate through the process, or refer them to an insurance navigator. I’ve even made a home visit to help a parent who didn’t have a computer work out the forms.“

“The whole system application process can be complicated, and what I see is kids slipping through the cracks,” she said.

There are some existing safety nets to prevent kids bouncing on and off coverage: Children keep coverage for a full year each time their eligibility is approved. Eight states — Colorado, Minnesota, New Mexico, New York, North Carolina, Oregon, Pennsylvania and Washington — went further the last few years and extended that “continuous coverage” for young children until they turn 3 or 6 to create more stability.

But the Trump administration announced July 17 it would no longer let states extend coverage beyond a year.

Bruak called that decision a “kicker” on top of the cuts.

“That could really impact the stability of family and kids coverage,” she said.

Meanwhile, Szente is talking regularly with child care advocates to stay on top of changes so she can do what it takes to keep all three of her children covered.

“I’m terrified,” Szente said. “I’m scared for when my son gets older, what we’re going to have to do to be able to make sure that he can go see a doctor. And I’m scared for my older two, if I’m still going to be able to provide Medicaid for them.”

of those infected so far are vaccinated. The remaining patients are either unvaccinated or their vaccine status is unknown. 

Robert F. Kennedy Jr., the newly confirmed head of the U.S. Department of Health and Human Services, has a long history of around vaccines, including the one for measles. He recently put vaccine advisory meetings — where a panel of experts establish a vaccine schedule used to inform state policies — on indefinite and wields power over how organizations within HHS, such as the Centers for Disease Control and Prevention, respond to such crises. 

Earlier this month, his anti-vaccine organization, Children’s Health Defense, put out a blaming the Texas outbreak on the vaccines themselves, arguing, “The real issue is not a failure to vaccinate but a failing vaccine.”

“As measles outbreaks continue to surface, the mainstream media is now using them as a political weapon, attempting to blame … Secretary Robert F. Kennedy Jr. for so-called ‘anti-vaccine rhetoric,’” the statement read. “His warnings about vaccine-induced injuries and failures are validated by the very outbreaks being reported today.”

Rekha Lakshmanan, chief strategy officer at The Immunization Partnership, a Texas-based education advocacy organization that promotes childhood and adult immunization, said she is “just absolutely flabbergasted that there is intentionality to put blame on the vaccine when that is not where anybody should be spending their time or their effort. Our effort should be supporting families, making sure they’ve got the right information and supporting helping our public sector partners so we can try to get to the end of this crisis sooner rather than later.”

“CDC is aware of the death of one child in Texas from measles, and our thoughts are with the family,” Andrew Nixon, director of communications at HHS, wrote in a statement to ����Ӱ��. “CDC continues to provide technical assistance, laboratory support, and vaccines as needed to the Texas Department of State Health Services and New Mexico Department of Health, which are leading the response to this outbreak.”

There are now also at least nine reported cases in neighboring  

Kennedy that he’s following updates on the outbreak, which he noted was mainly in the Mennonite community. Despite the confirmed death of a child, Kennedy appeared to downplay the spread, saying, “It’s not unusual. We have measles outbreaks every year.”

Measles were declared eliminated in the United States in but there’s been a resurgence of cases as vaccination rates have dropped.

Mary Koslap-Petraco, a pediatric nurse practitioner who treats underserved children in New York state, said that when she heard about the child’s death Wednesday morning, “Quite frankly, I broke down in tears. This was [99%] preventable.”  

She placed much of the onus on the anti-vaccination movement, saying they planted “seeds of distrust” that ultimately scared parents.

“I know this family only wanted the best for this child,” she said, “and I’m really sorry that they weren’t able to encounter someone who could help them through this misinformation that they’re hearing to feel comfortable enough to vaccinate their child.”

‘Primed for something like this to happen’ 

Measles is a highly contagious which can be serious and sometimes fatal in children. If one person has it, up to 9 out of 10 people nearby will become infected if they , though spread is preventable through the measles, mumps and rubella vaccine, which is safe and about . The infection is often marked by a high fever, sore throat and rash; more severe complications can include pneumonia and swelling of the brain.

In a statement Wednesday, the Texas Department of State Health Services said the best way to prevent measles is through the vaccine. The department  it was “working with local health departments to investigate cases, provide immunizations where needed, and keep the public informed.”

Texas is one of 18 states that allow school-aged children to of vaccine requirements for medical, religious or “personal belief” reasons.

The majority of measles cases so far are in Gaines County, a small, rural county in West Texas, with one of the state’s highest vaccine exemptions rates: up from just over 4% a decade ago. And the actual number of unvaccinated kids in the county is likely significantly higher, because there’s no data for the many children who are homeschooled, according to reporting from the

Some of the initial cases appeared to be connected to . 

To be exempted for “reasons of conscience,” a parent or legal guardian has to submit a form to the school. Under certain circumstances — like an official emergency or epidemic — these students might not be allowed to go to school.

None of the four public school districts serving Gaines County immediately responded to a request for comment. The county’s small Loop Independent School District of K-12 students had a conscientious exemption for immunizations in 2023-24. The statewide vaccine exemption rate is 2%.

“We know based on a ton of research that these kinds of exemptions cluster,” Lakshmanan said. “They cluster geographically, they cluster in schools, they cluster in neighborhoods, they cluster in faith-based communities. Sadly we are seeing the practical reality of this type of loophole … when we start to see high exemption rates, we are bound and we are primed for something like this to happen.”

Kindergarten measles vaccination rates in Texas generally have fallen to below 95% since the pandemic, though they still remain just above national averages, according to a recent data analysis from  

A number of Texas parents who previously had not vaccinated their children are now changing course. “We’ve vaccinated multiple kids that have never been vaccinated before, some from families that didn’t believe in vaccines,” Katherine Wells, director of public health for Lubbock’s health department, told

Yet, as the outbreak spreads, Texas lawmakers are preparing to consider bills that would further loosen exemption requirements.

“Now is not the time to be playing a game of roulette with children’s lives or Texans’ lives and even contemplate making the exemption process easier,” Lakshmanan said.

Kate Gould said the classroom became a dangerous place for her son after took over the Douglas County school board and the district removed masking requirements.

After a prolonged back-and-forth, involving a pulmonologist and a special education attorney, district leaders finally agreed to an accommodation for his classroom, mandating masks. But mere weeks later, the superintendent was fired and, under new leadership, the district again removed the masking accommodation without consulting doctors or Gould, she told ����Ӱ�� in a recent interview. 

Now, almost four years later, Gould and her family live in Southern California — where they moved during the pandemic for its masking and eventual COVID vaccine requirements — and they and other parents, advocates and health experts are gearing up for what could be the next front of the school culture wars: a broader attack on school vaccine mandates by the incoming Trump administration.

Currently, all 50 states have vaccine requirements for children entering child care and schools. But with Robert F. Kennedy Jr. — who has peddled baseless conspiracy theories and “There’s no vaccine that is safe and effective” — potentially at the helm of the Department of Health and Human Services, advocates and parents are right to fear a rollback of requirements, enforcements and funding, according to interviews with about a dozen experts. 

“The anti-vax warriors have made it inside the castle walls,” said Richard Hughes, a George Washington University law professor who teaches a course on vaccine law.

Kennedy’s legitimization and the different levers he could pull, experts told ����Ӱ��, could have an immense impact on vaccination rates and the spread of preventable, contagious diseases in school-aged kids.

If confirmed by the Senate, Kennedy would take control of an agency with a budget and 90,000 employees spread across 13 agencies, including the and the . Dave Weldon, nominated by President-elect Donald Trump to head the CDC, has also endorsed debunked theories, and some chronic diseases.

Kennedy, whose nomination faces from health professionals and scientists and questioning by , did not respond to requests for comment. He has said he would not take away vaccines but look to make more of their safety and efficacy data available. 

“We don’t know what he’s going to do,” John Swartzberg, a professor at the University of California Berkeley’s School of Public Health told ����Ӱ��. “But if he tries to carry out the things that he’s publicly stated — not just recently but over a long, long time — then the implications for our children in school are dire.”

While most school vaccine requirements come from states, the recommendations they’re based on begin with federal agencies, such as the CDC, and enforcement is often left up to local districts. This leaves room for both federal influence and “a hodgepodge of enforcement,” said Northe Saunders, executive director of the pro-vaccine , who sees battles around school vaccination mandates playing out at the federal, state and school board levels.

Experts agreed the federal government is highly unlikely to attempt to take vaccines off the market or categorically ban mandates, and most don’t anticipate individual states will do away with their long-standing requirements.

But James Hodge, a public health law expert at Arizona State University’s Sandra Day O’Connor College of Law, pointed out, “You don’t actually have to pull the vaccine for people to stop using it. You have to raise doubts about it.”

That can happen by planting seeds of misinformation, he said, or by starting to require that vaccines be assessed differently for approval or federal funding. Any slight dropoff in parents vaccinating their kids entering schools or day care can result in disease outbreaks, an outcome Hodge said he expects to see over the next year or so. Such declines are

As secretary, Kennedy could delay FDA vaccine development and influence the selection of CDC advisory committee members who make the vaccine recommendations that states then use to determine their requirements. Programs that provide free vaccines for kids could also see their funding cut.

“There’s short-term threats in terms of funding and what’s going to be available for state immunization programs,” Saunders said, “[and then] there’s long-term threats about immunization policy and what the future of the immunization landscape in the country can hold.”

Even in Democratically controlled California, Gould, the mom whose son has cystic fibrosis, said she’s concerned about shifts in vaccine rhetoric, particularly at the school board level. 

“I think what I have learned from my experience in Douglas County, Colorado, is that when these individuals take over majorities on school boards, it really affects everyone … Despite the fact that we are a highly educated, very liberal, coastal section of Southern California, you definitely have people that are trying to make inroads — and these are people who are anti-science.”

Are vaccines the new critical race theory?

Parents across the country are able to apply for exemptions if their child is unable to get vaccinated for medical reasons. Most states also have religious exemptions, and 20 have some form of personal , leaving a varied landscape. 

School vaccine mandates have been around for , and while some pushback has always existed, it wasn’t until COVID that there was a real spike in vaccine hesitancy, according to Kate King, president of the and a school nurse in Ohio.

The source of the skepticism has shifted, too: “Rarely have we seen the federal government behind those debates in a way that this next administration could be,” said ASU’s Hodge.

Randi Weingarten, president of the American Federation of Teachers, sees the potential “unraveling of decades and generations of protective vaccines.”

“RFK believes he knows more than the totality of any science that has come before him,” she said. 

For a vaccine to get approved, it must first go through an advisory committee at the FDA. Another committee at the CDC then develops recommendations for vaccine schedules, which state legislators rely on to determine their school policies. Kennedy would have an enormous impact on who serves on these committees, and he could stack them with anti-vaccine advocates.

Kennedy could also request a review of all vaccines that have been previously approved by the FDA and subject them to new requirements. 

Many vaccines are paid for by the federal government. If Congress — under HHS’s direction or on their own — were to begin pulling that money, some of the most vulnerable children across the country could lose access to immunization. Trump has threatened to requiring vaccines for students. 

“The moment you start tacking on any price tag to a vaccination — any price tag whatsoever, even fairly minimal — you do see vaccination rates go down,” said Hodge.

Beyond policy actions, experts warned of the power of rhetoric. “We still rely — even under legal mandates that exist at the state level — on public acceptance of vaccines,” Hodge added, so for vaccine rates to remain high, so too must the public trust. The mere presence of a federal official who is skeptical and — at times outright hostile — towards vaccines gives the opposition more credibility.

Since the enforcement of these policies is typically left up to the district level, some advocates are anticipating increased pressure on school board members to take anti-vaccine positions. 

“The real tension is if a school board decides that they don’t want to support these [vaccine mandate] policies,” said Hughes, the GW law professor. “They can’t change the policies, but they might say, ‘We don’t support these policies. Not in our school district. No way, no how.’”

He said he’s already seen some groups use vaccines as a wedge issue, much like the debate over critical race theory — an academic framework used to examine systematic racism — that convulsed school boards a few years ago.

In , public health workers were recently forbidden from promoting COVID, flu and mpox — previously known as monkeypox — shots, according to a recent NPR investigation. And a regional public health department in Idaho is no longer providing COVID vaccines to residents in six counties after a by its board. 

There’s money in anti-vax anxiety

The anti-vaccination movement is not new. It can be traced back as far as the 18th century with Edward Jenner’s discovery of the smallpox vaccine. Because it was made from cowpox, people at the time were afraid that if they got the vaccine, they’d turn into a cow, said Swartzberg, the public health professor who has taught a course on the anti-vax movement for over a decade. 

“There’s always been opposition to vaccination because it’s the idea of the word inoculate, — meaning putting into you something foreign — and that scares people,” Swartzberg said. “I understand that. That’s where emotion has to be countered with data.” 

The group of people so stringently anti-vaccination that they refuse them is small but vocal, he said. Over the past few years, though, “something has dramatically changed in our society,” and the voices behind the movement have shifted from expressing personal fears to looking to monetize the fears of others. 

For example, Joseph Mercola, deemed one of the — the 12 people responsible for sharing the majority of anti-vax messaging on social media — made substantial sums of money by peddling far-fetched health claims and then as alternative treatments. Kennedy also appeared on the “Disinformation Dozen” list.

Others sell merchandise, books and tickets to events, offer exclusive paid content on platforms like Patreon, have sponsored content and display affiliate marketing links to anti-vaccine products.

“It’s turned into an incredibly lucrative field for anti-vaxxers, and what’s really facilitated this has been the internet and the lack of any monitoring of the internet for misinformation and disinformation,” Swartzberg said.

Just last week, Meta, the owner of Facebook, Instagram and WhatsApp, d that it will end its fact-checking program on social media posts. 

Using social media and other mechanisms, the anti-vax movement has targeted fairly insular groups around the United States with misinformation, he added. These include New York’s and the y in Minnesota, both of which have seen recent measles outbreaks. 

While the image of vaccine skeptical parents is often one of young, white “,” Keri Rodrigues, president of the National Parents Union, also pointed to “well-earned” trepidation among Black and Latino parents. 

Historically, she noted, significant harm has been done to Black communities through the weaponization of medical trials, and families of color have had particularly negative experiences with the health care system —

During the pandemic, Children’s Health Defense, Kennedy’s anti-vaccine advocacy organization, seemed to tap into this distrust when it put out targeting Black Americans with disproven vaccine claims. 

Gould, the California mom, said if she were still living in more conservative Douglas County she’d fear that people would “believe the disinformation [and] stop vaccinating their children. For kids with chronic illnesses — or like my son, a life-limiting illness — that has massive consequences. It has life-or-death consequences.”

In April 2020, just a few weeks into the pandemic, Dr. Mona Hanna-Attisha that said: “To expect resilience without justice is simply to indifferently accept the status quo.” With the imminent launch of , an ambitious program to eradicate child poverty in Flint, Michigan, the pediatrician aims to show the country and the world how to build a resilient community at a systems level. The program will scale up the promise of unconditional cash allowances as well as establishing new child care centers, expanding home visiting and partnering with groups like and .

Early Learning Nation magazine caught up with Hanna-Attisha, associate dean for public health in the MSU College of Human Medicine and director of the Michigan State University-Hurley Children’s Hospital Pediatric Public Health Initiative, to learn more about her new organization, her thinking and what drives her.

Transformative change is possible. Hanna-Attisha came to national prominence in 2015 by calling attention to the dangerous levels of lead in Flint’s drinking water. It was a long struggle, but she persisted and organized and eventually, she won over the skeptics and brought about reform. “We all would love to see overnight change,” she admits, “and it can get frustrating when that doesn’t happen, but in this work, it’s important to recognize the long game.”

After she testified before Congress on the dangers to children of the more than , Congress dedicatedin the 2022 National Infrastructure Act. As another example, she points to the that is now part of the U.S. Farm Bill. “If we can do it with water and nutrition,” she says, “we can do it with democracy and community building. It just takes a different way of looking at things.”

If things can change in Flint, they can change anywhere. Hanna-Attisha’s outspoken advocacy on the Flint water crisis prompted the Centers for Disease Prevention and Control to create the to monitor how residents are doing after the water crisis.

The emblem of the initiative is the Sankofa, the mythical African bird that’s flying forward but looking back and holding an egg in its mouth. “That’s what Flint is,” she says.  “We are determined not to be defined by the crisis, but rather to be defined by what we can do next.”

It’s not just about Flint. The city where and where, she says, the middle class was born, . The lead crisis was only the latest in a series of man-made disasters to befall Flint.

Hanna-Attisha describes Rx Kids as “a society-wide hug for an entire city.  We’re saying, ‘We see you, we hear you’.” And yet she maintains that the project goes beyond the residents of Flint and extends to reframing the narrative on poverty at a scale that hasn’t been tried before. “This is not about one city,” she contends. “It’s about shining a spotlight on how we could do better for all children.”

It’s not just about the cash, either. Inspired by the success of guaranteed income experiments like the and the Abundant Birth Project, Rx Kids will “prescribe” Flint families $7,500 in cash, including a one-time $1,500 payment to expectant mothers.

“It’s going to be coupled,” she says, “with arts and humanities and storytelling. And joy, as much as possible.” By running the program in a values-driven way, she aspires to rebuild the social contract and to have an impact on things like civic engagement, voting, crime, violence and trust in government.

Social entrepreneurship runs on trust. Top-down leadership has abused minority communities in Flint and around the world. That’s why everything Rx Kids does goes hand in hand with community. “We’re trying to do things in a way that restores self-determination and participatory democracy,” Hanna-Attisha says, citing a recent design retreat conducted with the participation of a mothers advisory panel. “They share their lived experiences of how hard it is to make ends meet, how hard it is to raise a family with limited resources,” she recalls.

She’s also building common cause with those she terms unlikely partners, including lawyers and CEOs. “When we break down silos,” she says, we find, ‘Oh my gosh, I had no idea this person cared about early childhood, about economic justice.’ When we make that tent bigger with partners who share our same passion, it allows us to advance this work.”

Immigrants make America healthy. Along with , Hanna-Attisha was born in another country. Her family, she notes, fled the dictatorship of Saddam Hussein’s Iraq. “We came for the American dream, and I grew up grateful every day, but also cognizant of what bad people in power can do to vulnerable populations,” she says.

Her 2017 New York Times editorial, “” excoriated President Trump’s ban on travel from Muslim countries to the United States. Needless to say, the Covid pandemic raised awareness of—and appreciation of—immigrants working in health care. In the process, she hopes that the country will rethink its immigration policies and attitudes toward immigrants.

Reading recharges. When the pediatrician/activist/author/entrepreneur needs to recharge her batteries, she reaches for a book. “Reading is my escape,” she says. “It’s my source of knowledge that I didn’t get in school, and it’s also how I am able to see and appreciate the world. Literature and the humanities help us develop our empathy. We can step into the shoes of others.”

The page on her personal website includes books on Michigan history, Arab-Americans, the environment and the Spanish Civil War, among other subjects. Recent favorites include Matthew Desmond’s and T.J. Klune’s (two very different titles).

Young patients still give her life meaning. Despite her growing responsibilities with Rx Kids, Hanna-Attisha still sees patients once a week. “My clinical time is joy,” she says. “Hanging out with kiddos is what grounds me. It gives me the drive to do the policy stuff and the population-level stuff.”

“We build relationships,” explains Rachel Campbell-Dotson, the organization’s executive director. Sometimes the relationship starts with someone coming in for a box of groceries, but Food Stamps don’t always last a full month, and after that visitor comes in two or three times for a grocery box, staff asks questions—not too nosy, just curious.

That first conversation might lead to a box of diapers or a car seat. It might lead to resume writing, life coaching or registration for public benefits. Inviting community members to volunteer is one of the Center’s strategies for engaging guests in job training programs. It starts with them feeling needed. They learn to use the iPad cash register at the thrift store, and then they have a job skill they didn’t have before. “People think there are no jobs,” Campbell-Dotson says, “but we have connections.”

The Dream Center collects and distributes used items. “Everything that you use, somebody can use,” Campbell-Dotson says. This past winter she obtained four twin beds for two boys and two girls in the care of their grandmother after her son had burned down her mobile home when he got out of jail. She also stocked their pantry, found them a couch and dresser and provided a Christmas tree with wrapped presents underneath.

“Serving this community is my love,” Campbell-Dotson says.

In places like Pike County, Kentucky, which has a population of about 60,000, the resources available for struggling families generally come from churches and hospitals. The Dream Center is a local affiliate of a , but Campbell-Dotson says her operation is mostly independent. , a Medicaid Managed Care company in the state, makes grants to support nutrition and other social determinants of health. A national $1.75 million investment made last year to is providing meals to kids and equipping families with food and nutrition education.

“We know that sufficient and nutritious food fuels the rapid growth and development that take place prenatally and during a child’s first years,” says Caron Gremont, No Kid Hungry’s director of early childhood. “The East Kentucky Dream Center is a critical nexus for nutrition and health care support.”

Last month, a baby was born six weeks early to a recently single mom, a 23-year-old who works at the local elementary school. “Pregnancy and child birth are scary,” Campbell-Dotson says. “Especially when you don’t have a partner.” The Dream Center provided easy-to-heat casseroles when they left the hospital and regularly drops off a box on the front porch with hamburger, chicken, lettuce, strawberries and other produce.

Addiction is a growing problem here, she notes, adding, “I’ve trained my team to take each interaction a step further and look at the root causes. We have to get comfortable having uncomfortable conversations.” The Dream Center helps people with substance use disorders, helping them to enroll in treatment programs and to secure transitional living arrangements after rehab.

Indeed, the opioid epidemic has had a catastrophic effect on this part of the country. , the state is ranked fifth in the United States for opioid overdose deaths. “Behind closed doors, substance use disorders are ripping Bluegrass families apart,” .

Although COVID has aggravated the challenges of hunger and addiction in east Kentucky, Campbell-Dotson remains enamored of the natural beauty here and the spirit of volunteerism among her neighbors, and she’s quick to point out the stories of people who have overcome the odds. Not long ago, for example, Virginia was a pregnant 15-year-old. Today she’s a registered nurse working to help families to get and stay healthy.

“You don’t have to be what you were born into,” Campbell-Dotson says.