Child care providers face difficult choices as funding cliff looms

Child care providers face difficult choices as funding cliff looms

By Jennifer Fernandez

BURLINGTON — Omira Thompson sat on the floor Wednesday feeding lunch to two of the boys in her infant classroom at First Presbyterian Child Development Center.

One made a face, then tried to wipe out his mouth with his bib, which made Thompson laugh. “Guess he doesn’t like pear,” she said.

Thompson, the lead teacher for the infant classroom, is one of 32 teachers at the five-star rated child care facility, which serves about 90 children — from infants through age 6.

Across North Carolina, child care centers such as First Presbyterian’s will be faced with some difficult decisions in the coming months as the last of federal pandemic aid dries up at the end of June. The money, which Congress first allocated in 2020 during the early, confusing days of the pandemic, helped centers pay teachers more through raises or bonuses; some were even able to provide benefits — often for the first time. The grants were renewed in 2021 and again last year

bar graph showing a blue bar representing the $14 median pay for child care workers compared to green bars representing higher pay for Costco, Target, Starbucks, Hobby Lobby and Verizon
Credit: NC Dept of Health and Human Services

If centers can’t maintain that level of pay, teachers may leave to make more money at places like Target or Starbucks, child care advocates say.


A survey of child care centers released last week shows that without that extra government funding, centers expect to lose teachers, close classrooms, raise tuition and fees or a combination of those measures. More than 1,500 child care facilities in North Carolina could close, according to the survey commissioned by the North Carolina Child Care Resource & Referral Council.

“The work that we do is significant. We deserve the respect. We deserve a salary that is commensurate with what we do,” said Davina Boldin-Woods, director of First Presbyterian Child Development Center. “But more importantly, our children deserve it.”

The ‘cliff’

Pandemic aid from the 2021 American Rescue Plan Act has helped child care providers boost pay and benefits, and it has subsidized the cost of child care for many families. 

Last year, legislators approved using $150 million in discretionary funding from federal pandemic aid to continue the stabilization grants. 

The so-called funding cliff, first expected in December 2023, is now expected to happen in June when that funding ends.

Child care providers, along with legislators from both parties, state officials and the state Chamber of Commerce, unsuccessfully petitioned the General Assembly to include $300 million in the state budget last year to cover the loss of the federal pandemic aid to help providers maintain raises or bonuses for staff for another year. 

“As long as I’ve been in the business, early education professionals have wrestled with the shortage of child care workers and a marketplace competing for teachers with better pay and benefits,” Andrew H. “Sandy” Weathersbee, owner of Providence Preparatory School in Charlotte, told the N.C. General Assembly’s Joint Legislative Oversight committee on Health and Human Services on Tuesday. 

“However, we’ve not been able to find a solution for the problem because it’s bigger than we are,” he said, “and we need help.”

Survey findings

A February survey of North Carolina child care providers found:

  • 29 percent of all providers (center-based/family based) expect to close. 
  • 52 percent have already increased tuition.
  • 58 percent said they plan to increase fees after June.
  • 58 percent have already cut expenses in anticipation of the grants expiring, including reductions in:
    • food costs (22 percent)
    • teacher hours (16 percent)
    • other staff hours (15 percent)
    • number of other staff (14 percent)
    • transportation costs (13 percent)
  • 41 percent of center-based programs expect to close or combine classrooms when the grants sunset.

Source:  North Carolina Child Care Resource & Referral Council

Effects on workforce

Child care plays a crucial role in the economy. Parents can’t work if they have nowhere to send their children.

A different survey last year of registered North Carolina voters showed that 26 percent of parents with children younger than 5 left the workforce because they couldn’t find affordable child care. 

Six in 10 of those same workers reported missing work because of a problem with child care, according to results of the phone and online survey of 500 people commissioned by the NC Chamber Foundation. 

Three in 10 did not pursue job training or continuing education due to a lack of affordable child care, and 37 percent refused a job opportunity, promotion or job change because it would increase child care expenses.

“Affordable, quality child care supports working parents on the job, allows businesses to recruit and retain talent, and helps North Carolina children develop skills for success in school and life,” Meredith Archie, president of the NC Chamber Foundation, said in a statement when their survey results were released. “The health of North Carolina’s economy is directly tied to the strength of its workforce. This survey shows that North Carolinians understand the critical role of child care and want it to be a top priority for the state.”

The chamber found that across the political spectrum, majorities of people wanted the state to increase funding to make affordable child care more accessible to workers.

A long-term study of children in Michigan who received quality early childhood care found they were more likely as adults to make a living wage and own a home compared with peers who did not receive that care.

“It’s not a child care issue. It’s not a parent issue. It’s an economic issue,” Boldin-Woods said. “So the economy, it literally doesn’t work unless early education and child care work.”

Educators, not babysitters

The first few years are a crucial time for children, whose brains are growing at nearly a million neural connections per second, according to Harvard University’s Center on the Developing Child

“The environment of every child’s first three years provides the foundation for the rest of their life,” Weathersbee said. “In other words, the cake is baked by the time a child turns 3 years old.”

Boldin-Woods said children spend anywhere from eight to 10 hours a day in an early education program “discovering and learning the things that are going to set them on the path to success.”

“I don’t think people see the significance of the work that is done, or understand the long-standing impact and the wide-ranging impact that early education … can have,” she said.

Children follow the teacher down the hall during lunch at First Presbyterian Child Development Center in Burlington. Credit: Jennifer Fernandez/NC Health News

Researchers from across the globe have studied the effects of high-quality child care and education, according to the Buffett Early Childhood Institute at the University of Nebraska. Information from more than 150 scientific studies shows that good care can have major impacts, short term and long term, on everything from cognition and social-emotional development to school progress and earnings. It can also reduce antisocial behavior, lower welfare participation and even reduce trouble with the law.

Research also shows how important brain development is to health outcomes later in life. 
A landmark North Carolina study, the Abecedarian Project, followed for decades children from low-income families who received high-quality child care. It found that children who received better care ended up healthier as adults, with lower rates of heart disease and diabetes and better mental health.

Finding solutions

“There is creative strategy going on,” said Janet Singerman, president and chief executive officer of Child Care Resources Inc. and co-leader of the Child Care Resources & Referral Council.

Kentucky legislators passed a bill in 2022 that set aside $15 million to create a public/private partnership between employers and the state to help families pay for high-quality child care.

States from Montana to Maine are increasing eligibility for child care subsidy funding through the federal Child Care and Development Block Grant program, according to a Feb. 21 article by the Center for American Progress.

Several states are pouring money into stabilizing the child care system: California is investing $600 million and Minnesota $316 million to increase pay for child care workers.

In the North Carolina budget passed last year, legislators addressed child care in several ways, such as $525,000 to increase the capacity of family child care homes and supporting a $900,000 pilot program that shares costs among families, the state and the provider. 

The budget also included an increase in child care subsidies, mostly federal money used to help offset the cost to parents, although the increase was based on older market data. 

Dark-haired woman holding child in blue top while washing pacifier in sink.
Jamie Chadwell, a teacher in the infant classroom at First Presbyterian Child Development Center in Burlington, washes a pacifier. Credit: Jennifer Fernandez/NC Health News

The reimbursement covers 30 percent to 50 percent of the cost of a classroom slot, said Ariel Ford, who runs the Division of Child Development and Early Education for the state Department of Health and Human Services. But you can’t operate a business at 50 percent of the cost, she told lawmakers.

Ford said legislators should again look at increasing subsidies when the General Assembly reconvenes later this month.

“What we know is that the child care subsidy as we have it now is based on what our local families can afford to pay. But that’s not really what it costs,” Ford told the committee during her testimony Tuesday. “What that means … is that those wages just keep getting pushed down for child care because they can’t raise the cost anymore for families to afford it, which means they can’t pay any more for teachers to be in the classroom.”

Weathersbee suggested several ways local governments and businesses could work together to fix the problem, from employer tuition sharing and tuition discounts for early educators to a tax credit for tenured staff and tax incentives for employees offering certain benefits to child care employees.

Closures already happening

Based on response to the Child Care Resource & Referral Council survey, the expected closures would leave about 92,000 children without a child care home. That’s on top of the thousands of children who have already lost a slot as hundreds of facilities closed in the past year alone.

According to state data, the number of licensed facilities dropped from 5,500 in February 2023 to 5,166 in February this year. Enrollment during that period fell from 220,303 to 214,088. There are also 386 fewer teachers.

Many of the providers that plan to stay open said they’ll have to increase tuition and fees and expect to lose staff, forcing them to combine or close classrooms, reduce the number of children they serve or close entirely.

“There is no question we need to increase investment in child care across this nation. It is an underfinanced system,” Singerman said.

She called the survey responses “sobering.”

“If we care about what’s happening to our children, and our parents in the workforce … then child care is an issue that we should all have a stake in,” Singerman said.

The post Child care providers face difficult choices as funding cliff looms appeared first on North Carolina Health News.

North Carolina counties losing elections directors. Concerns point to lousy pay, voter hostility.

Seven NC counties have lost elections directors since January. More than 50 have left in last 5 years. State worried about loss of knowledge.

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The ranching industry’s toxic grass problem

America’s “fescue belt,” named for an exotic grass called tall fescue, dominates the pastureland from Missouri and Arkansas in the west to the coast of the Carolinas in the east. Within that swath, a quarter of the nation’s cows — more than 15 million in all — graze fields that stay green through the winter while the rest of the region’s grasses turn brown and go dormant. 

But the fescue these cows are eating is toxic. The animals lose hooves. Parts of their tails and the tips of their ears slough off. For most of the year, they spend any moderately warm day standing in ponds and creeks trying to reduce fevers. They breathe heavily, fail to put on weight, and produce less milk. Some fail to conceive, and some of the calves they do conceive die. The disorder, fescue toxicosis, costs the livestock industry up to $2 billion a year in lost production. “Fescue toxicity is the most devastating livestock disorder east of the Mississippi,” said Craig Roberts, a forage specialist at the University of Missouri (MU) Extension and an expert on fescue.

In Elk Creek, Missouri, cattle stand in a pond to cool their fever caused by fescue toxicosis, which costs the beef industry as much as $2 billion a year in lost production.

By the early 20th century, decades of timber-cutting and overgrazing had left the ranching region in southern states barren, its nutrient-rich native grasses replaced by a motley assortment of plants that made poor forage. Then, in the 1930s, a University of Kentucky professor spotted an exotic type of fescue growing in the mountains of eastern Kentucky, which seemed to thrive even on exhausted land. Unlike most native grasses, Kentucky-31, as it was called, stayed green and hearty through the winter. Ranchers found the species remarkably resilient and, if not beloved by cattle, edible enough to plant. Over the next 20 years, much of the country’s southern landscape was transformed into a lush, evergreen pasture capable of supporting a robust cattle industry. 

As early as the 1950s, however, ranchers began to notice tall fescue’s disturbing effects. One study from that time showed that cattle had to be fenced out of other grasses before they’d touch fescue. When they did eat it, the cows saw only one-sixth of their normal weight gain and lost eight pounds of milk production a day. 

Between the cells in fescue grows an endophyte, a fungus living symbiotically inside the grass. The endophyte is what makes the fescue robust against drought and overgrazing, but it’s also what makes it toxic. When scientists engineered a version of fescue without the fungal endophyte, in 1982, its hardiness disappeared and ranchers saw it die out among their winter pastures. Farmers learned to live with the health impacts of the toxic version, and today it remains the primary pasture grass across 37 million acres of farmland. 

It’s a longstanding problem, and it’s spreading. Warming temperatures from climate change are now expanding the northern limit of the fescue belt, and the grass is marching into new areas, taking root on disturbed land, such as pastures. Northern Illinois and southern Iowa could already be officially added to the fescue belt, Roberts said, introducing toxicosis to new farming regions.

Illustration of the tall fescue endophyte made from a scientific photo. By Amelia Bates/Grist

“It’s becoming not just present but part of their normal pastures,” he said, noting that he increasingly gets calls from farmers in this region who are wondering what to do.

As more ranchers find themselves facing the challenges of toxic fescue, there are two strategies emerging to finally solve the decades-old problem, though in diametrically opposed ways. One involves planting a modified version of tall fescue — called “friendly fescue” — in which the toxic endophyte has been replaced by a benign one that still keeps the grass hearty and green all winter. Another would abandon fescue altogether and restore the native grasses and wildflowers that once dominated the region, helping to revitalize natural carbon sinks and fight climate change.

For a variety of reasons — some economic, some cultural — neither solution has really taken hold with most fescue belt ranchers. But the debate embodies the agricultural industry in the era of climate change: As ecosystems shift and extreme weather makes farming even more precarious, ranchers are facing tough decisions about how to adapt their land use practices. What is best for business, and will that ultimately be what’s best for the land and for the changing climate? 

Friendly fescue hit the market in 2000, developed by Pennington Seed, Inc. It looks identical to toxic fescue and behaves almost identically, thus requiring little change to the ranching habits of fescue belt farmers over the last 70 years. 

It would seem an ideal fit for an industry focused on maintaining the status quo amid climate challenges. But ranchers have been slow to embrace it. For one thing, friendly fescue, formally known as “novel endophyte fescue,” costs twice as much as the toxic variety — $4 for a pound of seed versus $2. And replacing one grass with another is labor-intensive; a 2004 report by the University of Georgia said it would take ranchers who made the switch about three years to break even. Matt Poore, a professor of animal science at North Carolina State University, chairs the Alliance for Grassland Renewal, a national organization dedicated to eradicating toxic fescue. Yet Poore, who also raises cattle, has only converted 30 percent of his fields, preferring to do it slowly. “The fear of failure is a big deal,” he said. “You’re sticking your neck out there when you go to kill something that looks really good.”

An overgrazed fescue pasture in Elk Creek, Missouri. Many ranchers are reluctant to abandon fescue, despite the problems it causes, because the fields stay lush and green through the winter.

Many ranchers would like to avoid the risk of total pasture makeovers, if they can. Until now, they have found ways to scrape by, relying on a parade of treatments that have come out through the decades, promising relief from toxicosis. 

They can supplement their cows’ diets with grain (an expensive remedy), or cut and dry their fescue and feed it to them as hay, which reduces its toxicity somewhat. They can dilute the toxicity of their fields by planting clover among the fescue, or clip the especially toxic seed heads before cows can graze them. They can try to genetically select cows with moderate fescue tolerance, which can salvage as much as a quarter of their losses. Poore counts over 100 such remedies. “If you do enough of those things you can tell yourself you don’t really have a problem,” he said. Meanwhile, the lush ground cover that fescue displays in winter is seductive.

A lack of trust, too, is a problem. In the early 1980s, when researchers introduced endophyte-free fescue, it was hailed as the answer to toxicosis, a way to save the industry. Ranchers trusted the scientists, and they lost a lot of money when that version withered in the fields. The sting of that debacle persists as researchers try to convince ranchers to trust friendly fescue. “The sins of the past have come back to haunt us,” MU’s Roberts said. “It’s going to take a while to overcome that screwup.”

Every March, Roberts and other scientists travel around the fescue belt giving workshops on friendly fescue to anyone who will listen. He tries to assuage ranchers who are worried about the expense and labor of pasture conversion. 

There aren’t good numbers on adoption rates because seed companies are guarded about how much they sell. But Roberts says he knows it’s rising. Some states promote it more than others, by offering cost-shares, for example, and hosting workshops like those Roberts leads.

A clump of native grass that has been browsed by bison in one of Amy Hamilton’s native grazing fields in Elk Creek, Missouri. The roots of native grasses reach three times deeper than fescue roots, making them drought-resistant as well as efficient carbon sinks.

It doesn’t help that endophyte-free fescue — the one that fails in the winter — remains on the market. The state of Kentucky even provides cost-share funding for ranchers who switch from toxic fescue to endophyte-free fescue. And several Kentucky ranchers said they were still unclear on the differences among toxic fescue, endophyte-free fescue, and friendly fescue. Farm supply stores often don’t even stock friendly fescue seed, as it’s less shelf stable.

Roberts noted that toxic fescue exudes fluids that “pretty much destroy the food web,” poisoning insects that quail and other creatures feed on. A 2014 study showed that climate change could increase the endophyte’s toxicity. Friendly fescue soil, by contrast, has more microbes than toxic fescue soil. And water quality is better with friendly fescue, too, since sick cows don’t have to congregate in streams and ponds to stay cool.

Despite the confusion and slow uptake, Roberts is optimistic, noting the 30 years it took for farmers to embrace the revolution of hybrid corn in the early 20th century. And he can point to some wins. Darrel Franson, a Missouri rancher who remembers the endophyte-free fescue debacle, nevertheless decided to take the risk, converting his 126 acres to friendly fescue. He loves the results. “It’s hard to argue with the production potential of tall fescue and the length of season it gives us,” he said.

Roberts’ employer, the University of Missouri, is betting that a modified version of exotic fescue will appeal to ranchers more than the idea of converting to native grasslands. “What we’re promoting is environmentally friendly as well as economically sound,” he said. “When you seed a nontoxic endophyte and add legumes [to dilute pasture toxicity], that works as well as anything, and we have a lot of data on it. It may take another 20 years for it to catch on, but it’s not going away. It’s too good.”

For decades, Amy Hamilton and her late husband Rex fought fescue toxicosis in Texas County, Missouri, the heart of the Ozarks. They watched their and their neighbors’ cows lose tail switches, hooves, and parts of their ears to gangrene. Finally, they’d had enough. 

But the Hamiltons didn’t reach for an artificially modified version of the exotic grass. Instead, in 2012, they converted 90 acres of pasture to native warm-season grasses, using their own money and cost-share funding from the U.S. Department of Agriculture’s Natural Resources Conservation Service, or NRCS. The effects were immediate; the next year they documented increased conception and weaning rates in their cows and calves. Since then, they’ve converted another 75 acres. A former soil conservationist with a degree in agronomy, Hamilton’s mission became to annihilate fescue, on her property and across the fescue belt.

Amy Hamilton, seen here in a patch of prairie blazing star in one of her native grazing fields, has made it her life’s work to eradicate fescue.

I visited Hamilton’s ranch in November 2022, where they run about 45 cows and 150 bison. She and her daughter Elizabeth Steele, who helps run the family’s native seed company, walked through a pasture where fescue grew 15 years ago. Now big bluestem, little bluestem, and sunflowers fill the main body of the pasture, and freshwater cordgrass and ironweed decorate a creek’s edge. Quail have returned for the first time in decades. 

Unlike the Hamiltons’ neighbors’ pastures, however, this field was not green; most of the plants had gone dormant for winter. Hamilton reached through a thick mass of bluestem and pointed to two diminutive, green plants: wild rye and a sedge species, cool-season grasses that provide a native analogue to fescue — and, crucially, winter forage.

“This is what would have been here pre-settlement,” said Steele, referring to the land before Europeans arrived. “A functioning grassland with different plants serving different functions. Nature’s design is not for monocultures.” 

To understand the fescue-native debate requires an understanding of the ecological tradeoff between warm- and cool-season grasses. Simply put, warm-season grasses grow in the summer, harnessing the strong sunshine to grow tall and robust; then they go dormant in the winter. Cool-season grasses do the opposite, putting their evolutionary resources into frost-tolerance. As a result, they tend to be smaller than their warm-season counterparts, providing less biomass and less food per plant for the cows that graze them. 

Hamilton and Steele have decided to bet on biodiversity. Instead of a year-round monoculture of fescue, they have a biodiverse mix of warm- and cool-season grasses, along with wildflowers. It’s not as visibly lush as a fescue field, but the benefits to cattle health, soil health, and climate resistance make it worth it. “It is a kind of faith that these prairies evolved for the good of the native species that were here,” Hamilton said.

Even with the leaner cool-season grasses, their native fields produce twice as much forage as the old fescue fields and generate a much higher amount of organic matter, enriching the soil and allowing the pasture to hold more water. A soil-health specialist from NRCS tested their soil’s organic matter content before the 2012 restoration, then again five years later. The result was pastureland that holds up to a half gallon more water than a typical fescue field. 

In a warming climate with more extreme droughts — much of the Ozarks was in severe drought last year — that extra water storage can make a critical difference for cattle and soil health. The southeastern U.S., the heart of the fescue belt, faces a future of more intense drought and floods. The Hamiltons’ biodiverse style of ranching helps address both extremes, and they expect their native ecosystems will be more resilient to climate change.

Elizabeth Steele, with help from her niece and sons, gathers native flowers for a bouquet near their ranch in Elk Creek, Missouri. “Nature’s design is not for monocultures,” she says.

“[The extra water] trickles into our stream through the year, as opposed to running off in a flood,” said Steele.

The roots of native grasses also reach three times deeper than fescue roots, making them drought-resistant as well as efficient carbon sinks. Grasslands are uniquely good at carbon sequestration. Unlike forests, they store more than 80 percent of their carbon underground, where it’s more safely sequestered than in aboveground trees where the carbon can potentially volatilize and return to the atmosphere. What’s more, intensive grazing of monocultures makes it hard to sequester carbon. A 2019 study, published in the journal Nature, showed that native, biodiverse, restored grasslands hold more than twice as much carbon as monocultures. The deep roots of the Hamiltons’ native species lock carbon deep underground, where it can take hundreds or even thousands of years to return to the atmosphere.

In the years since the Hamiltons converted their fields, the use of native warm-season grasses has gained momentum in the ranching industry. The University of Tennessee — firmly in the fescue belt — opened a Center for Native Grasslands Management in 2006 aimed at getting ranchers to incorporate native warm-season grasses (known as NWSGs) into pastureland. The Missouri Department of Conservation conducts workshops to familiarize ranchers with NWSGs. Research by the native grasslands center found that pastures of native switchgrass financially outperform fescue pastures. 

And Patrick D. Keyser, the center’s director, said native grasses significantly outperform fescue in climate resiliency. Fescue, he says, wants it to be 73 degrees and rainy every other day. “Think Oregon or Scotland,” he said. Native warm-season grasses in the fescue belt, on the other hand, can go weeks with blistering heat and drought without a problem. “To them, the worst climate projections that we’re getting really aren’t a big deal. From a resiliency standpoint, they absolutely win.” 

If replacing fescue with natives is moving slowly in general, replacing it with native cool-season grasses, to get year-round forage, remains nearly unheard of. As with friendly fescue, cost is partly to blame. Elizabeth Steele’s “cowboy math” estimates that a native conversion today would cost around $365 per acre, a scary number for ranchers. Proponents of native conversion also face a more complicated obstacle than cost as they seek buy-in from ranchers. The debate over how beef cattle are raised is caught up in the culture war over climate change. By some estimates, meat production accounts for nearly 60 percent of the greenhouse gasses generated by the food system, with beef as the leading culprit. Even as the concept of “regenerative ranching,” a method of cattle farming that tries to restore degraded soil and reduce emissions, has secured a toehold in the industry, “climate change” remains a political term in farm country, one that is largely avoided.

Ranchers like Amy Hamilton risk getting marginalized as “progressives.” So while she believes diverse native grasslands will make pastures more resilient to climate change, she doesn’t mention that when proselytizing to fellow ranchers. Instead she talks about increased water infiltration, more abundant wildlife, and improved soil health — things that matter to ranchers no matter their thoughts on climate change. 

She also tells them that native conversion pencils out. Hamilton doesn’t fertilize her pastures, and she rarely uses hay, as most ranchers do to supplement their cows’ fescue diet. And Steele estimates that, because native pastures produce more forage than fescue monocultures, increased forage and resulting weight gain makes up for the initial conversion costs in less than two years. “The more you emulate natural systems, the less money you have to spend on stuff like baling machines, herbicides, toxicosis effects, and fertilizer,” she said. That extra forage also allows ranchers to feed more cows. So if a rancher wants to expand their herd size, they can either expand their fescue acreage, for $3,000 an acre, or spend $365 an acre to convert the land they already have to natives. 

Saving money matters in the fescue belt. According to U.S. Department of Agriculture data, 60 percent of farms in Texas County, Missouri, run a deficit, and every state in the fescue belt loses money on agriculture, except for Illinois, which is largely a crop state. 

“Agriculture is so hard that if you don’t do it with your pocketbook in mind, you can cause people to go broke. I don’t want to do that,” Hamilton said. Hamilton estimates that more than 100 other fescue belt ranchers she’s in touch with are in the process of converting some or all of their pasture to native grasses. One of them, Steve Freeman, co-owns Woods Fork Cattle Company with his wife, Judy, in Hartville, Missouri. Freeman has converted 80 acres of fescue to natives, with plans to convert 180 more in three years. In total, that will make a third of his pasture diverse native grasslands.

Hamilton’s bison herd browsing in one of her native grazing fields in Elk Creek, Missouri.

“Almost all my inspiration has come from going to [the Hamiltons’] field days every year and seeing what this land could be,” Freeman said. For him it’s not just about eradicating fescue toxicosis, it’s about the whole suite of benefits for biodiversity, soil health, and water retention. “I realized we’re not going to get there with the grasses we have.”

Freeman notes the power imbalance between the informal effort to promote native grasses and the universities and beef industry groups that are pushing modified fescue. “There’s no money that backs this,” he said of native restoration. “The novel endophytes and those kinds of things, there’s a lot of money to be made. They’ve helped the universities. I think [Hamilton] is starting to change people’s minds, but it’s been 15 years of doing this.”

For his part, MU’s Roberts hears the subtle dig at his work. “Friends of mine in conservation groups think the university professors are hooked on fescue,” he said. “They’re not. What they’re hooked on is a long grazing season, good yield, and good quality. They’re hooked on criteria, not on a species.”

Either way, change on this scale takes time. The University of Missouri claims that 98 percent of pastures in the state are still toxic, with ranchers slowly opening up to either friendly fescue or native forage. “I’m sure there are ranchers out there that think we’re absolutely nuts,” Hamilton said. “But some of them are interested in thinking about new ways of doing things.”

As we drove out to visit her cows, we passed some of her neighbors’ fields. In one, a herd of emaciated cattle had grazed a fescue field down to stubble. In another, all but a few cows stood in the middle of a pond, trying to cool themselves on a mild, cloudy day. 

“These are good people,” Hamilton said. “They’re just trying to make a living.”

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Medical students help rural schoolchildren avoid suspension with mobile physicals

Shows a woman in a purple shirt using an instrument to look in the mouth of a child while sitting on a bus.

By Jaymie Baxley 

In North Carolina, first-time public schoolchildren and students who have moved here from other states are required to have a physical health assessment within 30 days of their enrollment. Those who don’t run the risk of suspension, which could make them fall behind academically. 

The risk is heightened in rural, economically distressed areas like Duplin County, where many residents lack health insurance and providers are scarce. More than a quarter of the county’s children live in poverty, according to a 2022 study of health needs.

Duplin County has about 49,000 residents, a quarter of them under 18 years old, and only four pediatricians. Several surrounding counties have even fewer providers. 

A heat map of North Carolina showing the number of pediatricians per 10,000 in each of the state's 100 counties. Duplin and other Southeastern counties show up pale, indicating few practitioners.
Duplin County and several surrounding counties (Pender, Jones, Sampson) have fewer than four pediatricians, making access to care a challenge for many. Credit: Sheps Center for Health Services Research at UNC Chapel Hill

Over the past three years, medical students from East Carolina University have provided free physicals for hundreds of schoolchildren in Duplin. The effort is part of Healthier Lives at School and Beyond, an initiative launched by the university in 2016 with funding from the U.S. Department of Health and Human Services. 

Originally a telemedicine program, Healthier Lives was expanded to offer in-person health screenings after the university converted a Wi-Fi-enabled transit bus into a mobile clinic in 2020. The bus now makes regular visits to K-12 campuses in Duplin, Jones and Sampson counties.

Lauren Nuriddin, a third year M.D. candidate at ECU’s Brody School of Medicine, gave an overview of the program during last month’s Rural Health Symposium in Greenville. The at-school physicals, she said, have “been successful in addressing barriers to care that the children in our rural communities face.”

Some of those barriers include “medical mistrust,” immigration status and limited access to transportation, according to Nuriddin. She said many parents are unable to take their children to a medical provider because they can’t afford to miss work. 

“All children deserve the right to education and should not have to forfeit this right based on reasons beyond their control, such as not having a school health assessment,” Nuriddin said, adding that she and her classmates “know the negative impact of suspension on school-aged children, and we are committed to doing something about it.”

Effects of suspension

Nuriddin said suspension can cause several “research-proven, negative long-term side effects,” especially in older children. They may fail to graduate on time, she said, and could face difficulty “obtaining employment with a living wage” after they do. 

A 2021 study by the American Institutes for Research found that suspensions had a “consistent negative effect on […] long-run educational outcomes for students.” The study was based on a decade’s worth of suspension data for middle and high school students in New York City. 

Another study, published in 2022 by the nonprofit Learning Policy Institute, found students were “less likely to earn a high school or college degree” after being suspended. An analysis of national data showed that suspensions were “meted out disproportionately to Black students, Native American students, and students with disabilities,” according to the study.

North Carolina has seen a similar disparity. A 2020 report by the N.C. Institute of Medicine  revealed that Black students were more likely to be suspended than their white peers. 

“In the education system, children of color are disproportionately punished through mechanisms like short-term suspension from school,” authors of the report wrote. “These punishments inhibit academic achievement and open a gateway that can, in time, lead to subsequent involvement with the justice system.

“Lower educational attainment and incarceration both have long-term negative impacts on health and well-being by decreasing employment opportunities and income potential.” 

While the bus physicals currently make up a small percentage of the Healthier Lives program’s encounters with students, Nuriddin said the share is growing. She hopes the service will contribute to the institute’s goal of lowering the state’s short-term suspension rate by 2030. 

Seeing the impact

Nuriddin and her fellow medical students have helped more than 300 schoolchildren avoid suspension since ECU began offering mobile health assessments. 

She said the effort has saved parents an estimated 330,000 miles worth of travel. It has also “increased instructional time for students who otherwise would have had to miss school” to attend doctor’s appointments.

Kristen Hall, chief officer for district effectiveness and student support services for Duplin County Schools, called the program an “invaluable service.”

“Beyond the students’ enjoyment of the unique experience of having their assessments conducted on an ECU athletic bus, our school system reaps significant benefits from this service,” Hall wrote in an email to NC Health News. “The seamless integration of the mobile health assessment bus contributes to the overall efficiency and effectiveness of our school system, ensuring the well-being and accessibility of healthcare services for all enrolled students.”

Shows a woman in a white jacket using an instrument to measure the hearing of a little boy during a physical exam.
Nestor Yanez-Coria, a student at B.F. Grady Elementary School, receives a hearing test. Credit: Photograph by Cliff Hollis/ECU

The bus physicals aren’t just helping schoolchildren, they’re “benefiting students at all levels,” according to Nuriddin.

“For public school students, reducing school suspension by completing required health assessments [results in] improved academic engagement and performance,” she said. “For medical students, providing school-based outreach opportunities in the curriculum enhances learning and engagement.”

Nuriddin described her time in the program as a career-affirming experience. She said she feels “blessed” for the opportunity to make a difference in the lives of children.

“Gaining this direct experience with children in their schools was invaluable and inspired me to see the impact I can make as a future physician beyond the clinic walls,” she said.

The post Medical students help rural schoolchildren avoid suspension with mobile physicals appeared first on North Carolina Health News.

Access to mental health care in Western NC only partially helped by telehealth

Kara Nash. Psychiatric telehealth in WNC article.

NC mountain counties struggle to recruit mental health specialists. Telehealth helps bridge the gap, but won’t work for all patients.

Access to mental health care in Western NC only partially helped by telehealth is a story from Carolina Public Press, an award-winning independent newsroom. Our breakthrough journalism shines a light on the critical overlooked and under-reported issues facing North Carolina’s 10.4 million residents. Please consider making a contribution to support our journalism.

Proposed timber project in Nantahala could clash with new federal policy

old growth

Old-growth acreage in Crossover Project in Nantahala National Forest slated to be harvested. A new federal policy may change that.

Proposed timber project in Nantahala could clash with new federal policy is a story from Carolina Public Press, an award-winning independent newsroom. Our breakthrough journalism shines a light on the critical overlooked and under-reported issues facing North Carolina’s 10.4 million residents. Please consider making a contribution to support our journalism.

Crooning for a Cure: The star-studded song that changed NC’s health care landscape 

By Jaymie Baxley 

No matter where you went in the early months of 1947, the song “It’s All Up To You” was inescapable.

A recording of the song by Frank Sinatra and Dinah Shore played in heavy rotation on the state’s radio stations and jukeboxes. The swinging big band tune’s lyrics appeared on the front pages of local newspapers. Copies of the song’s sheet music were distributed to public schools, where students were required to learn and perform it.

Though largely forgotten today, “It’s All Up To You” was written to raise awareness of North Carolina’s poor health conditions. It was the centerpiece of a public education and public relations campaign that had a lasting effect on the state’s health care infrastructure.

Creating the Good Health Plan

Two years before the song’s release, the State Hospital and Medical Care Commission presented some troubling statistics to the General Assembly.

North Carolina had had the nation’s highest rate of draft rejections during World War II. More than half of the state’s conscripted men were deemed medically unfit for military service, with many of them suffering from hookworm, tuberculosis and other diseases.

By 1945, North Carolina had only 2,300 doctors for its 3.5 million residents. The shortage of physicians was so severe that a quarter of babies born in rural counties were delivered without a doctor present.

Thirty-nine of the state’s 100 counties lacked hospital beds for Black patients, who in the Jim Crow South were forced to seek care at segregated facilities. In 33 counties, there were no hospitals at all.

These and other issues contributed to the abysmal state of conscripts’ health.

At Gov. Joseph Broughton’s request, members of the commission developed a plan to improve the situation. Their proposal called for the construction of hospitals and clinics to provide “better distribution of facilities, medical care, and public health services for every citizen Irrespective of race, creed, or financial resources.”

They called it the “Good Health Plan.”

Calling on Kyser 

The commission knew it needed public support to persuade lawmakers to fund the $48 million plan.

In March 1946, the commission organized a meeting of 200 of the state’s “leading medical men and laymen” in Thomasville. From that gathering came the Good Health Association, a volunteer committee that sought to “educat[e] the people of North Carolina as to the desperate need” for more doctors and hospital beds. Isaac Greer, superintendent of the Baptist Children’s Homes orphanage, was named the association’s president.

Hoping to enlist a well-known North Carolinian to assist with the effort, Greer reached out to bandleader Kay Kyser. The Rocky Mount native had released several chart-topping swing records with his big band orchestra in the 1940s. He had also appeared in a string of successful Hollywood comedies, including “You’ll Find Out,” “Playmates” and “My Favorite Spy.”

Ol’ Professor of Swing Kyser needed little convincing. After learning about his home state’s health woes, the musician embarked on an impromptu tour of more than 30 counties to solicit funding for the education campaign. He also drew from his experience in show business to craft a marketing and publicity prospectus for the Good Health Association, which adopted the document.

Over the next few months, marketing from the plan was unavoidable. The association used dramatic billboards, brochures, news releases, displays in pharmacy windows, essay writing contests for school children and all manner of other media to extoll the benefits of the Good Health Plan.

But Kyser believed that many residents “would never read about the State’s bad health record, or listen to even the most eloquent speaker discuss startling statistics,” according to a report released by the association at the campaign’s conclusion.

“He felt that these people would, however, sit up and listen to a musical appeal.”

Spreading the ‘health alarm’

Kyser passed the assignment to arguably the second most successful songwriting duo, behind Rodgers and Hammerstein, on Tin Pan Alley.

Lyricist Sammy Cahn and composer Jule Styne were established hitmakers in New York, having first teamed up three years earlier for the Oscar-nominated “I’ve Heard That Song Before.” Their most enduring collaboration, the Christmas staple “Let it Snow! Let it Snow! Let it Snow!,” propelled crooner Vaughn Monroe to the top of the charts in 1945.

Cahn and Styne wrote the words and jaunty music for “It’s All Up To You” in less than 24 hours. They framed it as a call to action, urging North Carolinians to “spread the health alarm to every town and farm” across the state.

“We need vitamins and medicines and beds to spare

Places where the sick can go and get some care

Lots of new equipment to combat disease

Clinics where the poor can go for moderate fees”

The lyrics also reference Leonora Martin’s poem “The Old North State,” which would be recognized a decade later by the General Assembly as the official toast of North Carolina:

“If we do these things then we will be the state 

Where the weak grow strong and the strong grow great”

With the association’s “musical appeal” now on paper, Kyser set out to find singers who could make “It’s All Up To You” resonate with radio listeners. As luck would have it, he shared a record label with two of the country’s biggest rising stars.

Sinatra and Shore 

Frank Sinatra and Dinah Shore were among Columbia Records’ most popular acts in 1946.

Sinatra had released his first full-length album, the best-selling “The Voice of Frank Sinatra,” earlier that year. Though he was a New Jersey native, Sinatra had something in common with many men in North Carolina: He had also been rejected for military service during WWII.

Shore, a new signee to Columbia, was enjoying a successful run of singles that included “Laughing on the Outside (Crying on the Inside)” and “The Gypsy,” which peaked at No. 2 on the Billboard chart.

When Kyser approached Sinatra and Shore with “It’s All Up To You,” they agreed to sing it for free. They recorded their vocals with Kyser’s orchestra in about an hour at a studio in Connecticut, according to newspaper reports.

Cover of the sheet music for “It’s All Up To You.”

“It’s All Up To You” officially premiered in North Carolina on New Year’s Day in 1947 as part of a special program broadcast on every radio station in the state. More than 9,000 copies of the track were later sent to the stations to give out to listeners.

“Even after they had given away their allotment of the records, many radio stations continued to play ‘It’s All Up To You’ daily, and disk jockeys reported many requests for the number,” read a report published by the association.

Records were also sent to the superintendents of county and city school systems, along with printouts of the song’s sheet music. Some schools required students to perform “It’s All Up To You” during Good Health Week that February.

The track was provided to jukebox operators in the state’s largest cities. Displays promoting the song were placed in the windows of record stores. Stories about it ran in newspapers.

One article, published in The State Port Pilot of Southport, called the recording a “songsation.”

“Perhaps no single phase or feature of the never-a-dull-moment Good Health publicity campaign has clicked so decisively as this latest device,” the paper wrote.

Lasting impact

The Good Health Plan was approved that March by the legislature, which agreed to put $32 million — equivalent to roughly $440 million in 2023 — toward the initiative.

An additional $16 million came from the Hill-Burton Act, a federal measure signed into law the previous year by President Harry Truman to increase the nation’s supply of hospital beds.

Mary Cannon, 3, shows an outline of the Good Health Plan to Gov. Gregg Cherry in 1947. The plan was created at the request of Cherry’s predecessor, Joseph Broughton.

Money from the act would eventually fund the creation of 230 health care facilities in North Carolina, according to the National Health Law Program.

In addition to its role in expanding the state’s hospital system, the Good Health Plan paid for the construction of a four-year medical school at the University of North Carolina in Chapel Hill.

The once-ubiquitous anthem that helped drum up support for the plan has faded into obscurity, but it hasn’t been lost to time. “It’s All Up To You” can be heard today on Spotify, Apple Music and YouTube.

The post Crooning for a Cure: The star-studded song that changed NC’s health care landscape  appeared first on North Carolina Health News.

Second chances for formerly incarcerated women grow on this farm in Alamance County

A rural 13-acre farm showing a plot of land where formerly incarcerated women grow flowers and herbs to make body care items and candles

By Rachel Crumpler

Mona Evans left prison on May 2, 2022, after almost five years spent behind bars.

She traded the clanging doors, constant supervision and sterile environment of Anson Correctional Institution in Polkton — a town about one hour east of Charlotte — for a quiet 13-acre farm in rural Alamance County.

Housing and employment awaited her on her first day back in the community at Benevolence Farm, a rural reentry program and social enterprise supporting women leaving incarceration.

When Evans set foot on the property for the first time, it was a breath of fresh air — literally. Surrounded by nature for the first time in years, she basked in the sunlight and rows of flowers and herbs in bloom.

A formerly incarcerated women hugs two of her kids
Mona Evans with two of her children. Credit: Stacey Sprenz courtesy of Benevolence Farm

When she entered her room in the three-bedroom farmhouse, she saw that staff had purchased crochet hooks, yarn and a journal for her — all in her favorite color purple. She had a cabinet in the kitchen stocked with her favorite snacks, like potato chips and chocolate doughnuts. She was handed a cell phone that she used for hours that first night talking to her kids.

Evans said she was refreshingly treated like an individual human again — something that had long been lost from the monotonous treatment in prison.

During that first week, she started getting paid to produce the farm’s body care and candle products, applied for state IDs, paid parking tickets and went shopping at Walmart.

Benevolence Farm provided a safe landing ground and solid foundation of support, Evans said, as she grappled with establishing her life in the community again — this time with the stigma of a criminal record.

“A lot of stuff that you stress about as far as coming home is provided for you within that first week with this program,” Evans said. “That took a lot of stress off of me, and it gave me the opportunity to focus more on setting my goals.”

After five months, she left Benevolence Farm, finding her own footing in the community.

Now, over a year and a half since her release from prison, Evans rents a house in Burlington where she is reunited with her three kids. She’s working as a caregiver and also as a staff member at Benevolence Farm, where she is helping other women navigate reentry challenges — particularly family reunification.

“Without this program, I wouldn’t be where I’m at today, especially not this fast,” Evans said.

Dire need for reentry support

A woman stands for a headshot
Kristen Powers, Benevolence Farm’s executive director. She stared as a volunteer in 2017, then a board member and became executive director in 2019. Credit: Doug Burke courtesy of Benevolence Farm

Kristen Powers, Benevolence Farm’s executive director, said the nonprofit is helping fill a massive gap in housing, employment and other support for women leaving North Carolina prisons and jails.

Over the past four decades, the number of women incarcerated nationwide has ballooned by more than 525 percent, rising from a total of 26,326 in 1980 to 168,449 in 2021, according to The Sentencing Project. More than half of these women have a child who’s younger than 18.

However, Powers said there hasn’t been a corresponding increase in services for these women.

“I think they are often forgotten in the conversation about incarceration,” Powers said.

In North Carolina, women make up about 8 percent of the state’s total prison population, which is more than 31,000 people. In 2022, 2,714 women were released from North Carolina prisons, according to data from the Department of Adult Correction. However, on average, about one-third of women released from prison will be re-arrested within two years and 14 percent will be re-incarcerated, according to data from the North Carolina Sentencing and Policy Advisory Commission.

“We’ve basically stripped incarcerated people of everything that they had prior to going to prison or jail, and if you’re expecting people to resume normal, everyday activities, you need that infrastructure around them when they get out,” Powers said. “That’s not a reality for so many people coming home.”

Evans realizes how fortunate she was to land at Benevolence Farm. Staying with family wasn’t an option because she had none in North Carolina.

“If I didn’t go to Benevolence Farm or didn’t have a reentry program to go to, I wouldn’t have had anywhere to go,” Evans said. “I wouldn’t have got home from prison. That alone shows you why reentry programs are so important. So many formerly incarcerated individuals are homeless or go back to committing crimes right after release because they don’t have the resources that they need to survive.”

Since welcoming the first resident in December 2016, Benevolence Farm has served over 50 formerly incarcerated women. Unlike some other reentry programs, Benevolence Farm accepts women of all conviction types and allows them to stay up to two years, though most don’t stay the full duration.

A brick farmhouse in Alamance County surrounded by land
This three-bedroom farmhouse in Graham provides housing for up to six formerly incarcerated women for up to two years. Residents also work on the farm. Credit: Rachel Crumpler/NC Health News

The farm in Graham, funded primarily through individual charitable donations and major gifts, provides housing and work for up to six women at a time. Staff receive dozens of applications for the six slots, and some people with a 2028 release date have already applied, Powers said.

While Powers said she realizes that Benevolence Farm could serve more women if the allowed length of stay was shorter, she said the time given is part of what makes the program special and effective.

“We try to do long-term because there are so many peaks and valleys to the reentry process,” Powers said. “People have all the quick wins when they get home — an ID, a bank account, a driver’s license — and then things start to get harder or emotions start to get harder, and it helps to have community around to support you.”

Life at the farm

Returning to the community after incarceration is a big adjustment — mentally, socially, physically and economically. That’s why Benevolence Farm seeks to create a space where women can process, heal and prepare for what’s next, Powers said.

When a new resident arrives at the farm, a two-week onboarding process begins where staff help the person secure essential items like IDs, birth certificates and bank accounts as well as needed health care such as mental health and substance use services, Powers explained. Time is also given to rest and reacclimate, she said.

“When you’re in prison, you’re so used to being locked down behind metal doors all the time,” Evans said. “You don’t have the freedom to even go to the kitchen. I remember the first few days, I would just walk in the kitchen, open up the refrigerator and close it. I was just getting used to having nobody in my ear telling me what to eat, when to eat, when to get up. It took time getting used to having my freedom back.”

Navigating the transition surrounded by nature has its benefits, said Powers, who moved to a farm as a teenager and saw how the change in environment and pace affected her well-being.

Katie Anderson, a former resident who arrived on the farm in May 2020, agrees. She said the farm was a refreshing contrast to prison.

She went from being locked down in her cell during the COVID pandemic for months, when she said she wasn’t allowed outside at all, to absorbing all the time she could outside working in the fields.

“I just loved the sun,” Anderson said. “I just wanted to be outside. I wanted to smell the air and not have to be confined.”

  • An aerial shot showing a plot of land where formerly incarcerated women grow flowers and herbs.
  • A chicken coop
  • two women pour wax to make candles
  • Two Benevolence Farm candles — one scented amber noir and another cranberry chutney
  • A table with body care products and candles on it that are sold at a local craft fair

Residents work three days a week earning $15 per hour as they make Benevolence Farm’s body care products and candles using flowers and herbs grown on the property like rosemary and lavender. Several of the products were pitched and designed by residents, such as the honeysuckle and turmeric soap and the charcoal face soap.

Last year, sales generated about $75,000 in revenue, which is used to help fund operations at the farm.

The other two days of the week and weekends are dedicated to each resident’s personal tasks and goals, Powers said. This includes doctor’s appointments, probation appointments and visits with family and friends. Five staff members — two of whom were formerly incarcerated — are available to help navigate challenges that come up.

Residents leave the farm at their own pace, Powers said, and only three residents have stayed the full two years.

Powers added that most residents have established successful lives in the community after leaving Benevolence Farm, achieving small and big milestones from getting off probation to promotions at work to securing house keys.

However, Powers said about 15 percent of former residents have returned to incarceration — mostly for technical violations regarding their probation or parole. For example, one person on the sex offender registry did not have a proper address, and another squatted in an abandoned house.

“Overwhelmingly, we’re showing what happens when you build community around someone and meet their basic needs and how that affects their life moving forward,” Powers said.

Scalable ideas

Powers is acutely aware that what Benevolence Farm provides only scratches the surface of the need among formerly incarcerated women. That’s why Benevolence Farm has expanded its footprint in recent years.

In May 2022, the nonprofit opened a Burlington home that can house up to four women at a time in their own rooms. That bumped the organization’s total housing capacity up to 10 women.

But housing remains a monumental barrier to successful reentry, Powers said. She’s seen many landlords reject people with criminal records or charge double the security deposit, which can often put housing out of reach. To help address this problem, Benevolence Farm launched its Housing First Fund this year. The pilot program, made possible by the Coastal Federal Credit Union Foundation, helps women — primarily formerly incarcerated mothers — move into safe and stable housing of their choosing by paying the security deposit.

Powers also has her sights set on establishing a tiny home community on the Graham property to serve more women. The goal is to build six tiny homes, and fundraising for the project is ongoing.

But she knows that Benevolence Farm, which was named one of nine U.S. innovation sites by the Rural Justice Collaborative in 2022, can never meet all the need. Doing so will involve other players — employers, housing agencies, nonprofits, municipalities, community members and government officials — stepping up to “holistically support” people coming home from incarceration, Powers said.

“Our ideas are scalable and lessons are scalable,” Powers said.

“I do think we’re onto something here,” she continued. “I’m hoping that more folks can see that and learn from it and continue to push North Carolina in a direction that is more welcoming to formerly incarcerated people and willing to make the bold moves to keep people in the community in the first place.”

The post Second chances for formerly incarcerated women grow on this farm in Alamance County appeared first on North Carolina Health News.

Do NC nursing homes have enough nurses?

Advocates for residents say proposed federal staffing requirements for nursing homes are ‘a step in the right direction.’ Industry supporters say they aren’t attainable.

Do NC nursing homes have enough nurses? is a story from Carolina Public Press, an award-winning independent newsroom. Our breakthrough journalism shines a light on the critical overlooked and under-reported issues facing North Carolina’s 10.4 million residents. Please consider making a contribution to support our journalism.