Pennsylvania faces a shortage of psychiatrists that children's advocates call "alarming," and they're concerned about the impact it might have on young people whose needs become more intense and could require medication.

A June 2020 report found there aren't enough psychiatrists to meet the demand for mental-health assistance in the Commonwealth. Pittsburgh-based psychologist Dan Warner said this means the responsibility of prescribing medication for children with severe mental-health challenges often falls on pediatricians. He said the first step should be talking to a mental-health professional.

"Under significant stress, there might be a need to elevate and really looking at a biomedical intervention," he said. "Very often, the first line of that is starting with your pediatrician. Those people are not specially trained in the needs of children with mental health issues, and they don't necessarily have the time to do all the kind of work."

The most recent Pennsylvania Youth Survey found 38% of students reported feeling sad or depressed most days.

One possible solution getting the support of some health professionals is Senate Bill 25. It would allow certain nurse practitioners to have full authority to prescribe medication without requiring them to have a collaborative agreement with a physician.

State Sen. Camera Bartolotta, R-Greene County, who introduced the bill, said it would assist communities hit hardest by the shortage, both rural and urban.

"It's very specific," she said. "It would be highly regulated, but it would open the doors to incredibly good health care that is needed right now more than ever, especially mental health care. We've got hundreds of qualified nurse practitioners that could easily jump into that field and fill the void."

Terry Clark, president and chief executive of the Pennsylvania Council on Children, Youth and Family Services, which published a position statement on the state's psychiatric shortage, said this expansion can help save children's lives.

"Not every child needs a psychiatrist, but for those most vulnerable children who do, they go without the help they need," he said, "thus the reason suicide is growing amongst our adolescent age group."

Senate Bill 25 would require a qualified nurse practitioner to have 3,600 hours and three years under a physician's collaborative agreement. The bill passed out of committee in recent months and awaits a vote in the full Senate. According to Bartolotta, it has bipartisan support.

In just two months, it should be easier for providers of children's services in Pennsylvania's child-welfare and foster-care system to get the liability insurance they need. Governor Tom Wolf signed a bill into law that outlines who takes responsibility when an incident or accident occurs in the child-welfare system.

Some counties' contracts require the private children's service provider to take full responsibility, even when they are not at fault.

Samea Kim, vice president for Legal & Public Affairs at the Pennsylvania Council of Children, Youth & Family Services said as a result, the private providers have had trouble getting affordable, quality liability coverage - and this should make it easier for them to do so.

"This bill would allow the agency to take ownership of something that may have come up, if it was within the scope of what they did. Otherwise, if it was something related to the county, then the county would be able to take responsibility for their own actions," Kim said.

Kim added under the current system, providers were making insurance payouts even in cases when they were not at fault, because the county contract requires the provider to take liability. The new law goes into effect February 1. There are nearly 15,000 children in Pennsylvania's child-welfare system.

Laura Maines, CEO of Every Child, Inc., a nonprofit adoption and foster care organization based in Pittsburgh, said groups like hers have faced limited liability insurance coverage options and high premium costs, driven in part by the contracts that require private providers to indemnify government agencies in any situation. So, they advocated for House Bill 2214.

"This is about fairness," Maines said. "This is about accountability. This is really about partnership and service continuity. And so, what [HB] 2214 does is it says if there is any language in a public foster care contract or child welfare contract that seeks to transfer 100% of the risk to the private agency, it's unenforceable."

Maines added professional liability insurance protects the agency if something happens to a child and there is a claim brought against their agency.

Backers of legislation awaiting Gov. Tom Wolf's signature said it would improve the odds of success for teens transitioning out of foster care.

More than 5,500 children in foster care in Pennsylvania are age 14 or older, and House Bill 1866 outlines the steps county child-welfare agencies must take to help them make a smooth transition to adulthood with support from caregivers or family members.

Kari King, president and CEO of Pennsylvania Partnerships for Children, said it is important to spell out the details.

"And it really tries to make much clearer what those county offices need to do to better support these youths," King explained. "Some of those provisions are working with the youth on what's called a permanency plan. So, really working with that child to say, you know, 'What are your goals? What do you want to see as kind of the outcome?' "

The bill passed in October with bipartisan support. After the governor signs the measure, it will take effect in 60 days. King added the bill was introduced by state Rep. Karen Boback, R-Luzerne County. It requires counties do more to improve their data collection and document family-finding efforts, increase teens' opportunities for permanency and help them maintain supportive adult connections.

King noted the end goal is to prevent homelessness when a young person ages out of the foster-care system. She emphasized they let policymakers know not having adequate planning and support services to ease the transition often means a poor outcome, which for some, has had lifelong effects.

"Something that we've really raised is that 37% report that they don't have stable housing, and 25% don't have either a GED or a high school diploma," King reported.

King added transition-age youth often struggle as a result of being in foster care, so it is important they have supportive connections, and child-welfare agencies document their own steps and provide the information to the young person in transition to adulthood.

October is National Bullying Prevention Awareness Month and experts are reminding Marylanders to be aware of the patterns within bullying.

The National Center for Education Statistics said one in five students reports being bullied. With the rise of online interaction among students cyberbullying has come to the forefront as a problem, but experts say there is frequently an offline component to bullying.

Maryland criminalized cyberbullying in 2013 and strengthened the law in 2019, increasing the penalties, and reducing the burden on victims in proving bullying is happening.

Jan Helson, co-founder and board chair of the Global Game Changers Children's Education Initiative, a nonprofit focused on social-emotional learning, said building confidence and empathy are key in helping to prevent bullying.

"If you build a child's core where they feel confident about themselves and who they are, and have empathy for others, then it helps to avoid bullying in the first place," Helson asserted.

Students who are bullied are at a higher risk for depression, anxiety and sleep problems, along with lower academic achievement and dropping out of school.

Research suggests school-based anti-bullying programs decrease bullying by 20%. No matter the approach, Helson emphasized it is important for students to remain in dialogue with parents and teachers.

"Whether it's a teacher communicating with students, or whether it's a parent communicating is to really stress the importance of opening up that dialogue and providing your child a safe space and looking for those signs, whether they are the victim or the bully," Helson outlined. "Parents have to be open-minded to both sides of that."

Helson explained the root cause of bullying often is the bully's own insecurity, and noted it is helpful to consider the inner life of the bully.

"What is it about their background? I think having children understand and have empathy that maybe that bully has something going on in their life that they have no control over," Helson advised. "It's a way of them feeling like they have control of something, making them feel bigger than others."

She added empathy for the bully does not mean accepting their behavior, but giving students insight into the lives of others may help break down the barriers with bullies.