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 early August, fall registration opens at several South Dakota locations offering a national program geared for grade-school-age girls. It combines social and emotional skill building with physical activity.

Girls on the Run is a nonprofit, which built the youth development curriculum. It is carried out by roughly 200 councils in North America, with trained volunteer coaches leading spring and fall seasons.

Jasmina Nelson, program coordinator for South Dakota for the group, said they want to help the target age group navigate new situations they encounter, such as bullying.

"We want the girls to understand that who they are is very unique and special and that they should be confident in who they are and their unique abilities," Nelson explained.

This after-school activity lasts for 10 weeks, capping the season off with a noncompetitive, celebratory 5K run. There is a registration fee, but organizers say they are willing to work with families on overcoming any cost barriers to ensure access to the program. The South Dakota locations with upcoming registration can be found on the local chapter's website.

Nelson pointed out they also thrive on volunteers and encourage interested adults to learn more about helping out. She added the running component is just a catalyst for the mission, and the girls are not pressured to become track stars.

"It's all about the movement," Nelson noted. "They can hop, skip, jump all the way across their finish line, or they can run whatever their pace is."

The program is designed for girls in grades 3-8. Most of South Dakota's sites are for the younger grade levels. A study by the University of Minnesota found 85% of program participants improved in areas such as confidence, caring and connection to others.

The summer season and violent crime can fuel narratives by the public and the media about safety in urban settings. But in Minnesota's largest city, an emerging effort aims to show that some youth want to firmly establish peace through communication.

Like many other places, Minneapolis has seen increases in violent crime in the past couple of years. On the north side, a group called Nonviolent Peaceforce is scaling up its Community Peace Builders program.

Will Wallace, a local mentor for the initiative, said a handful of young adults are trained in risk-assessment and de-escalation.

"I just think your tongue is your worst enemy," said Wallace. "They got this thing where they say, 'Oh, this summer is going to be hot, there's gonna be a lot of killing.' Well, we need to erase that."

The training emphasizes terms such as "listen" and "affirm." Peace Builders who are recruited are young adults who have overcome past issues tied to conflict in the streets.

Beyond easing tension among peers, they also provide unarmed security at local events.

Elijah O'Neal, one of the local Peace Builders, said he hopes to stifle narratives that area residents are only capable of violence.

He said he wants his peers to know they can overcome stereotypes and think about the bigger picture.

"We're not used to talking," said O'Neal. "All we're used to doing is yelling and screaming and trying to get somebody to hear us. But I'm trying to get them to understand that we could talk it out without getting so violent."

Fellow Peace Builder Markess Wilkins said one challenge is overcoming skepticism among his acquaintances. But he said he remains undeterred in convincing everyone about the path he chosen, hoping others follow suit.

"It kind of drains me a little bit," said Wilkins. "But at the end of the day, I know the work I'm doing. So, I don't ever let the putdowns get to me."

These Peace Builders began to hone their mentorship skills through the local organization EMERGE.

The training offered by Nonviolent Peaceforce has been used in conflict zones around the world.

Students may be settled into their summer break - but in Minnesota, some remain focused on setting a peaceful tone ahead of their return to school this fall. Those involved with an emerging Minneapolis program hope it becomes a model elsewhere.

Through a Centers for Disease Control and Prevention grant, the group Nonviolent Peaceforce has teamed up with the district for the Building Peaceful Schools project at two city high schools.

Student advisory groups work with peers and administrators on things such as relationship building and de-escalation.

Jassani Bland is a recent graduate of Roosevelt High School. She said she appreciated student-led discussions about certain scenarios, and gave examples.

"If your friend tells you they're going to be getting into a fight after school, are you going? Are you going to be the person that's recording?" said Bland. "And it created a big conversation, like, 'You're not a good friend if you're not going to be there for your best friend that's fighting. But then on the other hand, you're encouraging violence, you should be discouraging them.'"

She said having students lead the way allows peers to better understand each other's backgrounds, and how issues such as community violence factor into their lives.

Program leaders say after the July 4th holiday, they'll open a safe space for weekly discussions, while holding new training sessions. Others involved suggest additional grants would help to expand to other districts.

The project follows Minneapolis Public Schools' decision to no longer contract with the city's police department after George Floyd's murder.

Brandon Krona is the building peaceful schools project coordinator for Minneapolis Public Schools. He said some school resource officers were effective, but adds this new initiative puts students in the driver's seat.

"You're not going to be able to change everybody's opinion," said Krona. "But try to change minds and hearts eventually, and give these kids that opportunity to have a voice in what they want to see in their schools prevention-wise."

Sam Taitel, a program manager and community trainer for Nonviolent Peaceforce, said the project is a detour from bowing to personal pride and reputation amid tension within the student body.

"There are a lot of defense mechanisms to valid trauma," said Taitel, "and how to actually disrupt that cycle is difficult."

To get past that barrier, Taitel said students and staff are encouraged to show vulnerability.