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.

Bridgeport is one of six U.S. cities selected for an 18-month project kicking off this month, to create more education and career opportunities for young people.

The National League of Cities has awarded Bridgeport a $150,000 grant to support projects promoting STEM education and careers, particularly for young people not working or in school.

Marc Donald, executive director of the Regional Youth Adult Social Action Partnership (RYASAP), said the funds will be used for the Park City Career Pathways program. The goal is to help eliminate barriers to getting jobs in STEM fields.

"It's just really trying to get them on a better path, where they graduate with a high school diploma and then, get into some sort of post-secondary opportunity," Donald explained. "Or jump right into some sort of career pathway, especially in the STEM careers or around advanced manufacturing."

Other participating cities are Houston; Sacramento, California; Madison, Wisconsin; Saint Paul, Minnesota; and Lauderhill, Florida.

Through the same grant, the United Way of Coastal Fairfield County will also support RYASAP's work.

Gwendolyn Brantley, lead of the United Way's Greater Bridgeport STEM Learning Ecosystem, said when presenting STEM opportunities to young people, it is about showing them it is within reach to find work that interests them.

"We are introducing our students to careers in the gaming industry through e-sports," Brantley noted. "We're trying to really be intentional, using tools that are exciting and will get our students to want to look into these careers."

Brantley added they have developed e-sports teams across the city, for kids from elementary school into their 20s. They are also working with the district to help students set up profiles on the networking platform Tallo, where they can learn about STEM internships and scholarships, and connect with potential employers.

The Texas foster-care system is suffering a severe shortage of safe and appropriate placement homes, resulting in an expert panel being convened to address the problem and a myriad of others.

Kate Murphy, senior child welfare policy associate at Texans Care for Children, said the number of kids who did not have a safe home within the foster-care system hit a record high in mid-2021, but is now declining.

"We know we've had a really significant spike in the number of kids we couldn't find homes for," Murphy noted. "Part of the reason those numbers are going down is because we're placing kids out of state, or we're using temporary, emergency placements."

In the past two years, at least 65 Texas foster-care operations have closed, more than a third of them for safety reasons, creating a loss of more than 2,000 available beds. Texas lawmakers passed several pieces of legislation this year to address ongoing issues including approving millions to fund caseworkers, retain providers and increase foster-care capacity.

Murphy pointed out many in the state's foster-care system receive a "child without placement" designation, meaning the state cannot find a suitable placement. She added those children have the most acute levels of need, often suffering from trauma or abuse, drug addiction or mental illness.

"So what we're seeing is that kids are coming into care because they can't get their needs met, and then the system is unable to meet those needs," Murphy observed. "We're seeing that happen disproportionately with older youths."

The pandemic has been a unique stressor for older youths, according to Murphy, because of system challenges, but also because they are more vulnerable.

"We have so many young adults who leave foster care and have limited resources," Murphy explained. "They depend on some of the jobs that were most effected by the pandemic, like the service industry."

Murphy is gratified new policies adopted by the state this year will help older youths transitioning out of foster care to establish a rental history and credit rating, a serious challenge for those who have been in the system for a number of years.

COLUMBUS, Ohio -- In a system plagued by a history of disparities, Ohio's child-welfare workers and children's advocates say it is time to reimagine child protection.

Robin Reese, executive director of Lucas County Children Services, contended transformation begins with defining the role of child protection. She explained it has become "everything to everyone," with work often falling into the realms of juvenile justice and mental health.

Reese described the whole child-protection system as completely overwhelmed.

"Is the state listening? I think they're listening," Reese stated. "But in child protection, we've got to scream louder, because I don't think that they understand the immediacy of the issue and the weight of child protection."

Susan Walther, director of Warren County Children Services, advocated not only for improving foster care, but for entire system transformation. She said they are committed to keeping kids in families.

"Child welfare history can be generational," Walther pointed out. "How do we change this and empower these families and have kids who are able to be functioning in their own communities, staying in their own schools, staying with their families?"

Walther noted connecting families with work programs, food assistance, mental health care and other wraparound services can keep families safely and successfully together, and often prevent the need for child protection involvement.

Alexandra Citrin, senior associate at the Center for the Study of Social Policy, argued transformation needs to start outside the foster-care system, with flexible funding for partner agencies, and more collaboration.

"Our Department of Health, our Departments of Medicaid, our early childhood systems, Department of Mental Health, Addiction Services, Developmental Disabilities... to be able to work together outside of their silos, and really create a comprehensive continuum of supports and services that meets the diverse needs of the community," Citrin outlined.

Walther added structural racism must also be addressed to get better outcomes for children and families. She emphasized it means viewing transformation through a racial equity lens, to better connect with families of color.

"It's important to recruit caseworkers of different races and nationalities," Walther stressed. "There is a trust people have when they see an image of themselves. So, I think it's important to have that in county agencies, because there is a mistrust at times."