In 2021, a series of articles in the Bethlehem Press looked at the rising rates of pediatric mental health issues and some reasons that the problem seems intractable: the proliferation of ever-present internet-connected devices in young people’s environments, inadequate numbers of clinicians trained to diagnose and treat pediatric mental health complaints, and challenges in medicating a population for whom many adult drugs have not been approved. With these issues in mind, we spoke with two administrators in the Bethlehem Area School District who are part of a state-leading effort to ensure teens’ access to mental health resources.

Seven years ago, the Bethlehem Area School District embarked on a journey to a trauma-informed schools (TIS) mindset, beginning with conversations at the building level at Broughal MS and Liberty HS. Liberty Principal Dr. Harrison Bailey III recalls watching pediatrician Nadine Burke Harris’s TED talk about adverse childhood experiences (ACEs) and their effects on children’s overall well-being.

“We knew there was an issue,” he says. “We knew kids and staff were really struggling, but we didn’t have a name for it, so we dove in and began the process of creating committees, researching what this was about, and it built steam over time.”

One pressing issue was access to continuity of care, Bailey explains.

“From a building perspective, when this started, we didn’t have any social workers in our buildings. That was extremely problematic in terms of providing services for kids. The services we did have were outside […] It was a very disjointed way of providing services.”

He notes that students received service on a first-come, first-served basis, so young people whose serious challenges arose later in the academic year sometimes had to wait to have their needs appropriately met.

After identifying this shortfall, the district moved to address it.

“It forced us to look at our referral system, our SAP [Student Assistance Program] process, the services kids have and how they get them,” Bailey says. “That grew first into what we called the wellness office: one social worker and one Communities in Schools worker; around two-and-a-half to three years ago, that blossomed into an actual wellness center, with four social workers, one Communities in Schools worker, occupational therapy through Moravian University, a peace room […] We also contracted with the Pratyush Foundation to bring mindfulness into schools.”

Pratyush Sinha Foundation is an Allentown-based nonprofit organization founded in 2013 to help children, teens and adults improve their health through mindfulness and yoga programs. The group uses the MindfulSchools.org definition of mindfulness as “being present here and now, paying attention to thoughts, bodily sensations, emotions, and the external environment with kindness, nonjudgment, and curiosity.”

Tracey Hirner, who had been principal at Thomas Jefferson ES, was appointed the district’s first supervisor for social and emotional health services at the beginning of the 2021–22 academic year. One year later, Hirner was named director of student services for the district when BASD realigned some administrative roles as part of creating its Office of Equity Initiatives. She points out that both high schools and all four of the district’s middle schools have mindfulness training, as well as several elementary schools. “It’s also a natural part of the ‘Leader in Me’ work” at all of the district’s elementary schools, she notes. (“Leader in Me” is a program developed by Franklin Covey as a young people’s version of the popular “Seven Habits of Highly Effective People” training for adults. Habits that both adults and children learn include “Think win-win” and “Sharpen the saw.”)

BASD’s current three-tier system of supports includes social and emotional services provided to all students, as well as two levels of additional, need-based support.

“From what we hear as we get on calls beyond the Lehigh Valley, it [BASD] seems to be out in front,” Hirner notes.

All elementary students, as well as students at Broughal MS and Northeast MS, receive Leader in Me training. All secondary students receive training in restorative practices; at Freedom HS and Liberty HS, specific training for teachers addresses the five pillars of “social and emotional learning”: self-awareness, self-management, social awareness, relationship skills, and responsible decision-making.

Tier 2 supports are either small-group or targeted individual interventions; Tier 3 supports are provided on an individual basis and tailored to the child’s specific needs.

“All 22 of our [school] buildings are certified outpatient clinics,” Hirner explains. “We partner with St. Luke’s and Lehigh Valley Hospital Network, and they have outpatient rooms that have been certified where the therapists from St. Luke’s and LVHN are deployed.”

In a situation that is unique to BASD, individual buildings have anywhere from a half-day to four days per week of hospital therapists on-site.

Therapeutic and psychiatric services are billed to students’ insurance; the district helps uninsured and underinsured students apply for medical assistance, as well as investing General Operating Budget funds in social workers and therapists so that Tier 2 services can be deployed rapidly.

Bailey remarks that Liberty HS has a higher SAP referral rate than other Lehigh Valley high schools, a data point highlighted in a November 2022 report by the Lehigh Valley Justice Institute using data from the Pa. Youth Survey. However, he contends that the disparity is “not [because] other schools aren’t experiencing [mental health issues], but [because] our referral system is set up in a way that we have made it a priority to refer kids when we see the issue.”

The LVJI report suggests that BASD’s proactive approach to mental health issues may be responsible for the district’s student-reported depression rate being lower than the other Lehigh Valley school districts included in the report.

PAYS data show that – as noted in nationwide publications – depression and suicidality have been rising among young people for more than a decade, and worsened as schools across the state went virtual and students lost access to normal social activity.

“It was an issue pre-pandemic, and it’s especially an issue post-pandemic,” Hirner says. “We’re so grateful that the district supports investing in social and emotional well-being, and that we have wellness centers in place. We just have to figure out how to keep growing it, because it’s not getting easier.”

Speaking frankly, she states, “We can’t imagine where we’d be if we didn’t have wellness centers in place.”

In an era when the demand for youth mental health practitioners outstrips the supply, BASD’s school-based approach may be the most reliable way to meet the most students’ needs.

“The obvious advantage is that students are here in the building from 7:30 to 2:30, so for our social workers, that gives them the ability to schedule and access students in terms of the appointments while they’re here,” Bailey explains. “The challenge when you’re working in the community is coordinating. Now you have to coordinate with parents to provide transportation, and students’ work schedules, and there are so many barriers to just providing the appointment.”

Putting the BASD experience into a national context, Bailey comments, “You ask any high school principal ‘What’s your number one issue?’ and everyone will say ‘mental health.’ We’ve gotta start moving on this at a much larger scale, especially in areas in our state that don’t have services. You talk to some of these people in the middle of the state, who are out of the urban areas, it’s a mental health desert […]

“We’re fortunate,” he asserts, “that we did a lot of this work up front, and garnered resources as a district and a school early on, because […] if you have an issue, and you’re trying to find services for yourself or your child, you might be waiting weeks or months. You’re at the mercy of what you can find, which is a tough reality, especially if the kid is in crisis. It’s a very real issue.”