BETHLEHEM, PA — Urban school counselors are eager to use proven therapies for children’s anxiety and depression, according to a study led by a Lehigh University College of Education professor.
A comprehensive study of 719 therapists, of whom over half identified as ethnic minorities, across 27 Pennsylvania mental health agencies, shows strong support for bringing evidence-based treatments, such as Cognitive Behavioral Therapy (CBT), into Philadelphia’s urban schools. This work responds to the state’s Intensive Behavioral Health Services (IBHS) policy, which mandates that community providers deliver these therapies directly in schools to reach underserved youth. Providers rated CBT above 4 out of 5 for acceptability, ease of use, and fit with student needs, signaling strong readiness even though actual CBT knowledge averaged only 12 out of 20—highlighting a clear need for training.
“Cognitive Behavioral Therapy offers practical, skills-based support that teaches kids to recognize and change negative thought patterns and behaviors that fuel anxiety, depression, trauma, or school-related struggles. In short sessions, students build tools to reframe worries, manage emotions, gradually face fears, and replace unhelpful habits with proactive coping strategies. Decades of research show that it reduces symptoms and improves daily functioning,” explained Dr. Vanesa A. Mora Ringle, lead author of the study, Pre-implementation Perceptions of Urban School-Based Mental Health Providers and a bilingual clinical psychologist and assistant professor at Lehigh University’s College of Education.
Dr. Mora Ringle and co-authors analyzed pre-training surveys collected early in the COVID-19 pandemic, when schools emerged as critical mental health lifelines amid shrinking community access. Agencies demonstrating proactive, knowledgeable, and perseverant leadership—along with strong implementation climates—fostered greater provider enthusiasm, openness to mandates, and positive attitudes toward these therapies.
This organizational support proved key: providers who perceived a strong focus on evidence-based practices, such as CBTs, recognition for their use, and openness to hiring were more willing to adopt required treatments. Schools remain essential gateways to children’s mental healthcare, yet co-located providers face real pressures—from paperwork and parental consent to stretched resources—that could derail success. These positive baseline perceptions offer hope for overcoming such barriers.
Mora Ringle and her team found that community providers generally perceived their organizations as having strong implementation climates and leadership, and reported high CBT acceptability, appropriateness, and feasibility, as well as positive attitudes toward EBPs. Almost entirely consistent with theoretically-grounded directional hypotheses, and similar past work, they found that provider perceptions of implementation climate and leadership were associated with EBP attitudes and CBT knowledge.
“We additionally found that provider perceptions of CBT acceptability, feasibility, and appropriateness were also associated with EBP attitudes and CBT knowledge,” said Mora Ringle. “We explored and found that implementation climate perceptions, but not leadership, varied significantly with provider ethno-racial group.” She hopes more implementation science work focused on organizational factors will take into account the theory of racialized organizations and provider ethnocultural background.
As youth mental health crises escalate—especially in diverse urban districts—these findings arrive at a pivotal moment. Pennsylvania’s IBHS policy drives EBP expansion through partnerships among schools, counties, Medicaid funders, and community agencies. Strong provider buy-in predicts higher fidelity, reach, and student outcomes, but uneven ethno-racial perceptions risk inequitable delivery, particularly under top-down policy changes rather than voluntary efforts.
Dr. Mora Ringle, who directs the HEAL Together Lab at Lehigh, emphasized the study’s implications: “Schools provide essential access to mental healthcare, but we must understand how organizational climate and leadership shape provider readiness. The variations across ethno-racial groups underscore the urgent need for culturally responsive strategies to optimize implementation—ensuring that high-quality, evidence-based services reach every student equitably.”
Published in School Mental Health (DOI: 10.1007/s12310-025-09836-0), the research—grounded in frameworks such as the Consolidated Framework for Implementation Research—calls for practical next steps: equity audits of workplace climates, tailored leadership training, incentives aligned with diverse provider needs, and pre-implementation assessments to build buy-in before rollout.
This work builds on long-standing Philadelphia partnerships, such as the Beck Community Initiative, underscoring that policy alone isn’t enough—agency culture determines real-world impact.
The results have far-reaching implications beyond Philadelphia, offering a blueprint for school mental health success nationwide. Strong agency leadership and supportive climates consistently predicted counselors’ enthusiasm for delivering proven therapies such as CBT, underscoring that organizational culture—not just policy mandates—determines whether kids receive effective treatment for anxiety and depression. Parents nationwide can advocate for similar workplace conditions in their districts, ensuring providers feel equipped, recognized, and rewarded. Counselors everywhere should flag equity gaps in support to prevent uneven care delivery. Ultimately, this research shows that schools remain vital mental health hubs when leaders prioritize readiness and inclusion, helping underserved youth thrive regardless of location.
Co-authors on the study include Elyse Ganns, a Graduate Student Researcher in the Department of Education and Human Services at Lehigh University, and Dr. Torrey A. Creed, Associate Professor of Psychiatry at the Hospital of the University of Pennsylvania and Director of the Beck Community Initiative, Perelman School of Medicine, University of Pennsylvania.
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