Perspective of School-Based Occupational Therapy Practitioners in Addressing Students’ Mental Health Needs Open Access

PURPOSE: The purpose of this study was to further explore occupational therapy practitioners’ (OTPs’) perceptions of how mental health issues are addressed within the context of the school environment and how OTPs support students’ mental health.

RATIONALE: Mental health (MH) in childhood is defined as “reaching developmental and emotional milestones, and learning healthy social skills and how to cope when there are problems.” In the United States, approximately 5 million children have some type of MH challenges that significantly interfere with daily life. OTPs are considered to be among the front line personnel to address development of children and support academic achievement and social participation within school routines.

However, the role of OTPs in addressing MH challenges with students is less recognized. Although the American Occupational Therapy Association has advocated the role of OTPs addressing MH through prevention, promotion, and intervention, a preliminary study conducted by Salamat and colleagues in southern California summarized that 63% of OTPs reported that they do not address MH issues in the school setting.

DESIGN: A phenomenological design to explore the role of OTP via individual interviews and focus groups

PARTICIPANTS: Fifteen licensed registered occupational therapists and certified occupational therapy assistant practitioners with ≥6 mo experience working in school-based setting.

METHOD: Fifteen open-ended semistructured questions were designed on the basis of a literature review and piloted with experienced OTPs prior data collection. Two focus groups and two individual interviews were conducted.

ANALYSIS: Responses were transcribed verbatim, coded individually by each researcher, and then as a group to determine reoccurring categories. Seventeen categories were identified and through concept mapping five themes concluded.

RESULTS: Five main themes emerged: perceived scope of practice of OTPs in the school-based setting, process to qualify for MH services, approach utilized by other disciplines to address MH, facilitators to addressing MH in the school, and barriers to addressing MH in school. Several OTPs defined MH as complex and felt that their role was ambiguous, leaving them feeling unfit. MH challenges were considered as a secondary condition rather than a primary diagnosis. Thus, OTPs commonly treat MH problems through indirect sensory processing interventions.

The process to qualify students for MH services was described as challenging and varied between districts. The interdisciplinary approach addressing MH was identified as reactive rather than proactive, which suggests that there is a lack of MH prevention and promotion approaches and utilization of OTPs in the school environment. Many OTPs felt that past experiences in MH gave them motivation to address and advocate for the needs of students with MH challenges.

DISCUSSION: Results of this study suggest a need for OTPs to promote awareness and advocacy for their role in a school-based practice in order to support promotion, prevention, and intervention of MH and ultimately support students’ participation in the academic setting.

This study also concludes that OTPs should continue interdisciplinary collaboration in order to help foster successful outcomes for student MH needs. Last, this study suggests designing continuing education courses for OTPs to address students’ MH needs as essential team members to support students’ achievements.

IMPACT STATEMENT: This study is critical to school-based practice because it contributes to occupational therapy scope of practice. The research reveals that OTPs experience many challenges to addressing MH in the school-based setting and is thus an area of practice that should be considered as critical to students’ MH.