Journal Club Discussion #14: Treating Mental Health in School-Based Practice

Hey readers! This week’s journal club discussion is brought to you based on a question that came to my mind at AOTA Conference. While I was at the conference, I attended a Conversations That Matter session entitled “A Climate of Crisis Post-Parkland: How to Optimize & Advocate for the Use of Mental-Health Approaches in School-Based OT; A Florida Occupational Therapy Association Ad Hoc Initiative.” I will talk more about each of the sessions that I attended in a blog post going up later this week, but this discussion got me thinking about mental health in the school setting. We spent much of the conversation talking about what we can do as OTs after students experience trauma – whether in their own school or as the result of the societal trauma that American children and adults alike are facing due school shootings. This got me thinking: Why are we talking about what to do after trauma is experienced when we should be discussing what OTs can do to prevent these horrific events from happening in the first place.

Unfortunately, the research on this is limited to non-existent. (If you have any information on what OTs specifically can do to reduce the occurrence of school shootings, please send me a link!) In my opinion, this will essentially come down to treating mental health in general in schools (ie. coping, social, and emotional skills). In fact, occupational therapy started with a focus on mental health, so it only makes sense for OTs to be on the frontline of treating mental health in the school system. Since there is limited research on what OTs can do for prevention of school gun violence, I found a phenomenological study by Arezou Salamat, Heather Javaherian-Dysinger, Dragana Krpalek, Saloni Parikh, Kelly Lee, Blake Christensen, Amy Liu, Karen Ngo, and Yoshiaki Goya titled “Perspective of School-Based Occupational Therapy Practitioners in Addressing Students’ Mental Health Needs.” Let’s discuss what they found!

Background Info

The purpose of this study was to determine the perceptions of school-based occupational therapy practitioners (OTPs) regarding how to address mental health in schools. The authors define childhood mental health as “‘reaching developmental and emotional milestones, and learning healthy social skills and how to cope when there are problems’…[and state that] approximately 5 million children have some type of [mental health] challenges that significantly interfere with daily life” (Salamat et al., 2016, n.p) in the United States. The role of an OT in a school is to support the occupation of education in all school contexts, so it may be possible that mental health is not being treated. AOTA members can access the article here!

Methods & Participants

The authors conducted a phenomenological study with 15 participants. This was completed by asking 15 open-ended semistructured questions in individual interviews and focus groups.

The Results

The five themes that emerged were:

  • “perceived scope of practice of OTPs in the school-based setting,
  • process to qualify for [mental health] services,
  • approach utilized by other disciplines to address [mental health],
  • facilitators to addressing [mental health] in the school, and
  • barriers to addressing [mental health] in school” (Salamat et al, 2016).

The authors concluded that some school-based OTs feel as though their role is ambiguous and they are not fit to treat mental health in the school. Furthermore, their role is to support education while treating mental health is a secondary goal. Qualifying students for mental health OT services is challenging, however the OTs see the need for treatment to prevent mental health conditions from developing or worsening. Finally, many OTs feel as if there is currently a reactive approach to mental health services when it should be proactive or preventative.

What I Think

I think that it is imperative to approach mental health in schools with a proactive and preventative viewpoint rather than a reactive one. It is in OTs’ scope of practice to treat mental health in the school system, but it will come down to OTs advocating for themselves and for their students. This is a larger problem that needs to be solved – in our society and in our school districts. I believe that OTs can play a critical role in improving mental health outcomes and reducing school gun violence, but they need more resources. There needs to be more than one OT in each school district, they need to have fewer children on their case load, and there needs to be referrals specifically for mental health OT treatment. OTs can also lead school-wide initiatives and groups to promote coping skills and social and emotional learning.

Question of the Week: If you practice OT in a mental health setting (school, inpatient, outpatient, community, etc.) what are your thoughts on this topic or suggestions for school-based mental health interventions?

Learn More: If you also believe that gun violence in schools needs to end, check out Moms Demand Action. This organization works to promote gun sense in America, which I believe is critical to ending school gun violence. I don’t want to get into a political debate here, but this organization is great if you have similar beliefs. You can get involved in your state or school by calling your representatives, signing petitions, making a donation, and staying up to date on the policies that Moms is pushing through Congress via regular emails.

Citation: Salamat, A., Javaherian-Dysinger, H., Krpalek, D., Parikh, S., Lee, K., Christensen, B., Liu, A., Ngo, K., & Goya, Y. (2016). Perspective of school-based occupational therapy practitioners in addressing students’ mental health needs. American Journal of Occupational Therapy, 70. doi: 10.5015/ajot.2016.70S1-PO5121

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