School-Based Mental Health Interventions for OTPs

Providing mental health services in an academic setting can help support students.

Providing mental health services in an academic setting can increase accessibility to services and support the occupation of learning. Based on information from the CDC, depression, anxiety, behavior problems, and attention deficit hyperactivity disorder are the most common mental health issues for school-aged children. Data from a 2019 survey found that of adolescents 12-17 reported receiving school-based mental health services. This percentage is close to the 17% of adolescents who received services outside of school. Occupational therapy professionals (OTPs) can provide mental health services for students in a school-based setting.

Recommended course: Occupational Therapy’s Role in School-Based Positive Mental Health Initiatives 

Occupational therapy services and the academic model 

Occupational therapists in the school system deliver services under the academic model of services. Unlike the medical model of services, school-based services have to be tied to academic performance. 

In the school system, an OTP and the team that supports the student determine the appropriate way to provide services when needed. Services can be implemented based on various plans and programs. These include:

• Individual education programs (IEPs)
• 504 plans
• Response to intervention (RTI)
• A multi-tier system of supports (MTSS) 
• School-sponsored programs

OT services in the school system 

OTPs are most sought out for school-based services when a student displays skill set deficits such as: 

• School-based self-care skills that hinder participation in the expectations of the academic day
• Fine motor skills that impact handwriting and cutting abilities
• Visual perceptual and visual-motor skills that affect reading abilities and handwriting
• Sensory processing disorders that make it difficult to pay attention to and engage in academic activities
• Executive function skills that impact the ability to problem solve and sequence in the classroom

Although OTPs are skilled in assessing and providing interventions for the areas mentioned above, OTPs are also essential to an interdisciplinary school-based mental health intervention team. School-based mental health services can be provided by a team that includes occupational therapists, school psychologists, and school faculty and staff.  

OTPs help students learn about and develop emotional management abilities using occupation-based interventions. OTP interventions can be provided individually or in a small group setting. 

Internalizing and externalizing problems 

Poverty and discrimination are two factors cited by the CDC that can adversely affect a child’s mental health. A 2022 study identified additional factors for mental distress in relation to the COVID-19 pandemic. These factors include: 

• Low socio-economic status
• Living in a rural area
• Being the friend or a family member of a healthcare worker

Children can present with internalizing and externalizing problems because of their mental health state. A 2021 study examined the effects of mental health needs in childhood and adolescence in young adults. The study reported that children with externalizing problems due to their mental health needs can have more difficulty with academic participation. 

Internalized problems are inwardly directed, whereas externalized problems are projected outward. Examples of internalizing problems are: 

• Shyness
• Experiences of rejection
• Frequent worrying
• Frequent crying
• Problems with peers

Examples of externalizing problems are: 

• Body restlessness
• Distractibility
• Frequent interrupting
• Disturbing others
• Rule breaking

Cognitive Behavioral Therapy 

Cognitive Behavioral Therapy (CBT) can be used with children who are active participants in changing maladaptive behaviors caused by negative thinking. A study published about CBT for the pediatric population found CBT is effective for children needing mental health intervention.  

Another pediatric mental health study published in 2023 examined the feasibility of telehealth trauma-focused cognitive behavioral therapy (TF-CBT) with children in foster care. The study concluded that virtual therapy services were effective for children in foster care. With telehealth services becoming increasingly available for school-based services, even in a post-pandemic environment, TF-CBT can also become more accessible as well. 

Social and emotional learning 

Social and emotional (SEL) skills can teach children tools to help them with future difficulties. This process helps students learn and apply social, emotional, and related skills, attitudes, behaviors, and values. An SEL program can be embedded in an academic program for groups of students. SEL can begin as early as preschool to lay a foundation for self-regulation and interactions with others. The SEL framework contains five competencies: 

• Self-awareness
• Self-management
• Social awareness
• Relationship skills
• Responsible decision making

Several SEL programs can be used to facilitate SEL. A 2019 study explored the components of evidence-based elementary school SEL programs. The components the researchers found occurred most frequently were: 

• Social skills in 100% of programs
• Identifying the feelings of others in 100% of programs
• Identifying one’s feelings in 92.3% of programs
• Behavioral coping skills and relaxation in 91.7% of programs

Mental health OT interventions benefit children

Students benefit when they can access mental health services to maintain their mental well-being and address future mental health challenges. Mental health interventions can increase a student’s: 

• Self-esteem, giving them the confidence to engage in academic and non-academic school activities
• Social network, assisting them with the tools needed to form and maintain healthy peer relationships
• Ability to focus on academic and non-academic school activities without the primary or secondary distractions caused by their mental health
• Positive experiences in the school setting where their mental health is supported during school-based activities

Resources for OTPs 

Occupational therapy is rooted in mental health, and OTPs already provide school services supporting academic access. OTPs can use team collaboration and education to improve student outcomes. Bridging the knowledge gap for clinicians is vital for successful participation in school-based mental health support.  

Fortunately, resources are available to supplement the knowledge of OTPs who work in the school system and want to learn more about providing school-based mental health services.  

Some resources include: 

• The American Occupational Therapy website provides a resource for school-based mental health
• Mental health continuing education courses for school-based OTPs 
• Every Moment Counts initiative website