Occupational Therapy’s

Distinct Value

MENTAL HEALTH PROMOTION,

PREVENTION, AND INTERVENTION
Across the Lifespan

Occupational therapy’s distinct value is to improve health and quality of life through facilitating participation
and engagement in occupations, the meaningful, necessary, and familiar activities of everyday life.
Occupational therapy is client-centered, achieves positive outcomes, and is cost-effective.

Occupational therapy has a rich history of promoting mental health in all areas of practice through the use of
meaningful and enjoyable occupations (Meyer, 1922). The aim of occupational therapy services in mental health
is to help all individuals develop and maintain positive mental health, prevent mental ill health, and recover from
mental health challenges in order to live full and productive lives.

This document focuses on occupational therapy’s distinct value in mental health promotion, prevention, and
intensive interventions across the lifespan by fostering participation in meaningful occupations for persons with,
at-risk of, and without mental health challenges. Occupational therapy services emphasize the use of meaningful
occupation to promote participation in occupations (education, play, leisure, work, social participation, activities
of daily living [ADLs], instrumental ADLs, sleep and rest) within a variety of environments, such as school, home,
community, work, residential, and health care settings (American Occupational Therapy Association, 2014).

The actual “doing” of occupations is believed to be transformative, promoting adaptation, creating personal and social
identities, connecting people to their communities, and enabling ongoing personal growth and development.
(Krupa, Fossey, Anthony, Brown, & Pitts, 2009, p. 156).

The Relationship Between Engagement in Occupation and Mental Health Outcomes

Occupational therapy practitioners are distinctly qualified to provide occupation-based practice because of expertise
in occupational performance, activity analysis and design, environmental analysis, neurophysiology, psychosocial
development, and group dynamics, to name a few. When interacting with other mental health providers (e.g., psy-
chologists, social workers, counselors, psychiatrists), it is important to articulate the distinct value of our services as
the use of evidence-based meaningful activities to promote participation in everyday life. Research from the field of
positive psychology has further confirmed that participating in meaningful occupations that result in positive emo-
tions helps build resilience and fuel mental well-being (Donaldson, Csikszentmihalyi, & Nakamura, 2011; Fredrick-
son, 2004; Seligman & Csikszentmihalyi, 2000). The findings of an evidence-based review in pediatric occupational
therapy practice, for example, indicate that activity-based interventions involving play, leisure, and recreation help
improve children’s social interaction, self-esteem, and positive feelings, and they reduce behavior problems (Bazyk
& Arbesman, 2013). An occupational therapy preventative lifestyle intervention, Lifestyle Redesign, was shown to
promote mental well-being with older adults living in the community (Clark et al., 2012).

“There is no health without mental health.”

—World Health Organization [WHO], 2001
Mental Health, Mental Illness, and Everyday Functioning
Occupational therapy practitioners provide services to people across the lifespan who experience a range of men-
tal health and ill health based on genetic predisposition and/or life stressors (e.g., disability, injury, trauma). The
continuum of mental health can range from acute mental illness or mental health challenges at one end, to men-
tally healthy and flourishing at the other (Keyes, 2007). Mental health is not merely the absence of mental illness,
but the presence of a cluster of characteristics including positive affect, positive psychological and social function-
ing, and the ability to adapt to change and cope with life challenges (Keyes, 2007; U.S. Department of Health and
Human Services, 1999). People who are mentally healthy, even with the presence of an identified mental illness,
function better in everyday life and engage in activities to maintain health (Keyes, 2007; Rasciute & Downward,
2010; Sabatini, 2011). Because of the dynamic nature of mental health and mental ill health in a person’s life, occu-
pational therapy practitioners tune into and address the mental health needs of all clients in all practice settings.

Mental Illness Languishing Becoming Positive Mental Flourishing

Diagnosis of a Low levels of Unwell Health High levels of
mental disorder affective well- Experiencing Feeling good affective well-
(e.g., depression, being and positive being and positive
schizophrenia, early signs and emotionally,
functioning mild symptoms doing well functioning,
anxiety, etc.)
with low levels of of mental illness, functionally, with or without
functioning may be due having fulfilling the presence of
to situational relationships, mental illness
stressors coping with
challenges

(Barry & Jenkins, 2007; Keyes, 2007; Miles, Espiritu, Horen, Sebian, & Waetzig,
2010; U.S. Department of Health and Human Services, 1999)

Public Health Approach to Mental Health in Occupational Therapy

The WHO (2001) has advocated for a public health approach to mental health,
which emphasizes the promotion of mental health as well as the prevention of,
and intervention for, mental illness. This model provides a useful framework
for describing occupational therapy’s distinct value in mental health promo-
tion, prevention, and intensive interventions across the lifespan (Miles et al.,
2010; National Research Council and Institute of Medicine, 2009). Following a
brief description of the focus of services at each level, specific examples of occu-
pational therapy practice and research at each level are provided in Table 1.

As a profession, occupational therapy traditionally lays claim to

meaningful occupations as its core and has included health
promotion and wellness in its scope of practice
(Hildenbrand & Lamb, 2013, p. 267).

The Three Major Levels of Service

Tier 3–Intensive interventions are provided for individuals with identified mental, emotional, or behavioral disorders
that limit daily functioning, interpersonal relationships, feelings of emotional well-being, and the ability to cope
with challenges in daily life. It is well documented that people with serious mental illness experience occupation-
al disruptions (Krupa et al., 2009) and higher incidences of many chronic medical conditions (Keyes, 2007; Saha,
Chant, & McGrath, 2007). Occupational therapy practitioners are committed to the recovery model which focuses
on enabling persons with mental health challenges through a client-centered process to live a meaningful life in the
community and reach their potential (Champagne & Gray, 2011). Occupational therapy practitioners, with an in-
depth knowledge of both physical and mental health, are distinctly qualified to provide integrated care to address a
person’s functioning in a variety of occupations (e.g., education, work, leisure, ADLs, social and community partici-
pation) using occupation-based psychosocial, self-management, and environmental interventions.
Settings
• Inpatient behavioral mental health
• Community mental health
• Alternative and public schools
• Residential (group homes, nursing homes)
• Home-based services
• Organizational workplaces

Focus of Services (Direct–Individual or Group,

Consultation)
• Engagement in occupation to foster recovery and/or
“reclaiming mental health” resulting in optimal levels of
community participation, daily functioning, and quality of life
• Functional assessment and intervention (skills training, accommodations, compensatory strategies) (Brown,
2009, 2012)
• Identification and implementation of healthy habits, rituals, and routines to support wellness (Champagne &
Gray, 2011)
• Social skills and friendship promotion groups (Bazyk & Arbesman, 2013)
• Community integration (recreation, leisure, work) (Arbesman & Logsdon, 2011; Bazyk & Arbesman, 2013)
• Normative life roles (Gibson, D’Amico, Jaffe, & Arbesman, 2011)
• Sensory strategies (Brown, 2009, Champagne, 2006, Downing, 2011)
• Supported employment, supported education (Arbesman & Logsdon, 2011)
• Cognitive behavioral strategies (Bazyk & Arbesman, 2013)
• Strategies for stress reduction (Downing, 2011)
• Trauma-informed care (Champagne, 2006)
• Motivational interviewing (Stoffel & Moyers, 2004)
• Intensive behavioral interventions (e.g., dialectical behavioral therapy)

Occupational therapy professionals can play a key role in improving the health of a population through prevention and
wellness by reaching out to communities and organizations and by working with clients in managing chronic conditions
(Hildenbrand & Lamb, 2013, p. 266).

Tier 2—Targeted services are designed to prevent mental health problems in

persons who are at risk of developing mental health challenges, such as those Occupational therapists in all
who have emotional experiences (e.g., trauma, abuse), situational stressors rehabilitation settings in which
(e.g., physical disability, bullying, social isolation, obesity) or genetic factors clients with stroke will be served
(e.g., family history of mental illness). Individuals at this level are often not must be prepared to assess and
identified as needing mental health services and may include persons with treat mental health impairments
mild mental disorders, physical disabilities, and those living or working in so that stroke survivors may fully
stressful environments. Occupational therapy practitioners are committed participate in and receive the
to early identification of and intervention for mental health challenges in maximum benefit of rehabilitation
(Hildenbrand, 2015).
all settings. Services at this level emphasize both prevention of mental illness
(e.g., reducing risk factors such as unhealthy daily routines, chronic stress,
negative thinking) as well as the promotion of competencies to offset early symptoms (e.g., relaxation strategies, so-
cial and emotional competencies, healthy lifestyle, basic life skills) and involve a more direct role in evaluation and
intervention compared with Tier 1 services (Barry & Jenkins, 2007; Catalano, Hawkins, Berglund, Pollard, & Arthur,
2002; Miles et al., 2010). The use of character strengths, coping strategies, participation in enjoyable occupations,
and environmental supports serve as important “buffers” in the prevention of mental ill health (Catalano et al.,
2002).

Settings: All hospital, clinic, school, residential, home, and community-based environments
Focus of Services (Small groups, Consultation, Accommodations,
Education)
• Engagement in occupations to promote mental health and diminish early
symptoms
• Small, therapeutic groups (Olson, 2011)
• Environmental modifications to enhance participation (e.g., create senso-
ry-friendly classrooms, home, or work environments)
• Modification of expected task or expectations
• Strategies for enhancing coping skills and social and emotional
competencies
• Transition and re-entry (e.g., veterans, refugees, survivors of domestic abuse)

Philosophically, occupational therapy is steeped in health-promoting constructs and behaviors such as

using time in meaningful and productive ways, “doing things” or engaging in occupations as part of
an active lifestyle, and maintaining social connectedness
(Meyer, 1922/1977 as cited in Hildendbrand & Lamb, 2013, p. 267).

Tier 1—Universal services are provided to all individuals with or without mental health or behavioral problems,
including those with disabilities and illnesses (Barry & Jenkins, 2007; Jané-Llopis & Mittlemark, 2015). Occupation-
al therapy services focus on mental health promotion and prevention for all: encouraging participation in health-pro-
moting occupations (e.g., enjoyable activities, healthy eating, exercise, adequate sleep); fostering self-regulation
and coping strategies (e.g., mindfulness, yoga); promoting mental health literacy (e.g., knowing how to take care
of one’s mental health and what to do when experiencing symptoms associated with mental ill health). Services at
this level also focus on creating social and physical environments and activities that are enjoyable and successful
for all individuals. Occupational therapy practitioners develop universal programs and embed strategies to promote
mental health and well-being in a variety of settings, from schools to the workplace.

Settings: All hospital, clinic, school, residential, home, work and community-based environments

Focus of services: individual, group, school-wide,

employee/organizational level
• Universal programs to help all individuals successfully
participate in occupations that promote positive mental
health (Bazyk, 2011)
• Educational and coaching strategies with a wide range of
relevant stakeholders focusing on mental health promo-
tion and prevention
• The development of coping strategies and resilience
• Environmental modifications and supports to foster
participation in health-promoting occupations (Spangler,
Koesten, Fox, & Radel, 2012)
• Mental health literacy—educating individuals and groups
on mental health, mental illness, and activities and lifestyles that promote mental health (Jorm, 2012).

Occupational therapy practitioners are distinctly qualified to analyze the relationship between the
person, environment, and occupation in order to promote participation in everyday life.
Occupational therapy practitioners use a combination of “detailed occupational analyses; activities graded to meet
personal needs; explicit time use planning to encourage balanced participation; education to provide individuals
with the information about their occupational situations, with which to empower an individual to effect change;
focused efforts to capitalize on strengths and build skills; and consultation and environmental modification to
secure the best match between the person and the occupation in which she or he is seeking to participate” (Krupa
et al., 2009, p. 158).
Occupational therapy is client centered
“Occupational therapy practitioners work collaboratively with people in a manner that helps to foster hope, moti-
vation, and empowerment, as well as system change” (Champagne & Gray, 2011, p. 1).

Occupational therapy is cost effective

• Evidence indicates it is more cost effective to support a person with serious mental illness to live in the commu-
nity than it is to house them in a nursing home setting (O’Donnell, 2013). Occupational therapy practitioners
provide the skills training assistance that individuals who have lived in institutionalized settings need to re-es-
tablish daily routines, to manage and monitor health conditions, to develop new roles (e.g., tenant), and to
participate in their communities (Jones, 2015).
• In school settings, the impact of occupational therapy is maximized with integrated services to students with
disabilities and mental health challenges in natural schools contexts. Such integrated services are cost effective in
that students at risk of developing mental health challenges as well as those without risks benefit from integrated
occupational therapy (Bazyk & Cahill, 2015).
• With community-dwelling older adults, occupational therapy lifestyle intervention has been shown to lead to
significant positive changes in mental health and social functioning, and decrease depressive symptoms (Clark et
al., 1997, 2012) leading to health care savings exceeding the cost of intervention (Hay et al., 2002).
• Occupational therapy intervention strategies (e.g., environmental modification, wellness-promoting activities,
education for caregivers) has been found to save money by improving health status and quality of life for both
clients and caregivers while decreasing hospital and skilled nursing admissions (Graff et al., 2008 as cited in Hart
& Parsons, 2015).

Examples of Distinct Value of OT Mental Health Practice Across the Lifespan—Exemplary Practice, Model
Programs, Evidence-Based Reviews, Websites, Information Sheets, Video Vignettes

TIER 3: Intensive Interventions for Individuals With

Identified Mental Health Challenges
Children/Adolescents Adults/Older Adults
Exemplary practice, research, website: Exemplary practice, model program, videos:
Early Detection & Identification for the Prevention of Psy- Nutrition and Exercise for Weight Loss and Recovery
chosis Program (EDIPPP)—Donna Downing serves as the (NEW-R)—Adults with serious mental illness have high
lead occupational therapist for this national, multi-site levels of obesity, which can lead to chronic medical
initiative focusing on the early detection and interven- conditions. Catana Brown and collaborators created a
tion of severe mental illness in adolescents. In addition weight-loss program called RENEW: Recovering Energy
to community outreach and education, OT services through Nutrition and Exercise for Weight loss (Brown,
focus on supported education and employment inter- Goetz, & Hamera, 2011; Brown et al., 2015). Retrieve
ventions in collaboration with vocational specialists the curriculum, including videos, from www.cmhsrp.
on each team (Downing, 2006, 2011; Ruff, McFarlane, uic.edu/health/weight-wellbeing.asp
Downing, Cook, & Woodberry, 2012). See the PIER
Training Institute at www.piertraining.com and the Exemplary practice:
National Association of State Mental Health Program Transitioning From Nursing Homes to the Community
Directors at www.nasmhpd.org OTs at Trilogy Behavioral Healthcare support peo-
ple with serious mental illness to move from nursing
Information sheets: homes where they have lived for years to their own
AOTA School Mental Health Toolkit for Tier 3—Informa- independent apartments in the community (Thanos,
tion sheets on addressing a variety of mental health 2014; Thanos & Rotter, 2014)
challenges in school settings (e.g., anxiety, depression,
reducing restraint and seclusion). Developed by AOTA’s
School Mental Health Workgroup. See www.aota.org/
Practice/Children-Youth/Mental%20Health/School-
Mental-Health.aspx
 TIER 3: Intensive Interventions for Individuals With
Identified Mental Health Challenges
Children/Adolescents Adults/Older Adults
Exemplary practice, research, website: Exemplary practice, manual:
Trauma-informed Care (TIC), Sensory-Based Approaches Promoting Health and Wellness for People in Mental
and Occupational Therapy. Tina Champagne, director Health Recovery
of the Institute for Dynamic Living, has developed Margaret Swarbrick and collaborators designed a guide
occupational therapy interventions focusing on sen- for community sites to conduct health fairs for people
sory modulation–related interventions for those with with serious mental illness. The health fairs are meant
disorders of trauma and attachment (DTAs) and worked to provide health screenings, education, and resources
to integrate these within mental health systems of care to support individuals to manage chronic health issues
(e.g., sensory-supportive equipment, furnishing, and (Swarbrick et al., 2014). See more at www.integration.
modalities; sensory modulation–related kits, carts, and samhsa.gov/health-wellness/wellness-strategies/UIC_
rooms) (Champagne, 2011). See the OT Innovations CSPNJ_Health_Fair_Manual.pdf
website at www.ot-innovations.com
Exemplary practice:
Exemplary practice: Activity-Health Needs
Transitioning From Inpatient Programming to Communi- Terry Krupa designed an occupational time-use inter-
ty Living: Towson University’s Institute for Well-Being in vention, Action Over Inertia, to encourage occupational
Baltimore, Maryland, provides life skills development balance and participation with individuals with serious
services for adolescents and young adults. Services at mental illness living in the community (Edgelow &
the program center are provided to community mem- Krupa, 2011; Krupa et al., 2010).
bers but are also made available through special coordi-
nation with Tier 3 service settings. Towson University Exemplary practice:
Occupational Therapy Center: www.towson.edu/iwb/ Creating Sensory Rooms in Acute Psychiatric Care
therapy/index.asp Tina Champagne created and evaluated sensory rooms
in an acute psychiatric unit. The rate of seclusion/re-
Exemplary practice: straint in the unit was reduced by 54% during the year
Department of Occupational Science and Occupational of sensory room implementation (Champagne, 2006).
Therapy at the University of Southern California Collabora-
tion With the Violence Intervention Program-Community Exemplary practice:
Mental Health Center (VIP-CMHC). Nancy Bagatell and Development and Use of Community Living Skills (CLS)
Briana Hamill Pollard developed an OT intervention Group Protocols for Functional Skill Development in
program for children who have been abused and/ Acute Mental Health Settings. Occupational therapy
or neglected focusing on engaging in co-occupation, practitioners at Johns Hopkins Hospital in Baltimore
embedding regulation strategies into daily routines, and implement CLS groups in the inpatient and day hospi-
fostering play (Bagatell & Pollard, 2010). tal focusing on IADLs, including health management,
community navigation, home management, budgeting
Exemplary practice: and money management, meal preparation, and gro-
Promoting Self-Regulation in Youth With Severe Emotional cery shopping (Lichtenstein Spense, Schwartzschild, &
Disturbance (SED) Using the ALERT Program in an 8-Week- Synovec, 2015).
Long Group (Barnes, Vogel, Beck, Shoenfeld, & Owen,
2008). Embedding the ALERT Program within the class-
room for students with severe emotional disturbance
for 8 weeks resulted in improvements in self-regulation.
 TIER 3: Intensive Interventions for Individuals With
Identified Mental Health Challenges
Children/Adolescents Adults/Older Adults
Video vignette, exemplary practice: Exemplary practice:
OT Leisure Coaching With a Young Male With Severe Intensive Individualized Occupational Therapy improved
Emotional Disturbance (SED), Anxiety, and Developmental indicators of recovery (social functioning) within a
Disabilities. David Weiss provides OT Leisure Coach- pilot controlled study of individuals with psychotic
ing to help a young male explore and participate in a conditions. Outcomes suggest potential to improve
community-sponsored adaptive soccer program. See community integration and function through OT inter-
the Every Moment Counts website to view this video at vention (Cook, Chambers, & Coleman, 2009). Func-
www.everymomentcounts.org/view.php?nav_id=192 tional improvement scores were also noted with early
occupational therapy intervention for acute episodes of
AOTA Practice Guideline: schizophrenia (Tanaka et al., 2014).
Bazyk, S., & Arbesman, M. (2013). Occupational therapy
practice guidelines for mental health promotion, prevention, Systematic Review: Community Integration and Normative
and intervention for children and youth. Bethesda, MD: Life Roles for People With Serious Mental Illness. An in-
AOTA Press. vestigation evaluating the effectiveness of occupational
therapy interventions focusing on recovery (social skills
training, life skills training, neurocognitive training
paired with skills training) in the areas of work, social
participation, and IADLs (Gibson et al., 2011).

Evidence-based review:
An Occupation-Based Perspective on Interventions for
Persons With Substance-Use Disorders. The application
of brief interventions, cognitive behavioral therapy,
motivational strategies, and 12-step self-help groups
to occupational therapy practice is described (Stoffel &
Moyers, 2004)

AOTA Practice Guideline:

Brown, C. (2012). Occupational therapy practice guide-
lines for adults with serious mental illness. Bethesda, MD:
AOTA Press.
 TIER 2: Targeted Services: Prevention of Mental Illness and Promotion of
Positive Mental Health for At-Risk Groups
Children/Adolescents Adults/Older Adults
Model program: Exemplary practice, model program:
Zones of Regulation—Self-Regulation Using Social Promoting Mental Health in Older Adults
Thinking and Sensory Strategies. Occupational thera- Occupational therapists Tracy Chippendale & Marie
pist Leah Kuypers developed the Zones of Regulation Boltz (2015) developed the Living Legends program
curriculum to provide a systematic, cognitive behav- which uses life review writing and intergenerational ex-
ior approach to teach children about their emotional change to promote occupation among community-liv-
and sensory needs in order to self-regulate and control ing older adults at risk for depression.
emotions and impulses, manage sensory needs, and
improve the ability to solve conflicts. The program was Exemplary practice:
initially applied with children with autism spectrum Yoga to Reduce Combat Stress
disorder, but is now applied widely in schools with all A sensory-enhanced 3-week yoga intervention created
students (Kuypers, 2011). See the website at and delivered by occupational therapists was found to
www.zonesofregulation.com reduce anxiety among deployed military personnel at
risk for post-traumatic stress disorder (Stoller, Greuel,
Model program: Cimini, Fowler, & Koomar, 2012).
Self-Regulation Using Sensory and Thinking Strategies—
ALERT Program ® for Self-Regulation of Arousal. Exemplary practice, model program:
Developed by occupational therapists Williams and Increase Well-Being in Cardiac Rehabilitation
Shellenberger, this program uses an engine analogy An occupation-focused 12-week cardiac rehabilita-
to teach children and adults how to understand their tion program promotes a self-management strategy to
sensory processing needs and use sensory strategies to enhance self-efficacy. The goal is to increase a sense
self-regulate arousal in order to function successfully of well-being, promoting occupational performance
throughout the day (Williams & Shellenberger, 1996). (White & Buyting, 2011).
The website has additional information and products
www.alertprogram.com/index.php. Evidence-based review:
Effective Interventions for Adults With Psychological or
Video vignette: Emotional Impairment After Stroke. As many as 50% of
Teaching Self-Regulation to Students at Risk of Mental stroke survivors experience mental health challenges
Health Challenges Using Social Thinking and Sensory (anxiety, depression) post-stroke. A number of inter-
Processing Strategies—This video features Carol Conway ventions effective in promoting mental health are
co-teaching Zones of Regulation in special and gener- supported by research, including problem-solving and
al education classrooms with teachers and the school motivational interviewing behavioral strategies, mul-
counselor. See the Every Moment Counts website to ticomponent exercise programs, stroke education and
view this video at: www.everymomentcounts.org/view. care support, and community-based leisure participa-
php?nav_id=190 tion (Hildenbrand, 2015).

Exemplary practice, research: Exemplary practice, research:

Occupation-Based Groups for Low-Income Youth in an Reduce Depression in Stroke Survivors
After-School Setting—Occupational therapist Susan In a randomized controlled trial, an occupational ther-
Bazyk developed the OT Groups for HOPE (Healthy Oc- apy home-based leisure program was found to improve
cupations for Positive Emotions) for low-income urban participation and satisfaction with leisure activities,
youth attending a community-based after-school pro- and reduce depression in individuals recovering from a
gram. These occupation-based groups take place over stroke. (Desrosiers et al., 2007)
8-weeks and focus on participation in healthy hobbies
and interests and social and emotional learning. The
meaning of the groups from the children’s perspective
was explored using phenomenology (Bazyk & Bazyk,
2009).
 TIER 2: Targeted Services: Prevention of Mental Illness and Promotion of
Positive Mental Health for At-Risk Groups
Children/Adolescents Adults/Older Adults
Exemplary practice: Exemplary practice:
Transition From Foster Care to Independent Adulthood Stepping Stones Program
Adolescents in foster care may experience significant Texas Woman’s University (TWU) in Denton, Texas, of-
transitional challenges toward the development of fers an occupation-based program for individuals with
adult occupations. Occupational therapy’s emerging early stage Alzheimer’s disease and their caregivers. The
practice potential has been noted for this population. occupational focus is intended to improve quality of
Individuals encountered in adolescent Tier 3 settings life indicators (Brown & Evetts, 2013).
frequently have foundations in this Tier 2 potential
area of practice (Paul-Ward, 2009; Paul-Ward, Lamb- Exemplary practice:
din-Pattavia, & Haskell, 2014). Community Behavioral Health Centers may provide a new
setting for coordination of adolescent and young adult
Video vignette: services (Parsons, 2015). More information is available
Occupation-Based Group Emphasizing Social and Emotion- at www.samhsa.gov/section-223
al Skills and Friendship for Students Experiencing Anxiety
and Bullying Exemplary practice, research:
Jenny Negrey offers the Game Break group focusing DVD Training to Enhance Therapists’ Mental Health
on playing games at an outpatient clinic setting with Practices and Depression Identification and Treatment in
children with disabilities who also experience anxiety, Older Adults. Lysack and colleagues have developed,
social exclusion, and bullying. View the video clip at implemented and evaluated the use of a DVD training
www.everymomentcounts.org/view.php?nav_id=193 program to increase OT’s knowledge of how to identify
and treat mental health challenges (e.g. depression) in
Information sheets: older adults. Findings suggest that the DVD trainings
AOTA School Mental Health Toolkit for Tier 2 are effective in increasing knowledge, attitudes, and
Occupational therapy information sheets on address- practice change with older adults (Lysack, Leach, Russo,
ing a variety of situational stressors that place children Paulson, & Lichtenberg, 2013; Lysack, Lichtenberg, &
and youth at risk of mental health challenges in school Schneider, 2011).
settings (e.g., grieving and loss, obesity, bullying, child-
hood trauma). Developed by AOTA’s School Mental
Health Workgroup. See www.aota.org/Practice/Chil-
dren-Youth/Mental%20Health/School-Mental-Health.
aspx
 TIER 1: Universal Strategies

Children/Adolescents Adults/Older Adults

Exemplary practice, model programs, website: Exemplary practice, research:
Applying A Public Health Approach to Children’s Mental Applying a Public Health Approach to Workplace Health at
Health In School and Community Practice: the Organizational Level: Nancy Spangler is a consultant
Susan Bazyk is the project director of Every Moment to the American Psychiatric Association on workplace
Counts: Promoting Mental Health Throughout the mental health. She has developed a model for address-
Day, an Ohio Department of Education–funded mental ing all aspects of the mental health continuum: Tier
health promotion initiative led by occupational thera- 1 strategies focus on preventing distress and building
py practitioners (2012–present). A multi-tiered, public organizational resilience; Tier 2 prevention strategies
health approach to mental health in school and com- focus on providing information, resources, and benefits;
munity settings guides this initiative. Major goals in- and Tier 3 strategies involve active intervening with
clude: (1) building capacity of OT practitioners to do this employees with mental health challenges (Spangler et
work throughout Ohio using Communities of Practice al., 2012).
(Bazyk et al., 2015); (2) developing and implementing
model programs and embedded strategies; and (3) dissem- Exemplary practice:
inating materials on the initiative’s website (www. Reducing Stress Through Yoga
everymomentcounts.org) Evidence indicates that yoga can reduce anxiety
• Embedded classroom strategies: Video vignette de- (Chugh-Gupta, Baldassarre, & Vrkljan, 2013). Lynn
picting an OT (Lezlie Fahl Kinder) fostering mental Stoller, a Boston-based occupational therapist and
health literacy and self-regulation with a student hatha yoga instructor, shares seated poses for a calming
with disabilities. Video link: www.everymoment- lunchtime break in the web-based Yoga Journal.com.
counts.org/view.php?nav_id=188; also see Moments
Seewww.yogajournal.com/article/advanced-poses/day-
for Mental Health, embedded mental health promo-
15-desk-yoga-poses-inner-peace/
tion strategies at http://www.everymomentcounts.
org/view.php?nav_id=137
Exemplary practice, research:
• Comfortable Cafeteria: 6-week program embedded
during lunch to create a positive lunch environment Lifestyle Intervention With the Well Elderly
for all students to enjoy their meal and socialize with An occupational therapy preventative lifestyle interven-
friends. Goal is to educate and coach cafeteria super- tion, Lifestyle Redesign, was shown to promote mental
visors in helping students with and without disabili- well-being, including vitality, social function, mental
ties and mental health challenges. Video link: www. health, life satisfaction and depressive symptomology,
everymomentcounts.org/view.php?nav_id=184 with older adults living in the community (Clark et al.,
• Refreshing Recess: 6-week program embedded during 2012)
recess to help all children enjoy play and socializing
with friends. OTs educate and coach recess super- Exemplary practice:
visors in creating a positive recess experience for Wellness Navigators
students with and without disabilities and mental
Occupational therapists work as wellness navigators
health challenges. Video link www.everymoment-
in primary health care, providing resources and emo-
counts.org/view.php?nav_id=187
tional support to individuals, families, and community
groups. Preliminary evidence indicates that they are
effective in keeping citizens from “falling through the
cracks” of health care systems (Moore, 2013)
 TIER 1: Universal Strategies

Children/Adolescents Adults/Older Adults

Exemplary practice, model programs: Exemplary practice, research:
Drive Thru Menus for Relaxation & Stress Busters; and Use of Sensory-Enhanced Yoga to Combat Stress in De-
Attention & Strength. Tere Bowen-Irish developed the ployed Military Personnel. Sensory-enhanced yoga (7
classroom “menus” of short activities to help students days/week) was found to be an effective preventive
engage in activities to promote relaxation or attention. intervention to reduce anxiety and enhance feelings of
The OT educates teachers on how to embed this menu mental well-being and quality of life in military person-
of activities within the classroom to help students nel (Stoller et al., 2012).
function successfully in school. The program contains
a manual, colorful posters, and a DVD overview of how Exemplary practice:
to implement the activities (Bowen-Irish, n.d.a, n.d.b). Promoting Occupation, Health, and Well-Being
A Canadian framework in progress, Do-Live-Well, is
Exemplary practice: grounded in evidence with a broad focus on occupation
Applying a Multi-Tiered Approach to Mental Health Pro- and the impact of everyday activities on health and
motion, Prevention, and Intervention at Sierra Academy in well-being (Moll et al., 2015)
San Diego. Erin Schwier has applied a public health ap-
proach to mental health in this alternative school set- Exemplary practice:
ting. Tier 1, “Sierra Strong” strategies emphasize health Driver Safety Programs for Older Adults are noted to
promotion; Tier 2, “Sierra Survivor” strategies include address sensory and motor concerns that affect driver
summer extended services emphasizing activity-based awareness and control of the motor vehicle. Occupa-
interventions; and Tier 3, intensive individual or group tional therapy has additional distinct value in its sensi-
interventions focus on successful activity participation tivity and adaptation related to the emotional value of
(Schwier, 2015). driving as occupation (Golisz, 2014).

AOTA Self-Paced Clinical Course: Exemplary practice:

Bully Prevention and Friendship Promotion. Bazyk, Wellness Programs
S. (2014). Bully prevention and friendship pro- Towson University’s Center for Well-Being offers a
motion: OT’s Role in School Settings. One hour comprehensive community-based wellness program for
self-paced clinical course. AOTA Continuing Educa- older adults. The center has a multidisciplinary staff
tion. myaota.aota.org/shop_aota/prodview.aspx?- that enables individuals to access additional support
TYPE=D&PID=241197935&SKU=WA1080 and wellness services. www.towson.edu/iwb/wellness/
index.asp
Exemplary practice:
Promotion of Health Habits in Sleep, Physical, and Eating Research:
Routines of Children as a Prevention and Promotion of Understanding How Sensory Dissonance Provokes Nega-
Health and Well-Being (Persch, Lamb, Metzler, & Fristad, tive Mental States and Distress (Bailliard, 2015).
2015).

Information sheets:
AOTA School Mental Health Toolkit for Tier 1
Strategies for promoting mental health including
strengths-based approaches, creating positive cafete-
ria and recess experiences, and social and emotional
learning. Developed by AOTA’s School Mental Health
Workgroup. See www.aota.org/Practice/Children-Youth/
Mental%20Health/School-Mental-Health.aspx
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Additional Resources: Occupational Therapy With Children and Youth

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Additional Resources: Occupational Therapy With Adults and Older Adults

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dysfunction and depressive symptoms associated with reduced participation of people with severe congestive heart
failure. American Journal of Occupational Therapy, 65, 306–313. http://dx.doi.org/10.5014/ajot.2011.000588
Gibson, E. R., Cunnane, K. B., Edwards, D. F., Morrison, M. T., Ewald, G. A., Geltman, E. M., & Zazulia, A. R. (2011). Executive
dysfunction and depressive symptoms associated with reduced participation of people with severe congestive heart
failure. American Journal of Occupational Therapy, 65, 306–313. http://dx.doi.org/10.5014/ajot.2011.000588
Hand, C., Law, M., & McColl, M. A. (2011). Occupational therapy interventions for chronic diseases: A scoping review. American Journal
of Occupational Therapy, 65, 428–436. http://dx.doi.org/10.5014/ajot.2011.002071
Hunjan, R., & Twiss, K. L. (2013). Urgent interventions: Promoting occupational engagement for clients with urinary incontinence. OT
Practice, 18(21), 8–12. http://dx.doi.org/10.7138/otp.2013.1821f1
Kannenberg, K., Amini, D., & Hartmann, K. (2010). Occupational therapy services in the promotion of psychological and social aspects
of mental health. American Journal of Occupational Therapy, 64, 878–891. http://dx.doi.org/10.5014/ajot.2010.64S78
Leibold, M. L., Holm, M. B., Raina, K. D., Reynolds, C. F., III., & Rogers, J. C. (2014). Activities and adaptation in late-life depression: A
qualitative study. American Journal of Occupational Therapy, 68, 570–577. http://dx.doi.org/10.5014/ajot.2014.011130
Lorig, K., & Holman, H. (2003). Self-management education: History, definition, outcomes, and mechanisms. Annals of Behavioral
Medicine, 26(1), 1–7.
Martín-Martín, L. M., Valenza-Demet, G., Jiménez-Moleón, J. J., Cabrera-Martos, I., Revelles-Moyano, F. J., & Valenza, M. C. (2013).
Effect of occupational therapy on functional and emotional outcomes after hip fracture treatment: A randomized controlled
trial. Clinical Rehabilitation, 28, 541–551.
Martin, B.A., & Suane, S. N. (2012). Effect of training on sensory room and cart usage. Occupational Therapy in Mental Health, 28(2).
118–12.
Martin, L. M., Triscari, R., Boisvert, R., Hipp, K., Gersten, J., West, R. C., … Escobar, P. (2015). Development and evaluation of the
Lifestyle History Questionnaire (LHQ) for people entering treatment for substance addictions. American Journal of Occupational
Therapy, 69, 6903250010. http://dx.doi.org/10.5014/ajot.2015.014050
Peloquin, S. M., & Ciro, C. A. (2013). Self-development groups among women in recovery: Client perceptions of satisfaction and
engagement. American Journal of Occupational Therapy, 67, 82–90. http://dx.doi.org/10.5014/ ajot.2013.004796
Scheinholtz, M. B. (Ed.). (2010). Occupational therapy in mental health: Considerations for advanced practice. Bethesda, MD: AOTA Press.
Speicher, S. M., Walter, K. H., & Chard, K. M. (2014). Interdisciplinary residential treatment of posttraumatic stress disorder and
traumatic brain injury: Effects on symptom severity and occupational performance and satisfaction. American Journal
of Occupational Therapy, 68, 412–421. http://dx.doi.org/10.5014/ajot.2014.011304
Warner, E., Koomar, J., Lary, B., & Cook, A. (2013). Can the body change the score: application of sensory modulation principles in the
treatment of traumatized adolescents in residential settings? Journal of Family Violence, 28, 729–738. http://dx.doi.
org/10.1007/s10896-013-9535-8
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