1. Mental Health Promotion, Prevention, and Intervention in Practice
Claudette Fette, PhD, OTR, CRC

2. AOTA Official Documents

3. AOTA Statements

4. Mental Health Promotion, Prevention, and Intervention in Occupational Therapy Practice, 2017
Occupational therapy’s role
Education and qualifications
Core mental health skills applied to OT practice
Occupational therapy process in mental health
Case studies
Evaluation
Intervention, Promotion, and Prevention Strategies
Outcomes
Promote participation - Focus on what they want and need to do

5. More AOTA Resources; Practice Guidelines,
Distinct Value

6. Children & Youth

7. OT Practice Guidelines for Mental Health Promotion, Prevention, and Intervention for Children and Youth
Sue Bazyk, PhD, OTR/L, FAOTA
Marian Arbesman, PhD, OTR/L
oT PG for Children & Youth follows a Public Health Model … focus is on promotion of occupational performance at all 3 tiers
OT domain and process guide the promotion of occupational performance which results from dynamic interaction between client/ context /occupation – p 15
OT uses task analysis to align relationship of person /environment /occupation with emphasis on competency enhancement and use of meaningful occupation – p16

8. Types of Services Promotion – learning how to become mentally healthy
competence enhancement
mental health literacy
skill building & strength-based approaches
Prevention: reduction of risks
Tuning into at-risk groups – ‘loners’, children who are obese, live in poverty, those with disabilities
Intensive, Individualized – Systems of Care
Wrap-around; Behavioral Intervention Plans, etc.
MH promotion focuses on competence enhancement – building strengths and resources in the whole population – p 18
MH prevention focuses primarily on reducing risk factors and enhancing protective factors – p 18
At each tier, PG lays out 1) Knowledge needed, 2) Evaluation 3) EB Intervention
Intensive interventions diminish the effects of identified MH px & seek to restore optiman functioning

9. Public Health Approach to SMH shifts from individually focused to school-wide; from deficit driven to strength-based; emphasis on early intervention & prevention
Tier 3  Tier 2  Tier 1 
3 – 1-5%
2 – 5-15%
1 – 80-90%

10. Let’s begin with ‘mental health’
What it isn’t?
MENTAL HEALTH is not the absence of
MENTAL ILLNESS
Sue Bazyk
Mental health is:
Positive affective or emotional state (feeling happy)
Positive psychological and social function (self esteem/ control, relationships)
Productive activities
Resilience – coping with challenges

11. Raising children … is vastly more than fixing
what is wrong with them. It is about identifying
and nurturing their strongest qualities, what
they own and are best at, and helping them
find niches in which they can best live out these
strengths.
Seligman & Csikzentmihalyi, 2000, p. 6
Opening statement in introduction

12. Tier 1 Universal Services
Focus on all children
Need for system change
Caseload to Workload
PBIS - Multi-tiered Systems of Support
SEL – CASEL
8 key features of contexts that promote positive youth development
Safety
Structure
Relationships
Belonging
Positive social norms
Efficacy and mattering
Skill building
Integration of family, school & community

13. Tier 1 Universal Services
Strong evidence for social skills programs
Moderate to strong evidence for use of play, recreation or leisure programs
Positive outcomes with focus on
health promotion
Every Moment Counts
Strong evidence for social skills programs ---- to increase Social Emotional functioning and decrease px behavior
Moderate to strong evidence for use of play, recreation or leisure programs to increase social competence and peer interaction
Positive outcomes with focus on health promotion eg stress mgmt, health literacy, yoga

14. Tier 2 Targeted Interventions
Children/youth at risk
OT background in psychopathology and social
participation
Consultation/modification of environment,
activity groups
At risk = Children with ID, disability, prodromal symptoms … need to know early signs of metal illnesses

15. Tier 2 Targeted Interventions
School
Activity based social skills group with
decreased peer interaction or problem behaviors
Social skills programming for youth with
ADHD or LD
Embed yoga, relaxation strategies
Facilitate play, recreation, leisure
Early intervening and 504 plans, teacher
consultation
Psychoeducation inservices, parent education
Knowledge --- learn early signs of MI, Know early intervention strategies
Evaluation tools
Intervention … above

16. Tier 2 Targeted Interventions
Community
Know benefit of structured leisure and share
Evaluate opportunities in community
Interventions – visit settings and build
opportunities, develop resource guide
Knowledge --- Know early intervention strategies
Evaluation tools
Intervention

17. Tier 3 Intensive Interventions
For youth with identified mental,
emotional or behavioral disorders
SED affect 5-9% and result in impaired
daily function in home, school and community.
For youth with disabilities, rate is 11.5%, and
only 42% of those receive mental health services.
70-80% percent of those needing mental health
services do not receive them p 50
When targeted interventions are not meeting the needs of the student, and behaviors are disruptive, dangerous or prevent learning.
At intensive level, person-occupation-environment transaction requires in depth knowledge of range of MH & behavioral disorders

18. Tier 3 Intensive Interventions
Begin with FBA … drives BIP
Subjective wellbeing and occupational justice
Evidence for cognitive behavioral approach
(includes psychoeducation, reframing, relaxation)
social skills, intensive play/leisure/recreation
Accommodations and supports for symptoms,
performance effects at school/work
Maintain focus on ID/building strengths and fostering engagement in occupation
Again, Broken down into:
Knowledge
Evaluation – FBA
Intervention
Know typical symptoms for thought disorders, mood do, anxiety do, and ways to build coping strategies + manage environment to enable success

19. Tier 3 Intensive Interventions
Promote development of individual interests
in school and community
Analyze sensory, cognitive and psychosocial needs
Collaborate with school team, in community
to build comprehensive system of care;
with teachers to modify classroom
Modify/enhance routines, provide tips to promote success
Group interventions for social participation/leisure
Psychoeducation regarding prodromal symptoms, CBT,
social skills, proactive/strength-based prevention

20. Preparation and Qualifications of OTs and COTAs
OT Practice Guidelines for Mental Health Promotion, Prevention, and Intervention for Children and Youth
Appendixes:
Preparation and Qualifications
of OTs and COTAs
Evidence –Based Practice
Evidence Tables
Supplementary information
Sue Bazyk, PhD, OTR/L, FAOTA
Marian Arbesman, PhD, OTR/L

21. OT Practice Guidelines for Adults with Serious Mental Illness
Catana Brown, PhD, OTR, FAOTA

22. Recovery Self direction Individual and Person Centered Empowerment
Holistic
Nonlinear
Strengths-based
Peer support
Respect
Responsibility
Hope
Core principles
Consistent with occupation based practice
Self direction – person is primary decision maker
Individual and Person Centered – each person’s recovery is unique
Empowerment – person maintains control over their destiny
Holistic – recovery involves all aspects of one’s life … physical, mental , spiritual
Nonlinear – recovery is not a strait line … setbacks often result in positive learning
Strengths-based – not impairment focused, capitalizes on individual strengths
Peer support
Respect – accept and appreciate, foster self acceptance
Responsibility
Hope

23. OTPF
Domain & Process
Discuss domain and process

24. Occupational Therapy Process
Referral
Evaluation
Occupational Profile
Analysis of Occupational Performance
Occupations
Performance skills, client factors, performance patterns
Contexts/environments, activity demands
Interpretation
Intervention Plan & Process

25. Evidence Based Interventions
General (related to areas of occupation)
Supported employment or individual place
& support (IPS) models (A)
Lifestyle interventions to improve health behaviors
related to obesity and metabolic syndrome (A)
Supported education programs (B)
Skills training plus health care management (B)
Physical activity, exercise, and outdoor activities to
improve symptoms of depression and anxiety (B)
A Strong recommendation
B recommended

26. Evidence Based Interventions
Performance Skills
Cognitive remediation to improve life skills
tied to real life practice (B)
Cognitive skills training in conjunction with
supported employment (B)
Social cognition and problem solving training (B)
Cognitive training to improve cognitive skills (B)
Emotional regulation and social skills training in
conjunction with supported employment (B)

27. Evidence Based Interventions
Performance Patterns
Context & Environment
Environmental supports improve adaptive functioning (A)
Cooking skills in both clinic and home (B)
Routines
Interpersonal and social rhythm therapy to establish
and maintain routines for people with bipolar d/o (B)
Activity Demands
Use of work behavior inventory to provide work related
feedback in combination with supported employment (B)

28. OT Practice Guidelines for Adults with Serious Mental Illness
Appendixes:
Preparation and Qualifications
of OTs and COTAs
Evidence –Based Practice
Evidence Tables
Resources for Recovery Oriented Practice
Catana Brown, PhD, OTR, FAOTA

30. Questions?