The Role of OT in Pediatric Mental Health

By AASLMay 29, 2017

Jennifer Schwarzschild, M.S., OTR/L, Occupational Therapist

“There is no health without mental health.” World Health Organization [WHO], 2001

Across the country, 1 in 5 children have, or will develop, a serious mental illness (NAMI, 2017). During the month of May, the National Alliance on Mental Illness (NAMI) is working to continue to raise awareness for mental health in efforts to overcome stigmas and provide support to those in need. Mental health is an area of practice that I hold especially close to my heart, since the practice of occupational therapy (OT) originated in the field of mental health, as did my OT career.

In the 1920’s, Eleanor Clark Slagle, a social worker, and Adolf Meyer, a psychiatrist-in-chief at Johns Hopkins Hospital, headed the first occupational therapy department. They developed “Habit Training,” (Cole & Tufano, 2008) and found that engagement in structured occupations helped individuals promote and restore mental health. By analyzing and adapting activities, individuals with mental illnesses were able to establish and/or reestablish the crucial connections between engagement in daily roles and mental wellness.

Flash forward ninety years, to my first day as an OT student at Johns Hopkins Hospital. I remember feeling excited, intimidated, and inspired as I walked into the “Meyer Building” to meet my supervisor (a brilliant OT who would teach me everything she knew). I had read all my textbooks and diligently prepared myself to rattle off all the signs, symptoms, and treatments for the varying diagnoses of clients I would soon be working with; diagnoses that for decades have accompanied fear, intolerance, and shame. I came to find that no lecture or book would provide me the comprehensive understanding of mental illness that I would soon gain from first-hand experience working with this population. Mental illness doesn’t discriminate by gender, age, race, or socioeconomic status. People with mental illnesses are just that, people, like you and me; our neighbors, family members, coworkers, and friends; people who need support to get back to living their lives with the tools to self-identify signs, manage symptoms, and prevent relapse.

After completing my clinical training, I continued on at Johns Hopkins, where I had the amazing privilege of working with children and young adults who were struggling with acute and persistent mental illnesses on both inpatient and outpatient units.  Every morning I had the incredible opportunity to round with some of the best and brightest psychiatrists, psychologists, social workers, and other occupational therapists, all dedicated to promoting wellness for each child on our service through collaborative and comprehensive care. I was able to learn so much not only from my own discipline, but also about pharmacology, behavior modification, family training, and so much more.

After rounds I spent time evaluating new patients who had joined the unit, utilizing a client-centered process to facilitate an understanding of what roles and activities (such as play, school, and age-appropriate self-care) the child needed and wanted to participate in, and then assessing the factors impacting the child’s ability to meet the demands of these tasks. Mental health plays a huge role in our ability to fully and successfully participate in our day-to-day lives. Take morning routines for example: To a well individual, waking up, taking a shower, brushing your teeth, dressing, eating breakfast, and getting to school or work is an almost automatic process. However, when a mental illness and all of the symptoms that accompany it come into play, just getting out of bed, combatting low energy, low motivation, disinterest, low mood, and intrusive thoughts, can feel like the biggest undertaking in the world. It was our special jobs as OTs to help children develop and implement strategies to overcome these types of barriers.

Treatment was provided through both group and individual therapy, through purposeful, preparatory, and occupation-based interventions aimed at enhancing emotional well being, social competence, and the skills required to resume participation in essential daily roles, whether they be academic, self-care, home, or community-based.  Empirical evidence in pediatric OT practice has shown that activity-based interventions and participation in meaningful roles and activities leads to increased social interaction (making and keeping friends, coping with anger and frustration, problem solving, understanding and following rules), self-esteem, emotional well-being, academic functioning, and decreased adverse behaviors (Bazyk & Arbesman, 2013 and Jones, Greenberg, & Crowley, 2015). AOTA further describes OTs job function in children’s mental health: “to promote social–emotional learning; regulate ​overactive or underactive sensory systems; collaborate with families and ​medical or educational personnel; and more,” (AOTA, 2017).  OT’s can additionally support children by “incorporating sensory and movement breaks into the ​day to enhance attention and learning” and support parents, teachers, and other professionals through program development (social stories, social groups, play skills groups, etc.) and “by breaking down study tasks, organizing supplies, and altering the ​environment to improve attention and decrease the effect of sensory overload in ​the classroom,” (AOTA, 2017). ​

Helping children to understand what is going on in their brains and bodies and helping them gain or regain the skills and confidence needed to get back to playing, learning, and growing, is a truly remarkable role to play as an OT. I am incredibly lucky to have had the opportunity to work at a progressive, forward thinking institution, where I was able to learn to combat stigma and provide children and families power over their wellness through education, intervention, empathy and acceptance. Unfortunately, there are still many places where excellent or even adequate mental health services are non-existent. By increasing awareness globally, we are helping to overcome barriers for those in need.

OT’s are #IntoMentalHealth, how about you? Help spread the word! For more information visit: Mental Health Month and Mental Health Facts – Children & Teens

All About Speech & Language’s skilled Occupational Therapists provide a comprehensive evaluation of your child’s ability to complete self-care, play, academic, and interactive skills at an age-appropriate level.  Learn more about our Occupational Therapy Services!

Contact us online here
Phone:  813-616-4004

American Occupational Therapy Association. (2016). Mental Health in Children and Youth: The Benefit and Role of Occupational Therapy. Retrieved May 1, 2017

Arbesman, M., Bazyk, S., & Nochajski, S. (2013). Systematic review of occupational therapy and mental health promotion, prevention, and intervention for children and youth. American Journal of Occupational Therapy, 67, e120–e130.

Cole, M. B., & Tufano, R. (2008). Applied theories in occupational therapy: A practical approach. Hantucket: SLACK incorporated.

Jones, D. E., Greenberg, M., & Crowley, M. (2015). Early social-emotional functioning and public health: The relationship between kindergarten social competence and future wellness. American Journal of Public Health, 105, 2283–2290.

NAMI:National Alliance on Mental Illness (2001).  Mental health: strengthening our response.

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