


































Global Research in Higher Education 
ISSN 2576-196X (Print) ISSN 2576-1951 (Online) 

Vol. 5, No. 1, 2022 

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1 

 

Original Paper 

Pediatric Mental Health Treatment and Confidence through the 

Lens of the School Based Occupational Therapist’s Role  

Stefanie Seanor
1
, Michelle M. McCraney

2
, Patricia Tobin

2
 & Sunddip Panesar-Aguilar

1* 

1
 College of Health Sciences, University of St. Augustine, USA 

2
 Riley College of Education, Walden University, Minneapolis, USA 

*
 Sunddip Panesar-Aguilar, College of Health Sciences, University of St. Augustine, USA 

 

Received: November 5, 2021   Accepted: November 19, 2021   Online Published: January 27, 2022 

doi:10.22158/grhe.v5n1p1                 URL: http://dx.doi.org/10.22158/grhe.v5n1p1 

 

Abstract 

Given the rise in mental health needs in children and adolescents and the historical roots of 

occupational therapy in psychiatry, occupational therapists may be well-equipped and well-suited to 

offer expert contributions on school-based mental health teams. Occupation-based assessments and 

interventions for schoolchildren with mental health conditions are essential but are often overlooked 

because occupational therapy is traditionally solicited to support children with physical health 

concerns. The research problem for this study was that it was unclear how school-based occupational 

therapists perceive pediatric mental health treatment preparedness and confidence. The purpose of this 

basic qualitative study was to explore school-based occupational therapists’ perceptions of their 

preparedness and confidence to offer pediatric mental health treatment. Semistructured interviews 

were conducted through video conferencing. Self-efficacy and adult learning theories were used as 

guiding frameworks. Results of thematic analysis exposed five themes: the importance of university and 

fieldwork education; professional self-directness and intrinsic motivation; readiness to learn and role 

clarity; collaboration and communication; and advocacy. These findings have significant implications 

for occupational therapy students as well as their educators and employers.  

Keywords 

Mental health education, Occupational therapists, self-efficacy, school-based mental health, 

professional development, occupational therapy support 

 

 

 

 



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1. Introduction 

Occupational therapy practitioners support individuals’ successful and independent completion of daily 

tasks and participation in meaningful activities (American Occupational Therapy Association [AOTA], 

2016). They offer evidence-based interventions to assist adults and children in minimizing barriers to 

learning and to promote positive behavior and social participation (American Occupational Therapy 

Association, 2017). Examples include independent and group interventions, collaboration with other 

rehabilitation professionals, and participation in interdisciplinary teams. 

Within the field of pediatrics, occupational therapists evaluate, assess, create treatment plans, and 

provide interventions for children diagnosed with a variety of disorders and conditions. These 

conditions include physical and intellectual disabilities, autism and attention disorders, sensory 

processing inconsistencies, and internalizing symptoms including those associated with depression, 

anxiety, and other mental health conditions. Demand for this role has increased due to a rise in 

prevalence of autism spectrum disorders, intellectual disabilities, and other mental health disorders in 

children and adolescents (Llanes et al., 2018). In addition, recent societal changes including disasters, 

crises, and local or widespread emergencies are contributing to pediatric mental health conditions 

(Malfitano & Lopes, 2018). As a result, occupational therapists must remain educated and informed 

with the most current data and updated information on mental health within the community and school 

settings in order to provide evidence-based interventions and participate in collaborative care. This 

work will allow occupational therapists to provide rehabilitation and wellness strategies effectively and 

efficiently to individuals in need and to restore meaningful activity performance in times of need. 

The research problem for this study was that it was unclear how school-based occupational therapists 

perceived pediatric mental health treatment preparedness and confidence. Due to limited information 

on this topic, the purpose of this basic qualitative study was to explore school-based occupational 

therapists’ perceptions of their preparedness and confidence to offer pediatric mental health treatment. 

A literature review revealed little research and investigation on occupational therapists’ perspectives of 

their competencies and confidence levels in the field of pediatric mental health, including services 

provided within the school setting. Within the limited information uncovered, discrepancies existed 

between: (a) university curricula, goals, and expectations, (b) fieldwork requirements and clinical 

supervisors’ expectations, (c) job descriptions within pediatric and school-based settings, and (d) 

occupational therapists’ perceptions of their own mental health treatment preparedness and confidence. 

This study used a qualitative methodology of semistructured interviews to elicit responses from 

occupational therapists regarding their own experiences and perceptions relating to training and 

preparedness in the field of mental health.  

Given the rise in mental health needs in children and adolescents and the historical development of the 

field of occupational therapy, occupational therapists are well-equipped and well-suited to participate 

on school-based mental health teams, disaster and emergency intervention squads, crisis committees, 



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and wellness commissions. They can help children and youths in need of occupation-based support. 

Reviewing the current literature and conducting interviews as part of this study uncovered trends and 

themes in support of initial and ongoing mental health training for occupational therapists. The study’s 

results emphasized the need for alignment in academic and clinical settings, developing evaluation 

procedures ensuring competencies in this field, and promoting of occupational therapists as essential 

members of school-based wellness support teams. 

Within the school setting, occupational therapists provide interventions to children identified with 

special needs. They address gaps in development, support academic achievement and facilitate social 

participation (Salamat et al., 2016). The AOTA has promoted the involvement of occupational 

therapists in addressing mental health and psychiatric needs through prevention, promotion, and 

intervention (Blackwell & Bilics, 2017). However, results of recent studies including those conducted 

by Salamat et al. (2016) and Ball (2018) indicated that occupational therapists traditionally focused on 

impairment-based interventions through a one-on-one service delivery model. Ball (2018) further stated 

that the school-based occupational therapy role should include the promotion of mental health in 

school-aged children and the support of administration in the implementation of alternate delivery 

models. In addition, occupational therapists need to expand their assessments and interventions to 

address student social participation (Leigers et al., 2016). 

Occupational therapy interventions within the school setting to address mental health needs include 

providing activities to reduce stress and sensory overload; introducing targeted interventions to support 

at-risk youths in managing day-to-day activities; incorporating regulation activities into the classroom; 

collaborating with teachers and other school-based interventionists in providing relaxation strategies 

and coping skills, and assisting in curriculum and assignment modifications to encourage the just-right 

challenge (American Occupational Therapy Association, 2017b). Additionally, occupational therapists 

may provide consultation services to parents and outside providers in the collaboration of care between 

the school, home, and community. Educators and therapists may work together to improve student 

behavior, attention to instruction, independent completion of schoolwork, emotional regulation, social 

relationships, academic performance, executive functioning skills, maintaining routines, and successful 

completion of personal tasks or activities of daily living (American Occupational Therapy Association, 

2017c). 

Barriers to occupational therapists addressing mental health disorders affecting children and youths in 

the school and community settings adversely affect fulfillment of the mission of the promotion, 

prevention, and intervention movement (American Occupational Therapy Association, 2017a). 

Although occupational therapists possess the initial training needed to promote wellness, prevent 

regression, and provide effective interventions for student success, occupational therapists are not often 

solicited for their expertise in these areas when the primary disability or effect is in social-emotional 

development or mental health (Salamat et al., 2016). Occupational therapists must advocate for their 



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role on the mental health team within school-based or other pediatric settings (Salamat et al., 2016). 

Alignment of academia and clinical experiences, effective training to support competence and 

confidence, and integrated collaboration with other mental health professionals may enhance effective 

outcomes. Additionally, knowledge of advocacy and legislation supporting occupational therapists in 

the provision of mental health care will also contribute to overall student health, well-being, and 

academic success.  

The need for preventative and early interventions for children and youths in the field of mental health 

and wellness is significant and can be addressed within the school setting (Tokolahi et al., 2016). 

Occupational therapists may provide early intervention in the areas of cognitive support, 

problem-solving and personal care, and recreation and social functioning. Chan et al. (2017), in their 

integrative review of school-based mental health interventions, suggested occupational therapists 

should involve themselves in the provision of psychotherapy, cognitive-behavioral, 

dialectical-behavioral therapy, and psychoeducation interventions. However, this purpose can only be 

accomplished with the alignment of academic and clinical goals with exceptional mental health training. 

These changes will ensure occupational therapists have the professional knowledge and confidence to 

carry out the specific therapeutic program expectations. 

It was unclear how school-based occupational therapists perceive their pediatric mental health 

treatment preparedness and confidence. Although occupational therapists complete rigorous training in 

pediatrics and mental health (psychiatry) at the time of their university training, the fields are very 

complex and change rapidly (Maïano et al., 2018). A focused literature review uncovered a variety of 

resources, peer-reviewed studies, and articles on occupational therapists’ knowledge and perceptions 

on confidence and treatment preparedness in each of the fields of pediatrics and mental health. It also 

revealed that only limited research has been conducted on occupational therapists’ perspectives of their 

competencies and confidence levels in the combined fields of pediatric mental health, including 

services provided within the school-based setting (Kirby et al., 2019). With roots in psychiatry and 

mental health, occupational therapists are educationally prepared to implement interventions to address 

the social and emotional needs of children through occupation-based activities (American Occupational 

Therapy Association, 2017a). 

With the education and knowledge needed to address stress management, symptoms of anxiety, 

emotional regulation, and social skills within the school environment, occupational therapists can work 

in partnership with the school staff as a part of an interprofessional mental health team to implement 

occupation-based interventions and programmatic changes and to address children’s mental health 

needs (Ball, 2018). This collaboration with school-based professionals may enhance all students’ 

ability to succeed (Bolton & Plattner, 2020). However, there is a lack of research addressing the 

perceptions of school-based occupational therapists of their preparedness and confidence to offer 

pediatric mental health treatment. The research problem for this study was that it was unclear how 



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school-based occupational therapists perceive pediatric mental health treatment preparedness and 

confidence. 

Occupational therapists are integral and essential team members in the provision of community mental 

health and are listed as credentialed staff that may be included on community health clinic intervention 

teams (American Occupational Therapy Association, 2017b). The burdens of anxiety, depression, and 

other mental health conditions are increasing in school-aged children (Llanes et al., 2018). However, 

research on the role of the occupational therapist in addressing impairments in function in children 

diagnosed with mental health conditions is limited (Leigers et al., 2016; Tokolahi et al., 2016). 

Occupational therapy interventions for schoolchildren with mental health conditions are often 

overlooked, as services traditionally are solicited to support children with physical health concerns 

(Chan et al., 2017; Leigers et al., 2016). Egan and Cahill (2017) suggested that occupational therapists 

can be regarded as valuable members of the school-based interprofessional team if other school-based 

professionals are educated about the therapists’ training, skills, and scope of practice. Investigating 

perceptions of school-based occupational therapists on their pediatric mental health treatment 

preparedness and confidence provided valuable information to contribute to the literature. 

Theoretical Framework 

The guiding theoretical frameworks supporting this study included Bandura’s (1977) self-efficacy theory 

and Knowles’ (1973) adult learning theory. This section describes these theoretical frameworks. 

Additionally, the connection between these theoretical frameworks and the research questions are also 

presented.  

Self-Efficacy Theory 

Self-efficacy refers to the belief in the capacity to demonstrate behaviors necessary to produce certain 

performance attainments and the potential to cope with change or to react to a conflict using critical 

reasoning (Bandura, 1999). Self-efficacy supports chosen activities in which a person engages and is 

measured by the level of effort and limitations involved (Venskus & Craig, 2017). High self-efficacy has 

been linked to better academic performance and practical skills in occupational therapy students (Opseth 

et al., 2017). 

Beliefs may contribute to the transfer of skills and confidence from one domain to another. 

Understanding the values of occupational therapists and the field of occupational therapy contributes to 

the profession and to the professional behaviors exhibited by occupational therapists (Drolet & 

Désormeaux-Moreau, 2016). Values support identity and assist to define not only the therapists but also 

the role that the therapists play on interprofessional teams (Kucharczyk et al., 2019).  

Best practice and evidence-based practice promote collaborative care in addressing the needs of 

individual patients (Gigli et al., 2020). Whereas the evidence supports comprehensive and 

interprofessional teamwork, individual professional and profession-based values and beliefs affect 

occupational therapists’ practice and their performance on a team (Drolet & Désormeaux-Moreau, 2016). 



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Self-efficacy reflects confidence to control motivation, professional behavior, and the social 

environment through fundamental beliefs and values (Kucharczyk et al., 2019). The experiential 

components of interaction and intervention affect the guided learning by the occupational therapist as a 

learner and the contributions as a practitioner on a collaborative care team. Understanding 

profession-based values and personal-professional values or beliefs contribute to a healthcare 

practitioner’s capacity to perform essential tasks as well as to provide skilled contributions on an 

interprofessional team (Gigli et al., 2020). Self-efficacy theory provides a framework for this sequential 

analysis. 

Adult Learning Theory 

The perspective of learning by the learner as an adult professional is included as a secondary framework 

for this study. Developed by Knowles in 1968, adult learning theory or andragogy posited that adults 

learn differently than children and require a reason for why they are learning something. Adults rely on 

experience, self-directedness, a need to know, readiness to learn, orientation to learning, and intrinsic 

motivation (Knowles, 1973). Adult learners’ perception of education and training, within a university 

setting, allows not only self-directed learning but also contributions to the transformation (Cole & 

Tufano, 2019). After completing a professional program, occupational therapists contribute to the social 

dimension of occupation through the “contexts of other disciplines” and identify the common global 

themes of culture and meaning in social relationships within the global community (Cole & Tufano, 2019, 

p. 7).  

Occupational therapists learn through understanding the greater meaning in their teachings, including the 

effect they can make in their future practice. Continuing competence is a standard and mandated practice 

by state and national regulatory boards for occupational therapists postgraduation. However, the 

strategies chosen to maintain competence can be self-selected by occupational therapists (with few 

guidelines) following their university training. Occupational therapists can then begin to understand the 

transition and transformation of values from the student experience to their new values and beliefs within 

the professional arena through engagement in ongoing professional development opportunities (Murray 

et al., 2020). 

 

2. Method 

2.1 Purpose 

The purpose of this basic qualitative study was to explore school-based occupational therapists’ 

perceptions of their preparedness and confidence to offer pediatric mental health treatment. This 

research study incorporated open ended, semistructured interviews to gather information for analysis. 

The target population was school-based occupational therapists employed within the elementary and 

secondary settings, who were willing to participate in the study and to engage in an interview. This 

investigation and analysis contributed to the research literature regarding perceptions of occupational 



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therapists on their pediatric mental health treatment preparedness and confidence in the provision of 

effective interventions. 

The research questions included: 

RQ1. What are school-based occupational therapists’ perceptions of their pediatric mental health 

treatment preparedness? 

RQ2. What are school-based occupational therapists’ perceptions of their confidence in pediatric 

mental health treatment? 

RQ3. What are school-based occupational therapists’ perceptions of barriers to pediatric mental 

health treatment preparedness? 

2.1.1 Sampling 

Because the research design was specific by nature, a limited group of participants were able to partake 

in the semistructured interview process. The target population included school-based occupational 

therapists employed within the kindergarten to 12
th

 grade settings in the Northeast region of the United 

States. This study relied on 10 voluntary participants. Purposive methods were used to ensure the 

reflection of the features of the sampled population (Creswell, 2012). Therefore, the study used 

inclusion criteria to ensure relevance to the subject matter and allowed for diversity within the group. 

For this study, the purposive sampling criteria included graduates of university occupational therapy 

programs who were currently employed within a school setting in the Northeast region of the United 

States serving kindergarten to 12
th

 grade students.  

2.1.2 Data Collection 

Semistructured interviews were conducted over four weeks through video conferencing with privacy 

considerations in place in early March, 2021. Participants’ demographics were gathered at the 

beginning of each of the semistructured interviews. Information was collected on participants’ gender, 

age, highest degree earned, years since graduation, years working in the field of pediatrics, years 

working in a school setting, and the ages of their current students. After the initial gathering of 

demographic data, qualitative data were collected from the video conference interviews in the form of 

documented participants’ responses (Brenner, 1994). Written researcher notes recorded participants’ 

answers as close to verbatim as possible and were read back (echoed) to participants immediately 

following each answer for clarity (DeJonckheere & Vaughn, 2019). Time was allowed following each 

interview to review notes for accuracy and to ensure transparency, methodological rigor, and 

consistency.  

The alignment of the interview questions to the research questions is shown in Table 1. 

 

 

 

 



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Table 1. Alignment of Interview Questions with Research Questions 

Interview Questions Research Questions 

1. Describe your university training and 

fieldwork experience in the field of pediatric 

mental health.  

-How do you feel your university training and 

fieldwork experience in the field of pediatric 

mental health impacted your treatment 

preparedness? 

-How do you feel your university training and 

fieldwork experience in the field of pediatric 

mental health impacted your confidence? 

RQ1. What are school-based occupational 

therapists’ perceptions of their pediatric mental 

health treatment preparedness? 

RQ2. What are school-based occupational 

therapists’ perceptions of their confidence in 

pediatric mental health treatment? 

2. Describe any specialty or advanced training 

you have attended in the field of pediatric mental 

health after receiving your occupational therapy 

degree.  

-Was the training self-initiated or employer 

initiated?   

-How do you feel this specialty or advanced 

training has impacted your treatment 

preparedness in providing pediatric mental health 

interventions within a school-based setting? 

-How do you feel this specialty or advanced 

training has impacted your confidence in 

providing pediatric mental health interventions 

within a school-based setting? 

RQ1. What are school-based occupational 

therapists’ perceptions of their pediatric mental 

health treatment preparedness? 

RQ2. What are school-based occupational 

therapists’ perceptions of their confidence in 

pediatric mental health treatment? 

3. Please describe your ability to treat pediatric 

mental health conditions within the school-based 

setting?  

RQ1. What are school-based occupational 

therapists’ perceptions of their pediatric mental 

health treatment preparedness?  

RQ2. What are school-based occupational 

therapists’ perceptions of their confidence in 

pediatric mental health treatment? 



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4. Please describe your perception of confidence 

in providing treatment interventions in the field 

of pediatric mental health.  

-Please describe your awareness of pediatric 

mental health.  

-Please describe your readiness to engage in 

pediatric mental health treatment interventions.  

RQ1. What are school-based occupational 

therapists’ perceptions of their pediatric mental 

health treatment preparedness? 

RQ2. What are school-based occupational 

therapists’ perceptions of their pediatric mental 

health treatment confidence? 

5. How would you describe your overall pediatric 

mental health treatment preparedness and 

confidence in providing interventions within the 

school setting? 

RQ1. What are school-based occupational 

therapists’ perceptions of their pediatric mental 

health treatment preparedness? 

RQ2. What are school-based occupational 

therapists’ perceptions of their pediatric mental 

health treatment confidence? 

6. Please describe your current involvement in 

pediatric mental health within the school setting. 

RQ1. What are school-based occupational 

therapists’ perceptions of their pediatric mental 

health treatment preparedness? 

RQ2. What are school-based occupational 

therapists’ perceptions of their confidence in 

pediatric mental health treatment? 

RQ3. What are school-based occupational 

therapists’ perceptions of barriers to pediatric 

mental health treatment preparedness? 

7. How would you describe your inclusion in a 

school-based pediatric mental health team?  

-Please describe how you are supported on a 

school-based mental health team. 

-Please describe any barriers you face for 

inclusion on a school-based mental health team. 

RQ3. What are school-based occupational 

therapists’ perceptions of barriers to pediatric 

mental health treatment preparedness? 

8. Is there anything else you would like to share 

that you feel would benefit this study? 

RQ1. What are school-based occupational 

therapists’ perceptions of their pediatric mental 

health treatment preparedness?  

RQ2. What are school-based occupational 

therapists’ perceptions of their confidence in 

pediatric mental health treatment?  

RQ3. What are school-based occupational 

therapists’ perceptions of barriers to pediatric 

mental health treatment preparedness? 



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2.1.3 Participant Demographics 

All 10 participants identified as females between the ages of 27 to 64 years. One held a doctorate 

degree in occupational therapy; seven participants had received a master’s degree in occupational 

therapy, and two of the participants had received a bachelor’s degree in occupational therapy. Years 

since graduation ranged from 3.5 years to 35 years, and years working in the field of pediatrics ranged 

from 3.5 years to 30 years. Years worked in a school setting ranged from 3.5 years to 30 years. 

Participants reported ages of students on their current caseloads as young as 3 and up to 21 years old. 

Participant demographics are shown in Table 2. 

 

Table 2. Participants’ Demographics 

Participant Gender Age Degree 
Years since 

Graduation 

Years in 

Pediatrics 

Years in a 

School 

Setting 

Ages of 

Current 

Students 

1 Female 47 MSOT 18 18 15 8-21 yo 

2 Female 27 MSOT 3.5 3.5 3.5 5-10 yo 

3 Female 40 MSOT 16 10 10 4-9 yo 

4 Female 48 BSOT 26 14 14 3-10 yo 

5 Female 36 MSOT 12 12 12 3-10 yo 

6 Female 48 MSOT 20 20 18 3-15 yo 

7 Female 64 MAOT 35 30 30 8-11 yo 

8 Female 52 MOT 24 8 8 14-21 yo 

9 Female 41 BSOT, OTD 19 19 19 5-10 yo 

10 Female 44 BSOT 22 22 9 3-8 yo 

Notes. MSOT=Master of science in occupational therapy  

BSOT=Bachelor of science in occupational therapy 

MAOT=Master of arts in occupational therapy 

MOT=Entry level master’s degree in occupational therapy 

OTD=Doctor of occupational therapy degree 

 

3. Results 

Responses from 10 participants were coded and analyzed and categorized into themes. Five major 

themes were identified in participants’ responses to the eight semistructured interview questions. The 

five themes identified in this basic qualitative study aligned with the three research questions and the 

theories of self-efficacy and adult learning as related to professional occupational therapists and their 

advancement in their field of practice. Components based on codes and responses included perceived 

self-efficacy, development of self-efficacy, influences of self-efficacy, and barriers to self-efficacy. 



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Codes identified based on adult learning theory included the need to know, experience, self-concept, 

readiness, problem orientation, and intrinsic motivation. The five identified themes as related to codes 

and participants’ responses are shown in Table 3.  

 

Table 3. Themes Identified Based on Participants’ Responses and Connection to Research 

Question 

Theme Participant # Codes Research 

Question 

University training and experience 

enhance treatment preparedness and 

confidence in the provision of 

intervention in the field of pediatric 

mental health. 

 

1,2,3,4,5,7,9,10 Perceived self-efficacy 

Engagement 

Instruction 

Fieldwork or internship 

Mentorship 

Practice 

Self-assurance 

Confidence 

Readiness 

Self-concept 

RQ1, RQ2 

Self-directedness and intrinsic 

motivation support ongoing 

education to meet the needs of 

socio-environmental changes. 

 

1,2,3,4,6,7,8,9, 

10 

Development of self-efficacy 

Existing skills 

Ongoing learning 

On-the-job training 

Self-initiation 

Critical Thinking 

Awareness of change 

Goal Achievement 

RQ1, RQ2 

Readiness to learn and relevance 

support role clarity and 

contributions within the scope of 

practice. 

 

1,2,4,6,7,8,9,10 Influences of self-efficacy 

Proactive strategies 

Reactive strategies 

Scope identification 

Role identification 

Reflective Practice 

Exploration of interests 

Design realization 

Skillset considerations 

RQ1, RQ2 

Professional identity and practicality 2,3,4,5,6,7,8 Influences of self-efficacy RQ1, RQ2, RQ3 



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Theme Participant # Codes Research 

Question 

encourage collaboration and 

comprehensive care within the 

school-based practice. 

 

Essential collaboration 

Supportive teamwork 

Comprehensive care 

Relationships matter 

Flexible interactions 

Shared resources 

Shared validation 

Feedback or encouragement 

Inclusion or exclusion 

Reasonable expectations 

Creative opportunity 

Advocacy and organizational 

change are needed to maintain 

effectiveness and to limit barriers to 

effective treatment. 

 

1,2,3,4,5,6,7,8, 

9,10 

Barriers to self-efficacy 

Known school climate 

Facing difficult situations 

Lack of experience 

Insufficient exposure 

Lack of administrative support 

or vision of OT 

Feelings of overwhelm 

Lack of time/space 

Limited materials 

Unknown scope or skillset 

Lack of self-reflection 

Needed Assertiveness 

RQ1, RQ2, RQ3 

 

3.1 Theme 1: University Training and Experience Enhance Treatment Preparedness and Confidence in 

the Provision of Interventions in the Field of Pediatric Mental Health 

Participants were asked to describe their university education in the field of pediatric mental health. In 

addition, they were prompted to describe training completed as part of any fieldwork opportunities. 

Follow-up questions focused on gaining insight into their perception of how university education and 

training affected treatment preparedness including providing examples of relevant experiences.  

Common issues identified were the lack of university training and fieldwork education in the pediatric 

mental health field; the absence of mentorship or effective mentorship; the lack of engagement and 

supportive instruction; and recognition of the need for continued practice. The few participants who 



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described their thorough and comprehensive university training and internship opportunities in the field 

of pediatric mental health indicated they felt prepared to treat children with psychological issues. 

Majority of participants described a lack of comprehensive training in pediatric mental health and 

therefore did not feel prepared to treat in this field. Overall, participants reported that university training 

and experience enhanced treatment preparedness and confidence in the provision of interventions in the 

field of pediatric mental health. This conclusion answered the first and second research questions 

regarding occupational therapists’ perceptions of treatment preparedness and confidence in this field. 

Blackwell and Bilics’ (2017) survey research also examined the preparation of occupational therapy 

students to address mental health within the school setting. The authors gathered the perspectives of 

graduate-level occupational therapy program directors on the curriculum and the preparation level of 

their graduating students. Results indicated that occupational therapy students received a 

comprehensive education in the field of general school-based therapy and the role of the occupational 

therapist working within the school setting. However, participants reported limited training in the areas 

of mental health promotion, prevention, and intervention in the school setting. The current study’s 

findings supported those of Blackwell and Bilics (2017). The results from these studies demonstrate the 

need for improved education and training of occupational therapy students in the area of school-based 

mental health and wellness.  

3.1.1 Theme 2: Self-directedness and Intrinsic Motivation Supports Ongoing Education to Meet the 

Needs of Socio-environmental Changes 

Targeted education should not stop once the occupational therapy practitioner has graduated. All 

participants stressed the importance of ongoing training and the need for self-initiated training 

postgraduation and post fieldwork completion to be prepared for the provision of effective treatment 

interventions. Participants were asked questions about fieldwork selection and participation as well as 

any additional training they had received after graduation. Follow-up prompts included whether or not 

the additional or specialty training in the field of pediatric mental health was self-initiated, or employer 

initiated. The participants provided insight into how any additional training affected preparedness and 

confidence in this field.  

Participants identified a gap between university training they received and the knowledge and experience 

they needed when working in the field to provide effective services. Many highlighted the importance of 

engagement in ongoing educational opportunities, awareness of change, continued practice, critical and 

flexible thinking, and specific on-the-job training to support preparedness. After they have graduated, 

occupational therapists continue to develop competencies in current practices, and it is the 

responsibility of the practitioner to track their continuing education training. Coffelt and Gabriel (2017) 

recommended future research on graduate education on current mental health trends and on continuing 

competencies required by the discipline. Adult students can reach a level of expertise and professional 

competency through engagement in specialized training. This specialized training helps them to 



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develop a professional vision and improves the quality of care they provide to their patients (Bair et al., 

2019). 

These highlighted areas all contributed to the second theme: self-directedness and intrinsic motivation 

supported ongoing education to meet the needs of socio-environmental changes. The current study’s 

findings supported those of Coffelt and Gabriel (2017) and Bair et al. (2019). This theme answered both 

the first and second research questions on occupational therapists’ perceptions of pediatric mental health 

treatment preparedness and confidence. 

3.1.2 Theme 3: Readiness to Learn and Relevance Supports Role Clarity and Contributions within the 

Scope of Practice 

Participants were asked to elaborate upon their perceived ability to treat mental health conditions 

within the school-based setting. Influences on self-efficacy related to ability included: obtaining and 

maintaining the skills to provide proactive and reactive strategies; exploration of interests and needs; 

and design realization. Professional scope and specific role identification supported contributions to the 

interdisciplinary evaluation teams and collaborative groups.  

Coffelt and Gabriel (2017) investigated the practices and perceptions of occupational therapists 

regarding their ongoing education to ensure competencies in the changing fields. In this investigative 

research study, occupational therapists completed a self-report survey on their participation and 

engagement in professional learning programs. Occupational therapists valued planning professional 

activities with colleagues and continuing their education. Topics emerging from this study included 

conducting self-assessment and self-reflection exercises, engaging in employment-specific continuing 

education, and searching for journal articles of interest specific to the occupational therapists’ roles 

within the institution. Challenges were noted in the areas of productivity and meaningful learning.  

Participants highlighted the need for proper identification of personal and professional skillsets and 

reflective practice to enhance the provision of effective interventions. These answers and highlighted 

areas contributed to the therapists’ perceptions of the influences of self-efficacy and readiness to learn. 

Relevance of job-specific requirements to continuing education practices supports role clarity and the 

ability to contribute effectively within the scope of practice. This theme answered both the first and 

second research questions on occupational therapists’ perceptions of pediatric mental health treatment 

preparedness and confidence. 

3.1.3 Theme 4: Professional Identity and Practicality Encourage Collaboration and Comprehension 

Care with the School-based Practice 

Participants were asked questions regarding current involvement in school-based mental health teams. 

Probing follow-up questions were used to gain additional insight on the process of referrals, 

evaluations, treatment planning, and the provision of interventions and collaborative care. By providing 

examples of the interdisciplinary model, participants emphasized the importance of supportive 

teamwork and effective collaboration in evaluating, planning, and treating. The analysis uncovered 



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participants repeated mentioning of relationships, interactions, resources, feedback, and opportunities 

for creativity.  

Current research indicated that occupational therapists contribute to interdisciplinary mental health 

teams by assessing and treating atypical neurophysiological responses to both auditory and visual 

stimuli, deficits in emotional prosody, impaired cognitive performance, deficits in visual perception, 

and inadequate interactions with the physical environment (Brooks & Bannigan, 2018; Ikiugu et al., 

2017). Interventions may support occupational performance in areas such as dynamic participation in 

activities of daily living, instrumental activities of daily living, rest and relaxation, academic 

performance, vocation, play and leisure, and social participation. Occupational therapists can also 

increase meaningful task completion among individuals with mental illness (Ikiugu et al., 2017). 

Therefore, occupational therapists should be considered essential contributing members of every 

school-based mental health team.  

Understanding reasonable expectations and essential components of collaborative care were identified as 

critical components of treatment preparedness. Professional identity and practicality facilitate 

collaboration and the provision of comprehensive care within the school-based practice. This theme 

addressed all three of the research questions involving occupational therapists’ perceptions of treatment 

preparedness and confidence, and potential barriers affecting readiness to treat effectively. 

3.1.4 Theme 5: Advocacy and Organizational Change are Needed to Maintain Effectiveness and to Limit 

Barriers to Effective Treatment 

Barriers to self-efficacy and feeling prepared were explained by participants through descriptions of 

unknown or changing school climates, lack of administrative support, and feelings of being 

overwhelmed. Participants were asked about inclusion on school-based mental health teams and any 

barriers they faced affecting their readiness and confidence to provide effective interventions. 

Participants explained that facing new or difficult situations can be even more challenging without an 

advocate or an organizational framework to support their contributions to effective interventions. 

Additionally, such a lack of support adversely affects collaboration with other professionals and 

interdisciplinary care.  

Frequently, other school-based professionals are not informed of the skillset and services that 

occupational therapists can provide to interdisciplinary teams to support students at risk (Leigers et al., 

2016). Egan and Cahill’s (2017) mixed methods study described how the instructional team within a 

special education setting learned about the role of the occupational therapist within the mental health 

arena and how their perceptions changed following the occupational therapists’ contributions to the 

team. Results indicated that special education teams learned that occupational therapists could 

contribute insight and valuable skills and interventions for students in identifying and achieving 

occupational performance goals. These services are provided in other venues, including hospitals, 

mental health facilities, and outreach programs. Future research would increase awareness of these 



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services within the school setting. 

One of the most influential factors contributing to the need for advocacy and organizational change (in 

response to societal change) is the need for other professionals to know the scope of the profession of 

occupational therapy and the skillset of occupational therapists. The results from both the current study 

and those of Egan and Cahill (2017) demonstrated the need for occupational therapists to self-reflect, 

promote their strengths to colleagues, and willingly participate in interdisciplinary mental health teams. 

This final theme identified in the current study is that advocacy and organizational change are needed to 

maintain effectiveness and limit effective treatment barriers. This observation addresses all three 

research questions regarding therapists’ perceptions of pediatric mental health treatment preparedness 

and confidence, and barriers affecting the process. 

3.1.5 Trustworthiness of the Data 

Throughout this study, specific strategies were used to ensure the consistency and reliability of the data 

collected. Credibility and transferability refer to whether the findings accurately and fairly represent the 

data, and if the findings can be applied to other settings and contexts (DeJonckheere & Vaughn, 2019). 

Credibility and transferability were established through subject recruitment, peer reviews, triangulation, 

member checks, saturation, and reflexivity. Strategies of variation were used for participant selection to 

include different genders, ages, locations, student caseload, age range, and roles. Although participants 

included a wide range of ages, educational backgrounds, school locations, and student caseloads, all 

participants were female.  

Peer reviews by an expert panel and professional colleagues supported the alignment of interview 

questions with the research questions, the applicability of the questions to the study, and ease and 

appropriateness of the interview process. Triangulation of the data was used to increase the 

trustworthiness of the research and to minimize any misinterpretations that may have been made 

(Merriam & Tisdell, 2016). Dependability was also addressed, which refers to whether the findings were 

consistent and sustainable over time (DeJonckheere & Vaughn, 2019). The different sources of 

triangulation and dependability included the data from the peer review process, the written notes from the 

interviews with the school-based occupational therapists, and the data from the member checking process 

following each interview question.  

Following the presentation of each interview question and the written documentation of the responses, 

each participant’s answers were read back to check for accuracy of the notes. This strategy was used to 

strengthen the validity as well as dependability (Merriam & Tisdell, 2016). Confirmability was 

established through reflexivity and peer review. Reflexivity was accomplished through the pause of time 

following each interview question, and between interviews, during which could be reviewed and 

reflected on the responses. Additionally, the peer review of the applicability of research questions and the 

piloting of interview questions also supported confirmability to reduce researcher bias (DeJonckheere & 

Vaughn, 2019). Even though recommendations were solicited from the reviewers and experts, there were 



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no additional suggestions, and, therefore, changes were not made to the interview procedures. 

 

4. Discussion 

4.1 Research Discussion  

Occupational therapists can provide targeted interventions to support at-risk youths. Examples include 

managing day-to-day activities, incorporating regulation activities into the classroom, collaborating 

with teachers and other school-based interventionists, and assisting in curriculum and assignment 

modifications (American Occupational Therapy Association, 2017b). However, for occupational 

therapists to believe themselves prepared and confident in the provision of interventions for children 

with mental health conditions, they must be appropriately educated; receive ongoing training and 

mentoring; be self-directed and ready to develop enhanced skills; understand professional identity and 

role clarity; and receive support from administrators and mental health colleagues within the 

school-based setting. With this systematic framework in place, occupational therapists and educators 

may work together to improve student outcomes. 

Alignment of academia and clinical experiences is imperative. Effective training to support competence 

and confidence is essential. Ongoing effective communication and integrated collaboration with other 

mental health professionals are crucial. Knowledge of advocacy and legislation supporting 

occupational therapists in the provision of mental health care is vital. Occupational therapists must 

advocate for their essential and contributing role on the mental health team within school-based or 

other pediatric settings. Their membership in these teams will enhance educational outcomes and 

student health, well-being, and personal success (Salamat et al., 2016).  

4.1.1 Limitations 

Although qualitative research seeks to provide answers to questions without bias through predetermined 

procedures, limitations in research design and methodology pertain to transferability and dependability 

(Ritchie et al., 2013). These limitations place restraints on the research being conducted (Ritchie et al., 

2013). The principal imitations of this study included time constraints and shortcomings in the questions. 

Other limitations included variations in the responses received uncovering unanticipated subgroups 

within the sample, limited applicability to the population studied, participation bias, and 

misinterpretation of the results due to researcher bias.  

Measures were taken to address research design factors, conditions, and biases, which could have 

influenced the study outcomes. These were: identifying a clearly defined purpose with appropriate data 

collection methods (including participants based on selection criteria), identifying an adequate time 

frame, and allowing for flexibility (Ritchie et al., 2013). Additionally, this objective research plan 

observed fundamental ethical principles, respected the dignity of participants, and allowed for adequate 

time for collecting, coding, and analyzing data.  

 



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Purposive methods for selecting the study sample were used. The data were gathered from school-based 

therapists in certain locations and therefore may not be able to be generalized to different populations or 

regions. Additional procedural limitations included scheduling, availability, practitioners’ specific 

experience, and the familiarity and accessibility of the video conferencing format. Video conferencing 

took between 45 to 60 minutes.  

Within the specific timeframe, practitioners who were willing to participate may have had limited 

availability to complete the specific guided questions and to answer any follow-up questions. Their 

experiences, values, beliefs, specific job descriptions, or specific affiliation or internship training may 

have affected their knowledge, perceptions, or confidence levels. Due to these effects, the study results 

may not have provided an accurate representation of the sample. 

4.1.2 Implications for Future Research 

The findings from this research study supported those of similar studies that examined the inclusion of 

occupational therapists on the pediatric mental health team. The themes provided answers to the three 

identified research questions. These findings from research study have the potential to expand 

practitioners’ understanding of how school-based occupational therapists perceive their preparation and 

confidence in the field of pediatric mental health treatment. The study uncovered perceptions of 

treatment preparedness and confidence and therefore helped to fill a gap in the literature on these topics 

(Kirby et al., 2019). Those who may benefit from the findings include occupational therapists, university 

training program administrators, program managers, education coordinators and administrators, and 

other collaborating professionals. This study could also expand practitioners’ knowledge and 

understanding of how school-based occupational therapists perceived their preparation and confidence in 

the provision of pediatric mental health treatment.  

Future studies analyzing perceptions of school-based therapists should use a larger sample or a sample 

inclusive of professionals from other regions. In addition, interviews could be conducted with 

occupational therapy practitioners holding doctorate, master’s, and bachelor’s degrees. The perspectives 

of certified occupational therapy assistants with associate degrees could also be gathered. The findings of 

these interviews could be compared and contrasted based upon both training and experience. 

Additionally, interview questions could address job satisfaction and the benefits of employment. Finally, 

this study or a similar study could be expanded using a mixed-methods approach employing both survey 

and interview components.  

4.1.3 Conclusion 

This research study had themes that supported the implementation of coursework and fieldwork that 

specifically address the field of pediatric mental health. These themes promoted alignment of academic 

and clinical settings; access to ongoing training (through professional organizations or the workplace) 

based on relevant socio-environmental changes and current events; development of ongoing evaluation 

procedures to ensure updated competencies in this field; and advocating for occupational therapists as 



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contributing experts essential for membership on school-based wellness support teams.  

This study’s findings expanded practitioners’ understanding of how school-based occupational therapists 

think about their preparation and confidence in the provision of pediatric mental health treatment. It was 

designed to contribute to the literature and potentially support occupational therapy-related training, 

inclusion, and advocacy programs. The study was developed to address the increased need for pediatric 

mental health intervention and the essential contributions of occupational therapists as part of the mental 

health team within the school-based setting. 

 

References 

American Occupational Therapy Association. (2016). Occupational therapy services in the promotion 

of mental health and well-being. American Journal of Occupational Therapy (AJOT), 70(S2), 

1-15. https://doi.org/10.5014/ajot.2016.706S05 

American Occupational Therapy Association. (2017a). Guidelines for occupational therapy services in 

early intervention and schools. American Journal of Occupational Therapy, 71(S2), 1-10. 

https://doi.org/10.5014/ajot.2017.716S01 

American Occupational Therapy Association. (2017c). Successful participation at school: Strategies 

for all students. Retrieved from 

https://www.aota.org/~/media/Corporate/Files/AboutOT/Professionals/WhatIsOT/CY/Tips-for

 Educators-Successful-Participation-School-Strategies-for-All-Students.pdf 

Bair, M., DeFrance, N., Diarrassouba, N., & Stockton, T. (2019). Developing a professional vision: 

The role of faculty learning labs as a peer-mentoring model. Journal of Faculty Development, 

33(1), 15-24. 

Ball, M. A. (2018). Revitalizing the OT role in school-based practice: Promoting success for all 

students. Journal of Occupational Therapy, Schools & Early Intervention, 11(3), 263-272. 

https://doi.org/10.1080/19411243.2018.1445059 

Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological 

Review, 84(2), 191-215. https://doi.org/10.1037/0033-295X.84.2.191 

Bandura, A. (1999). Self-efficacy: Toward a unifying theory of behavioral change. In R. F. Baumeister 

(Ed.), The self in social psychology (pp. 285-298). Psychology Press.  

Blackwell, C. D., & Bilics, A. (2017). Preparing occupational therapy students to address mental health 

promotion, prevention, and intervention in school-based practice. Journal of Occupational 

Therapy, Schools & Early Intervention, 11(1), 77-86. 

https://doi.org/10.1080/19411243.2017.1386605 

Brenner, P. (1994). Interpretive phenomenology: Embodiment, caring, and ethics in health and illness. 

Sage Publishing. 

 

https://doi.org/10.5014/ajot.2016.706S05
https://doi.org/10.5014/ajot.2017.716S01
https://doi.org/10.1080/19411243.2018.1445059
https://doi.org/10.1037/0033-295X.84.2.191
https://doi.org/10.1080/19411243.2017.1386605


www.scholink.org/ojs/index.php/grhe            Global Research in Higher Education                  Vol. 5, No. 1, 2022 

20 
Published by SCHOLINK INC. 

 

Brooks, R., & Bannigan, K. (2018). Occupational therapy interventions in child and adolescent mental 

health: A mixed methods systematic review protocol. JBI Database of Systematic Reviews & 

Implementation Reports, 16(9), 1764-1771. https://doi.org/10.11124/JBISRIR-2017-003612 

Chan, C., Dennis, D., Kim, S. J., & Jankowski, J. (2017). An integrative review of school-based mental 

health interventions for elementary students: Implications for occupational therapy. Occupational 

Therapy in Mental Health, 33(1), 81-101. https://doi.org/10.1080/0164212X.2016.1202804 

Coffelt, K. J., & Gabriel, L. S. (2017). Continuing competence trends of occupational therapy 

practitioners. Open Journal of Occupational Therapy (OJOT), 5(1), 1-15. 

https://doi.org/10.15453/2168-6408.1268 

Cole, M. B., & Tufano, R. (2019). Applied theories in occupational therapy: A practical approach (2nd 

ed.). Slack Incorporated. 

Creswell, J. W. (2012). Educational research: Planning, conducting and evaluating quantitative and 

qualitative research (4th ed.). Pearson. 

Creswell, J. W., Hanson, W. E., Clark Plano, V. L., & Morales, A. (2007). Qualitative research designs: 

Selection and implementation. The Counseling Psychologist, 35(2), 236-264. 

https://doi.org/10.1177/0011000006287390 

DeJonckheere, M., & Vaughn, L. M. (2019). Semistructured interviewing in primary care research: A 

balance of relationship and rigour. Family Medicine and Community Health, 7(2), 1-8. 

https://doi.org/10.1136/fmch-2018-000057 

Drolet, M.-J., & Désormeaux-Moreau, M. (2016). The values of occupational therapy: Perceptions of 

occupational therapists in Quebec. Scandinavian Journal of Occupational Therapy, 23(4), 

272-285. https://doi.org/10.3109/11038128.2015.1082623 

Egan, B., & Cahill, S. (2017). National survey to identify mental health topics in entry-level OT and 

OTA curricula: Implications for occupational therapy education. Journal of Occupational Therapy 

Education, 1(1), 1-14. https://doi.org/10.26681/jote.2017.010104 

Gigli, K., Davis, B., Ervin, J., & Kahn, J. (2020). Factors associated with nurses’ knowledge of and 

perceived value in evidence-based practices. American Journal of Critical Care, 29(1), e1-e8. 

https://doi.org/10.4037/ajcc2020866 

Ikiugu, M. N., Nissen, R. M., Bellar, C., Maassen, A., & Van Peursem, K. (2017). Clinical 

effectiveness of occupational therapy in mental health: A meta-analysis. American Journal of 

Occupational Therapy, 71(5), 1-9. https://doi.org/10.5014/ajot.2017.024588 

Kirby, A., Terrill, A., & Henderson, J. (2019). Youth suicide: Examining pediatric OT practitioner 

knowledge, comfort, and raining needs. American Journal of Occupational Therapy, 73(S1), 1. 

https://doi.org/10.5014/ajot.2019.73S1-PO3001 

Knowles, M. S. (1973). The adult learner: A neglected species. Gulf Publishing. 

 

https://doi.org/10.11124/JBISRIR-2017-003612
https://doi.org/10.1080/0164212X.2016.1202804
https://doi.org/10.15453/2168-6408.1268
https://doi.org/10.1177/0011000006287390
https://doi.org/10.1136/fmch-2018-000057
https://doi.org/10.3109/11038128.2015.1082623
https://doi.org/10.26681/jote.2017.010104
https://doi.org/10.4037/ajcc2020866
https://doi.org/10.5014/ajot.2017.024588
https://doi.org/10.5014/ajot.2019.73S1-PO3001


www.scholink.org/ojs/index.php/grhe            Global Research in Higher Education                  Vol. 5, No. 1, 2022 

21 
Published by SCHOLINK INC. 

 

Kucharczyk, S., Sreckovic, M. A., & Schultz, T. R. (2019). Practical strategies to promote reflective 

practice when working with young children with and at risk for disabilities. Early Childhood 

Education Journal, 47, 343-352. https://doi.org/10.1007/s10643-019-00932-w 

Leigers, K., Myers, C., & Schneck, C. (2016). Social participation in schools: A survey of occupational 

therapy practitioners. American Journal of Occupational Therapy, 70(5), 1-9. 

https://doi.org/10.5014/ajot.2016.020768 

Llanes, E., Blacher, J., Stavropoulos, K., & Eisenhower, A. (2018). Parent and teacher reports of 

comorbid anxiety and ADHD symptoms in children with ASD. Journal of Autism and 

Developmental Disorders, 50(5), 1520-1531. https://doi.org/10.1007/s10803-018-3701-z 

Maïano, C., Coutu, S., Tracey, D., Bouchard, S., Lepage, G., Morin, A. J. S., & Moullec, G. (2018). 

Prevalence of anxiety and depressive disorders among youth with intellectual disabilities: A 

systematic review and meta-analysis. Journal of Affective Disorders, 236, 230-242. 

https://doi.org/10.1016/j.jad.2018.04.029 

Malfitano, A., & Lopes, R. (2018). Social occupational therapy: Committing to social change. New 

Zealand Journal of Occupational Therapy, 65(1), 20-26. 

Merriam, S. B., & Tisdell, E. J. (2016). Qualitative research: A guide to design and implementation 

(4th ed.). Jossey-Bass. 

Murray, C. M., Edwards, I., Jones, M., & Turpin, M. (2020). Learning thresholds for early career 

occupational therapists: A grounded theory of learning-to-practise. British Journal of 

Occupational Therapy, 83(7), 469-482. https://doi.org/10.1177/0308022619876842 

Opseth, T. M., Carstensen, T., Yazdani, F., Ellingham, B., Thørrisen, M. M., & Bonsaksen, T. (2017). 

Self-efficacy for therapeutic mode use among occupational therapy students in Norway. Cogent 

Education, 4(1), 1-9. https://doi.org/10.1080/2331186X.2017.1406630 

Ritchie, J., Lewis, J., Nicholls, C. M., & Ormston, R. (Eds.). (2013). Qualitative research practice: A 

guide for social science students and researchers. Sage Publications. 

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, S1. 

https://doi.org/10.5014/ajot.2016.70S1-PO5121 

Tokolahi, E., Hocking, C., & Kersten, P. (2016). Development and content of a school-based 

occupational therapy intervention for promoting emotional well-being in children. Occupational 

Therapy in Mental Health, 32(3), 245-258. https://doi.org/10.1080/0164212X.2015.1129522 

Venskus, D. G., & Craig, J. A. (2017). Development and validation of a self-efficacy scale for clinical 

reasoning in physical therapists. Journal of Physical Therapy Education (American Physical 

Therapy Association, Education Section), 31(1), 14-20. 

https://doi.org/10.1097/00001416-201731010-00005 

https://doi.org/10.1007/s10643-019-00932-w
https://doi.org/10.5014/ajot.2016.020768
https://doi.org/10.1007/s10803-018-3701-z
https://doi.org/10.1016/j.jad.2018.04.029
https://doi.org/10.1177/0308022619876842
https://doi.org/10.1080/2331186X.2017.1406630
https://doi.org/10.5014/ajot.2016.70S1-PO5121
https://doi.org/10.1080/0164212X.2015.1129522
https://doi.org/10.1097/00001416-201731010-00005

