Marian Arbesman, Susan Bazyk, Susan M. Nochajski; Systematic Review of Occupational Therapy and Mental Health Promotion, Prevention, and Intervention for Children and Youth. Am J Occup Ther 2013;67(6):e120–e130. https://doi.org/10.5014/ajot.2013.008359
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© 2019 American Occupational Therapy Association
We describe the results of a systematic review of the literature on children’s mental health using a public health model consisting of three levels of mental health service: universal, targeted, and intensive. At the universal level, strong evidence exists for the effectiveness of occupation- and activity-based interventions in many areas, including programs that focus on social–emotional learning; schoolwide bullying prevention; and after-school, performing arts, and stress management activities. At the targeted level, strong evidence indicates that social and life skills programs are effective for children who are aggressive, have been rejected, and are teenage mothers. The evidence also is strong that children with intellectual impairments, developmental delays, and learning disabilities benefit from social skills programming and play, leisure, and recreational activities. Additionally, evidence of the effectiveness of social skills programs is strong for children requiring services at the intensive level (e.g., those with autism spectrum disorder, diagnosed mental illness, serious behavior disorders) to improve social behavior and self-management.
Tier I: universal, or whole-population, programs provided to all children, including those with or without mental health or behavioral problems or other disabilities and illnesses
Tier II: targeted, or selective, services designed to support children and youth who have learning, emotional, or life experiences that place them at risk of engaging in problematic behavior or developing mental health challenges
Tier III: intensive services provided to children and youth with identified mental, emotional, or behavioral disorders that limit their participation in needed and desired areas of occupational performance (AOTA, 2008; Miles, Espiritu, Horen, Sebian, & Waetzig, 2010).
Level I: Systematic reviews, meta-analyses, randomized controlled trials
Level II: Two groups, nonrandomized studies (e.g., cohort, case control)
Level III: One group, nonrandomized (e.g., before and after, pretest and posttest)
Level IV: Descriptive studies that include analysis of outcomes (e.g., single-subject design, case series)
Level V: Case reports and expert opinion that include narrative literature reviews and consensus statements.
The article was published in either a peer-reviewed journal or a peer-reviewed evidence-based review since 1980 in the English language.
The age range of study participants was 3 to 21 yr.
The intervention described in the study was embedded in activities and within the domain of occupational therapy, although it did not have to be a common occupational therapy intervention or administered by an occupational therapist or occupational therapy assistant.
Outcomes measured in the study included social or peer interactions or compliance with adult directives or social rules and norms (including ADLs).
The article provided Level I, II, or III evidence.
Strong evidence was found that Tier I occupation- and activity-based interventions in many areas, such as social–emotional learning programs, schoolwide programming to prevent bullying, and after-school programs, are effective in improving social skills.
The evidence is strong that social and life skills programs for Tier II are effective for a wide range of at-risk children and youth, such as those who are aggressive or rejected and teenage mothers.
Strong evidence indicates that children with intellectual impairments, developmental delays, and learning disabilities benefit from social skills programming and play, leisure, and recreational activities.
The effectiveness of occupation- and activity-based programs at Tier III to improve social behavior and self-management is supported for children with ASD and for children and adolescents with diagnosed mental illness or serious behavior disorders.
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