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adolescent mental health, school-based, emerging practice, survey


Presentation: 22:26

Presentation completed in partial fulfillment of a Post Professional Occupational Therapy Doctorate degree at Thomas Jefferson University.


Introduction: There is a significant crisis in adolescent mental health (American Academy of Pediatrics, 2021; Radhakrishnan et al., 2022) that have been compounded by traumatic experiences experienced during the COVID-19 pandemic (Substance Abuse and Mental Health Services Administration, 2022) and widespread fear of violence in schools (Silver et al., 2021). The crisis and resulting vulnerability has led to a dire need to focus on overcoming mental health challenges and moving forward in the face of adversity, which calls for a focus on resilience to promote overall life outcomes (Fenwick-Smith et al., 2019; Ijadi-Maghsoodi et al., 2022; Steiner et al., 2019). Occupational therapy demonstrates potential in providing resilience-focused interventions to adolescents attending public high schools (Reitz et al., 2020; Collins et al., 2022). Schools provide an opportunity to provide services to those who are minoritized and economically disadvantaged (Ali et al., 2019; Ijadi-Maghsoodi et al., 2022; Steiner et al., 2019). An existing program called the Occupational Therapy Program of Wellness and Resilience (OT-POWER) has attempted to address the crisis. Due to a need for interprofessional collaboration to enhance resilience (Longhi et al., 2021; Masten & Motti-Stefanidi, 2020), the OT-POWER is in need of evaluation from interprofessional experts.

Objectives: The purpose of the study is to synthesize the perspectives of interprofessional experts regarding the OT-POWER manual designed to enhance adolescent resilience. The study aimed to assess consensus on the program’s scope and sufficiency among interprofessional experts.

Methods: Researchers utilized a modified Delphi methodology requiring systematic multi-staged surveys. The capstone project reported on the first round of the Delphi study, which collected the perspectives of interprofessional experts from occupational therapy, trauma-informed care, diversity, equity, and inclusion, psychology, secondary education, and academic medicine. Participant reviewers were asked to review a 50-page program manual and respond to a 95-item survey integrating Likert scale questions, dichotomous yes and no questions, and open comment items to provide their perspective on the manual’s organization, format, and content. Data analysis consisted of descriptive statistics and a rapid content analysis to identify actionable feedback to integrate into the next iteration of the program manual.

Results: Six interprofessional experts from the fields of secondary education, school administration, occupational therapy, diversity, equity, and inclusion, and academic medicine completed the first survey round. Consensus was achieved for 100% of the 84 quantitative questions within the first survey round. Qualitative comments identified areas of strength and recommendations for improvement related to the manual’s content.

Conclusion: This study identified interprofessional perspectives regarding the OT-POWER to enhance the congruence of the manual and program with the desired target population for the program and manual users. The results will inform revisions to the next iteration of the program manual. Future research will include the completion of a second survey round to assess agreement of the changes, and a final round including a brief survey of the potential end-users of the manual to evaluate its perceived usability and feasibility to implement.


Ali, M. M., West, K., Teich, J. L., Lynch, S., Mutter, R., & Dubenitz, J. (2019). Utilization of mental health services in educational settings by adolescents in the United States. Journal of School Health, 89(5), 393-401.

American Academy of Pediatrics. (2021). AAP-AACAP-CHA Declaration of a National Emergency in Child and Adolescent Mental Health. Retrieved from

Collins, T., Koenig, V. E., Wong, S. J., Buccinna, M., Purohit, R. B., Leiser, S. K., & Cullinane, D. (2022). Community-Based OT Program Planning: A Virtual Level II Fieldwork Program Developed in Response to the Global Pandemic. Journal of Occupational Therapy Education, 6(3), 18.

Fenwick-Smith, A., Dahlberg, E.E. & Thompson, S.C. (2018) Systematic review of resilience-enhancing, universal, primary school-based mental health promotion programs. BMC Psychol 6, 30.

Ijadi-Maghsoodi, R., Venegas-Murillo, A., Klomhaus, A., Aralis, H., Lee, K., Rahmanian Koushkaki, S., Lester, P., Escudero, P., & Kataoka, S. (2022). The role of resilience and gender: Understanding the relationship between risk for traumatic stress, resilience, and academic outcomes among minoritized youth. Psychological trauma: theory, research, practice, and policy, 14(S1), S82-S90.

Longhi, D., Brown, M., & Fromm Reed, S. (2021). Community-wide resilience mitigates adverse childhood experiences on adult and youth health, school/work, and problem behaviors. American Psychologist, 76(2), pp. 216–229.

Masten, A.S., & Motti-Stefanidi, F. (2020). Multisystem Resilience for Children and Youth in Disaster: Reflections in the Context of COVID-19. Adversity and Resilience Science, 1, pp. 95–106.

Radhakrishnan, L., Leeb, R.T., Bitsko, R. H., et al. (2022) Pediatric emergency department visits associated with mental health conditions before and during the COVID-19 pandemic - United States, January 2019–January 2022. MMWR Morb Mortal Wkly Rep 71(8), 319–324.

Reitz, S. M., Scaffa, M. E., & Dorsey, J. (2020). Occupational therapy in the promotion of health and well-being. American Journal of Occupational Therapy, 74(3), 7403420010p1-7403420010p14.

Silver, R.C., Holman, E.A. & Garfin, D.R. (2021). Coping with cascading collective traumas in the United States. Nature Human Behavior, 5, pp. 4–6.

Steiner, R. J.,Sheremenko, G., Lesesne, C., Dittus, P. J., Sieving, R. E., & Ethier, K. A. (2019). Adolescent Connectedness and Adult Health Outcomes. Pediatrics, 144(1), e20183766.

Substance Abuse and Mental Health Services Administration. (2022). Key substance use and mental health indicators in the United States: Results from the 2021 National Survey on Drug Use and Health (HHS Publication No. PEP22-07-01-005, NSDUH Series H-57). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.

Synopsis: Six experts with different professional backgrounds answered a survey about an occupational therapy mental health and wellness program. At least 80% of the experts agreed on all the questions about the program manual. They also suggested ways to improve the manual’s content and format. Suggestions will be used to improve the manual’s match with the program's goals. Expert advice will focus on best ways to help high school students from disadvantaged backgrounds.

Acknowledgments: I would like to express my deepest appreciation to Susan Toth-Cohen, PhD, OTR/L who served as my faculty mentor and advisor throughout my scholarship project and coursework. I would like to extend my sincere thanks to Pamela Talero, OTD, BSOT(Col), OTR/L, CPAM, COT, Thomas Jefferson University who served as an independent faculty reviewer, Carolyn Giordano, PhD, FASAHP, FNAP, Drexel University College of Medicine who served as a survey expert consultant, and Susan Bazyk, PhD, OTR/L, FAOTA, Cleveland State University who served as a content expert reviewer on the fellowship proposal committee for the project. I would also like to acknowledge the contributions of the OT and OTA students who are the reasons for how the program is able to exist and grow because of the compassion and dedication that they show to the students in the Bethlehem Area School District and the OT-POWER. The program would not have been made possible without the partnership created between Liberty High School, Bethlehem Area School District, Pinebrook Family Answers, Community in Schools, and Moravian University in Bethlehem, Pennsylvania. Finally, I would like to thank the participant reviewers of the manual who contributed to the validation of the manual to ensure its scope, sufficiency, usability, and feasibility.