Pediatric Mental Health Treatment and Confidence through the Lens of the School Based Occupational Therapist’s Role

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. 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. 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. 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


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, www.scholink.org/ojs/index.php/grhe Global Research in Higher Education Vol. 5, No. 1, 2022 3 Published by SCHOLINK INC. 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 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. 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 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 & Dé sormeaux-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 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 (

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 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.

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.

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.

MOT=Entry level master's degree in occupational therapy
OTD=Doctor of occupational therapy degree

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. 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.

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.  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. 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 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.

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.

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, 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.

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)  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.

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

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).

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. 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.

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.

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 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.