"School settings are the most common place children and youth receive mental health services. School-based mental health and behavioral health services cost nearly $4 billion dollars annually and represent close to 80% of all treatment (Osagiede et al., 2018). Although schools have become the de facto mental health center for children and youth, many do not have enough trained personnel to adequately meet students' mental health needs (Cahill & Egan, 2017a). Strategic service delivery models are necessary to optimize resource use and maximize the number of students who can be served. Most schools organize mental health services around the public health model, which is based on three increasingly intense tiers. Additionally, school-based mental health services follow a systematic problem-solving approach that is overseen by a problem solving team open to different school professionals, including occupational therapy practitioners (OTPs) (Cahill & Lopez-Reyna, 2013). The traditional three-tiered model for school-based mental health services is consistent with other large school-based program frameworks (i.e., Positive Behavioral Interventions and Supports, Response to Intervention [RtI]). Tier 1, also referred to as the universal level, offers mental health supports to all students. These schoolwide interventions focus on mental health promotion, social-emotional learning, and supporting positive social interactions. Universal screening is typically completed in Tier 1 and 80% of students are expected to have screening results that indicate they are thriving and expected to benefit solely from this level of services (Cahill & Egan, 2017b). The remaining 20% of students are expected to need targeted Tier II and intensive Tier III supportive services to address screening results indicative of mental health concerns. Tier II students (15%) present with issues and screening results which categorize them as languishing and being at-risk for mental health challenges. Students in need of Tier II supports are typically good candidates for early intervening services usually provided in a small group format. Tier II group interventions are focused on providing just-in-time targeted support to address internalizing and externalizing behaviors and to prevent or delay the student from meeting the diagnostic criteria for a mental health disorder. Those students who meet the criteria for a mental illness or who have already been diagnosed with a mental disorder represent the 5% who may benefit from intensive services. Services at this level are justifiably individualized and closely monitor changes (both positive and negative) in symptoms and reports of subjective well-being (Cahill & Egan, 2017b). OTPs have a rich history of working in traditional mental health settings. Their contributions and role in serving school-based mental health needs has grown and continues to grow over the past decade. According to an American Occupational Therapy Association position statement on mental health recovery (2016), school systems practice was identified as a key mental health practice setting. OTPs are uniquely positioned in schools to support the development, provision, and monitoring of interventions designed to meet the mental and behavioral health needs of students enrolled in special education and general education. In a study by Cahill and Egan (2017a), a small group of school psychologists and social workers (traditional mental health providers) completed several online modules and discussions about how occupational therapy professionals could support students' mental health promotion and prevention needs. They unanimously concluded that occupational therapists should be doing more and saw great value in occupation-based group interventions for students receiving Tier II and Tier III school-based mental health services"--