i

SPECIAL EDUCATION TEACHERS’ EXPERIENCES ADDRESSING MENTAL HEALTH

CONCERNS IN STUDENTS WITH COMORBID DISABILITIES: A

PHENOMENOLOGICAL STUDY

by

Alison Leigh Simmons

Liberty University

A Dissertation Presented in Partial Fulfillment

Of the Requirements for the Degree

Doctor of Education

Liberty University

2024
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SPECIAL EDUCATION TEACHERS’ EXPERIENCES ADDRESSING MENTAL HEALTH

CONCERNS IN STUDENTS WITH COMORBID DISABILITIES: A

PHENOMENOLOGICAL STUDY

by Alison Leigh Simmons

A Dissertation Presented in Partial Fulfillment

Of the Requirements for the Degree

Doctor of Education

Liberty University, Lynchburg, VA

2024

APPROVED BY:

Rollen Fowler, Ph.D., Committee Chair

Lucinda Spaulding, Ph.D., Committee Member

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ABSTRACT

The purpose of this transcendental phenomenological study was to describe the lived experiences

of special education teachers in public schools regarding addressing mental health needs in their

students experiencing comorbid disabilities. The theory guiding this study was contextual

organizational framework as it applies to individual special education teachers addressing

comorbid mental health concerns in their students. The research addresses the central research

question: What experiences within the organizational context(s) do special education teachers

describe with regard to working with special education students with comorbid mental health

disorders? All participants were special education teachers in either elementary or secondary

schools, who have been chosen purposefully using criterion sampling methods. Data was

collected through structured interviews conducted through an online platform and audio

recorded. Data was analyzed using a coding system to determine phenomenon between

participants. From the data, three themes emerged: (a) mental health impact, (b) lack of resources

and training, and (c) professional development. The results of this study provided stakeholders

with an increased understanding of special education teachers’ lived experiences with regard to

addressing comorbid mental health concerns in their students. Study findings may inform

practices and professional development decisions including educational practices with regard to

mental health resources.

Keywords: comorbid disability, contextual organization, mental health, special education

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Dedication

I dedicate this dissertation to my past, present, and future students. I have learned

through each of you and continue to be amazed by your progress.

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Table of Contents

ABSTRACT................................................................................................................................... iii

Dedication ...................................................................................................................................... iv

List of Tables ................................................................................................................................. ix

List of Figures ..................................................................................................................................x

List of Abbreviations ..................................................................................................................... xi

Virginia Department of Education (VDOE) .................................................................................. xi

CHAPTER ONE: INTRODUCTION ..............................................................................................1

Overview ..............................................................................................................................1

Background ..........................................................................................................................2

Situation to Self....................................................................................................................8

Problem Statement .............................................................................................................10

Purpose Statement ..............................................................................................................11

Significance of the Study ...................................................................................................12

Research Questions ............................................................................................................14

Definitions..........................................................................................................................17

Summary ............................................................................................................................18

CHAPTER TWO: LITERATURE REVIEW ................................................................................20

Overview ............................................................................................................................20

Theoretical Framework ......................................................................................................20

Related Literature...............................................................................................................24

Summary ............................................................................................................................49

CHAPTER THREE: METHODS ..................................................................................................52

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Overview ............................................................................................................................52

Design ................................................................................................................................52

Research Questions ............................................................................................................55

Setting ................................................................................................................................55

Participants .........................................................................................................................57

Procedures ..........................................................................................................................60

The Researcher's Role ........................................................................................................61

Data Collection ..................................................................................................................62

Demographic/ Work Related Information .............................................................62

Interviews ...............................................................................................................63

Professional Development Self-Reflection ............................................................68

Focus Groups .........................................................................................................69

Data Analysis .....................................................................................................................71

Trustworthiness ..................................................................................................................73

Credibility ..............................................................................................................74

Dependability and Confirmability .........................................................................74

Transferability ........................................................................................................75

Ethical Considerations .......................................................................................................75

Summary ............................................................................................................................76

CHAPTER FOUR: FINDINGS .....................................................................................................78

Overview ............................................................................................................................78

Participants .........................................................................................................................78

Linda ......................................................................................................................79
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Jennifer ...................................................................................................................79

Meghan ..................................................................................................................80

Janice......................................................................................................................81

Amy........................................................................................................................82

Lydia ......................................................................................................................83

Laura ......................................................................................................................83

Kim ........................................................................................................................84

Mary .......................................................................................................................85

Jacob ......................................................................................................................85

Holly ......................................................................................................................86

Ted .........................................................................................................................87

Results ................................................................................................................................87

Summary ..........................................................................................................................105

CHAPTER FIVE: CONCLUSION..............................................................................................107

Overview ..........................................................................................................................107

Summary of Findings .......................................................................................................108

Implications......................................................................................................................112

Delimitations and Limitations..........................................................................................118

Recommendations for Future Research ...........................................................................119

Conclusion .......................................................................................................................120

REFERENCES ............................................................................................................................122

Appendix A ..................................................................................................................................139

Appendix B ..................................................................................................................................140
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Appendix C ..................................................................................................................................141

Appendix D ..................................................................................................................................143

Appendix E ..................................................................................................................................144

Appendix F...................................................................................................................................146

Appendix G ..................................................................................................................................147
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List of Tables

Table 1. Participants Demographics…………………………………………………………….59

Table 2. Themes and Subthemes………………………………………………………………..89
Table 3. Words and Phrases in Relation to Central Research Question………………………..101
Table 4. Words and Phrases in Relation to Sub- Question One………………………………..102
Table 5. Word and Phrases in Relation to Sub-Question Two…………………………………103
Tabel 6. Word and Phrases in Relation to Sub-Question Three………………………………..104
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List of Figures

Figure 1. Themes Word Cloud…………………………………………………………………90

Figure 2. Theme One Tree Chart……………………………………………………………….91
Figure 3. Theme Two Tree Chart……………………………………………………………….95
Figure 4. Theme Three Tree Chart……………………………………………………………...98
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List of Abbreviations

Diagnostic and Statistical Manual of Mental Disorders (DSM)

Hillcrest City Schools (HCS)

Individualized Education Program (IEP)

Individuals with Disabilities Education Act (IDEA)

Institutional Review Board (IRB)

Virginia Department of Education (VDOE)

Other Health Impairment (OHI)

Autism Spectrum Disorder (ASD)

Emotional Disability (ED)

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CHAPTER ONE: INTRODUCTION

Overview

The purpose of this transcendental phenomenological study was to explore the lived

experiences of special education teachers in regard to addressing the mental health needs in

students experiencing comorbid disabilities. Comorbid disabilities occur when several disorders

overlap or are comorbid with one another in the same individual (Forness et al., 2012). Special

education teachers are often relied on to address more than academic needs in their students,

such as when they struggle with mental health issues that then impacts their learning (Even &

Quest, 2017; Flanagan et al., 2015).

Addressing the impact of mental health issues on students, Flanagan et al. (2015) stated

“the consequence of such a set of circumstances is a host of long-term negative sequelae for

youth who are otherwise unable to access quality mental-health services” (p. 289). An instance

of negative long-term sequelae of mental health in children include their academic performance

(Even & Quast, 2017; Kutash et al., 2015). Special education teachers should be equipped and

prepared to meet the needs of special education students struggling with comorbid mental illness.

Teachers understand that they can play a role in supporting students with behavioral, emotional,

and social difficulties, however, there is a need for training and support to implement effective

practices (Reinke et al., 2011). By understanding the perspectives of special education teachers,

developments in training and interventions can occur that better support these individuals as they

address mental health needs in their students (Reinke et al., 2011).

The purpose of this chapter was to provide an overview for this study designed to

describe the lived experiences and characteristics of special education teachers in relation to

comorbid mental health concerns in special education students. The background was discussed
 2

through a historical, social, and theoretical lens. Following the background, the situation to self-

section discusses the desire I have to explore this transcendental phenomenological study. Next,

the problem and purpose statement detail the reasons why this research was impactful and

necessary. After the purpose statement, the research questions are identified with corresponding

explanations. In closing, the terms and definitions significant to this study are provided.

Background

Recently, the media coverage has highlighted an increase in concerns revolving around

mental health and its impact on society. It is important to understand the characteristics of

adolescents to better assist in their mental health needs (George et al., 2018). Suicide rates are

increasing, school shootings are more prevalent, and other socially destructive behaviors are

apparent. Data shows suicide is the third leading cause of death among children and adolescents

age ten to nineteen (Wu et al., 2010). Data also demonstrates the increase of school shootings

and a connection to mental illness is apparent. A high percentage of school shooters experience

school bullying, isolation from not getting along with others, and noncompliance in the use of

psychiatric medication and problems with the side effects (Teasley, 2018).

The impact is not limited to communities; mental health issues are evident in public

school systems as well. Greene (2014) stated:

In many schools, kids with social, emotional, and behavioral challenges are still poorly

understood and treated in a way that is completely at odds with what is now known about

how they came to be challenging in the first place. (p. xi)

The gap between mental health struggles and services are evident (Forness et al., 2012). Unmet

mental health struggles put children at risk for difficulties in school, poor attendance,

suspensions, and poor grades which then coincides with poor outcomes across one’s life span
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and often lead to premature mortality (George et al., 2018). The current study aims to explore the

lived experiences of special education teachers in regard to addressing mental health concerns in

their students who demonstrate comorbid disabilities. The following sections depict the

historical, social, and theoretical components of the mental health crisis in relation to the public-

school system.

Historical

Mental health has been recognized as a critical topic for public health training since the

mid-1900s (Walker et al., 2016). However, mental health concerns have been an increasing and

significant topic in society in the last decade. Communities and schools have witnessed the

growing impacts of mental health issues. Mental health struggles affect one in ten children and

young adults (Humphrey & Wigelsworth, 2016). Pearce-Stevens (2018) stated “each year, an

estimated 5,000 Americans between the ages of 15 and 24 take their own lives” (p. 2). Suicide

attempts are often followed by additional attempts which indicate a great need for mental health

services (Wu et al., 2010). This number has more than tripled in the United States since the

1960s. The majority of children who attempt suicide are found to have a significant mental

health disorder (Pearce-Stevens, 2018).

Mental health can be seen in oppositional defiant disorder, anxiety, depression,

posttraumatic stress, and many others. Twelve to twenty-two percent of all children under 18

need services for mental, emotional, or behavioral problems (Adelman & Taylor, 2006). School

shootings, which can be linked to mental health struggles, have increased in the United States

from 179 to 245 between 1990s and 2013 (Teasley, 2018; data from Lee, 2013). Despite the rise

in mental health concerns in students, there is a disparity between prevalence and actual services

which has significant impact on students’ academic progress (Forness et al., 2012).
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Mental health struggles in youth are on the rise and the need for schools to address these

struggles are significant. Promotion of mental health is significant to enhance knowledge, skills,

and attitudes in order to foster social and emotional development, a healthy lifestyle, and

personal well-being (Adelman & Taylor, 2006). By providing the supports to promote positive

mental health and well-being will meet the growing needs of children struggling with mental

health. Greene (2014) stated “a student’s challenging behavior is just the means by which he [or

she] is communicating that he [or she] is having difficulty meeting certain expectations… the

behavior is just the signal” (p. 8). Collaboration of stakeholders, such as teachers, parents,

administrators, and community members, can foster a comprehensive approach to addressing

mental health concerns in public school systems and address the lack of skills and support

children may be experiencing. Collaborative and proactive steps solve problems and skills are

built where they are lacking (Greene, 2014).

Youth are 21 times more likely to visit a school-based mental health service than

anywhere else (Eklund et al., 2017). Adding programs and supports to school systems develops a

continuum of services and supports provided to the youth with mental health issues (Eklund et

al., 2017). Through the depictions of special education teachers’ backgrounds and perspectives,

valuable information can be gained to implement training and supports to assist in meeting

student’s mental health needs. Special education teachers are just one group of important

practitioners who are involved in ensuring a special education student receives an appropriate

education to address their educational needs. Inclusion of mental health supports, and programs

aid in eliminating barriers that could hinder the targeted and intense mental health services

necessary to meet the child’s mental health needs.

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Social

Public schools are in a transformative time where vital decisions must be made to

promote stable futures for all children. Greene (2014) depicted three shifts that need to occur in

the public education system in regard to addressing challenging student behaviors; (a)

improvement in understanding the factors contributing to challenging behavior; (b) creating

mechanisms that are proactive instead of reactive; and (c) creating structures and processes so

children and adults can solve problems together. It is apparent that public schools are being

called upon to address the rising concerns with mental health (Flanagan et al., 2015; Reinke et

al., 2011). Schools and educators are essential partners in working with mental health needs of

students (Adelman & Taylor, 2006). Taking these two concepts into consideration, now is the

time for public schools to develop early interventions to address the growing mental health

concerns. This in turn will develop a more stable community and society.

Mental health issues are likely on the rise due to a multitude of reasons. Such reasons

include physical and cognitive health, mental functioning, social environment, family features,

and stressful life events such as being bullied (Sharhraki-Sanavi et al., 2020). A high percentage

of school shooters experienced school bullying and isolation because of not getting along with

others, and noncompliance in the use of psychiatric medication. Schools can also assist in

addressing mental health concerns and the influences children experience daily. Schools can play

a significant and large role in promoting mental health awareness by “emphasizing the dynamic

interplay between emotional well-being and academic success” (Flanagan et al., 2015, p. 290).

Special education teachers often feel pressured to “fix” the mental health struggles of students

with comorbid disabilities. Teachers are more likely to be able to impact behavior and mental

health needs in children daily due to their position and specific training (Reinke et al., 2011).
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Trainings, both during pursuit of a degree and during one’s educational career, provided by

certified mental health educators, resources, and supports for public schools, children can receive

the proper mental health support which in turn will positively impact society.

Perceptions and lived experiences of school personnel are significant with regard to

promoting positive programs and systems to address mental health conditions. When one has a

negative outlook on a task or concept, they are more likely to not work to the fullest to meet a

common goal. It is critical for a school system to be “on the same page” when working towards a

common goal. Schools serve as a part of the system of care with regards to student development

both academically and emotionally (Lawson & Cmar, 2016). Incorporating a system of care in

public school systems will make for a smoother transition and assist in meeting a goal more

effectively. Pre-service teacher training and in-service professional development is imperative to

prevention and interventions with regards to dealing with mental health issues (Reinke et al.,

2011). School’s place demands on children (e.g., for focused learning, self-starting, organizing,

sustained effort, and getting along with others) that is often more intense than the demands

placed on them in the home setting (Greene, 2014). These demands are often exemplified in

students who are classified with a disability and struggle with mental health. Schools must take

these expectations into consideration and build on skills that students are lacking to better

address behavior challenges.

Combating mental health conditions in public schools is becoming more relevant.

However, there are several barriers including poor understanding of mental health issues and

services, coordination among agencies, limitations in both the number and quality of staff,

transportation issues, and bureaucracy (Weist et al., 2001). Schools must answer the call to step

up and be a part of the conversation. The amount of time a special education teacher spends in
 7

contact with students makes them a significant contributor to notice symptoms and behaviors

associated with mental health struggles (Shelemy et al., 2019). By describing the lived

experiences of special education teachers in the public-school system, a better understanding of

struggles surrounding addressing comorbid mental health concerns in students may emerge. The

more training and in-service professional development an educator has, the more time a student

will spend in class receiving critical educational experiences to be successful in school and life

beyond school. “We all need to be on the same page and coordinate our efforts” (Greene, 2014,

p. 27). It is essential that the stakeholders work together and remain open to utilizing a variety of

resources to meet the needs of those struggling with mental health issues. Special education

students are often found eligible for services due to their struggles with academics. However,

comorbid disabilities can often affect a child and significantly impact their school experiences.

Special education teachers, and teachers in general, often deliver and support mental health

programs in the school setting (Shelemy et al., 2019). By describing the characteristics and lived

experiences of special education teachers in regard to working with students with comorbid

mental health disabilities (e.g., attention deficit disorder, anxiety, depression, and oppositional

defiant disorder) a better understanding of combating mental health struggles in youth can be

established.

Theoretical

Special education teachers take part in a significant role in the organizational context of

the public school system. Organizations, like public schools, are under consistent pressure by

internal and external sources (Beycioglu & Kondakci, 2020). The public educational system has

a unique history and distinct set of values, principles, and beliefs (Ringeisen et al., 2003). When

it comes to supporting students with mental health issues, the unique and distinctive nature of
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public schools offers a contextual organizational framework that can be applied to highlight

factors uniquely relevant at a particular level of setting context (Ringeisen et al., 2003). For

example, teachers’ live-in dynamic, constant interaction with their contexts such that their own

attributes, immediate environments, and culture all shape their professional development and

effectiveness as educators (Schwartz et al., 2019). By understanding the current knowledge of

special education teachers, insight was gained to guide support and trainings contexts to current

and future educators (Reinke et al., 2011). These supports and trainings can promote organized

contextual change in relation to successful education and meeting mental health needs of

students.

The current study aimed to use a contextual organizational framework (Ringeisen et al.,

2003). The contextual organizational framework model that is commonly applied in support of

school-based support for children’s mental health includes three factors: individuals,

organizational, and state/national levels (Ringeisen et al., 2003). Teachers live in context

parallels with the developmental niche of a child as teachers and students are in constant

interaction (Schwartz et al., 2019). The insight and observations of individuals, such as special

education teachers, a better understanding of the needs for the organizational and state/national

level can be determined. The current study aimed to describe the lived experiences of special

education teachers with regards to comorbid mental health struggles in students with special

education services.

Situation to Self

Through my 13 years’ experience as a special education teacher, I have seen the growing

need for resources to combat mental health in the public-school system. It is through these

experiences with students on my own caseload that I find a need for more training and resources.
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When a child is struggling with mental health issues, learning simply is limited or nonexistent.

Increase of mental health struggles, not only in schools, but in society. Suicides, school

shootings, and a plethora of other mental health struggles plague the media daily. It is through

the daily struggles I see in my students and the societal needs that mental health concerns must

be explored and described through the lived experiences of special education teachers like me.

More resources, programs, collaboration, and professional development would significantly

impact the educational experiences of those children struggling with mental health. These

resources would also build the needed confidence in educators and school systems to combat the

mental health crisis. There is a rise in the mental health crisis and schools’ systems are not

prepared to address or combat this increase. The nation can do better; school systems can do

better.

There are several perspectives I, the researcher, bring to this study. First, from an

ontological philosophical perspective, this study attempted to identify multiple realities using

quotes and presenting different experiences from individuals (Creswell, 1998). Through sharing

the different lived experiences of special education teachers with regards to addressing mental

health of their students, multiple realities will emerge. “Multiple realities are constructed through

our lived experiences and interactions with others” (Creswell & Poth, 2018, p. 35). These

experiences impact perspectives and understanding of the world around us.

Second, from an epistemological philosophical perspective, the study aimed to conduct

research within the schools of the special education teachers participating. According to Creswell

(1998), epistemological research “means that researchers try to get as close as possible to the

participants being studied” (p. 18). As the researcher, I will collect firsthand information from

participants to construct knowledge regarding the lived experiences of special education teachers
 10

in reference to addressing mental health concerns in their students.

Third, from a rhetorical philosophical perspective, information will accurately be relayed

from the participants through direct quotes and dictation of their different lived experiences.

“The language of the qualitative researcher becomes personal, literary, and based on definitions

that evolve during a study rather than being defined by the researcher” (Creswell, 1998, p. 19).

Using direct quotes, I described the lived experiences of special education teachers with regard

to working with students with comorbid mental health disabilities and with mental health

concerns. Finally, from an axiological philosophical perspective, I incorporated my explicit

thoughts and experiences throughout the research process. As the researcher, I will actively

report values and biases as well as the value-laden nature of information gathered from the field

and individual values was honored and are negotiated among individuals (Creswell, 1998;

Creswell & Poth, 2018).

A paradigm or model for the current study included social constructivism. The study

aimed to rely on the lived experiences and views of the special education teacher participants. I

aimed to describe participant’s constructions of meaning in his/ her account (Creswell & Poth,

2018). Through the interpretations, an understanding of the world in which they live and work

with regards to mental health struggles in students was depicted (Creswell & Poth, 2018).

Problem Statement

Special education teachers acknowledge the role they play in supporting students with

behavioral, emotional, and social difficulties, but there is a need for training and support to

implement effective practices (Reinke et al., 2011). The needs of students in special education

settings are often complex (Kutash et al., 2015). Special education teachers are trained in
 11

specialized instruction to meet the academic needs of students. However, the need for additional

training to address rising mental health struggles in students is more evident now than ever.

Up to 20% of United States children experience a mental, emotional, or behavioral

disorder each year (Kutash et al., 2015). Prevalence rate data reveal that anywhere from one in

10 to one in five children in the public-school setting have a diagnosed mental, behavioral,

and/or learning problem that interferes with their ability to be successful and effective in the

school setting (Ball et al., 2016; Kutash et al., 2015). Children with additional learning needs are

often at risk for developing mental health struggles (Danby & Hamilton, 2016). Academics and

learning in general often take a back seat when students struggle with a mental health disorders

on top of an existing disability. The vision for mental health of children and youth in the schools

is cloudy (Kutash et al., 2015).

The problem is, there is little understanding and insight regarding the lived experiences of

special education teachers working with special education students with comorbid mental health

problems (Reinke et al., 2011). Although there is shared interest by many educators and mental

health professionals, there is little consensus on ways to integrate support within schools (Atkins

et al., 2010). Understanding characteristics, such as prior experience and in-service professional

development, of these special education teachers can shed light on the lived experiences and

perceptions held by these special education teachers. Educational initiatives demonstrate a

potential for expanding behavioral health services within the organized contexts of public-school

systems.

Purpose Statement

The purpose of this transcendental phenomenological study was to describe the lived

experiences of special education teachers supporting students with comorbid mental health
 12

disabilities. The study defined comorbid disabilities as being eligible under one of IDEA’s 13

educational disability categories in addition to having a DSM-V diagnosed mental health

disorder, such as attention deficit hyperactivity disorder (ADHD), anxiety, depression, and

others. Common qualities of human science research including focusing on the wholeness of the

experiences, searching for meanings and essences of experiences, questions and problems reflect

the interest, involvement, and personal commitment of the researcher, and many others

(Moustakas, 1994, p. 21). It is through these qualities that the current study demonstrated a

transcendental phenomenological study.

A contextual organizational framework (Ringeisen et al., 2003) guided the current study,

a framework that included factors reflecting a particular context, characteristics unique to a

specific group, community, society, and individual (Ringeisen et al., 2003). According to

Creswell and Poth (2018), a social theorist is described as an individual that seeks understanding

of the world in which they live and work. Through the review of the special education teachers’

lived experiences, a better understanding of social behavior with regards to special education

students with comorbid mental health struggles within the public-school system may emerge.

Significance of the Study

Mental health concerns are on the rise and public schools lack the resources to address

these concerns. The current study aimed to describe the lived experiences of special education

teachers regarding special education students with comorbid mental health problems. Research

suggests that mental health services are limited by insufficient training, lack of support, and

teaching conditions, such as student load, direct services, and personal preferences (Castillo et

al., 2017). Through the description of the lived experiences of special education teachers a plan

can be made to address the insufficiencies involving mental health and public-school systems.
 13

Empirically, the study aimed to add to the literature a description of special education

teachers’ experiences addressing comorbid mental health struggles in special education students.

“Phenomenological methods are particularly effective at bringing to the fore the experiences and

perceptions of individuals from their own perspectives, and therefore at challenging structural or

normative assumptions” (Lester, 1999, p. 1). Phenomenological studies are concerned with the

wholeness and are committed to the descriptions (Mousatakas, 1994). Using a transcendental

phenomenological design, a rich description of the experiences of special education teachers

were depicted and the essence of addressing mental health concerns in students were presented.

Present studies depict experiences of school guidance counselors and general education teachers.

However, there is a gap in research of the experiences of special education teachers with regards

to addressing mental health concerns in students.

Theoretically, this study expanded upon the organizational contextual framework

(Ringeisen et al., 2003). Organizational context characteristics have been found to influence the

effectiveness of interventions and the overall outcomes of students (Ringeisen et al., 2003). The

current study aimed to discuss the organized context and describe the prior knowledge and

experiences of special education teachers to better understand the ways in which these teachers

address mental health concerns in students with comorbid disabilities. It is through the lens of a

special education teacher that additional support, training, and resources may emerge for public

schools to address mental health concerns in their students.

There is a growing and unmet need in society and schools to provide mental health

services for children and youth (NASP, 2016). For practical and educational reasons schools and

special education teachers need to be equipped to meet mental health concerns. By fostering

positive mental health, a special education teacher would positively impact the lives of their
 14

special needs students and quite possibly their families as well. Mentally healthy and stable

children are more successful in school and life (NASP, 2016). Schools are a natural opportunistic

environment where adults can influence social-emotional development of students (Trach et al.,

2018). While authorities and organizations like NASP establish the need and benefits of fostering

positive mental health as an outcome for students, little is known about the actual lived

experiences of educators, specifically special education teachers, related to their efforts in

addressing the day-to-day mental health struggles of special education students (Ball et al., 2016;

Skaar et al., 2020).

Exploring and describing the lived experiences of special education teachers allow for a

different perspective. Children in special education programs are often impacted by more than

just academic struggles. Combating the stigma of mental illness is critical to improving the

quality of life of persons and developing more successful moments for that person (Kutash et al.,

2015). Special education teachers have an important role in addressing and combating mental

health in youth experience comorbid mental health struggles.

Research Questions

Moustakas (1994) stated that transcendental phenomenological studies are rooted in

questions that give directions and focus on meaning. I have personal interest and investment in

the research questions being proposed.

Central Question: What experiences within the organizational context(s) do special

education teachers describe when working with special education students with comorbid mental

health disorders?

The central question establishes the phenomenological design of the study (Moustakas,

1994) and focuses the study to address the current literature gap regarding special education
 15

teachers lived experiences with regards to addressing mental health issues in students within the

context of the school environment. The central question seeks to determine the challenges and

successes of special education teachers through their depictions and descriptions. Teachers are

embedded in an organizational context which influences directly with individuals in the system

and impacts the success of interventions (Ringeisen et al., 2003). Organizational context

characteristics have been found to impact the effectiveness of social services and student

outcomes in schools (Ringeisen et al., 2003). By better understanding the organizational context

of special education teachers, a better understanding of the effectiveness and overall student

outcomes can be developed. The position of the National Association of School Psychologists

(2016) states that schools are the ideal place to provide mental health services and school mental

health services promote the meaning of school. Quality practices in mental health need

connections between best available sciences and ongoing feedback from real-world contexts are

essential for educational growth (Ringesisen et al., 2003).

Sub-Question 1: What do special education teachers report about their pre-service and

in-service training experiences related to special education students with comorbid mental health

disorders?

Professional teaching standards should serve an important role in defining the scope of a

special teacher’s practice (Ball et al., 2016). Characteristics, such as training and certification,

that special education teachers possess influence perspectives and experiences. Teachers report

limited training in mental health and behavior management in the classroom (Ball et al., 2016).

Lack of knowledge, skills, and resources to make appropriate mental health supports for children

are a noted concern of teachers (Reinke et al., 2011). All states have content on school mental

health; however, the content and extent of the content varies across the country (Ball et al.,
 16

2016). The set standard for the mental health training teachers receive prior during their

educational career varies; there are no consistent standards for mental health in the United States.

However, by exploring the credentials and background knowledge of a variety of teachers a

better understanding of need can possibly be determined.

Sub-Question 2: How are special education teachers’ lived experiences influenced by

the challenges of contextual organizations in providing services to special education students

with comorbid mental health disorders?

Barriers to provision of mental health services include training and lack of funding

(Reinke et al, 2011). One in ten children have a mental, behavioral, or learning problem that

interferes with their ability to function effectively in school (Kutash et al., 2015). There are a

multitude of consequences of mental health, impairment in the school setting includes stress,

absenteeism, behavior and discipline problems, poor concentration, disruptions to school climate,

dropout, delays in learning, social skill deficits, and more (Even & Quast, 2017). When students

are in mental health crisis, they are not learning. The buy in from educational staff and the

struggles to maintaining programs (Flanagan et al., 2015). Often transferability is a struggle with

lack of proper resources and trainings. Addressing mental health must be a collaborative effort

from schools and outside agencies. Teachers reported in two different studies the limited training

in mental health and behavior management which impacts their ability to make informed and

appropriate decisions regarding the mental health concerns in their students (Ball et al., 2016;

Reinke et al., 2011).

Sub-Question 3: What do special education teachers describe as potential in-service

professional development topics that would improve their ability to address the comorbid mental

health disorders of special education students?

 17

Reflective writings allowed participants to relay their past in-service professional

developments and expand on the topics that can improve the learning experiences of their

students. Qualitative inquiry, such as reflective writings, contributes to the knowledge base as

participants express their individual and collective perspectives on their lived experience,

interpreted within the context of those experiences (Patton, 2015).

A focus group of special education teachers allowed for an open discussion of the lack of

support and resources to address mental health disorders in students. A focus group interview

organized in an online format was conducted to accompany the individual interviews and to

cross-check for consistency in the data (Patton, 2015). The focus group created an opportunity to

cultivate new insights from participants and encourage them to be expressive regarding their

lived experience. These insights can be shared with teachers, administration, outside agencies,

and other public-school stakeholders to enhance mental health support in schools.

Definitions

The following terms and definitions are provided to ensure understanding and context for

future transcendental phenomenological research studies.

1. Mental health- social, emotional, and behavioral health and the ability to cope with

life’s challenges (NASP, 2016).

2. Special education- a wide range of teaching practices shown to work for children

with disabilities and has a positive impact on these children (Cook & Schirmer,

2003).

3. Comorbid disabilities- Occur when a number of disorders overlap or co-exist with

one another in the same individual (Forness et al., 2012).

 18

4. Mental health disorders- characterized by a combination of abnormal thoughts,

perceptions, emotions, behavior, and relationships with others. Mental health

disorders include depression, bipolar disorder, schizophrenia and other psychoses,

dementia, and developmental disorders including autism (WHO, 2019).

Summary

The purpose of this chapter was to provide an overview for the current study which

planned to describe the lived experiences of special education teachers relating to comorbid

mental health concerns in special education students. When students are experiencing mental

health crises they are not learning. Mental health impacts a multitude of academic areas:

impairment in the school setting includes stress, absenteeism, behavior and discipline problems,

poor concentration, disruptions to school climate, dropout, delays in learning, social skill

deficits, and more (Even & Quast, 2017, p. 9). Lawson and Cmar (2016) remind educational

practitioners that “[s]chools serve as a part of the system of care” (p. 2). Public schools play a

significant role in a child’s daily life and even more so when a child experiences a disability that

impedes their learning process. The concerns intensify when a child has learning disabilities and

exhibits mental health struggles.

The NASP (2016) reports that students who receive social–emotional and mental health

support are more successful academically and socially. Thus, schools must be equipped with

resources and support to meet the need of those struggling with mental health. By doing so,

positive impacts will occur for the surrounding communities and society as a whole. Schools

have the unique position of having the opportunities to interact with children and provide the

necessary counseling or programs to aid those struggling with mental health.

 19

This transcendental phenomenological study aimed to give insight into the contextual

lived experiences of special education teachers addressing comorbid mental health concerns in

students. Such studies also aim to describe the experience and seek to provide vivid and accurate

first-person accounts (Moustakas, 1994). Schools are a convenient location for providing mental

health support for students (Flanagan et al., 2015) with educators being called upon to provide

quality mental health support for students. Organizational context framework guided this

transcendental phenomenological study. Examining special education teachers’ lived

experiences, a clearer understanding of how to improve their ability to provide support may

arise.
 20

CHAPTER TWO: LITERATURE REVIEW

Overview

The purpose of this chapter is to provide a theoretical framework as it is related to special

education teacher’s lived experiences in addressing comorbid mental health concerns in students.

Furthermore, a literature review of existing knowledge of mental health and ways to combat

mental health in the public-school systems is provided. However, a gap in the research is evident

with regards to special education teacher’s lived experiences. Researchers have explored the

perceptions of school counselors and regular education teachers in relation to addressing mental

health (e.g., Carlson & Kees, 2013; Reinke et al., 2011). However, research regarding special

education teacher’s lived experiences is not evident in existing literature. The literature review

examines the contextual organizational framework that impacts individuals, organizations, and

state/national levels in relations to public schools (Ringeisen et al., 2003).

Theoretical Framework

This section provides direct connections of the theoretical frameworks in relation to

special education teacher’s lived experiences in addressing comorbid mental health needs in

students. Theoretical orientation is defined as providing “a general explanation as to what the

researcher hopes to find in a study or a lens through which to view the needs of participants and

communities in a study” (Creswell & Poth, 2018, p. 18). The current study was guided by the

contextual organizational framework. Hickson et al. (1969) described “context” as the variables

related to structure and performance that impact the setting and development of an organization.

The structure of an organization, like a school, is related to the context within which it functions,

such as the surrounding community and society (Hickson et al., 1969).

 21

The contextual organizational framework recognizes identity issues relevant to educators

and can provide a lens to observe, identify, and analyze to influence policymakers and

curriculum designers (Schachter & Rich, 2011). Maslow’s (1943) third level of hierarchy of

needs described social needs including organizational culture. Organizational culture is a

network of values and norms that guides an individual’s behaviors and can be described as the

glue that holds an organization together (Upadhyaya, 2014). Organizational culture includes

experiences, norms, values, philosophy, and rituals that hold the organization together

(Upadhyaya, 2014).

Contextual variables such as organizational climate and support affect the

implementation of mental health treatments and supports in schools (Santiago et al., 2014). For

the purpose of this study, the organizational culture of the public schools in relation to special

education teachers is important to describe. Researchers (e.g., Carlson & Kees, 2013; Reinke et

al., 2011; Schonert-Reichl, 2017) have focused on guidance counselors and regular education

teachers’ experiences, however, there is a lack of focus on special education teachers lived

experiences. Contextual organizational framework is divided into three factors: individuals,

organizational, and state/nation (Ringeisen et al., 2003). For this study, the individual factor was

the focus as the research will explore special education teachers lived experiences.

Contextual Organizational Framework

There are several aspects of public-school contexts that influence practices, educators,

and students (Ringeisen et al., 2003). Maslow’s (1943) organization culture is defined as a set of

beliefs, values, assumptions, and experiences that are acquired through learning, socializing, and

sharing with other members if the social unit such as a public school (Upadhyay, 2014). Special

education teachers’ lives are in context conceptualizes that are in constant interaction with their
 22

own attributes, immediate environments, and larger culture (Schwartz et al., 2019). These

interactions include students, specifically student’s development and culture (Schwartz et al.,

2019). The contextual organizational interaction of special education teachers in regard to

addressing students with comorbid mental health struggles is important to explore. By

researching the lived experiences of special education teachers addressing comorbid disabilities

and mental health in their students is significant for efforts to improve mental health services and

interventions in public-schools (Neal et al., 2018).

Contextual organizational framework includes three factors: (a) individual, (b)

organizational, and (c) state/national levels (Ringeisen et al., 2003). Individual levels of

contextual factors includes those related to special education teachers (i.e., training, support), as

well as the student (i.e., academic achievement, peer relationships) (Ringesisen et al., 2003).

Regarding special education teachers, the context of niche over time acts as a support or barrier

to their well-being and capability to teacher (Schwartz et al., 2019). Special education teachers

often pull from their support and prior knowledge to address situations that arise during a given

school day.

By exploring the individual lived experiences of special education teachers, a better

understanding of the supports and barriers that impact those addressing comorbid disabilities in

students who struggle with mental health would be beneficial. There is a lack of seamless,

comprehensive services provided to students who struggle with mental health concerns (Conroy,

2016). The organizational and state/national levels of contextual frameworks can be influenced

through the exploration of individual experiences of special education teachers and can better

benefit students who experience comorbid disabilities including mental health struggles.

Recognizing issues that are relevant to special education teachers lived experiences can provide a
 23

powerful lens to observe, identify, and analyze classroom practices, curriculum design, and

policymakers’ deliberations and decisions (Schachter & Rich, 2011).

Maslow’s Hierarchy and Social and Emotional Wellbeing

In the 1940’s Maslow (1943) first reported his hierarchy of needs, which continues to be

significant and relevant in present day society (Gorman, 2010). Human experience is controlled

by needs and behaviors to satisfy those needs (Matias et al., 2020). Often displayed in a pyramid

format, Maslow’s hierarchy of needs suggests five stages including: physiological or basic needs,

safety, social, esteem, and self-actualization (Mucedola, 2015). An individual is motivated to

achieve certain needs and work to fulfill as they strive towards reaching their full potential

(Mucedola, 2015). The stability of the system of needs relies on the strength of its foundational

level (Matias et al., 2020). Basic needs, physical and emotional safety, love and belonging, and

esteem must be met first in order for an individual to reach self-actualization (Crandall et al.,

2020). Self-actualization includes the ability to be self-accepting and have self-regard. Self-

actualization can be targeted through activities that enhance one’s purpose, empowerment, and

self-worth by addressing symptoms of mental health disorders such as depression (Mucedole,

2015).

Failure to meet basic needs often leads to a higher risk of depression and an increased

rate of depressive symptoms which in turn hinders the growth of self-actualization (Crandall et

al., 2020). Unfulfilled basic needs, physical and emotional safety, love and belonging, and

esteem dominate an individual thinking and behavior until they are satisfied (Gorman, 2010). A

lack of emotional and physical safety have both been associated with adolescent depression and

struggles with self- esteem (Crandall et al., 2020). Late adolescence and young adults are at a

greater risk of vulnerability for mental health struggles as academic and social demands increase
 24

(Connor et al., 2020). When basic needs are not being met, the state of emotional and social

wellbeing in which an individual can cope with normal stresses of life and achieve their potential

is significantly hindered (Gorman, 2010).

Currently, the world is experiencing a pandemic that is impacting every individual in

varying and intense ways. Children stuck in Maslow’s lower levels or do not have their basic

needs being met, are in survival mode and may never fully attain their educational potential

(Kuzujanakis, 2021). These aspects put these children at a higher risk for experiencing anxiety

and depression (Kuzujanakis, 2021). Mental health disorders in children and adolescents impact

their abilities to participate in successful educational experiences. These mental health concerns

are even more of a concern as the world navigated a global pandemic. There is significant

information in exploring the perceptions of special education teachers in addressing comorbid

mental health disorders in their students.

Related Literature

Public schools are in a transformative time where vital decisions must be made to

promote stable futures. Mental health in special education students and ways special education

teachers will address these concerns in students is one area of need in public schools. Limited

research exists addressing the involvement of teachers with school-based mental health services

and their perceived level of efficacy associated with providing those services (Franklin et al.,

2012). Mental health struggles affect one in ten children and young adults (Humphrey &

Wigelsworth, 2016). Recognition and knowledge of mental health symptoms can improve help-

seeking intentions, inform interventions, and guide programs that address mental health concerns

(Spiker & Hammer, 2018). Mental health is defined as an “overall wellness of how you think,

regulate your feelings, and behave. A mental illness, or mental health disorder, is defined as
 25

patterns or changes in thinking, feeling, or behaving that cause distress or disrupt a person’s

ability to function” (Mayo Clinic, 2020, para. 2).

Mental health concerns are evident in the society that surrounds public education.

Research has established an increase in the number of children struggling with some form of

mental health issues (Flanagan et al.,2015). With the continual rise in mental health concerns, it

is evident that special education teachers are lacking the training and support to address mental

health struggles in their students (Castillo et al., 2017; Reinke et al., 2011; Skaar et al., 2020). In

fact, only one in five children struggling with mental health concerns are receiving professional

assistance (Flanagan et al., 2015).

Public schools are being called upon to address the rising concerns about mental health.

Schools are essential partners for doing the work with mental health conditions (Adelman &

Taylor, 2006). Schools are a primary source of interaction for children and are being called upon

to take on more responsibility and reliability to implement quality mental health supports

(Flanagan et al., 2015). Educators are key implementers in the efforts to address and prevent

mental health needs in youth and adolescents (Stormont et al., 2011). Despite the progress that

has been made, public-schools often still fail to offer appropriate mental health services and

prolonged support over long periods of time for children who struggle with mental health

disorders (Verlaan et al., 2016). By exploring the lived experiences of special education teachers,

a better understanding of the supports and barriers to address comorbid disabilities and mental

health concerns in students are evident.

This literature review explored components related to the current research study. These

components included comorbid disabilities, Maslow’s (1943) hierarchy of needs and social-

emotional wellbeing, mental health, and public schools, combating mental health in public
 26

schools and prolonged mental health disorders. Additionally, the significant impact of the

COVID-19 global pandemic on mental health disorders and struggles regarding youth and

adolescents is a growing concern (Cowie & Myers, 2020). Presently, there are gaps in the

research in references to special education teacher’s involvement and perceptions of addressing

mental health struggles in their students. However, special education teachers, among other

school staff, are essential in meeting the mental health needs of students in public school

systems.

Comorbid Disabilities

Comorbid disabilities are defined as a disability occurring when several disorders overlap

or are comorbid with one another in the same individual (Forness et al., 2012). Students with

disabilities are 25 to 40% likely to also have co-occurring or comorbid mental health disorders

(Lambros et al., 2016). These comorbid disabilities can include high rates of attention-deficit/

hyperactivity and anxiety disorders (Lambros et al., 2016). For example, a student who is

receiving special education services to address specific learning disabilities and displays negative

behaviors, depression, or anxiety struggles would be exhibiting comorbid disabilities. Despite a

students need for special education services, psychological support is seldom offered (Malboeuf-

Hurtubise et al., 2017) to address comorbid disabilities.

Often children and adolescents found to be educationally impacted by ADHD, specific

learning disabilities, or emotional disorder have individualized education programs (IEPs) to

address their academic and occasionally behavioral needs. Students who are categorized as

qualifying for special education services are given IEPs and often work with special education

teachers, among other supportive staff. However, these students can also have comorbid mental

health disorders that impact their social-emotional success, as well as their academic progress
 27

throughout their educational journey. There is an overwhelming amount of research exploring

ADHD and disruptive behaviors (Aitken et al., 2018; Tamm et al., 2021; Wiener & Daniels,

2016) and seemingly limited research exploring other special education disorders and their

comorbidity to mental health disorders. However, it is important to understand that special

education teachers address a variety of academic and social-emotional disorders. Their lived

experiences of addressing comorbid mental health disorders in their students is significant for

interventions and support in the public-school setting.

Students with ADHD often struggle with executive functioning with impacts their

neurocognitive processes in the areas of academic, social, and behavioral (Tamm et al., 20211).

As many as 80% of students with ADHD also have disruptive behaviors (Aitken et al., 2018).

ADHD symptoms could include higher-order language comprehension, difficulty problem

solving, and struggles generalizing strategies to new situations (Aitken et al., 2018). These

difficulties can impact their understanding of their behaviors and make interventions and support

slower or less consistent to make gains. Additionally, older children in secondary education

report feelings of failure and disappointment in relation to their inability to master basic

educational skills (Wiener & Daniels, 2016). The feelings of failure and disappointments can be

related to internalizing behaviors that can negatively impact the mental health of that child.

ADHD has also been demonstrated to co-occur with such disabilities as specific learning

disabilities due to struggles with executive functioning such as working memory (Wiener &

Daniels, 2016).

Specific learning disabilities are characterized as a neurodevelopmental disorder that

involves difficulties in reading, written expression, and/or mathematics (Bonifacci et al., 2016).

Approximately 4.8% of American students have a learning disability (Malboeuf-Hurtubise et al.,

 28

2017). Students who are identified with a specific learning disability (SLD) often struggle with

their self-esteem which can be tied to internalizing symptoms such as anxiety and depression

(Bonifacci et al., 2016) and externalizing behaviors like conduct and oppositional disorders

(Malboeuf-Hurtubise et al., 2017). It is essential for schools to develop interventions that are

skill based and adapt to the needs of the children or adolescents (Malboeuf-Hurtubise et al.,

2017), including those who are diagnosis with learning disabilities and ADHD.

Research exploring comorbid disabilities in elementary special education students

determined a significant number displayed social skill impairments and problem behaviors along

with emotional disability (Forness, 2005; Malboeuf-Hurtubise et al., 2017). Students with

learning disabilities also demonstrated substantial levels in problem behaviors and tended to have

higher number of suspensions or expulsions (Forness, 2005), poor communication skills,

difficulty identifying and understanding the emotions of others, low self-esteem from long

history of failure, and other negative impacts (Carnazzo et al., 2018). Often, mental health

concerns with students identified with a learning disability takes a backseat as academics are the

primary focus for special education teachers.

Unaddressed, mental health struggles can result in difficulties in school, including poor

academic functioning, chronic absenteeism, and disciplinary concerns (Ball et al., 2016). Left

untreated, mental health concerns in special education students often leads to poor academics and

social-emotional development issues later in adolescence and adulthood (Kelchner et al., 2019).

For instance, less than 1% of school-age children are identified with the emotional disorder, but

data suggest that there are approximately 12% of school-age children with at least moderate to

severe emotional or behavioral disorders (Santiago et al., 2014). Often problem behaviors are not

addressed until they are well established in one’s functional repertoire making them increasingly
 29

resistant to long-term change (Conroy, 2016). The presence of more than one disability and/or

diagnosis often complicates the developmental and social profile for students on this group and

impacts functioning across multiple areas (Lambros et al., 2016).

Individualized education programs (IEPs) are grounded/based on a comprehensive

evaluation of the referred students’ educational needs, data that provides educators with what is

known as the Present Levels of Academic Achievement and Functional Performance. The

“present level” data serve as a baseline that shows educators what effect the student’s

skill/knowledge deficits has had on their educational performance and which can be used for

progress monitoring, but more importantly, it provides critical information to help develop IEP

goals to address academic and functional needs. Unfortunately, in many cases the primary focus

of the IEP is on academics to the exclusion of daily adaptive/functional needs such as mental

health or behavioral supports (Lambros et al., 2016). As a result, students on IEPs who have

emotional-behavioral challenges often have their mental health needs unaddressed (Lambros et

al., 2016). In addition, there is limited evidence showing that systematic screening for underlying

mental health disorders is conducted once a child is found eligible for special education services

(Santiago et al., 2014). Through the exploration of special education teachers lived experiences,

a better understanding of addressing comorbid disabilities in relation to mental health concerns

in students is essential. The current phenomenological study aims to describe the lived

experiences of special education teachers, in a Virginia school district, regarding comorbid

disabilities and the impact on mental health concerns in special education students.

Mental Health and Public Schools

Mental health concerns have been a significant topic throughout society in recent years.

Mental health in schools is a board category that describes different psychosocial interventions
 30

and services designed to be learning supports for students with social, emotional, and learning

challenges (Franklin et al., 2012). Society often holds a negative stigma regarding mental health

disorders. The stigma forms attitudinal barriers that influence basic human needs including self-

perception, interpersonal relationships, and seeking mental health support (McDonald, 2018;

Sickel et al., 2014). Some people with proper treatment can recover or find ways to cope with

their mental illness; however, when left untreated people can become socially isolated and

stigmatized (Smith et al., 2019). Additionally, increasing pressures for higher academic

standards and outcomes for all students are reaching nearly unattainable levels for many students

who struggle with severe emotional and behavioral difficulties (Gresham, 2015). However,

mental health disorders are significantly impacting society and public schools can be a first

responder in addressing these concerns in adolescents.

Nearly 50% of instructional time in the public school system is spent dealing with

behavior concerns exhibited by students, a factor reported to be one of the most challenging and

persistent aspects of teaching (Flanagan et al., 2015). Virginia’s General Assembly (2020)

defined mental illness as:

A disorder of thought, mood, emotion, perception, or orientation that significantly

impairs judgment, behavior, capacity to recognize reality, or ability to address basic life

necessities and requires care and treatment for the health, safety, or recovery of the

individual or for the safety of others. (para. 18)

Currently, more media coverage has highlighted the increase in suicide rates, depression, mass

shootings and the global pandemic. The majority of children who attempt suicide are found to

have a significant mental health disorder (Pearce-Stevens, 2018). Mental health is often defined

or described through oppositional defiant disorder, anxiety, depression, posttraumatic stress,

 31

bipolar and many others. There is ample evidence of the relationship between emotional and

behavioral difficulties and poor interpersonal relationships (Trach, 2017). Public- school systems

are being relied on to develop plans to combat or address the rise in mental health concerns.

Existing knowledge proves that early interventions are key in meeting the needs of those who

struggle with mental health issues. However, school systems are not equipped to meet the

demands. As far back as 1997, Levin et al. stated that “educational services for children with

disabilities, including emotional and behavioral disorders have been inadequate” (p. 132).

Training, programs, resources, and support are lacking in public school systems.

Currently in society, the mental health disorders are becoming more prevalent as the

world navigates the effects of the coronavirus pandemic. COVID-19 is the biggest health crisis

seen in generations and has affected more than 200 countries around the world (Cowie & Myers,

2020) and the world will never be the same (Matias et al., 2020). The pandemic has brought

attention to the public of the intense crisis which is mental health disorders (Kuzujanakis, 2021).

Drastic measures to contain the virus, including restricting movement, lockdown, and closure of

workplaces, shops, and schools has and continues to impact people globally (Cowie & Myers,

2020). Media coverage of the pandemic is depicting “what’s wrong” in the world, and rarely

stating “what’s right” (Kuzujanakis, 2021) which can and is contributing to the rise of mental

health disorders such as anxiety and depression. It is estimated that over four billion people are

living in social isolation due to the pandemic and have limited access to mental health services

(Matias et al., 2020). The pandemic is affecting individuals across all socioeconomic levels,

ages, genders, causing everyone to feel as though they are stuck in “survival mode”

(Kuzujanakis, 2021). Children and young people are especially at risk for negative mental health
 32

impacts from COVID-19 due to their limited understanding of the events and situations

surrounding the pandemic (Cowie & Myers, 2020).

The nation is in a transformation period with regards to mental health and public schools

(Adelman & Taylor, 2006; Atkins et al., 2017; & Teasley, 2018). There is so much going on in

our society and it is trickling down to the school systems to address. There is a need to break

mental health into two components: mental ill health and wellbeing (Humphrey, 2018).

Considering this approach is important because some approaches were underplaying or ignoring

distress which in turn was taking away essential support for those who need them. Adolescents

and children general development including mental health and wellbeing are significant to the

development of individuals self and is often fostered by social support from the community,

friends, and family (McDonald, 2014). Therefore, to have a positive wellbeing one will have a

more positive mental health condition.

Mental health disorders can be categorized as internalized or externalized. Internalized

problems include such things as anxiety, depression, bipolar disorder, dysthymia, somatic

disorders (Mojtabai & Olfson, 2020). Externalizing disorders are among the most reported and

referred to school-based mental health services in the United States (Verlaan et al., 2018).

Externalizing types of problems include impulsive conduct, substance abuse, bullying, physical

aggression, vandalism, conduct and oppositional defiant disorders (Mojtabai & Olfson, 2020).

Both internalizing and externalizing mental health disorders significantly impact the academic

progress of students attending public school systems. Students with externalizing behaviors often

have difficulties managing peer conflicts, regulating emotions, impulsive behaviors, and can be

highly disruptive in the classroom setting (Verlaan et al., 2018). Often children who experience

internalizing and externalizing forms of mental health disorders are at a higher risk for a negative
 33

attitude towards learning, low academic performance, school failure, and dropping out of school

(Verlaan et al., 2016). Children and youth experiencing gender dysphoria often struggle with

internalized and externalized behaviors. Often boys with gender dysphoria display internalizing

problems such as separation anxiety (Aitken et al., 2016). While girls with gender dysphoria

often experience both internalizing and externalizing behaviors equally (Aitken et al., 2016).

Currently, researchers are seeing an increase in internalizing disorders such as anxiety,

depression, and suicide, while there is a decrease in externalizing disorders (Moitabai & Olfson,

2020). The increase in internalizing disorders could be attributed to the current world pandemic

that has plagued the world for the last 2 years.

Epidemiological evidence indicates that mental health problems affect one in ten children

and young adults (Humphrey & Wiglesworth, 2016). Between 12 and 22% of all children under

18 need services for mental, emotional, or behavioral problems (Adelman & Taylor, 2016). The

LGBTQ (Lesbian, gay, bisexual, transgender, and queer/questioning) community is just one

group of youth public schools should be aware of regarding mental health disorders. Students

who identify in the LGBTQ community are described as experiencing higher levels of mental

health disorders than heterosexual students (McDonald, 2018). Authorities report that 30% of the

LGBTQ community experience anxiety, depression, and post-traumatic stress disorders (PTSD)

and nearly 32% attempt to commit suicide (Gato et al., 2021; McDonald, 2018; Schmitz et al.,

2021). Mental health concerns in children are often defined as delays or disruptions in

developing age-appropriate thinking, behaviors, social skills, or regulation of emotions

(Grigorenko et al., 2019; The Mayo Clinic, 2020). These behaviors and the societal stigmas often

disrupt their ability to function well in the academic setting. Difficulties in self-efficacy, growth,
 34

and development can result in heightened drug use and mental health disorders such as anxiety

and depression (McDonald, 2018).

Anxiety is another internalizing mental health disorder that is significantly present in

adolescents. In recent years, the prevalence of anxiety in children is between 5-8% with a 31.9%

prevalence of lifetime affects; in fact, less than one-third of individuals struggling with anxiety

seek treatment or supports (Kuzujanakis, 2021). Anxiety is among the top five health burdens in

the United States, however, is the least likely of the major pediatric mental health disorders to be

treated (Seeley et al., 2018). Anxiety in children can be characterized by poor school

performance, school, phobias, stomachaches and other bodily aliments, restlessness, irritability,

loss of appetite, and difficulty sleeping (Kuzujanakis, 2021). All these characteristics or

symptoms of anxiety negatively impact the educational experiences of students who struggle

with this mental health disorder. Untreated anxiety can worsen and lead to signs of depressive

symptoms such as hopelessness, exhaustion, frequent school absences, social isolation, and

negative obsessive thinking (Kuzujanakis, 2021). Due to the current world pandemic, closures of

schools and limited access to friendship groups has added additional stress and acute anxiety to

children and young people (Cowie & Myers, 2020).

Anxiety has a high comorbidity with many other disorders including disruptive behaviors

and autism (Seeley et al., 2018). Despite the high comorbidity of anxiety with other disorders, it

is not easily recognizable and often goes untreated (Seeley et al., 2018). Another consideration is

poor social skills can foster low self- efficacy in social situations, such as schools, leading to

anticipatory anxiety, increased social isolation, depression, and other negative impacts (Connor

et al., 2020). For example, those who have autism and struggle with social and vocational
 35

engagements, are at a higher risk for anxiety and depression due to the lack of social skills

(Connor et al., 2020).

Depression is one of the most common internalizing mental health disorders in children

and adolescents (Flanagan et al., 2015). Ten to 15 percent of anxious adolescents have comorbid

depression, alternatively, up to 15% of depressed youth have comorbid anxiety (Kuzujanakis,

2021). Maslow’s (1943) basic hierarchy needs have a direct and indirect impact on adolescent

depression (Crandall et al., 2020). For teachers and parents, it is sometimes hard to decipher the

behaviors of being a child and having true symptoms of depression. An absence of emotional and

physical safety has been linked to enhancing adolescent depression symptoms (Crandall et al.,

2020).

Depression is described as a persistent feeling of sadness and loss of interest that disrupts

one’s ability to function adequately in school and interact with others (The Mayo Clinic, 2020)

and is often accompanied by anxiety and can be seen in symptoms such as attention difficulties,

irritability, and difficulty sleeping (Flanagan et al., 2015). Depression symptoms may also

include feelings of hopelessness, worthlessness, helplessness, and loss of interest in activities

(Mucedola, 2015). Adolescent depression is associated with academic issues, behavior problems,

difficult sleeping, weight fluctuations, inability to care for oneself, self-harm, and suicide

(Crandall et al., 2020). It is estimated that 5,000 Americans between the ages of 15 to 24 commit

suicide; this number has more than tripled since the 1960’s (Pearce-Stevens, 2018).

Most children who commit suicide or display self-harm behaviors have or were

struggling with some form of mental health disorder. The Center for Disease Control reported an

56% raise in suicide deaths in the United States among persons in the 10-24 age range from

2007-2017 (Curtin, 2020). Those in the LGBTQ community are 2 to 6 times more likely to
 36

attempt suicide than those in the general population (Veltman & La Rose, 2021). An estimated

40% of transgender adults who struggle with gender dysphoria attempt suicide at some point in

their lifetime (Smith et al., 2019). Children and adolescents who struggle with gender dysphoria

are 28.8% to 41% more likely to display self-harm and 11.9% to 15.8% more likely to attempt

suicide (Aitken et al., 2016). Presently, there is a need to change and find early detection systems

to address sadness in teens (Pearce Stevens, 2018). By developing universal guidelines, a more

systematic approach to support and services for those struggling with mental health did become

evident. These guidelines would bridge a gap between health care providers, community

agencies, guardians or parents and public-school systems which in turn will develop more

meaningful services, supports, and treatments for students struggling with mental health

condition.

Another consideration includes self-esteem, having influential aspirations, personal goals,

and interactions with others (Mann et al., 2004). Maslow’s (1943) hierarchy of needs including

the positive interactions of organizational culture and human resource management can result in

self- esteem and self- actualization (Upadhyaya, 2014). Positive self-esteem can lead to better

overall health, control with internalizing and externalizing problems efficiently, and positive

social interactions. For example, students with high self-esteem attribute their success to their

own efforts, while those with lower self-esteem, including those with learning disabilities,

believe their success if due to chance or luck (Carnazzo et al., 2018). Those with disabilities,

such as a learning disability, struggle with self-esteem which in turn impacts their academic

progress and ultimately their educational success.

Meeting one’s self-esteem needs leads to feelings of capability and internal control which

motivates an individual to continue to achieve their needs (Crandall et al., 2020). Self-esteem is
 37

associated with responses to success and failure; low self-esteem creates vulnerability and

depression (Matias et al., 2020). Individual’s self- esteem may act to mediate between metal

health services and one’s willingness to seek support and treatments (Sickel et al., 2014). Those

children with higher self-esteem often have higher academic achievement and can be linked to

job satisfaction later in life (Mann et al., 2004). Social-emotional learning (SEL) practices can

develop positive self-esteem in students. By developing positive relationships with teachers and

other students can boost the self-esteem of students. SEL practices produces positive student

outcomes through changes to the educational context that in turn affects teacher and student

relationships and promotes safer and more inclusive learning environments (Trach et al., 2018).

Thus, addressing self-esteem and developing a system to promote positive self-esteem can lead

to an overall better mental health condition.

The effects of mental health are impacting society and ultimately the public-school

systems. Self-esteem moderates the associations between body-related self-conscious emotions

and depressive symptoms (Matias et al., 2020). Conduct problems are more prevalent than

anxiety and depression and are important to consider when planning treatment services (Lambros

et al., 2016). The need for interventions to combat or address mental health are at an all-time

high. Mental health condition is a serious topic that must be addressed with supports and

preventions. Public school systems are being called upon to aid with developing programs and

supports to address mental health conditions and as Lawson and Cmar (2016) point out,

“[s]chools serve as a part of the system of care” (p. 2). Educators are significant stakeholders in

addressing mental health disorders because parents often consult with teachers regarding

concerns about their child’s development and behavior (Loades & Mastroyannopoulou, 2010). It

is vital that all those involved in the public school system have some type of training, both
 38

preservice and professional development, to help with early detection and prevention of

catastrophic mental health behaviors (Grigorenko et al., 2019).

Combating Mental Health in Public Schools

Children and adolescents with psychiatric disorders are consistently underserved,

however, schools are gateways to additional mental health services that they need (Green et al.,

2013). Schools are like bridges between home life and the community and are key sites for

identification and interventions for children experiencing mental health needs (Frauenholtz et al.,

2017). Schools are familiar establishments for families which makes it more comfortable for

families to participate in children’s mental health services (Doll et al., 2017). Evidence suggests

that teachers are significant partners in delivering mental health interventions because they are

more involved with students for prolonged periods of time and across different school programs

or academics (Franklin et al., 2012). These prolonged interactions are noted to be the largest

impact on student functioning (Franklin et al., 2012). Educators have a role in terms of being

problem recognizers and providing early interventions (Loades & Mastroyannopoulou, 2010). A

school’s direct and daily access to all children in a community makes it possible to seamlessly

integrate prevention, ecological intervention, and wellness promotion into a community’s

comprehensive system of mental health services (Doll et al., 2017). Public schools and educators

can provide important opportunities for students to address their mental health needs to better

their educational experiences.

Early identification and referral resources reflect a school culture that normalizes

discussions of emotional/ behavioral health and reduces the stigma of receiving help within the

school community (Green et al., 2013). People are more motivated to participate in education

that they perceive as helping them to meet their hierarchy of needs. If education is not perceived
 39

as meeting a need, then there can be little motivation to strive to achieve a higher education

(Gorman, 2010). These perceptions significantly impact those students who attend public schools

and struggle with mental health disorders. The negative attitudes and stigma towards mental

health disorders often extend into many facets of an individual’s life, including their educational

setting, and can limit their motivation to seek support and treatment (Sickel et al., 2014). It is

imperative that school districts, teachers, special education teachers, and other public-school

stakeholders understand the hierarchy of needs and motivational factors of students who

experience mental health disorders and comorbid disabilities.

Bullying and cyberbullying are two areas that significantly impact the mental health and

functioning of children and adolescents. Bullying is defined as an interpersonal aggressive

behavior characterized by intentionality, repetition, and an imbalance of power through physical

contact, by words, or social isolation or exclusion (Berchiatti et al., 2021); while cyberbullying

includes the use of computers, smart phones, and other platforms to contact by words or social

isolation and exclusion repeatedly and with hostile or aggressive messages (Kwan et al., 2020).

Bullying and cyberbullying has a high prevalence in schools with a rate above 20% (Orue et al.,

2021). In the United States, 88% of teens have access to a desktop or laptop computer and 95%

have access to smartphones or other platforms (Kwan et al., 2020).

Bullying and cyberbullying subsequently critically impacts those with learning

disabilities, ethnicity, gender dysphoria, and sexual orientation due to their differences and

impairments (Berchiatti et al., 2021; Orue et al., 2021). School bullying is stated to affect both

mental health and academic outcomes as victims show higher levels of depression, dislike for

school, lower academic scores, and no involvement with classmates (Berchiatti et al., 2021). For

those in the LGBTQ+ community, victims of bullying because of homo/transphobia causes

 40

significant suffering in their lives, especially during critical developmental phases (Dominguez-

Martinez & Robles, 2019). Bullying and cyberbullying can negatively impact the developmental

stages of children and adolescents which is critical for their academic and adulthood journeys.

Schools play a key role in preventing bullying and promoting respect for diversity because they

are places where children and adolescents spend most of their day (Dominguez-Martinez &

Robles, 2019). Bullying and cyberbullying should be intolerable, especially in what should be

considered a safe place (Dominguez-Martinez & Robles, 2019) such as a school.

Public school educators rarely receive mental health professional development, despite

up to one in five students suffering with some form of mental health disorders (Kuzujanakis,

2021). Teachers are professionals who are involved in the lives of children daily, but the

majority of them are not specialist trained in mental health disorders and services (Loades &

Maatroyannopoulou, 2010). Furthermore, mental health services and interventions are often

developed without consideration of their relevance or compatibility to the public-school context

making teacher “buy-in” and trust in mental health services and interventions more difficult to

achieve (Neal et al., 2018). Educators are often lumped into a singular group; therefore, they are

not distinguished by facilitators, barriers, experiences, and among other criteria (Neal et al.,

2018). A significant challenge is the limited empirically supported treatments and lack of well-

designed mental health services in general for students with special education services (Lambros

et al., 2016). Another major challenge are the instruments and interventions used for identifying

mental health disorders in children. Often these instruments and interventions are derived from

adult versions (Mierau et al., 2020) which do not always meet the needs or develop

understanding of children and adolescents’ mental health struggles. Additionally, another

challenge is gaining mental health resources in public-schools is the high ratio of students to
 41

related services personnel and the finances needed to provide mental health interventions

(Teasley, 2018).

Educators often report feeling unprepared to address mental health needs in the classroom

because they are not provided with comprehensive training and professional development

opportunities (Ball et al., 2016; Franklin et al., 2012). Empowering educators, specifically

special education teachers, with comprehensive training and professional developments will

assist in combating mental health concerns in their students. Therefore, empowering educators

with effective and sustainable approaches to addressing mental health concerns in students

improves the educational experience overall for all students (Flanagan et al., 2015).

Empowerment must occur with primary or elementary school teachers because externalizing

problem behaviors often occur as early as preschool (Flanagan et al., 2015). Training for

educators are important for developing teachers’ social emotional skills and includes self-

development and wellbeing (Rae et al., 2017). Sustainability and implementation of programs

that combat mental health conditions are also significant factors to consider for a continual

process that empowers the context of the school environment (Rae et al., 2017).

Due to the unique position of access to children, schools are increasingly bearing the

responsibility and reliability of providing quality mental health support for their students

(Flanagan et al., 2015). To provide cohesive mental health services for children and adolescents,

coordinate care across community and school mental health providers, community partnerships,

and stakeholders must be involved in designing, implementing, evaluating, and refining mental

health services (Doll et al., 2017). By collaborating, schools and agencies can reach more

children and families in need of support and treatment. Collaboration can promote program

development that will meet the needs of the community (Baker, 2013). Thus, when
 42

collaborating, providing the necessary supports and services for not only individuals, the needs

of the community will also be met. This is critical considering the path society is currently

following and the impact that the pandemic is having on individuals, especially children and

youth.

The sustainability of collaboration between school systems and outside agencies is often

difficult to maintain and significant changes to current protocols and procedures would need to

be addressed (Flanagan et al., 2015). To maximize the benefits of mental health supports, there

needs to be an emphasis on innovative approaches that can enhance the impact and sustainability

through a variety of contexts and collaborations (Dopp et al., 2019). Public schools often lack

enough mental health counselors and school psychologists (Kuzujanakis, 2021) demonstrating

the significant need for schools and outside agencies to collaborate to ensure proper mental

health support for students in need. Children on average are at school for six to eight hours a day

for at least nine months a year (Baker, 2013). This only exemplifies why it is significant that

school systems be on board in developing and implementing mental health supports and services.

Within a school system, there are several significant positions that should be involved in

all mental health situations. The utilization of a school psychologist, school social worker, and

school counselors (Eklund et al., 2017). For this literature review, I would also add special

education teachers. A core, cohesive group should be formed to develop the best support and

systems for those with mental health issues. Youth are twenty-one times more likely to visit a

school-based clinic for mental health care than anywhere else (Eklund et al., 2017). Thus, it is

critical that school systems have a plan and programs in place that are available for those in need.

The number one way to meet student’s mental health needs is the development of

teacher-student relationships (Franklin et al., 2012; Trach et al., 2018). Peer and teacher
 43

relationships are a significant factor in preventing bullying and cyberbullying (Berchiatti et al.,

2021). When a relationship is established, children have a confidante that can model and guide

them into making positive behavioral decisions. Building relationships is a core factor in a

child’s development and provides them with social competences necessary for mastering social

challenges (Berchiatti et al., 2021). Adding programs and support to school systems develops a

continuum of services and support provided to the youth with mental health issues (Eklund et al.,

2017).

Social-emotional learning (SEL) programs or practices can be an option for schools to

meet the intrapersonal and interpersonal needs of their students. School-based -prevention

programs have been shown to be effective in targeting depression and other mental health

disorders impacting adolescents (Mucedola, 2015). SEL includes the ability to learn and apply

the knowledge, attitudes, and skills needed to manage emotions, set and achieve goals, feel and

show empathy, establish and maintain relationships, make responsible decisions, and avoid

negative behaviors (Trach et al., 2018). Using a social-emotional learning program reduces

aggression and antisocial behaviors in school aged children (Portnow et al., 2015). Currently all

50 states have a preschool social-emotional learning program in place (Jones & Doolittle, 2017).

However, only four states have SEL standards for kindergarten through twelfth grade; Virginia is

not a state with established SEL standards (Jones & Doolittle, 2017). Until social-emotional

learning is addressed in the public-school systems, schools are not meeting the needs of the

whole student. There is no recipe to match assessments with interventions, rather SELs are useful

for conceptualizing and guiding IEP teams in better understanding individual student needs

(Skaar et al., 2020).

 44

A collaborative, systematic, and continuum of needs about addressing mental health

disorders in youth and adolescents is essential for public-schools to make an impact. A

continuum of needs and/or supports which includes public health promotion and maintenance,

preschool-age support, early-schooling targeted interventions, improvement of ongoing supports,

interventions prior to referrals, and overall intensive treatments (Adelman & Taylor, 2006).

These six components when working as a continuum and/or collaboration can combat mental

health conditions both in schools and society. As mentioned in the paragraph above, there is a

lack of targeted programs that are used in kindergarten to secondary to address behavioral and

emotional concerns in students.

The lack of early interventions in public-schools disrupts the continuum of needs those

students struggling with emotional and behavioral concerns (Adelman & Taylor, 2006; Sotardi,

2018). Also, the lack of communication and collaboration between schools and community

agencies negatively impacts the continuum of needs for those students struggling with mental

health disorders (Baker, 2013; Flanagan et al., 2015; Greene, 2014; & Weist et al., 2001). School

engagement in early identification is meaningful in developing services for adolescents with

mental health and behavioral disorders (Green et al., 2013; Kern, 2015). School systems

educators, and collaboration of community agencies must foster positive attitudes and behaviors

that develop positive wellbeing and mental health conditions.

There is a disappointing reality surrounding sustainability and implementation (Elias et

al., 2003). Often programs are not fully utilized or the perceptions regarding the program are

negative. Thus, the program is not being utilized to its fullest potential and may not necessarily

be effective. Special education students are one group of children for whom comprehensive and

integrated academic and mental health services are warranted, but not always received within the
 45

school system (Lambros et al., 2016). When considering a support system, school systems much

take into consideration who will and how will it be implemented.

Special educators must have considerable knowledge and skills to assess students’

learning needs, design and implement individualized interventions, collaborate with other

educators to modify instruction, and facilitate inclusion to effectively serve students with

disabilities (Bettini et al., 2016). Lack of training and development of these programs are sure to

continue to lead to negative results regarding mental health conditions. “As funding dollars

diminish, the need increases for collaborative efforts between school systems and community

mental health agencies” (Baker, 2013, p. 59). The Virginia Department of Behavioral Health and

Development Services (VDBHDS; n.d.) stated the system of services for children and families is

complex, multi-faceted, and rapidly evolving. However, the growth of these services has solely

relied on support by public funding through Medicaid and the Children’s Services Act with

limited state funding provided (VDBHDS, n.d.).

The undeniable limitation with regards to research in the mental health field is the lack of

funding. The Patient Protection and Affordable Care Act (2010) was formed to provide funds to

create and expand school-based mental health services (Doll et al., 2017). However, it is evident

that there is varying definitions of school-based mental health services and inconsistent

understanding of where funds should be used which stalls the development of these essential

programs (Doll et al., 2017). Society is turning a “blind eye” to these significant concerns rather

than rallying for research and development (Grigorenko et al., 2019; Teasley, 2018). There is a

significant importance of collaboration between schools and community agencies (Baker, 2013,

Weist et al., 2001). By these two entities working together treatment providers can reach children
 46

and families who may not otherwise seek support. However, none of this is possible without the

appropriate funding and guidelines.

The mental health needs of children and adolescents currently surpasses the ability of the

current system to respond to the need (Weist et al., 2001). To address mental health disorders,

training needs to go beyond basic classroom management and include other areas that are

essential to student well-being, improving quality of life, and future planning (Kern, 2015).

Teacher expertise is not sufficient for teacher effectiveness, rather teachers need supportive

school structures, resources, and schedules that allow them to use what they know to impact the

educational experiences of their students (Bettini et al., 2016). Transformation is happening in

the school systems and society. It is time to take a stand and work to better support and treat

those struggling with mental health conditions.

Prolonged Mental Health Disorder Impact

Prolonged mental health from childhood to adulthood has a considerable cost to society

both financially and emotionally (Cobbett, 2016). Additionally, mental health disorders cause

detrimental effects on a person’s quality of life (Mierau et al., 2020) and major disruptions in an

individual’s thinking, feelings, and behaviors (Price et al., 2016). Approximately 20% of the

working population are currently suffering with a mental health disorder, while 40% of the

working population may be affected by a mental health disorder over their lifetime (Mierau et

al., 2020). Mental health disorders are a major public health issue and the leading cause of

disability and contribute to approximately 8 million deaths worldwide annually (Walker et al.,

2016).

Mental health disorders from childhood to young adulthood may largely affect

educational and employment status (Veldman et al., 2015). Major disruptions can include
 47

chronic stress, loss of jobs, and dysfunctional behaviors that result in disabilities and health risk

behaviors (Price et al., 2016). Among young adults who struggle with mental health disorders,

13.5% left the educational system without basic education level training (Veldman et al., 2015).

These young adults then lack essential skills to be successful in the work force and/or if they find

jobs, they are often temporary and for low wages (Veldman et al., 2015).

Children and adolescents experiencing mental health disorders eventually become adults

who experience mental health disorders (Mierau et al., 2020). Child mental health is a serious

public health and social problem that lacks cohesive interventions and collaboration (Cuellar,

2015). Those with externalizing behaviors are more likely to drop out of school and be

unsuccessful in the workforce (Veldman et al., 2015). Often people non-conforming gender

identity or gender dysphoria are prone to prolonged suffering from stigmatization and bullying

among other psychiatric issues which lead to higher risk of self-harm, suicidal ideation, and

suicidal behaviors (Surace et al., 2021). Furthermore, children and youth struggling with mental

health disorders that do not receive effective interventions early, they are more likely to have

prolonged mental health disorders, fail in education, develop drug addictions, participate in

criminal activity, and become parents to similar children and repeat the cycle (Cobbett, 2016).

Untreated, mental health disorders can have negative consequences such as lower

educational attainment, lower wages, lower likelihood of employment, and more crime (Cuellar,

2015). Research suggest that girls often have more unmet mental health disorders than boys.

Girls who exhibit external mental health disorders often have more unmet needs, more severe

impairment, and shorter service retention compared to boys with external behaviors (Verlaan et

al., 2018). However, the one concise thought process among researchers is that early intervention
 48

is better than later intervention especially for disadvantage and disabled children (Adelman &

Taylor, 2006; Cuellar, 2015; Sotardi, 2018).

Often, children who display mental health disorders often have parents or other adults in

their lives with long-standing struggles with mental health disorders including problematic

consumption of alcohol and/or drugs (Verlaan et al., 2018). In the United States, 46% of adults

will have a major mental health disorder during their lifetime (Price et al., 2016). Diagnosis

include schizophrenia, bipolar, depression, obsessive-compulsive disorder, posttraumatic stress

disorder, and other psychotic disorders (Price et al., 2016). Adults with mental health disorders

are 2.22 times more likely to have mortality rates compared to those without mental health

disorders (Price et al., 2016). People who experience mental health disorders die 10-25 years

younger than the general population (Walker et al., 2016). Kidney disease and diabetes have

been found to be associated with depression, anxiety, and fear of the future (Wilson & Stock,

2019). Additionally, 2.4 million adults with severe mental health disorders have a comorbid

struggle with substance abuse (Price et al., 2016).

It is critical to understand the impact of mental health disorders as children move through

life into adulthood. Addressing the challenge of mental health disorders means development,

implementing, and disseminating programs and policies to prevent mental health struggles and

increase access to services is essential to improve the quality of life of children, youth, and adults

(Walker et al., 2016). Educational interventions forming a collaboration between parents,

educators, mental health professionals, and the general community should be used to promote

against mental health disorders, stigma, and social isolation to prevent risky behaviors like self-

harm and suicide (Surace et al., 2021). Mental health disorders affect educational and

employment status in a negative way in children to adulthood (Veldman et al., 2015). By schools
 49

providing the training and support for educators to address mental health disorders in students,

the positive impact it will have on students as they move into adulthood and being productive

members of society.

Summary

This chapter presented information about the theoretical framework and related literature

in regard to special education teacher’s lived experiences in addressing comorbid mental health

concerns in their students. A contextual organizational framework emphasizing the individual

factor was explored (Ringeisen et al., 2003). Mental health related issues are on the rise in the

public education system (Flanagan et al., 2015) and is considered one of the most disabling

factors throughout a person’s lifetime (Mierau et al., 2020). Children and young people are

facing a variety of societal and environmental influences that impact their overall mental health.

Increased educational demands, rising divorce rates, media exposure, social media, and

other stressors are just a few challenging influences children face daily (Flanagan et al., 2015).

Bullying and cyberbullying also negatively impact one’s mental health and academic progress,

especially for those with learning disabilities, gender dysphoria, and in the LGBTQ+ community.

“One’s ability to achieve success depends on capitalizing on one’s strengths and correcting or

compensating for one’s weaknesses through a balance of analytical, creative, and practical

abilities” (Parkay et al., 2014, p. 231). Currently, a global pandemic is also proving to have a

significant impact on children and young people’s overall mental health. Schools must be

prepared with an understanding of a student’s hierarchy of needs and developmental stages to

develop the appropriate supports and services to meet the demands of mental health issues in

their students. Administrators, special education teachers, and counselors must have a comfort

level with the support and services and a knowledge of what is available. Unfortunately,
 50

literature suggest that many educators have limited knowledge of children’s mental health and

are unprepared to support students that are struggling with their mental health (Frauenholtz et al.,

2017).

Schools represent the primary source and more universal natural setting for delivering

treatment for mental health disorders (Flanagan et al., 2015; Weist et al., 2001). Schools are

being held to a standard of improving children’s emotional and psychological well-being and

they are expected to both prevent and combat mental health disorders in children and adolescents

(Loades & Mastroyannopoulou, 2010). Seventy to eighty percent of students who experience

conduct disorders, such as oppositional defiant disorder, receive services only provided by the

school they attend (Flanagan et al., 2015). At any given time, twelve to twenty percent of

children are struggling with some sort of mental health crisis and research shows this percentage

is on the rise (Flanagan et al., 2015).

Social-emotional learning practices promote positive student outcomes and sets a stage

for greater success in students (Trach et al., 2018). Currently, there is no single system in the

United States that identifies and treats children with mental health disorders (Cuellar, 2015)

meaning it takes a collaboration of services and systems. School is just as much of a social-

emotional environment as a learning environment. Thus, it is critical to be thought of in that

manner. Students who are struggling to maintain positive social and emotional interactions are

going to struggle academically as well. The struggle can occur from missing vital class time

through suspensions or pulls out due to disruptions. School systems need to be prepared and

ready to address the needs- socially, emotionally, and academically- for all students.

Unfortunately, currently only four states have SEL standards for kindergarten through twelfth

grade. The state of Virginia has not established SEL standards (Jones & Doolittle, 2017).
 51

Public school systems must develop standards that meet the whole student- academics

and social-emotional learning. Many educators feel that their job is to teach academics, rather

than address behavior problems and that they are not sufficiently trained to address and prevent

behavior problems like mental health disorders (Kern, 2015). Through the incorporation of

additional supports, such as SEL and development of teacher-student or student-student

relationships, school systems can better meet all the needs of their students. By arming educators

with understanding of Maslow’s (1943) hierarchy of needs and contextual organization more

successful and meaningful ways to combat mental health struggles in students can be established.

The key to meaningful and successful programs is to be creative and flexible (Flanagan et al.,

2015). Empowering educators with trainings, programs, and supports that aid them in addressing

mental health is what is necessary to meet students in the present and future educational system

(Reinke et al., 2011).

The current transcendental phenomenological study aimed to examine the lived

experiences of special education teachers regarding addressing comorbid mental health concerns

in students. While prior research has emphasized the experiences of regular education teachers

and school counselors, there is a lack of research emphasizing the experiences of special

education teachers. The current study aimed to use rich descriptive data from first-person

accounts to determine the needs to meet mental health concerns in students within the public

school system.
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CHAPTER THREE: METHODS

Overview

The purpose of this transcendental phenomenological study is to explore the lived

experiences of special education teachers addressing comorbid disabilities and mental health

concerns in their students. Mental health concerns are an increasing phenomenon throughout

society, specifically in public school systems across the nation. Public schools are burdened by

the agenda and process of combating mental health issues in school age children (Pearce-

Stevens, 2018). Mental health issues have significant impact on student academic achievement

and the overall achievement of public-school systems (Even & Quast, 2017; Kutash et al., 2015).

Through the exploration of special education teachers’ lived experiences of student mental health

in public-schools, a better understanding of this contextual organizational framework and the

impact that an individual has on organizational and state/nation level establishments (Ringeisen

et al., 2003). The purpose of this chapter is to present research design, setting, participants,

procedures, the researcher’s role, data collection methods, analysis, trustworthiness, and ethical

considerations for the present research study.

Design

Qualitative research attempts to make sense of and interpret events in one’s “real-life”

and is defined as an inquiry process of understanding that explores a social or human problem

and is conducted in a natural setting (Creswell & Poth, 2018). Qualitative methodologies allow

for the focus to be on the wholeness of an experience rather than solely on its objects or parts

(Moustakas, 1994). With the use of qualitative methods, researchers can search for meanings and

essence of personal experiences rather than by objective measurements and explanations

(Moustakas, 1994). A qualitative method were used in this study as opposed to a quantitative
 53

method. Quantitative studies aim to measure and explain data, as pointed out by Moustakas

(1994). However, the current study aimed to explore the experiences by relaying first-person

accounts of life events. It is through personal interaction with participants that a description of

their experiences was depicted. Qualitative research includes multiple types of designs including

ethnography, grounded research, hermeneutics, heuristics, and phenomenology (Creswell &

Poth, 2018). Concerning transcendental phenomenology, Moustakas (1994) described it as being

used when researchers are searching for meanings and essence of experiences. The current study

aimed to describe the meaning and essences of special education teachers lived experiences

addressing comorbid disabilities and mental health concerns in students.

For the current study, a transcendental phenomenological design was used. The

transcendental approach to phenomenology involves “a return to experience in order to obtain

comprehensive descriptions that provide the basis for a reflective structural analysis that portrays

the essences of the experience” (Moustakas, 1994, pp. 10-11). A transcendental

phenomenological design describes the common meaning or experience of several individuals

(Creswell & Poth, 2018) and relies on intuition, imagination, and universal structures in a

transcendental phenomenological study to obtain a picture of the experience (Moustakas, 1994).

The researcher is supposed to interview and interact with the participants in their real-life

environment. Transcendental phenomenological studies include a plethora of rich descriptive

data (Moustakas, 1994). Phenomenological approach is to identify phenomena through how they

are perceived by the participants in a situation and is powerful in gaining insight into a person’s

motivations and actions (Lester, 1999). The transcendental phenomenological researcher makes

participants feel really understood and involves a return to an experience (Moustakas, 1994).

Through a phenomenological study, researchers aim to describe rather than explain which
 54

effectively brings experiences and perceptions of individuals to the forefront and challenges

structural or normative assumptions (Lester, 1999). The current study aims to describe the

experiences of special education teachers addressing mental health in their students.

A study conducted by Giorgi (1985) outlined two levels of transcendental

phenomenology (Moustakas, 1994). At Level I, the original data is composed of descriptions

obtained through open-ended questions and conversations. Moustakas (1994) stated “all of the

studies were qualitative…emphasized processes that were open-ended and methods and

procedures that could be shifted and permitted alternatives in response to participants’ ideas and

suggestions, as needed for accuracy, safety, and comfort” (p. 110). Developing rapport with the

participants, the researcher will develop a comfortable and safe atmosphere which will generate

accurate accounts of the experiences. At Level II, the researcher describes the structures of the

experience based on reflective analysis and interpretation of the participant’s accounts or stories

(Moustakas, 1994). I described the experience based on reflection and interpretation of the

participants’ first-person accounts.

Qualitative research methods aim to review experiences rather than measurements.

Moustakas (1994) stated “the phenomenological approach involves a return to experience in

order to obtain comprehensive descriptions that provide the basis for reflective structural analysis

that portrays the essences of the experience” (p. 13). Through a return to the experience,

reflective analysis, and bracketing my bias and assumptions, the current study aimed to portray

the essence of the shared experiences of special education teachers with regards to addressing

mental health concerns in students.

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Research Questions

Central Question: What experiences within the organizational context(s) do special

education teachers describe when working with special education students with comorbid mental

health disorders?

Sub-Question 1: What do special education teachers report about their pre-service and

in-service training experiences related to special education students with comorbid mental health

disorders?

Sub-Question 2: How are special education teachers’ lived experiences influenced by the

challenges of contextual organizations in providing services to special education students with

comorbid mental health disorders?

Sub-Question 3: What do special education teachers describe as potential in-service

professional development topics that would improve their ability to address the comorbid mental

health disorders of special education students?

Setting

The study setting was originally Hillcrest City Schools (HCS; pseudonym). HCS was

selected for its convenient location to the researcher in region five of central Virginia, as well as

the size of the county. The school district is one of twenty in the fifth region of Virginia (VDOE,

2020). HCS has one preschool, four elementary, one middle, and one high school. HCS has

twenty-seven special education teachers across the school district, elementary and secondary, for

the current study to potentially include in the research. However, due to lack of volunteers,

another school district Grand County (GC; a pseudonym) was added to the study. Additionally,

the current study was open to social medias outlets to gain more volunteers following a lack of

participation from the two approved school districts. By using social media outlets, additional
 56

participants were gained from several states in the United States: Arizona, Colorado, Maryland,

and Virginia.

According to the Virginia Department of Education or VDOE (2020) School Quality

Report, accreditation was waived for all schools during the 2019-2020 and 2020-2021 school

years due to the COVID pandemic. The district identified 11.5% of the student population to be

identified with a disability of some form that requires special education services (VDOE, 2020).

The VDOE (2020) reported a total of 2,914 students enrolled at HCS during the 2020-2021

school year. HCS is a small, suburban school district in comparison to other divisions in the fifth

region. Students with a disability were shown to have chronic absenteeism of 34.6% that missed

10% or more instructional days and 65.4% that have missed less than 10% of instructional days

during the 2020-2021 school year (VDOE, 2020).

The district identifies a superintendent, assistant superintendent, director of student

services, and other areas such as human resources and general curriculum supervisors as

comprising the school board office. The composition of the school board is essential to

understand as these individuals do the hiring and develop the training that special educators

participate in throughout the school year. Each school building/level employs a varying number

of special education teachers. The number of special education teachers in each building varies

according to the number of students in need of special education services.

Pre-school, elementary, middle, and high school special education teachers were included

in the current study. The experiences between levels vary depending on presence of mental

health concerns in students, training of special educators, and available resources for special

education teachers. I was expecting more emphasis in mental health related supports and

trainings for students in secondary schools and alternative placements rather than at the
 57

elementary level. However, there is a professional emphasis concerning the importance and

significance of early interventions to meet the mental health needs of students (Adelman &

Taylor, 2006; Sotardi, 2018). The need for mental health training and support to be more equally

provided across all settings rather than just in upper-level schools.

Participants

The population from which special education teachers were recruited for participation in

the study consisted of two pre-schools, 12 elementary schools, eight middle schools, and five

high schools. HCS’s special education director has given written permission to conduct the

current study with district special education teachers at all levels. Once Liberty University IRB

approval was obtained, purposeful sampling was used to select participants. An approach

characterized by determining the selection criteria which is essential in selecting the people

included in the study (Merriam & Tisdell, 2016). Purposeful sampling led to information-rich

cases of special experiences from elementary and secondary special education teachers in HCS.

Unfortunately, there was limited interest from potential participants in the current study from

HCS. Therefore, amendments were made to the IRB proposal to include a raffle and additional

exposure through social media post and two additional school districts. By making those

changes, fifteen participants were found, however, only twelve were used in the current study.

Merriam and Tisdell (2016) described six types of purposeful sampling: typical, unique,

maximum variation, chain/snowball, and theoretical. Unique purposeful sampling was used for

the current study as I reflected on the unique, rare, and atypical lived experiences of special

education teachers with regards to addressing mental health needs in their students (Merriam &

Tisdell, 2016). Other purposeful sampling types would not be appropriate for this study because

the population is pre-determined and lived experiences are from a particular group of teachers,
 58

not all teachers.

Purposeful unique sampling reflects the purpose of the study and guides in the

identification of information-rich cases (Merriam & Tisdell, 2016). To qualify as a participant,

volunteers must meet the following eligibility inclusion criteria: (a) be special education teachers

employed in HCS preschool, elementary, and secondary settings; (b) have experience working

with students with IDEA eligibilities such as, but not limited to, Specific Learning Disability,

Other Health Impairment (e.g., ADHD, asthma, epilepsy, rheumatic fever), Traumatic Brain

Injury, or Emotional Disturbance who, in addition to their school related behavioral and/or

learning problems, also struggle with comorbid mental health issues as well (e.g., Depression,

Tourette Syndrome, Obsessive-Compulsive Disorder, Post-Traumatic Stress Disorder); (c) work

in collaborative, co-taught general education classrooms and/or pullout programs (e.g., resource

room, self-contained classroom); and (d) be willing to participate in an interview and focus

group via Zoom and be audio-recorded.

Potential participants, and their emails, were located from each respective school’s

website, through social media post, as well as through communication with school administration

(e.g., Principals, Director(s) of Special Services). Emails to prospective participants’ work or

personal addresses were sent from Liberty University’s student account. Follow-up emails from

the Liberty University account were sent to potential participants after a waiting period of one

week. Once informed consent is obtained, a demographic questionnaire was administered to

participants to include gender, years of experience, additional training specific to special

education, educational level, experience with comorbid disabilities. The study aimed to have at

least two participants from each school level in the district; giving the study a potential total of

14 participants. According to LU requirements, transcendental phenomenological studies require

 59

at least 10 participants; as a result, the current study attempted recruit more than 10 individuals

to ensure coding and data saturation is reached, meaning no new themes or findings are

identified with the addition of new participants. Table 1 depicts the demographic information for

the studies participants.

Table 1

Participants Demographics

Participants Location Ethnicity Gender Age

Years of
Pseudonyms (years)
Teaching
Experience
______________________________________________________________________________
Linda Virginia Caucasian Female 38 4 years

Jennifer Virginia Caucasian Female 32 8 years

Meghan Virginia Caucasian Female 32 8 years

Janice Maryland Caucasian Female 51 19 years

Amy Colorado Caucasian Female 43 7 years

Lydia Arizona Caucasian Female 40 11 years

Laura Virginia Caucasian Female 42 15 years

Kim Virginia Caucasian Female 33 8 years

Mary Maryland Caucasian Female 30 9 years

Jacob Virginia Caucasian Male 23 Almost 1 year

Holly Virginia Caucasian Female 28 7 years

Ted Virginia Caucasian Male 58 14 years

______________________________________________________________________________
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Procedures

Upon study approval from the research site (see Appendix B) and the LU IRB (see

Appendix A), prospective participants were identified via the school website and social media

post, whereupon teachers were then be invited to participate in the study via LU’s student email

account and encouraged to respond by email or phone if they are interested in participating

and/or if they have any questions about the study. As teachers responded with interest in

participating, they were screened to ensure they meet study qualifications, especially concerning

eligibility inclusion items “(b)” and “(d)” (see information presented the Participants section

above). Once it is determined that the special education teacher meets eligibility criteria, they are

invited to sign an informed consent form (see Appendix C).

After signing the consent form, interviews were scheduled with individuals; interviews

will take place via a video conferencing system, such as Zoom (see Appendix E for the interview

questions). Once informed consent has been signed, demographic data was collected. Interviews

were approximately an hour long and were audio-recorded for transcribing purposes; participants

were made aware of the recording and provided consent prior to the interview taking place.

Participants were also asked to compile an outline of desired professional developments and

support systems they feel would benefit their student population. Participants were asked to

email the outline back to me within a week of completing the interview process. Additionally, all

participants were asked to partake in a focus group to further discuss mental health disorders in

special education students and beneficial support needed to address those disorders. The focus

group lasted approximately an hour, took place via an online platform, and was audio-recorded. I

was able to get three elementary and three secondary special education teachers to participate in
 61

the focus groups. Due to the amount of transcribing and detailed notes, Microsoft transcribing

system was used for each audio-recorded interview.

The Researcher's Role

The role of the researcher in a transcendental phenomenological study includes becoming

one with the research (Moustakas, 1994). Transcendental phenomenology includes a human

scientist which “determine the underlying structures of an experience by interpreting the

originally given descriptions of the situation in which the experience occurs” (Moustakas, 1994,

p. 11). I have previous experience in special education in which I can relate to the participants of

the study. Reporting data on “how and why they think they did what they did, they can help

others determine whether, or how, the researchers’ perspectives influenced their conclusions”

(Check & Schutt, 2012, p. 13). Thus, a bias or assumption I bring to the research included the

struggles and frustrations that accompany combating mental health in public-schools. I

conscientiously engage in bracketing my own preconceptions so it does not taint the research

process by holding in abeyance my personal opinions/thoughts about the phenomenon under

investigation and, instead, focus on the analysis of the phenomenon; in so doing, I may better

understand the personal experiences relayed to me by the participants (Moustakas, 1994). I

described the lived experiences of special education teachers in HCS, GC, and volunteers from

social media platforms were depicted through interviews, self-reflective writings, and focus

groups. I am familiar with the expectations and guidelines special education teachers in the state

of Virginia are to adhere to, as well. However, I do not serve in a supervisory role over any

participants or have any prior relationships with participants other than working in the same

field.
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Data Collection

Data collection for the study will include open-ended, semi-structured interviews of

special education teachers. My researcher field notes were also taken into consideration and

analyzed. Bracketing of my own thoughts took place as to keep focus on the first-person reports

from special education teachers participating in the current study. First-person reports of life

experiences derive evidence of phenomenological research (Moustakas, 1994). Transcendental

phenomenological studies include a plethora of rich descriptive data (Moustakas, 1994).

Standardized interviews were conducted individually with each participant, preferably outside of

work hours so that participants were more relaxed. A self-reflective writing and focus group

were included in the data points to close gaps and develop a deeper understanding of the lived

experiences of the participants.

Due to the design of the study, I conducted and analyzed the data, as well as interjected

personal perceptions as the study lends to those thoughts. Moustakas (1994) described two levels

of transcendental phenomenological studies: Level I, description obtained through open-ended

questions and conversations and Level II, researchers describe experiences based on reflective

analysis. As a human instrument, I used the two levels of transcendental phenomenology

described by Moustakas (1994) to interpret and reflect data obtained both through open-ended

questions and conversations.

Demographic/Work-Related Information

Potential participants received a recruitment email with a link to complete a

demographic/work-related informational questionnaire (Appendix D). Once individuals

volunteer and complete the questionnaire, consent to participate in the study was obtained. The

information collected from participants was designed to improve and enhance the transferability
 63

of the current study. Demographic and work-related questions included asking how many years

of teaching experience they have with students with disabilities; what their level of education is;

gender; ethnicity/race; age; what grade level(s) and content areas they teach. Concerning their

students, teachers were asked what IDEA eligibility their students were identified as, and what

comorbid/secondary mental health related disabilities (e.g., DSM-V) their students have been

diagnosed with.

Interviews

Transcendental phenomenological studies often use long interviews with open-ended

questions as a form of data collection. Interviews provide rich first-person accounts of the

experiences and phenomenon being researchers (Moustakas, 1994). Open-ended interviews

allow for flexibility and exploration of the unique ways an individual defines the world (Merriam

& Tisdell, 2016). Interviews were audio-recorded, and Microsoft transcription system used by

the researcher to ensure accuracy of the data collected. Online interviews are becoming more

common and allow for the researcher and participants to be in their own comfort zones while

describing their past events and views on specific situations (Merriam & Tisdell, 2016).

Individual interviews were used to answer sub-research question 2 as it related to the

current study. Questions in the interview provide background information and experiences of the

participants and their explicit thoughts regarding addressing mental health concerns in students. I

utilized standardized open-ended interview questions that were used with all participants.

However, the interviews questions were open-ended to allow participants to explain their unique

experiences. The relationship developed between participants and the researcher is essential to

creating a relaxed and trusting atmosphere (Moustakas 1994). I created a climate in “which the

research participant will feel comfortable and will respond honestly and comprehensively”
 64

(Moustakas, 1994, p. 114). Interviews may take place via a video conferencing system, such as

Zoom. Participants were notified that the interview was audio-recorded for transcribing

purposes. Interview questions (see Appendix E) were asked “cold” meaning the participants

were not aware of the specific questions being asked until the interview takes place. This allowed

for the participants to give honest depictions of their perceptions regarding addressing mental

health in students with comorbid disabilities.

Standardized Open-Ended Interview Questions

1. Please introduce yourself.

a. What is your ethnicity/race? (Gender was recorded without needing to ask the
participant.)
b. What is your highest degree earned?
c. What is your age?
d. How many years have you been teaching students with disabilities?
e. What grade level(s) and content area(s) do you teach?
f. Do you have any specialized training/certification? If so, describe.
2. Describe the types of disabilities you work with daily.
a. What disabilities have your students been identified as having under IDEA?
b. In addition to their IDEA eligibility, what additional comorbid/mental health
disabilities are your students diagnosed with?
3. Describe how often you address mental health and/or behavioral concerns in the
students you work with.
4. What motivated or inspired you to become a special education teacher?
5. Please describe your experiences working with students with disabilities who also have
a mental health disorder diagnosis.
6. Without providing identifying information, please share about specific students who
immediately came to your mind when I asked this question. a. Did you feel
equipped to support the student(s)? Please explain.
7. What are some stigmas regarding mental health in the public schools in regard to
special education students?
 65

8. What available resources do you have in your school to address students’ mental health
issues?
9. In your opinion, how does the mental health of students impact their academic
performance?
10. In your opinion concerning students who demonstrate mental health disorders, what
are their relationships with their peers like?
11. Discuss the amount of time per day/week you spend addressing mental health
concerns in your students.
12. What forms of educational instruction (i.e., professional development, support, or
resources) help you when dealing with mental health crises?
13. What are your “go to” programs or resources for addressing mental health concerns in
special education students?
14. Without giving names, can you describe a time when you felt limited in regard to
addressing mental health concerns in special education students?
15. In your opinion, what do you think are important characteristics or signs of students
having positive mental health?
16. In your opinion, what are the characteristics of a positive mental health resource for
students with disabilities?
17. If money was not a concern, what programs or resources would benefit your students’
mental health?
18. What is your opinion regarding how the mental health issues of students with
disabilities are handled in your school setting?
19. How do you feel the mental health of students should be addressed in the school
setting?
20. What recommendations do you have for program administrators and faculty currently
preparing pre-service special education teachers for the profession?
21. What topics would you like to see included in professional development to better
assist you in helping students with mental health struggles?
22. Is there anything else you’d like to share about this topic or think I should ask future
participants to gain a deeper understanding of this issue?
 66

Question 1 allowed participants to introduce themselves to establish a formal greeting to

the interview process. The participants are asked to state their degrees obtained, years of

experience, and describe any specialized training they have received.

Questions 2, 3, 4, and 5 allowed the participants to describe their experiences with

students who have mental health disorders. Question 2 asked participants to describe the types of

disabilities they work with. Question 3 allowed the participants to describe the time allotted to

address mental health or behavioral concerns in the student population they work with. Question

4 allowed participants to describe why they chose to become special education teachers and what

motivates them as special education teachers. Question 5 asked participants to describe their

interactions with students struggling with mental health disorders in addition to educational

challenges.

Question 6 and 14 asked participants to give specific examples without using names of

students. These questions allowed participants to connect to specific examples they have

encountered throughout their teaching careers.

Question 7 asked participants to give their perception on mental health stigmas. This may

be within the school system or out in the community/ surrounding society. The input from this

question can gear how the participants view mental health and their involvement in combating it

within the school system. The growing and unmet need of mental health services for those

children who struggle (NASP, 2016). An “estimate of up to 60% of students do not receive the

treatment they need due to stigma and lack of access to services” (NASP, 2016, p. 1).

Question 8 was designed to ask participants to describe what available resources they

have to address mental health in their students. Schools have long been called upon to address
 67

mental health concerns in students, however, a lack of expertise and resources have impacted the

ability of schools to address mental health concerns (Atkins et al., 2017).

Questions 9 are designed to gain insight into the academic and social impacts of students

struggling with mental health disorders as perceived by the participants. It allows me to

understand and describe if those areas of impact are affecting other critical experiences for these

students at school (e.g., relationships with adults). “Increased access to mental health services

and support in schools is vital to improving the physical and psychological safety of our students

and schools, as well as academic performance and problem-solving skills” (NASP, 2016, p. 1).

Question 10 and 11 seek to understand how much time per day/week is spent addressing

mental health concerns and the impact mental health disorders have on students functioning with

peers. This information also gave insight into how much instructional time may be lost or how

addressing the concern affects/impact other students in the vicinity. It is additionally significant

to explore the relationships and lack thereof with regards to students with mental health

disorders.

Questions 12 and 13 helped reveal what available resources participants use when a

student is experiencing a mental health crisis. The information helped determine who the teacher

collaborates with and what materials are available in the environment in order to resolve a

matter. Collaborative principles and ecological practices enhance the focus on mental health

services for children (Atkins et al., 2017). These questions also allowed the researcher to

understand what is of importance to the teacher, what their “go to” strategies or programs are.

Questions 15 and 16 allowed the participant to give feedback on what a positive mental

health resource would look like. Giving this feedback can ultimately direct the district to finding

programs that promote positive mental health in the school district. If money was not a concern,
 68

listing programs or systems would best meet the needs of the students. Social-emotional learning

programs demonstrate a decrease in aggressive behaviors (Portnow et al., 2015).

Questions 17 through 22 allowed the participants to share what they see as being the

missing pieces. Discussion on what improvements can occur to better meet the needs of students

struggling with mental health. The use of mental health supports and empowers children and

ultimately a safer learning environment is developed (NASP, 2016). Teachers are uniquely

placed to influence mental health and “being in a position to ensure that mental health difficulties

are quickly recognized and treated, they can enhance the social and emotional development of all

children by creating a climate that promotes their mental well-being” (Hornby & Atkinson, 2003,

p. 3). These interview questions allow for a conversation of what they would see as weaknesses

and in their opinion, where resources, programs, or training would be beneficial. Educational

resources to address children with disabilities, including emotional and behavioral, are often

inadequate and lack resources and funding (Hornby & Atkinson, 2003; Levin et al., 1997). The

lack of knowledge, understanding, and skill set that most teachers experience when addressing

mental health concerns (Hornby & Atkinson, 2003). Without training and resources teachers are

left with limited options in addressing the concerns of mental health in students.

Professional Development Self-Reflection

The second data collection method included a professional development self-reflection

writing from participants, the data from which goes towards answering sub-research question 3

of the research study. Participants were asked to create a self-reflective writing piece which

includes what previous in-service professional development they have attended and/or what

special education teachers feel is needed to address mental health disorders in students

experiencing comorbid disabilities (see Appendix F). I used this information to describe what
 69

potential in-service professional development topics special education teachers feel would

improve their ability to address mental health disorders and comorbid disabilities in students.

Self-reflection writing exercise allowed the participant time to think over his or her experience

with the phenomenon (Patton, 2015). Self-reflective writings allowed participants to express

what they feel would be beneficial professional developments to better meet their needs of

addressing mental health disorders in their students. Participants were asked to type their self-

reflections and email to me within a week of their interview.

Focus Group

A focus group was conducted that included special education teachers from both

elementary and secondary backgrounds. The focus group is conducted for the purpose of

providing additional depth from the individual interviews and addressed the sub-research

question 1 (Patton, 2015). The focus group was asked to make professional recommendations on

in-service opportunities, based on their lived experiences, that could be shared with future

teachers, administration, outside agencies, and other stakeholders. I used the data collected from

the focus group to describe recommendations that elementary and secondary special education

teachers make for potential professional development in addressing mental health disorders and

comorbid disabilities in students.

From the subset of participants, a total of 12, six elementary and six secondary, special

education teachers were asked to participate in focus groups. Participants from elementary and

secondary levels were asked to volunteer to participate in focus groups. Preschool special

education teachers would have also invited to be included in the elementary focus group

depending on how many elementary teachers agree/volunteer to participate in the focus group.

However, while the option was open, their participation wasn’t needed. The focus groups met
 70

one time via an online platform and were audio-recorded for transcribing purposes. Additionally,

the focus group interviews aided to cross-check for consistency in the data collected through the

individual interviews (Patton, 2015). The following questions were used for the focus group and

were phrased to guide the discussion and allow the participants to share their lived experiences

(see also Appendix G).

1. Please introduce yourself and share your educational journey.

2. How would you describe the impact of special education students’ mental health

disorders on the learning environment?

3. Describe the resources and supports your district has available to address mental health

disorders in students.

4. Describe how your pre-service and/or in-service professional development has aided

you in addressing mental health disorders in students.

5. Without using specific names, discuss a time when you addressed mental health

disorders in your students and how you handled it.

a. Were there any supports or resources you wished were available to you during that

time?

6. What recommendations would you give your administration in regard to supports

and/or professional development in addressing mental health disorders in students?

7. We have discussed addressing mental health disorders in students. Is there anything

else you would like to add?

The focus groups were meant to elicit deeper understanding of special education teachers’

lived experiences with addressing mental health disorders in students with comorbid disabilities.

Question one allowed participant to introduce themselves and state their educational background
 71

which can impact their perceptions. Question two and five gave participants the opportunities to

describe specific lived experiences in addressing mental health disorders in their students.

Questions four, six, and seven allowed for participants to convey their professional thoughts

regarding the support and training needed to address mental health disorders in their students

with comorbid disabilities. The questions in the focus group communicated the perceived needs

that can be viewed by administration, outside agencies, and other public-school stakeholders.

Data Analysis

Transcendental phenomenological studies include a plethora of rich descriptive data

(Moustakas, 1994). From this data common themes begin to emerge with significant statements.

Data analysis focuses on text segments with similar codes and examining relationships among

different codes in order to determine commonalities (Check & Schutt, 2012). Categorizing data,

the essential meanings and themes can be discovered, which is referred to as horizonalization

(Moustakas, 1994). Horizonalization was determined by listing every significant statement

relevant to the experience of the special education teachers (see Appendix H). Each significant

statement was analyzed to determine if the moment of the experience is necessary and sufficient.

Significant statements were also evaluated for overlapping, repetitive, and vague expressions.

The horizons that remain were used to determine commonalities and themes in the data collected

from the interviews, outlines, and journaling. These comparisons can then be organized into

categories and a matrix (see Appendix H) formulated from clusters of meanings were created

(Moustakas, 1994).

A matrix is “a chart used to condense qualitative data into simple categories and provide

a multidimensional summary that will facilitate subsequent, more intensive analysis” (Check &

Schutt, 2012, p. 8). These clustered themes and meanings are used to develop the “textural
 72

descriptions of the experiences” (Moustakas, 1994, p. 118). Textural descriptions are where I

will write about “what” was experienced (Creswell & Poth, 2018). Textural description includes

thoughts, feelings, examples, ideas, and situations that portray what comprised an experience

(Moustakas, 1994). From the textural descriptions, structural descriptions and essences of the

phenomenon are constructed (Moustakas, 1994). Structural descriptions describe the “how” the

phenomenon was experienced (Creswell & Poth, 2018). Constructing a description of the

essence of the phenomenon is the goal of the research being conducted. The essence is the

reduction of the what and how leaving the essentials of the experiences (Creswell & Poth, 2018).

The use of a categorizing for phenomenological studies will include the following:

essence of the phenomenon with the following categories- personal bracketing (see

Appendix…), significant statements, meaning units, textural description, and structural

description (Creswell & Poth, 2018). I used the Taguette qualitative data analysis computer

software package to help organize, analyze, and find insights from the interviews. This program

also allowed for organization of coding, memos, and findings. Taguette was user friendly, which

allowed for richer descriptive data to be clearly conveyed. I was open and honest with

confirmation of the perceptions of the participants.

Confidence in the study conclusions were “strengthened by an honest and informative

account about how the researcher interacted with subjects in the field, what problems he or she

encountered, and how these problems were or were not resolved” (Check & Schutt, 2012, p. 12).

Triangulation and data validation were established through interviews, participant self-

reflections, and a focus group. Participants were asked to take part in interviews with open-ended

questions and provide outlines of professional developments they feel would be beneficial for

addressing mental health disorders in special education students. I used the procedures set forth
 73

by Moustakas (1994) to establish the phenomenon experienced by the participants in the current

study.

Trustworthiness

Trustworthiness addresses credibility, dependability, transferability, and confirmability. I

addressed trustworthiness through coding and constantly comparing significant statements,

allowing for an establishment of reliability. Due to the nature of the transcendental

phenomenological design of this study, the trustworthiness between the participants and the

researcher were established through common understanding and motivation for student success

(Moustakas, 1994). I used first-person accounts and direct quotes from participants to emphasis

the findings throughout the research manuscript (Moustakas, 1994).

Triangulation, to develop credibility of data, was conducted using multiple data

collection methods. These methods included interviews, self-reflections, and focus groups.

Dependability, transferability, and confirmability were addressed through rich descriptions of

themes, and a reflexive journaling kept by the researcher. While there are certain disadvantages

to using a computer qualitative data analysis software like Taguette (e.g., increasingly

deterministic and rigid processes, computer privileging of coding and retrieval methods;

reification of data, the pressure to focus on volume and breadth rather than on depth and

meaning, etc.), the freedom from manual tasks will save time, enable the manage large amounts

of word data, increase flexibility with data coding, and provide improved validity and

auditability of qualitative research, all of which are advantages for using such software to

improve overall trustworthiness of a study (St. John & Johnson, 2000; Zamawe, 2015).
 74

Credibility

Credibility refers to the extent to which the findings accurately describe reality.

Credibility in qualitative research is often achieved through triangulation. Triangulation is a

process whereby multiple data sources are used to examine the phenomenon under investigation

(Kemparaj & Chavan, 2013). Triangulation of data was conducted using multiple data collection

methods. In this study, triangulation was demonstrated through detailed interviews, professional

development self-reflections, and focus groups. Credibility is obtained through maintaining high

standards and conducting research openly and honestly (Check & Schutt, 2012). Firsthand

experiences with mental health issues and the perceptions of the special education teachers will

drive the determination of the study. Credibility was also achieved through the engagement in

one-on-one interviews conducted with participants and member checks of transcripts and

findings.

Dependability and Confirmability

Dependability and confirmability were addressed through coding being conducted by me.

Dependability refers to the stability of data over time and conditions and confirmability refers to

the neutrality of the data (Kemparaj & Chavan, 2013). A comparison of lived experiences of

special education teachers in elementary and secondary will emerge common phenomenon

addressing mental health needs in students. Dependability and confirmability can also be

addressed through rich descriptions of themes, and a reflexive journal (see Appendix) kept by

me.

Developing an audit trial, which is a systematic collection of documentation that allowed

an auditor to come to conclusions about the data (Kemparaj & Chavan, 2013), will reinforce

dependability and confirmability. Participants were asked to member check their transcripts for
 75

accuracy. During the focus groups, participants were presented with preliminary findings to

allow them to member check their authenticity and accuracy. By giving participants the

opportunities to member check and present them with preliminary findings, dependability and

confirmability were enhanced. I have process notes, materials relating to intentions and

dispositions, and raw data to demonstrate an audit trail.

Transferability

Transferability is established by providing readers with evidence that the research

study’s findings could be applicable to other contexts and situations (Creswell & Poth, 2018;

Kemparaj & Chavan, 2013). The study develops transferability as I was examining preschool,

elementary, secondary and alternative schools’ special education teachers’ perceptions. I did my

best to seek maximum variation with the constraints of my resources and relatively small

population of the district. Transferability was also established through the in-depth description of

the participants and the setting. Demographic information was collected through the

demographic questionnaire and embedded questions in the interview section to enhance and

improve the transferability of the current study. The descriptive information found in those

sections allows for this study to be conducted in similar circumstances.

Ethical Considerations

Prior to conducting the study, approval from Liberty University IRB was obtained. The

school districts provided signed letters from the school board administration to allow for

recruitment of special education teachers. Those letters were provided to the LU IRB upon

completion of the application. The LU IRB approval letter was then given to building level

district authorities as verification that I can proceed with recruiting participants and collecting
 76

data. I strived to disclose the purpose of the study, refrain from pressure on participants, and

have sensitivity to the needs of the vulnerable population (Creswell & Poth, 2018).

The Belmont Report (1979) defines three ethical principles related to human subject

research: respect for persons, beneficence, and justice (Check & Schutt, 2012). To respect a

person participating in a study involves protecting those involved by using autonomy.

Beneficences refer to limiting the level of harm and risk and maximizing the benefits. Justice

refers to distributing benefits and risks of research fairly. Following these three ethical principles

are essential in developing trust in the researcher and the research. Ethical considerations should

be taken into consideration regarding the confidentiality of students in participant’s classrooms

and the documentation analysis.

Pseudonyms were used to protect the site and participants. Informed consent and data

destruction were used in this study to exemplify ethical considerations. Allowing the participants

to review reports prior to their release to the public can gauge that their privacy was

appropriately taken into consideration (Check & Schutt, 2012). I established a clear agreement

with the participants, recognize the necessity of confidentiality and informed consent, and

develop procedures for insuring full disclose of the nature, purpose, and requirements of my

research (Moustakas, 1994). Electronic data storage was kept in a password protected program

and paper files were kept in a locked cabinet. I respected the privacy of participants,

communicate clearly, share reports with others, and report honestly (Creswell & Poth, 2018).

Summary

The current study aimed to describe the lived experiences of preschool, elementary,

secondary, and alternative special education teachers in addressing mental health disorders in

students. A transcendental phenomenological design was used to investigate common themes

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and considerations of special education teachers in addressing mental health disorders in their

students. The use of a transcendental phenomenological design enabled the researcher to apply

their own experiences and perceptions, as well as the perceptions of special education teachers,

to the research topic of student mental health in public schools. However, bracketing of my own

thoughts and feelings was used throughout the study to ensure the depiction of the participants’

experiences are accurately reflected. Triangulation of data through individual interviews, focus

group, and participation self-reflective writing. Through the triangulation of data, common

phenomena of special education teachers were described.

Through data analysis, I determined clusters of meaning and significant statements that

will also be evaluated for overlapping, repetitive, and vague expressions (Mosutakas, 1994).

Ethical considerations were held at the forefront. Approval from the research site(s) and from the

Liberty University IRB was obtained prior to the recruitment of participants and the collection of

data. Pseudonyms were used and full disclosure of the intent of the study was shared with

participants prior to conducting the study. I established a level of comfort and safety so that all

participants will relay accurate information regarding their experiences addressing mental health

concerns in their students (Moustakas, 1994). Through the collection of data, public school

districts can develop programs and training to enhance the experiences of special education

teachers and the overall positive mental health of their students.

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CHAPTER FOUR: FINDINGS

Overview

The purpose of Chapter Four is to present the results of the data analysis. This chapter

contains the results for this transcendental phenomenological study. The purpose of this

transcendental phenomenological study was to explore the lived experiences of special education

teachers in regard to addressing the mental health needs in students experiencing comorbid

disabilities. The contextual organizational framework (Ringeisen et al., 2003) was used to

examine the lived experiences of special education teachers in regard to addressing the mental

health needs in students experiencing comorbid disabilities. This chapter presents the

participants, demographics, the findings for the research study, and a summary of the data. Data

collected from individual interviews, focus groups, and reflective writing were presented through

themes and tables.

Participants

Twelve participants were interviewed for this study; two focus group interviews with

three participants each were also conducted; five participants completed and returned the

reflective writings. Participants are special education teachers in public school systems with a

variety of backgrounds including elementary, secondary, and alternative experiences. An attempt

was made to have preschool special education teachers participate in my research; however, no

interest was shown by teachers in this area. Participants’ teaching experiences ranged from being

a 1st year novice to 19-year veteran special education teachers with the average years teaching at

9.25 years. Participants’ ages ranged from 23 years to 58 years with an average age of 37.5

years. Participants were mainly located in school districts in Virginia, but also included

participants from Colorado, Maryland, and Arizona. Eight participants were from Virginia, two
 79

were from Maryland, one from Colorado, and one from Arizona. Participants were recruited in

multiple ways to ensure a variety of elementary and secondary special education teachers.

Recruitment of Virginia participants occurred through school district permission and/or

convenience sampling within the district I am currently employed in. Requirements from other

states were conducted through social media post looking for volunteers to platforms such as

LinkedIn and Facebook. Pseudonyms were developed for each participant to protect/safeguard

their identity. The following are rich descriptions using the pseudonyms of the special education

teachers who participated in the study.

Linda. Linda is a 38-year-old elementary special education teacher in Virginia. She holds

a bachelor's degree and has been teaching for four years. Before teaching, Linda worked as an

aide in a variety of classroom settings. Linda works at a public elementary school in central

Virginia. Linda holds certifications in an Autism program and reading certifications through

Orton-Gillingham. Linda was inspired to become a special education teacher because her sister

worked as a special education teacher. Also, as an aide she was mentored by a teacher who gave

her hope for good teachers and what she wanted to reflect on when she became a teacher. Linda

was asked in an individual interview which disabilities she works with; she stated she has

students with developmental delays, speech and language, specific learning disabilities, other

health impairment, autism, and oppositional defiant disorders. When asked how often Linda

encounters behavior and/or mental health concerns, Linda stated “Daily, usually, some of, I have

a couple almost hourly or at least to the half hour that requires redirecting or heavy support”

(Linda, individual interview, October 13, 2022).

Jennifer. Jennifer is a 32-year-old elementary special education teacher from Virginia.

She holds a master’s degree and has been teaching for eight years. Jennifer works at a school in
 80

the south-west region of Virginia. Jennifer holds reading certifications through Orton-

Gillingham. Jennifer was inspired to pursue special education as she worked in her pre-service

courses and practicum placements. She enjoyed working with these students and knew there was

a need for special education teachers, so she added the endorsement.

When asked what kind of disabilities Jennifer works with daily, she stated learning

disabilities, developmental delays, Other Health Impairment (OHI), emotional disorders, and

autism spectrum disorder. Jennifer stated she encounters and engages in behavior management

daily with students. When asked if Jennifer feels equipped and supported with addressing mental

she stated “supported, but I don’t feel that I am quite equipped” (Jennifer, individual interview,

October 29, 2022). Jennifer was asked what she feels are stigmas regarding mental health in

regard to special education students. She stated the following that she feels people are always

looking for reasons for the behaviors and often blame lands on home life. Jennifer stated that

drug abuse in adults has increased and often impacts the students she works with.

Meghan. Meghan is a 32-year-old alternative elementary school special education

teacher from Virginia. She holds a master’s degree and has been teaching for 8 years. Meghan

works at an alternative school associated with a public school district located in the piedmont

region of Virginia. Meghan is Safety Care certified, has Orton-Gillingham certifications, and

certified trauma and resilience practitioner certification. Meghan was inspired to become a

special education teacher during her pre-service and practicum coursework. Meghan knew she

wanted to get her master’s degree and was encouraged to do the special education endorsement

by her college professors. She figured she would never use the endorsement until she completed

student teaching in an elementary developmental delay classroom, and she knew that was her

calling.
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Meghan described her disability caseload to include Other Health Impairments,

emotional disorder, Autism Spectrum Disorder, Developmental Delay, Specific Learning

Disability, and Speech and Language Impairment. She describes comorbid disabilities to include

depression, anxiety, oppositional defiant disorder, sensory processing, and mental or

dysregulating mood disorders. Students on her caseload are either discipline placements or IEP

change placements from their homebased school. Meghan stated she addresses behavior

concerns in students about 95% of her day and on a daily basis. When asked if Meghan feels

equipped and supported with address mental health concerns, she stated at first, she did not.

However, she has been able to collaborate with peers and had to do a lot of seeking out

information on her own terms. Despite this, Meghan stated that county wise there are not many

resources for teachers or families with regards to addressing mental health. Meghan has found

success in consistent communication with parents and doctors to build relationships with these

students and families.

Janice. Janice is a 51-year-old secondary special education teacher focusing on social

studies and history from Maryland. She holds a master’s plus degree and has been teaching for

nineteen years. Janice works in a public school district located in the Northeast megalopolis of

Maryland. Janice does not hold any specialized training or certifications. Janice was inspired to

become a special education teacher because she likes working with special needs students. She

has a learning disability in math, so she knew she could relate to her students. Janice also noted

that she enjoys working with smaller groups of students. She feels like she gets to know them

better and builds stronger relationships with those students.

Janice described her caseload of students with specific learning disabilities, emotional

disorders, and Other Health Impairments. She also states that she encounters behavior concerns
 82

with her special education students daily. Janice states that she works on de-escalating students

who display anxious or bothered behaviors, so they do not escalate to walking out of class or

disturbing learning. Janice continued by stating that she thinks she needs to learn more about de-

escalating so she can be more comfortable working with students who have emotional disorders.

Amy. Amy is a 43-year-old secondary special education teacher from Colorado. She is a

doctoral candidate and has been a teacher for 7 years. Amy works at a public school district

located in Colorado and has experience in both elementary and secondary locations. Amy has

certification in TEACH, autism recognition through Colorado Department of education, and

certificate in micromanagement of microaggressions. Amy was inspired to become a special

education teacher after being a horse trainer for two decades. She knew that horse therapy was

often beneficial for children with Autism, and she wanted to make the switch to working with

children. This led Amy to complete her degree in special education.

Amy described her caseload including students on the autism spectrum and other high

need disabilities. She also describes working with comorbid disabilities including traumatic brain

injury, oppositional defiant disorder, and schizophrenia. Amy stated she addresses mental health

and behavior concerns daily which she keeps charts for data collection. When asked to describe

behaviors she encounters, Amy stated that with pre-k to 6th grade students she noticed their

struggle to communicate their needs so they would scream, yell, and jump on tables to

communicate their needs. When asked if she feels equipped to address mental health concerns in

students, Amy said yes, but only because she has extensive specialized training in behavior

management.

Lydia. Lydia (a pseudonym) is a 40-year-old elementary special education teacher. She

holds a master’s degree and an Ed.S. in educational leadership and has been teaching for eleven
 83

years. Lydia works in a public school district located in Arizona. Lydia has a certification in

ICPI. Lydia began her journey as a general education teacher at the secondary level with an

emphasis on social studies. However, she found that it was harder to find a job. She ended up

finding a special education position at an alternative school (Lydia, individual interview, March

9, 2023). This led her to get certified in special education. She also enjoys the small group

atmosphere that the resource room brings.

Lydia was asked to describe the students she has on her caseload. Lydia stated she works

with students who are on the autism spectrum and have orthopedic impairments. Comorbidity,

Lydia states that several of her students also have a diagnosis of ADHD. Lydia continued by

stating she addresses behavior concerns in her students daily. She stated that when she says

behaviors, she does not mean always malicious, but rather behaviors that impact their ability to

access the curriculum (Lydia, individual interview, March 9, 2023). Lydia stated that she often

works in small groups which she finds reduces the distractions of her students.

Laura. Laura is a 42-year-old elementary special education teacher from Virginia. She

holds a master’s degree and has been teaching for fifteen years in both alternative and public-

school settings. Laura currently works in a public school district located in the mid-Atlantic

piedmont region of Virginia. Laura does not have any additional certifications or training. Laura

was inspired to become a special education teacher following her visual impairment. She wants

students to know that despite their challenges, they can achieve and become whatever they want.

When asked to describe the types of disabilities Laura works with, she stated she works

with students with developmental delays, specific learning disabilities, emotional disorders, and

other health impairments. Laura also described comorbid disorders including ADHD and

anxiety. When asked how often she addresses behavior concerns in students, she stated it
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depended upon the student and if they are medicated that day or not. At Laura’s previous place

of employment, she described working in an alternative school for middle schoolers who

struggled with mental health concerns and had IEPs. Laura describes working with students with

emotional disturbance as defined under IDEA and those who are not on an IEP but who display

symptoms of emotional disturbance (e.g., internalizing, and externalizing types of disorders) that

require behavior support daily.

Kim. Kim is a 33-year-old secondary special education teacher, from Virginia, who

focuses on science courses. She holds a master’s degree and has experience in both elementary

and secondary settings where she has worked for the last eight years. Kim currently works in a

public high school located in central Virginia. Kim does not hold any additional certification or

training. Kim was inspired to become a special education teacher after working on a mental

health unit at a local hospital. She decided she wanted to finish school and do something along

the lines of mental health, but without needles. She also wanted a schedule that would be similar

to her children’s. Kim decided that because mental health and students with disabilities often go

hand in hand, she would become a special education teacher.

Kim described working with students with specific learning disabilities, autism,

emotional disorders, and hearing impairments. She also described working with students with

comorbid disabilities that include ADHD and other health impairments. When asked how often

Kim addresses mental health concerns in students, she stated daily and that she feels that COVID

has made those behaviors worse and more frequent. When asked her opinion on stigmas

regarding mental health and special education students, Kim stated she felt it was more normal

for people to have therapist and have someone to talk to too. She continued by stating that a lot
 85

of secondary students that she is involved with are open and willing to discuss that they seek

therapy.

Mary. Mary is a 30-year-old secondary, middle school, special education teacher from

Maryland. She holds a master’s degree and has been teaching for 9 years, with 2 years

exclusively in special education. Mary works in a public school district located in north-east

Maryland. Mary does not have any additional training or certificates. She was inspired to become

a special education teacher after working as a general education teacher. Mary enjoys

differentiating and meeting the needs of students with IEPs. She found when she was a general

education teacher, she could not pour into students with learning disabilities as she felt they

needed. This led her to getting her master’s degree and solidified her desire to work with

students in special education.

When asked what kind of disabilities Mary works with, she stated she has worked with

students with autism, traumatic brain injury, and down syndrome. She continued by describing

behaviors she has witnessed with these students to include outburst, frustration, and irritation.

Mary stated she built relationships with these students, used debriefing techniques, and cool

down areas to help these students through their behavior crisis.

Jacob. Jacob is a 23-year-old secondary special education teacher, from Virginia,

focusing on history and social studies. Jacob holds a bachelor’s degree and is working to

complete his master’s degree. He has been teaching for almost a year at a public high school

located in central Virginia. Jacob does not have additional training or certifications. He was

inspired to become a special education teacher after being able to experience working with

students with special needs during high school gifted and talented programs. Once in college, he

was guided by a college professor in choosing the special education path.

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Jacob described his caseload as involving students on the autism spectrum, varying

specific learning disabilities, hearing impairments, and others. When asked how often he

addresses mental health concerns, Jacob stated that it depended on the semester, but during this

interview he stated three to four times per week. He continued by stating that several of his

students are very vocal about their emotions and needs, which he states makes it easier for him to

guide those students. When asked if he feels equipped to address mental health concerns, Jacob

states to an extent. He stated he does his best to identify and address, but he doesn’t have the

training that a specialist or therapist would encompass.

Holly. Holly is a 28-year-old elementary special education teacher from Virginia. Holly

holds a bachelor's degree and has been teaching for seven years. Holly works in a public school

district located in the south-west region of Virginia. Holly does not have any specialized training

or certifications. Holly was inspired to become a special education teacher following courses in

her pre-service coursework. She was involved with Autism Speaks which included working with

children and adults. Holly’s passion for those that needed additional support continues to grow as

she researches and continues to work with this population.

Holly describes her caseload to include intellectual disabilities, autism spectrum disorder,

traumatic brain injury, specific learning disabilities, and other health impairments including

ADHD. When asked how often she addresses mental health concerns, Holly stated daily and

often multiple times a day. When asked what stigmas she feels relate to students with mental

health concerns, she stated that was a loaded question. Holly continued by stating that most

teachers seem to struggle with inclusion and how to teach complex children. She stated she

wasn’t sure if it was a lack of exposure to students with IEPs, disabilities, and emotional

struggles.
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Ted. Ted is a 58-year-old secondary special education teacher, from Virginia, focusing

on mathematic courses. Ted holds a bachelor's degree and has been teaching for 14 years. Ted

works in a public high school located in central Virginia. Ted is safety care trained and has

endorsements in a variety of special education disabilities. Ted was inspired to become a special

education teacher while in college. He was going for a general education degree, but some of the

courses he took guided him towards the special education realm. When asked to describe the

behaviors Ted encounters on a daily basis, he stated a lot of resistance, especially to follow class

directions and expectations. Ted feels there is a lack of understanding of the circumstances. He

continued by stating the lack of understanding surrounds a student’s living conditions and all the

other things outside of the school that impact them and contribute to their mental health.

Results

Transcendental phenomenological studies focus on common wholeness of the

experiences and search for meanings and essences of lived experiences, which in this case was

the lived experiences of special education teachers in regard to addressing mental health

concerns in their students (Moustakas, 1994). Participants signed an informed consent before

being interviewed, participating in the focus group, or sharing their reflective writings regarding

professional developments. Examination of each individual teacher’s perceptions were reviewed

in relation to the group of participants to establish categorize commonalities (Moustakas, 1994).

There was no attempt by me to persuade participants in any way regarding their experiences with

addressing mental health concerns in special education students.

I transcribed the recorded interviews while using Microsoft transcribing software,

listening, and reading, and rereading the interviews to check for accuracy. Interviews were

transcribed in a way to allow for my own thoughts and notes to emerge as themes. Once the
 88

interviews were transcribed, each participant in both individual interviews and in focus groups

were given the opportunity to member-check the transcripts. Each document was then uploaded

into the Taguette online program for coding purposes. The transcribed individual interviews and

focus groups and coding templates were compared and cross checked for accuracy and

consistency.

Theme Development

The results of the participant interviews, focus groups, and reflective writing were

analyzed to identify themes and commonalities among the responses. Themes “are perceptions,

experiences, feelings, values, and emotions residing in the minds of participants/ respondents of

a research” (Mishra & Dey, 2022). Using the steps of a transcendental phenomenological study

(Moustakas, 1994), I began with the individual interview results. I listened to, read, and reread

looking for meaningful units that were then grouped into emerging themes. I examined all

relevant information as I looked for repetition of words and phrases. Some repeated words and

phrases are listed in Table 2. Using the same method, I examined the focus group interviews for

repetition of words and phrases among the participants. Finally, the reflective writing was

examined using the same analysis.

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Table 2

Themes and Subthemes

______________________________________________________________________________
Key Themes Sub Themes
______________________________________________________________________________
Mental Health Impact Stigmas
Academic Impacts
Peer Interactions

Lack of Resources & Training Elimination of Supports

Professional Development Perceived Needs

______________________________________________________________________________

During the analysis of the interviews, focus groups, and reflective writing, three themes

emerged from the participants discussions. The first theme, mental health impact, included

participants’ lived experiences of addressing mental health concerns with students. The second

theme, lack of resources and training, described the participants’ thoughts and experiences with

the barriers they face when addressing mental health concerns in their students. The third theme,

professional development, included the participants’ thoughts on what is needed to move

forward with regards to helping students with mental health concerns.

Themes

After analyzing the interviews, focus groups, and reflective writing samples and coding

templates, three themes emerged: (a) mental health impact, (b) lack of resources and training,

and (c) professional development. Each theme and subthemes are aligned to a research question

and includes a discussion of the corresponding themes. Figure 1 displays a visual representation

in the form of a word cloud that includes the repeated phrases and words that were used to

develop themes and codes.

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Figure 1

Themes Word Cloud

Theme One: Mental Health Impact

Theme one corresponds to central research question, “what experiences within the

organizational context(s) do special education teachers describe when working with special

education students with comorbid mental health disorders?” Mental health impact, theme one,

was a common topic discussed throughout the interviews. The subthemes of stigmas, academic

impact, and peer interactions were also common discussions throughout the interviews and focus

groups. Every participant that was interviewed stated that in their opinion, mental health has a

significant impact on a student’s academic, peer relationships, and overall well-being. Linda said

it best when she stated, “if they’re not with it mentally, emotionally they’re not going to learn”

(Linda, individual interview, October 13, 2022). Figure 2 displays the repeated words or phrases

included in theme one.

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Figure 2

Theme One Tree Chart

Mental Health
Impact

Positive
COVID-19
Mental Health

Behaviors Stigmas Dysregulation

Most of the participants described the impact of a student’s mental health using words

and phrases like tremendous, needing heavy support, sensory needs, focus struggles, and many

others. Meghan stated:

Your amygdala is, you know, hyper or you're constant in fight or flight mode, you

literally can't access your prefrontal cortex. You can't learn. And so, I think when kids,

their brains are focused on so many other things or they're dealing with so many other

issues. They can't learn because they're, you know, dealing with all kinds of other things

that are, in their minds, way more important or they're worried about other things.

(Meghan, individual interview, November 11, 2022)

Several other participants echoed Meghan’s opinion regarding the impact of mental health. For

example, Linda stated, “If they’re not with it mentally, emotionally they’re not going to learn”

(Linda, individual interview, October 13, 2022). Jennifer emphasized this notion by stating,

“mental health is affecting the entire, their learning process” (Jennifer, individual interview,

October 29, 2022). Students who are hyper focused on home issues, internal dialogue, etc. often

struggle to connect with their learning and peers which in turn impacts their academic
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performance and educational experiences. One of the elementary special education teachers in

the focus group stated if students are struggling mentally and emotionally then it is going to be

harder for them to achieve academic success. However, that is the perfect place for special

education teachers to step in and build trust with the student to move past those struggles and

barriers.

Special education teachers, especially in the secondary setting, also described a

significant increase in absences when students are struggling with mental health. Janice stated “I

have just noticed that is causes a lot of absences. And I have, you know. They don't like school,

anxiety, and it just seems to cause tons of absences” (Secondary focus group, June 15, 2023).

Mary second that sentiment with stating “so I would also agree absence. Absence absences are

an issue” (Secondary focus group, June 15, 2023). The secondary teachers also touched on the

lack of motivation and desire to participate in their educational journey. Ted stated, “Just

uh overall motivation to participate in and receive support this it has a significant impact on their

attitude towards learning in general just because of the distraction of the other things that they're

dealing with” (Secondary focus group, June 15, 2023).

Stigmas

Stigmas are perceived characteristics that are often negative in nature. Participants were

asked in their opinion, what were stigmas that impact special education students in public

schools. All participants felt that there were some forms of stigma. Linda stated:

There’s definitely stigmas. I hear a lot of well, why are they in my room. You know, they

can’t do the work like others. Or I don’t want this kid in my room because he screams.

Which is understandable. They shouldn’t be here. A lot of isolation expected. They also

don’t recognize their ability levels… So, I don’t think a lot of teachers recognize how
 93

many strengths our students really actually have. And that is kind of overlooked because

of the stigma. And there’s also, you know, when I think back to when I was in high

school, when I was young, we did not blend students together. So, a lot of these teachers

are just in this old school mind, they shouldn’t be here. (Linda, individual interview,

October 13, 2022)

Meghan, an alternative elementary special education teacher, described the stigmas that she feels

surrounds students that integrate back into the public-school system. Meghan stated:

Kids that we get sent and kids and we send back, they have a target on their back, any

little thing they do it's like they're the bad kids. You know, a lot of, like, it's willful.

They're doing it, you know, for control or they're trying to manipulate you. When their

brains are literally not developed enough for that. (Meghan, individual interview,

November 17, 2022)

Other participants described similar experiences of stigmas. These participants stated that when

people see that a child has an Individualized Education Program or IEP, there is often prejudge

these students. One participant stated that she did not feel that stigmas were present as much as

panic.

Academic Impact

Academic impact students in varying manners and with significance. Participants in the current

study described how they feel that comorbid mental health disorders significantly impact the

academic performance of students. Linda stated that comorbid mental health disorders impact

academic performance “Tremendously. If they’re not with it mentally, emotionally, they’re not

going to learn. If they come to school angry, mad, that needs to be addressed before you even ask
 94

them to sit in a classroom and do their work” (Linda, individual interview, October 13, 2022).

Mary describes the impact as:

I think that if the student is in the right mindset and that you equip them with like the

right tools. I think that they can meet goals in different ways than other students. I think

that they need more support than students without disabilities, and I think that in order for

them to actually achieve different goals, you need to meet them where they are. Or else

they won't get it, but I think that they I think all students have the potential to get to meet

a goal and to get to where other students are, but they just need, they're going to get it in

different routes than typical students. (Mary, individual interview, March 21, 2023)

Several participants describe that students with comorbid mental health disorders often seem to

struggle with academic performance because they are preoccupied with their thoughts and

struggles. Meghan said it best when she stated, “you can’t learn when your brain is stressed”

(Meghan, individual interview, November 17, 2022).

Peer Interactions

All participants felt that peer interactions were a struggle in varying degrees for special

education students with comorbid mental health disorders. However, the secondary special

education teachers felt that students were able to make more connections with students with

similar struggles.

Theme Two: Lack of Resources and Training

Theme two corresponds to research question three, “how are special education teachers

lived experiences influenced by the challenges of contextual organizations in providing services

to special education students with comorbid disorders?” Theme two, lack of resources and

training, was a common discussion among the participants in the interviews and focus groups.
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The subtheme of elimination of supports was also discussed among the participants. Figure 3

displays the repeated words or phrases included in theme two.

Figure 3

Theme Two Tree Chart

Lack of
Resrouces and
Training

Beneficial

Lack of Resources Collaboration

Meghan said it best when she said, “we don’t do enough with understanding how the

brain functions in regard to mental health and to behavior” (Meghan, individual interview,

November 17, 2022). According to Mary, she felt that she has not received much training

regarding special education or mental health through her school district. Mary stated,

“Unfortunately, I have not received much in-service special education professional development.

The only professional development available is on writing IEP goals quarterly” (Mary, reflective

writing, June 5, 2023). Other participants also described a lack of professional development and

in-service training with regards to meeting student mental health needs. Mary stated,

I feel like a lot of the PD's were geared about social emotional learning, we're geared

more towards the typical students and really did not focus at all on students with

disabilities, which was a little frustrating because a lot of students with disabilities do

have to get frustrated, obviously, and UM, have a lot of those mental health situations,
 96

so I don't feel like I was given the resources I need. (Secondary focus group, June 15,

2023)

A common request or perceived need for public school education is the need for more

trained people to help with addressing mental health struggles in students. Linda stated she

would love to see therapists in every building. Jennifer described the need for trained school

psychologists in every building. Additionally, participants felt strongly about providing training

to general education teachers with regards to de-escalation strategies and better understanding of

disabilities in general. Amy stated, “I think behavior interventions need to come to the front of

the list and how to address them on the spot in class. I think teachers need to learn more” (Amy,

individual interview, March 8, 2023). Lydia believes there is a need for training for all teachers

on how to keep their cool and “identifying ways to deescalate situations and why we want kids in

class. Like preventative measures to prevent behavior” (Lydia, individual interview, March 9,

2023).

Holly stated, “it is hard to train you for what you are going to see until you get into it and

work with students” (Elementary focus group, June 2, 2023). The secondary level focus group

stated they do not feel they have been given the resources they need to address mental health

struggles to their full potential. During the secondary level focus group, Ted stated,

Bring in somebody and have them model over a period of time, not just, you know, 10

minutes in the classroom, but give us a week. Let's take a let's give them a student that

we're having challenges with and let them show us how it works. And see some tangible,

you know benefit or improvement based on you know the magic that they're trying to

teach use. (Secondary focus group, June 15, 2023)

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Meghan stated the need for more community supports and interactions with school systems. She

continued with describing her positive thoughts on play therapy and using that in classroom

settings. Meghan also stated that programs, support, and resources need to be school wide to

completely shift the culture of the school and meet the needs of students with mental health

concerns (Meghan, individual interview, November 17, 2022).

Elimination of Supports

Several participants described the decline in public-school budgets in the area of mental

health and support or services. Ted stated that he felt school districts are “more reactive versus

proactive” (Ted, individual interview, May 16, 2023). Participants also feel that during Covid-19

there was an emphasis on mental health supports that were beneficial. However, in recent years,

special education teachers report a decline in services and supports. Often these cuts are due to

budget constraints and leave teachers in positions to develop their own resources or programs.

Holly described these cuts impacting the district she works in that the programs for things like

day treatment are no longer available (Holly, focus group, June 2, 2023). Additionally, all the

participants feel that additional trained staff would be beneficial and describe this as being ideal

if money was of no concern.

Theme Three: Professional Development

Theme three corresponds to research sub-questions three, “what do special education

teachers describe as potential in-service professional development topics that would improve

their ability to address the comorbid disorders of special education students?” Professional

development, theme two, was described and discussed by participants during the interviews,

focus groups, and in the reflective writing. The subthemes of perceived needs were also

discussed throughout the data collection. Lydia stated it best when she said, “if all stakeholders
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make small steps toward preventing behavior issues that can negatively affect learning, I believe

students will experience more academic success” (Lydia, reflective writing, March 10, 2023).

Figure 4 displays the repeated words or phrases included in theme three.

Figure 4

Theme Three Tree Chart

Professional
Development

Pre-service

Percieved
Supports Training
Needs

Perceived Needs

Frustration with professional development provided by school districts was described by

several participants. Participants felt that professional development often is not geared towards

special education and more specifically mental health. Rather, emphasis on academics and

passing grades which they noted is important but does not address the whole child. One

participant stated, “reduction of PD and more modeling for teachers in the classroom what it

should look like and how to handle it” (Amy, individual interview, March 8, 2023). During the

elementary focus group, participants described the need to be on the same page and provided

professional development that supports the whole school in that target (Elementary focus group,

June 2, 2023). Jacob feels that professional development “geared towards potential signs and

how to recognize/ handle those signs before a situation is out of our control” would be beneficial

for public school staff (Jacob, reflective writing, May 22, 2023). Mary stated,
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I feel as though special education teachers feel that professional development to address

mental health disorders in students experiencing comorbid disabilities is very

important… Special education teachers should be receiving support in how to address

behavior concerns and academic concerns for different disabilities in order to help

understand why a student is either acting out or why they are performing so low. These

professional developments will help to meet the child where they are and to help bridge

those gaps. (Mary, reflective writing, June 5, 2023)

Jennifer, among other participants, stated “I would definitely like to see some behavior

professional development like classroom management, we do need a stronger classroom

management system” (Jennifer, individual interview, October 29, 2022). Meghan also described

the need for classroom management by stating,

I think ways to build positive classrooms and supportive classrooms without

necessarily having positive behavior plans or like classroom behavior systems. I think a

lot of the times classroom behavior system is falls short. The kids they work for, they'd

work for whether without them and the kids who need. Them they don't work for.

(Meghan, individual interview, November 17, 2022)

Several teachers described a difference in professional developments and resources

geared towards mental health since experiencing COVID. Kim stated historically, she feels there

has not been much training in mental health. She continued by stating she felt there was more of

an emphasis on mental health in 2020 and 2021 but feels that has tapered out and is being

forgotten (Kim, reflective writing, April 17, 2023). Janice stated that during the pandemic she

felt there were several professional developments and social emotional learning opportunities to

help teachers address how students may have been feeling. However, she continued by stating
 100

“since students began attending school in person there have not been many professional

developments on social-emotional or comorbid disabilities” (Janice, reflective writing, March

20, 2023).

Research Question Responses

Research questions are listed with the explanation of each question’s purpose. Data

collected from participants individual interviews, focus groups, and reflective writing were

examined regarding each question.

Central Research Question

Research question one asked, “what experiences within the organizational context(s) do

special education teachers describe when working with special education students with comorbid

mental health disorders?” This question was devised to understand how participants describe

their lived experiences of addressing mental health disorders in the organizational context of the

public-school setting. Participants descriptions and experiences provided insight into the

perceived needs regarding addressing mental health struggles in special education students. Data

analysis provided the first theme, mental health impact with subthemes of stigmas, academic

performance, and peer interactions. Participants described a student’s mental health as having a

significant impact on their academic performance, peer relationships, and overall well-being.

Table 3 depicted the themes in relation to the central research question.

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Table 3

Words and Phrases in Relation to Central Research Questions

______________________________________________________________________________
Codes Obtained Source How many times Percentage
codes mentioned
______________________________________________________________________________
COVID impact Individual Interviews 3 2%

Frequency of Individual Interviews 20 13%

behaviors

Mental health Individual Interviews 33 21%

Impact of behaviors Individual Interviews 65 41%

Positive mental Individual Interviews 25 16%

health

Comorbidity Individual Interviews 14 9%

Disabilities
______________________________________________________________________________

Research Sub-Question One

Research sub-question one asked “what do special education teachers report about their

pre-service and in-service training experiences related to special education students with

comorbid disorders?” This question was designed to better understand the pre-service and in-

service training that participants received regarding mental health struggles. Participants

described a lack of pre-service and in-service training that addresses mental health concerns in

students. Data analysis provided the third theme, professional development with a subtheme of

perceived needs. Participants described a need for de-escalation professional developments, not

only for themselves but for general education teachers as well.

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Table 4

Words and Phrases in Relation to Sub-Question One

______________________________________________________________________________
Codes Obtained Source How many times Percentage
codes mentioned
______________________________________________________________________________
Supports Focus group 31 44%

Professional Focus group 23 32%

Development

Perceived Needs Focus group 17 34%

______________________________________________________________________________

Several participants discussed the needs of additional professional development and in-

service opportunities that go beyond the special education department. “I don’t think there is

enough education and knowledge given outside of the SPED department” (Linda, individual

interview, October 13, 2022). Amy stated, “there’s not enough training” with regards to mental

health and de-escalation strategies (Amy, individual interview, March 8, 2023). Others stated

that most professional development currently provided often does not apply to the special

education realm. Participants describe having a lack of professional development geared towards

mental health or de-escalation strategies. Rather professional development is often focused on

improving academic skills. Special education teachers also describe a lack of pre-service training

that also impacts their daily job with interacting with mental health concerns with students. Most

describe only having classroom management pre-service, but nothing that included mental health

supports.

Research Sub-Question Two

Research sub-question two asked “how are special education teachers lived experiences

influenced by the challenges of contextual organizations in providing services to special

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education students with comorbid disorders?” This question was devised to better understand

how challenges impact special education teachers’ lived experiences and their abilities to address

mental health struggles in students. Data analysis provided the second theme, lack of resources

and training with the subthemes of elimination of supports. The majority of participants

described a lack of resources and training to address mental health needs in special education

students.

Table 5

Words and Phrases in Relation to Sub-Question Two

______________________________________________________________________________
Codes Obtained Source How many times Percentage
codes mentioned
______________________________________________________________________________
Resources Individual interviews 50 48%

Training Individual interviews 31 30%

Stigmas Individual Interviews 23 22%

______________________________________________________________________________

Several participants described the constraints of budgets and lack of resources for

addressing mental health concerns in students. Kim and Holly described an increase in these

services during Covid-19, however, both say those programs and resources have been eliminated

due to budgets constraints. Additionally, several participants described the struggles to find well-

trained individuals to support students in public-school systems.

Research Sub-Question Three

Research sub-questions three asked “what do special education teachers describe as

potential in-service professional development topics that would improve their ability to address

the comorbid disorders of special education students?” This question was designed to better

understand what topics and professional developments special education teachers feel would be
 104

beneficial to boost their ability to address mental health struggles in students. Data analysis

provided the third theme, professional development with a subtheme of perceived needs. Most

participants expressed a need for more modeling and direct instruction in addressing mental

health struggles in students rather than traditional professional development opportunities.

However, all participants described a need for more mental health related professional

development opportunities. Kim stated, “I think we have kind of a limited toolbox” (Kim,

individual interview, March 17, 2023).

Table 6

Words and Phrases in Relation to Sub-Question Three

______________________________________________________________________________
Codes Obtained Source How many times Percentage
codes mentioned
______________________________________________________________________________
Professional Reflective Writing 5 33%
Development

Training Reflective Writing 5 33%

Perceived Needs Reflective Writing 5 33%

______________________________________________________________________________

Participants identified several perceived needs as special education teachers in the public

school system. Several participants described the need for additional training, not just for special

education teachers, but for general education teachers and administration. Holly stated:

Whether or not they plan on working with them or not. I also think it's important that

current teachers, whether they be new, worked for 5-7 years or veteran teachers about to

retire, I think professional develop client centered on working with people with

disabilities or working with children with mental health issues and what signs to look out

for I just find that to be very important. (Holly, individual interview, March 24, 2023)
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The need for highly trained staff and more of them was also a significant perceived need.

Meghan stated that programs, support, and resources need to be school wide to completely shift

the culture of the school and meet the needs of students with mental health concerns. Meghan

continued by stating, “it's not so much of a program as opposed to a big picture thing and

understanding” (Meghan, individual interview, November 17, 2022).

Summary

Chapter Four contained data gathered from 12 participants who were public-school

special education teachers from a variety of states. The data represents the lived experiences of

the participants regarding addressing mental health struggles in special education students with

comorbid disabilities. The participant group consisted of 10 women and two men with years of

teaching experience ranging from almost 1 year to 19 years. Twelve participants participated in

individual interviews, three participants participated in the elementary focus group, three

participants participated in the secondary focus group, and five participants provided their

reflective writing responses.

The following three themes emerged from the data: mental health impact, lack of

resources and training, and professional development. Subthemes were also included as

participants discussed the impacts and needs in the public-school system with regards to

addressing mental health disorders in students. Each of the three identified themes were related

back to the research questions. The theme of mental health impact was connected back to

research question one. Participants described how they felt that mental health of a student has a

significant impact on their academic performance, peer relationships, and overall well-being. The

theme of lack of resources and training connected back to research questions three. Participants

described the challenges and barriers they perceive when addressing mental health struggles in
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students. All participants described a lack of resources or training with regards to this area. The

final theme of professional development was connected back to research question two and four.

Participants described a lack of mental health professional development, several participants

stating seeing a decline in those topics following the COVID pandemic. All participants

described the perceived need and benefit of more professional development geared towards de-

escalation and other ways to address mental health struggles in students.

In Chapter Five, a summary of the findings were presented complemented by the

discussion section with supporting literature for each research question. Implications,

delimitations, and limitations are also addressed. Finally, a discussion of future research was

presented.
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CHAPTER FIVE: CONCLUSION

Overview

The purpose of this transcendental phenomenological study was to describe the lived

experiences of special education teachers in regard to addressing mental health concerns in

students with comorbid disabilities. This chapter includes an interpretation of the findings,

theoretical and methodological implications, implications for policy and practice, limitations,

and delimitations, and recommendations for future research.

Discussion

The current research study explored the special education teachers (N=12) lived

experiences in regard to addressing comorbid mental health disorders in their students.

Triangulation of data sources outlined in the previous chapter were categorized into the

following three themes: (a) mental health impact, (b) lack of resources and training, and (c)

professional development. The following section discusses the study’s findings in relation to the

themes and the interpretation of those findings with empirical and theoretical literature

accompanied by narrative evidence from participants.

Interpretation of Findings

Public-school education is in a transformative period of time in which vital decisions

must be made to ensure a stable future for students. Special education teachers are impacted and

influenced by the contextual organizational framework of the public-school system. The

contextual organizational framework of public-schools impacts the individual special education

teacher, individual schools, school districts, and state/ national levels of education systems. This

framework provides guidance, boundaries, and sometimes hinderance for special education

teachers. Special education teachers’ lived experiences in regard to addressing comorbid mental
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health disorders in their students is significant to bettering the educational journeys of students

and the public-school systems.

Summary of Thematic Findings

The following three themes emerged from data analysis: mental health impact, lack of

resources and training, and professional development. The themes aligned with the contextual

organization framework depicted in this phenomenological research study. Special education

teachers described the impact that comorbid mental health disorders have on their students in the

public-school setting. Several participants described the daunting task of addressing comorbid

mental health disorders in their students that significantly impact their academic performance,

attendance, and peer interactions. One common thought was the need to build meaningful

relationships with students which aids in addressing mental health concerns.

These participants also depicted the lived experiences noting the lack of resources and

training available to public-school special education teachers and teachers in general regarding

mental health disorders in students. Several participants stated they are unsure of what resources

and training would be available geared towards addressing mental health concerns in their

students. Participants also noted that additional trained staff, such as behavioral specialists or

school psychologists, would be beneficial in the public-school systems. Special education

teachers noted that it takes more than one person to address and monitor students with comorbid

mental health disorders.

Lastly, special education teachers described the need for professional developments that

were more centered on the needs of special education realm rather than topics that apply to

mainly general education areas. Several participants stated that most professional development

provided by school districts are geared towards reading and math programs that are of limited
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use in the special education realm. Rather participants suggested having professional

developments geared towards the specific needs of special education students, including

addressing mental health concerns. Additionally, several participants described the benefits of

having time to collaborate with other special education teachers and general education teachers

to better develop plans to meet the needs of this population of students.

Mental Health Impacts the Education of Special Education Students. Through the

analysis of individual interviews and focus groups emerged the first theme. Participants

described comorbid disabilities of ADHD, anxiety, depression, and several others impacting the

special education students they work with. Literature regarding comorbid disabilities was

reflected in what participants had to share throughout the current study (Forness et al., 2012;

Lambros et al., 2016).

All twelve participants described the impact that a variety of mental health disorders has

on special education students. Two of the participants described chronic absenteeism, in their

opinion, as being connected to metal health struggles in students. Additionally, all participants

described academic functioning and peer relationship struggles as students are working through

emotions and not focusing on their academic or social demands. Both statements mirror the

points made by Ball et al. (2016).

Additionally, all the participants mentioned to a degree the pandemic and how that has

impacted the mental health of students. Two of the participants emphasized this factor and felt

that everyone is still navigating the effects of the pandemic, especially in relation to mental

health. As Cowie and Myers (2020) and Kuzujanakis (2021) stated, the pandemic has brought

attention to the intense crisis of mental health disorders. Special education teachers who

participated in this study reflected these struggles and the need for additional support.
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Special Education Teachers Describe a Lack of Resources and Training. Through the

analysis of individual interviews, focus groups, and reflective writing emerged the second theme.

All twelve participants described the need for additional resources and training which connects

with the literature from Ball et al. (2016) and Franklin et al. (2012). Two expressed that they

were unsure of what resources are out there, but feel they need something more than they have

currently available. This is also reflected in the literature from Lambros et al. (2016) in which it

is stated there is a lack of empirically supported treatments and well- designed mental health

services in general for students with special education services with comorbid mental health

disorders.

All twelve participants expressed a need for additional trained professionals that can

assist in addressing mental health disorders. Two different participants described that with the

professionals they currently have available, these professionals are often spread thin with relation

to what the need is and often students do not get adequate time with these professionals.

Kuzujanakis (2021) stated that most public schools lack enough mental health counselors and

school psychologists which mirrored the description from participants in the current study.

Prior research establishes the significance of early intervention to address mental health

disorders, which was also reflected in the perceived needs of participants in this study (Adelman

& Taylor, 2006; Cuellar, 2015; Loades & Mastroyannopoulou, 2010; Sotardi, 2018). Two of the

participants emphasized this concept as well. One of those participants stated the need to

understand the brain and the need for additional resources to help teachers intervene at earlier

stages. Additionally, three participants described the lack of communication and collaboration

between schools and community agencies which reflects the literature from Baker (2013),
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Flanagan et al. (2015), Greene (2014), and Weist et al. (2001). One of those participants

described not knowing what would be available outside of a pediatrician.

Professional Developments can Impact Special Education Teachers. Through the

analysis of individual interviews, focus groups, and reflective writing emerged the third theme.

All twelve participants stated a frustration with regards to professional development. The

participants described having to sit through professional developments regarding topics that do

not boost their particular focus in special education. Literature mirrored by the participants

statements emphasis the lack of mental health professional developments (Ball et al., 2016;

Franklin et al., 2012; Kuzujanakis 2021; Loades & Matroyannopoulou 2010; Rae et al., 2017).

All 12 participants perceive a need for professional developments that are geared towards special

education and, in regard to what was being asked in this study, more emphasis on addressing

mental health and associated behaviors. Two of the participants expressed that a non-traditional

professional development with more modeling and time for guidance would be more beneficial

than any professional development provided by school districts.

Participants in elementary, secondary, and alternative stated that they did not feel they

had pre-service or in-service training that related to special education students with comorbid

mental health disorders. Most participants stated that pre-service training in this specific area was

limited and typically only geared towards classroom management. Less than half of the

participants have additional certifications or training that are related to addressing comorbid

mental health disorders in special education students. Additionally, participants described having

in-service training for mental health around the beginning of COVID-19. However, according to

participants these professional developments have diminished. Participants described in-service

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training often are not geared towards special education students and have little impact or

usefulness for special education teachers.

Implications

The purpose of this transcendental phenomenological study was to describe the lived

experiences of special education teachers in regard to addressing mental health disorders in their

special education students. This study was guided by the contextual organizational framework

(Ringeisen et al., 2003). The theoretical, empirical, and practical implications of the current

study were made relevant through the rich data described in the findings of the lived experiences

of public-school special education teachers. The findings of this study are relevant and

potentially beneficial for various stakeholders associated with the public-school system.

Theoretical Implications

The contextual organizational framework (Ringeisen et al., 2003) was the theory driving

the current study. The described lived experiences the special education teachers who

participated in this study demonstrated the three areas in the contextual organizational

framework: individual, public-school organization, and the state/ national. The contextual

organizational framework of a public-school identifies issues relevant to educators and can

influence policymakers and curriculum designers (Schachter & Rich, 2011). As the researcher, I

hope the descriptions presented demonstrate the need for support and resources special education

teachers need to address the comorbid mental health disorders in special education students.

The public-school contexts that influence the practices, educators, and students

(Ringeisen et al., 2003). The implications of the current study could potentially influence the

practices, educators, and students in public-school systems. All participants in the current study

stated a need for additional support and services to address mental health disorders in their
 113

students. Public schools are in a transformative period in which vital decisions must be made to

promote a stable educational future for all students, but especially students with comorbid

disabilities. Through the recognition of needs and implications of mental health support and

services, an impact can be made at the individual, public-school organization, and state/ national

levels as put forth by the contextual organizational framework (Ringeisen et al., 2003).

Contextual Organizational Framework and Public Schools. In this study, special

education teacher’s lived experiences were gathered and analyzed with the contextual

organization (Ringeisen et al., 2003) of public-school in mind. The data utilized in this study was

collected through individual interviews, focus groups, and reflective writing samples to describe

the lived experiences of special education teachers. It is through the three levels of contextual

organizational framework that the data was analyzed: individual, organizational, and

state/national level.

Using the data collected, I looked for links that connected the context to the individual

special education teacher, public-school organization, and public-school in relation to state/

national level. The lived experiences of participants as they described the successes and

challenges of addressing mental health disorders in their special education students. Through the

description of the lived experiences of the participants, a lack of resources and support was made

evident in the context of the public school system. All twelve participants noted a need for

additional training in addressing mental health disorders in their special education students. Two

participants noted there is a need, but stated they were unsure of what topics or where to begin

with suggestions with regards to additional training or professional developments.

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Empirical Implications

Literature and previous research have described the perceptions of school counselors and

regular education teachers in relation to addressing mental health disorders (Carlson & Kees,

2013; Reinke et al., 2011). However, research including the perceptions of special education

teachers was not evident in existing literature. The current study spoke to this need by using rich

descriptive data that described the lived experiences of special education teachers.

Schools are essential partners in developing and implementing the work towards mental

health disorders (Adelman & Taylor, 2006; Stormont et al., 2011). The current research

demonstrates this implication as all twelve special education teacher participants described a

perceived need for districts and public schools to develop more opportunities for resources and

support. Special education teachers also depicted the need for professional developments geared

towards mental health or other similar topics that would be more useful to the context of special

education realm.

Practical Implications

Practical implications include how educators, and the public school system can use this

research to better the educational experiences of students with comorbid mental health disorders.

There is a demonstrated need for more support, training, and resources geared towards

addressing mental health disorders. Conroy (2016) stated there is a lack of seamless and

comprehensive services provided to students who struggle with mental health disorders.

Policymakers, administrators, community service providers, and educators need to come together

to build cohesive relationships that promote positive mental health for public-school students.

Schools are no longer able to just focus on the academic skills of students. Rather to develop a
 115

well-rounded student in the current society, emphasis on addressing mental health disorders must

be considered.

Implications for Policy

The current research study has several policy implications with regards to addressing

comorbid mental health disorders in special education students who attend public-school

settings. These policy implications include benefits that will impact not only special education

teachers, but students who have comorbid mental health disorders. Although the current study

did not focus directly on policy changes, a profile of what could benefit addressing comorbid

mental health disorders in public-schools settings became clear.

Additional Pre-Service Training. Incorporating additional or more specific pre-service

training in mental health disorders in teacher prep programs would be beneficial for potential

special education teachers. Reinke et al. (2011) stated that pre-service teacher training is

imperative to prevention and interventions with regards to dealing with mental health issues.

Two out of twelve participants described having certification and endorsements in Autism,

receiving those endorsements from their teacher prep programs. Holly described pre-service

training in “classroom management class” that she felt “kind of addressed mental health in

students somewhat” (Holly, Focus Group, June 2, 2023). Most of the training described by the

participants included professional developments provided by their district of employment. By

encouraging teacher prep programs to incorporate additional pre-service training in awareness

and addressing mental health disorders, special education teachers will be more prepared in their

future employment opportunities.

Providing Specific Professional Development. Public education is changing and in

need of more professional development that is geared towards specific special education needs,
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such as addressing mental health disorders. Holly stated, “providing training for working with

students with disabilities in general would be beneficial for the whole staff including

administration” (Holly, Focus Group, June 2, 2023). Participants stated that training on

deescalating situations and having all stakeholders being on the same page is important in

meeting the needs of students struggling with mental health disorders. Linda stated “I don’t think

there is enough education and knowledge given outside of the SPED department” with regards to

professional development and disabilities (Linda, Individual Interview, October 13, 2022).

Additionally, the secondary focus group felt that professional development in general does not

always address students with disabilities. Several participants described a lack of tools and

resources to address mental health concerns in students. When districts provide specific

professional development opportunities, the more prepared educators will be to address

significant areas such as mental health disorders in their students.

Funding for Personnel. Public-school districts often rely on a variety of resources

including the state and local agencies to support funding. Funding is essential to all faucets of

public-schools; including the need for funding towards mental health supports and resources.

When asked if money was no object, what do participants perceive as an essential need, most of

the participants stated that additional personnel to address mental health disorders would be

significantly beneficial. Jennifer stated she felt “we do need someone that's a more qualified

school psychologist in every school that can help” (Jennifer, Individual Interview, October 29,

2022). Several participants emphasized the need for more people available in public-school

buildings to help in addressing mental health concerns. Participants stated that more personnel

like counselors or therapeutic day treatment folks would be beneficial so that students had more

time with trained professionals. The importance of additional trained personnel can greatly
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impact the educational experiences of students who are affected by mental health disorders.

Teasley (2018) stated that the challenges of gaining mental health resources in public-schools

include the high ratio of students who have mental health needs, as well as finding the funding to

provide mental health interventions.

Implications for Practice

In addition to implications for policy, the current study provided implications for practice

for public-schools and special education teachers. Special educators describe the contextual

organizational framework of the public-school system. These contextual organizational

frameworks impact the practices and available resources in the public-school system. Special

education teachers want to be impactful with their abilities to address comorbid mental health

disorders in their students.

Seeking Professional Development Opportunities and Topics. The more training and

in-service professional development an educator have, the more time a student will spend in

class receiving critical educational experiences to be successful in school and life beyond school.

Kim stated, “I think we have kind of a limited toolbox” (Kim, Individual Interview, March 17,

2023). Greene (2014) echoed this notion by stating all educators need to be on the same page and

coordinate their efforts towards the educational experiences of their students. Participants stated

educators would benefit from less professional development and more modeling for educators in

the classroom about how to handle it with regards to addressing mental health concerns in

students. Several participants also mentioned that they are unsure of what forms of professional

developments are available and would be beneficial. Other participants stated there is a need for

specific training that is geared towards what special educators are facing with regards to

addressing mental health concerns in students, rather than reading training that impact general
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education students. Special educators need administrators and districts to analyze the needs of

this specific population and develop professional development opportunities that would be

beneficial to their educational success.

Collaboration Between Educators and Resources. Greene (2014) stated collaborative

and proactive steps solve the problem and skills are built where they are lacking. Common goals

and understanding build stronger platforms for educators and resources to work together for the

benefit of student success and achievement. Collaboration between the contextual organizational

framework and stakeholders, such as teachers, parents, administrators, and community members,

can foster a comprehensive approach to addressing mental health concerns in public school

systems. Several participants expressed the significance of collaboration between varying

resources and the public-school system to better meet the needs of students with mental health

concerns. Participants describe a need for better partnerships between educators, parents, and

other social services.

Delimitations and Limitations

Delimitations in this study included only using participants who were active special

education teachers in either elementary, secondary, or alternative public-school settings. An

attempt was made to recruit pre-school special education teachers; however, no potential

participants were identified. Participants were asked to participate voluntarily and recruited in

various manners. Due to lack of volunteers in the two IRB approved public-school districts,

social media was used to recruit participants from across the United States. Additionally, the

selection of a phenomenological study over other types of studies was a delimitation. A

phenomenological study allowed me to describe in depth the lived experiences that special
 119

education teachers have with regard to addressing comorbid mental health disorders in their

special education students.

Limitations are described as potential weaknesses of a study that cannot be controlled. In

relation to the current study, the sample of the study was a limitation. Participants were asked to

participate voluntarily, which provided a small turnout. Additionally, several districts or building

administration chose to not allow their teachers to participate in the study due to timing and

demands of their daily jobs. I was also looking for specific criteria including being an active

special education teacher which limited my sample size. Teachers were also asked to participate

in the interviews and focus groups outside of school hours and in their own time, evenings or

weekends. Furthermore, there was not a strong representation of ethnicity as all the participants

were Caucasian. There was also an underrepresentation of male special education teachers as

only two out of the twelve participants were males.

Recommendations for Future Research

The goal of this study was to describe the lived experiences of special education teachers

in regard to addressing comorbid mental health disorders in special education students. Based on

the findings from this study, several recommendations for future research may be made.

Although the number of participants was within the suggested research limits by Creswell

(2013), having more participants in specific areas, such as preschool and/or alternative

education, would give a better description of special education teachers lived experiences.

Originally my intention was to have two participants from each school in the districts located in

Virginia that were approved by the IRB. However, due to the volunteer process of this study, it

was difficult to recruit participants. Future research could include duplicating the same study
 120

with a wider range of participants to include areas such as preschool and alternative education in

the public-school systems.

Another consideration for future research includes the contextual impact of mental health

support in public schools. School-based mental health services are an increasing need and often

an unmet need of children and youth (NASP, 2016). Effective school-based mental health care

will result from the interaction of system reform efforts, capacity building, and the delivery of

intervention strategies (Ringeisen et al., 2003). Additional research that demonstrates the impact

of mental health support in school-based programs is essential to improving the educational

experiences of children and youth.

Conclusion

Chapter Five highlighted the findings in the current study, implications and driving

theory, delimitations and limitations, and recommendations for future research. The current

student was driven by the contextual organizational framework, more specifically special

education teachers and the public-school system. Through the rich descriptions collected through

individual interviews, focus groups, and reflective writing samples. Participants emphasized the

impact that mental health has on the public-school system and society, the lack of resources and

training, and the need for professional developments geared towards mental health disorders.

The current research added to a need for the perspective of the special education teacher

who addresses comorbid mental health disorders in special education students. Previous research

and literature depicted the experiences of school counselors and regular education teachers.

However, the current research emphasizes the importance of considering the thoughts and

perceived needs from the lens of special education teachers. The current research presents an
 121

opportunity for stakeholders, such as policymakers, community service providers, and

administrators to use the findings and make changes that better the future of students.

Limitations of the research included finding volunteers. Several school districts chose not

to allow their teachers to participate in the current study, while individuals are busy with their

demands from the school districts and personal lives. Future research including additional

participants to expand upon this important topic would be beneficial to the empirical research.

Additionally, research to promote the need for additional mental health resources, support,

training, and professional development in public-schools is essential. Research can encourage

change and have a positive impact on the educational world.

 122

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Appendix A
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Appendix B

Recruitment Email

Dear [Recipient]:

As a graduate student in the School of Education at Liberty University, I am conducting research

as part of the requirements for an Ed.D. degree. The purpose of my research is to describe the
lived experiences of special education teachers in addressing comorbid disabilities in their
students, and I am writing to invite eligible participants to join my study.

Participants must be (a) employed in preschool, elementary, or secondary settings; (b) have
experience working with students with Individuals with Disabilities Education Act (IDEA)
eligibilities who, in addition to their school-related behavioral and/or learning problems, also
struggle with comorbid mental health issues; and (c) work in collaborative, co-taught general
education classrooms and/or pullout programs. Participants, if willing, will be asked to
participate in a remote, audio-recorded, individual interview (approximately 1 hour); a remote,
audio-recorded focus group (approximately 45 minutes); and complete a reflective professional
development writing prompt (approximately 15 minutes). Participants will be emailed their
individual interview transcripts and asked to review them and confirm their accuracy. Names and
other identifying information will be requested as part of this study, but the information will
remain confidential.

To participate, please click here (include hyperlink to online survey) and complete the screening
survey by June 2022. You may contact me for more information.

If you meet the study criteria, a consent document will be emailed to you one week before the
interview. The consent document contains additional information about my research. If you
choose to participate, you will need to sign the consent document and return it to me via email at
the time of the interview.

Sincerely,

Alison Simmons
LU Doctoral Candidate

Appendix C

Participant Consent Form

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Title of the Project: Special Education Teachers’ Experiences Addressing Mental Health
Concerns in Students with Comorbid Disabilities: A Phenomenological Study
Principal Investigator: Alison Simmons, Doctoral Candidate, Liberty University

Invitation to be Part of a Research Study

You are invited to participate in a research study. To participate, you must (a) employed in
preschool, elementary, or secondary settings; (b) have experience working with students with
Individuals with Disabilities Education Act (IDEA) eligibilities who, in addition to their school-
related behavioral and/or learning problems, also struggle with comorbid mental health issues;
and (c) work in collaborative, co-taught general education classrooms and/or pullout programs.
Taking part in this research project is voluntary.
Please take time to read this entire form and ask questions before deciding whether to take part in
this research.
What is the study about and why is it being done?
The purpose of the study is to describe the lived experiences of special education teachers in
addressing comorbid disabilities in their students.
What will happen if you take part in this study?
If you agree to be in this study, I will ask you to do the following things:
1. An audio-recorded, remote interview (approximately 1 hour)
2. An audio-recorded, remote focus group (approximately 45 minutes)
3. A self-reflection, professional-development writing prompt (approximately 15 minutes)
4. Review the transcript of your individual interview to confirm its accuracy.
How could you or others benefit from this study?
Participants should not expect to receive a direct benefit from taking part in this study.
Benefits to society include a better understanding of the lived experiences of special education
teachers in addressing comorbid mental health disorders in their students. The results should
increase the awareness of mental health struggles for students in public schools and ultimately
impact and improve the learning outcomes of those students. This study will also give special
education teachers a voice to establish what they feel is needed to meet those needs in their
students.
What risks might you experience from being in this study?
The risks involved in this study are minimal, which means they are equal to the risks you would
encounter in everyday life.
How will personal information be protected?
The records of this study will be kept private. Published reports will not include any information
that will make it possible to identify a subject. Research records will be stored securely, and only
the researcher will have access to the records.
• Participant responses will be kept confidential through the use of pseudonyms. Interviews
will be conducted in a location where others will not easily overhear the conversation.
• Data will be stored on a flash drive that only the research has access to. After three years,
all electronic records will be deleted.
• Interviews and focus groups will be audio-recorded and transcribed. Recordings will be
stored on a flash drive for three years and then erased. Only the researcher will have
access to these recordings.
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• Confidentiality cannot be guaranteed in focus group settings. While discouraged, other

members of the focus group may share what was discussed with persons outside of the
group.
Is study participation voluntary?
Participation in this study is voluntary. Your decision whether or not to participate will not affect
your current or future relations with Liberty University. If you decide to participate, you are free
to not answer any question or withdraw at any time without affecting those relationships.
What should you do if you decide to withdraw from the study?
If you choose to withdraw from the study, please contact the researcher at the email
address/phone number included in the next paragraph. Should you choose to withdraw, data
collected from you, apart from focus group data, will be destroyed immediately and will not be
included in this study. Focus group data will not be destroyed, but your contributions to the focus
group will not be included in the study if you choose to withdraw.
Whom do you contact if you have questions or concerns about the study?
The researcher conducting this study is Alison Simmons. You may ask any questions you have
now. If you have questions later, you are encouraged to contact her. You may also contact the
researcher’s faculty sponsor, Dr. Rollen Fowler.
Whom do you contact if you have questions about your rights as a research participant?
If you have any questions or concerns regarding this study and would like to talk to someone
other than the researcher, you are encouraged to contact the Institutional Review Board, 1971
University Blvd., Green Hall Ste. 2845, Lynchburg, VA 24515 or email at [email protected].
Disclaimer: The Institutional Review Board (IRB) is tasked with ensuring that human subjects
research will be conducted in an ethical manner as defined and required by federal regulations.
The topics covered and viewpoints expressed or alluded to by student and faculty researchers
are those of the researchers and do not necessarily reflect the official policies or positions of
Liberty University.
Your Consent
By signing this document, you are agreeing to be in this study. Make sure you understand what
the study is about before you sign. You will be given a copy of this document for your records.
The researcher will keep a copy with the study records. If you have any questions about the
study after you sign this document, you can contact the study team using the information
provided above.
I have read and understood the above information. I have asked questions and have received
answers. I consent to participate in the study.
The researcher has my permission to audio-record me as part of my participation in this
study.
____________________________________
Printed Subject Name

____________________________________
Signature & Date
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Appendix D

Collection of Demographic/Work-Related Information

1. Please include your name, email, and phone number.

2. How many years of teaching experience do you have with students with disabilities?
3. What is your level of education?
4. What grade level(s) and content area(s) do you teach?
5. Do you have experience working with students who, in addition to their school-related
behavioral and/or learning problems, also struggle with comorbid mental health issues?
6. Do you work in a collaborative, co-taught general education classroom and/or pullout
program?
7. What IDEA eligibilities are your students identified under?
8. What comorbid/secondary mental health related disorders (e.g., DSM-V) are your students
with IDEA disabilities diagnosed with?
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Appendix E

Standardized Open-Ended Interview Questions

1. Please introduce yourself.

a. What is your ethnicity/race? (Gender will be recorded without needing to ask the participant.)
b. What is your highest degree earned?
c. What is your age?
d. How many years have you been teaching students with disabilities?
e. What grade level(s) and content area(s) do you teach?
f. Do you have any specialized training/certification? If so, describe.
2. Describe the types of disabilities you work with daily.
a. What disabilities have your students been identified as having under IDEA?
b. In addition to their IDEA eligibility, what additional comorbid/mental health disabilities are
your students diagnosed with?
3. Describe how often you address mental health and/or behavioral concerns in the students you
work with.
4. What motivated or inspired you to become a special education teacher?
5. Please describe your experiences working with students with disabilities who also have a
mental health disorder diagnosis.
6. Without providing identifying information, please share about specific students who
immediately came to your mind when I asked this question. a. Did you feel equipped to support
the student(s)? Please explain.
7. What are some stigmas regarding mental health in the public schools in regard to special
education students?
8. What available resources do you have in your school to address students’ mental health
issues?
9. In your opinion, how does the mental health of students impact their academic performance?
10. In your opinion concerning students who demonstrate mental health disorders, what are their
relationships with their peers like?
11. Discuss the amount of time per day/week you spend addressing mental health concerns in
your students.
12. What forms of educational instruction (i.e., professional development, support, or resources)
help you when dealing with mental health crises?
13. What are your “go to” programs or resources for addressing mental health concerns in special
education students?
14. Without giving names, can you describe a time when you felt limited in regard to addressing
mental health concerns in special education students?
15. In your opinion, what do you think are important characteristics or signs of students having
positive mental health?
16. In your opinion, what are the characteristics of a positive mental health resource for students
with disabilities?
17. If money was not a concern, what programs or resources would benefit your students’ mental
health?
18. What is your opinion regarding how the mental health issues of students with disabilities are
handled in your school setting?
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19. How do you feel the mental health of students should be addressed in the school setting?
20. What recommendations do you have for program administrators and faculty currently
preparing pre-service special education teachers for the profession?
21. What topics would you like to see included in professional development to better assist you
in helping students with mental health struggles?
22. Is there anything else you’d like to share about this topic or think I should ask future
participants to gain a deeper understanding of this issue?
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Appendix F

Professional Development Reflective Writing Directions:

Participants will be asked to create a self-reflective writing piece that includes the previous in-
service professional development they have attended and/or what special education teachers feel
is needed to address mental health disorders in students experiencing comorbid disabilities.
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Appendix G Focused Group Questions

1. Please introduce yourself and share your educational journey.

2. How would you describe the impact of special education students’ mental health disorders on
the learning environment?
3. Describe the resources and supports your district has available to address mental health
disorders in students.
4. Describe how your pre-service and/or in-service professional development has aided you in
addressing mental health disorders in students.
5. Without using specific names, discuss a time when you addressed mental health disorders in
your students and how you handled it.
a. Were there any supports or resources you wished were available to you during that time?
6. What recommendations would you give your administration in regard to supports and/or
professional development in addressing mental health disorders in students?
7. We have discussed addressing mental health disorders in students. Is there anything else you
would like to add?