August 2022 – Special Educator e-Journal

U.S. Department of Education Issues Dear Colleague Letter Calling for End to Corporal Punishment in Schools and Guiding Principles on School Discipline

The U.S. Secretary of Education Miguel Cardona wrote to Governors, Chief State School Officers, and School District and School Leaders and urged them to end corporal punishment in schools—the practice of paddling, spanking, or otherwise imposing physical punishmenton students. This letter reinforces the Department of Education’s (Department’s) position that corporal punishment in schools should be replaced with evidence-based practices, such as implementing multi-tiered systems of support like Positive Behavioral Interventions and Supports, that create a safe and healthy school environments. Every student and educator should feel safe and supported inside of school buildings; and more importantly, schools should always be free from the threat of violence.

“It’s unacceptable that corporal punishment remains legally permissible in at least 23 states. Our children urgently need their schools to raise the bar for supporting their mental health and wellbeing,” said U.S. Secretary of Education Miguel Cardona. “Despite years of research linking corporal punishment to poorer psychological, behavioral, and academic outcomes, tens of thousands of children and youth are subjected to beating and hitting or other forms of physical harm in school every academic year, with students of color and students with disabilities disproportionately affected. Schools should be places where students and educators interact in positive, nurturing ways that foster students’ growth and development, dignity, and sense of belonging—not places that condone violence and instill fear and mistrust.”

Despite decades of research showing the short and long-term harms of corporal punishment, the practice continues to be legal in at least 23 states.

In addition, the Department released guiding principles on how?to maintain safe, inclusive, supportive,?and fair learning environments for students and school staff, including specific recommendations for evidence-based practices?to give students?what they need?to learn and grow. The Department stands ready to support efforts to replace harmful disciplinary practices, including exclusionary discipline and corporal punishment. Through the historic funding under the American Rescue Plan Act of 2021 and the Bipartisan Safer Communities Act, and additional laws like the Elementary and Secondary Education Act of 1965, the Department can support these evidence-based practices consistent with program requirements. The Department will also continue to support schools in their efforts to move away from the use of exclusionary and physical punishment through its technical assistance centers, including the Best Practices Clearinghouse, National Center on Safe Supportive Learning Environments, and National Center to Improve Social and Emotional Learning and School Safety, among other resources.

These actions today show a continued commitment by the Biden-Harris Administration to Raise the Bar in education, advance equity, and support the well-being, safety and success of all students.

The letter builds upon the Department’s position from a similar action in 2016 under the direction of then Secretary John King Jr. and 2014 under the direction of Secretary Arne Duncan in the Obama-Biden Administration.

“I’m not Prepared:” Experiences of Professionals Working with Students with Disabilities and Co-occurring Mental Health Disorders

Megan Fujita, Ph.D., MSW

Grace L. Francis, Ph.D.

Jodi Duke, Ed.D.

George Mason University

***Note: This article is from the 2022 Spring/Summer edition of the Journal of the American Academy of Special Education Professionals (JAASEP)

Abstract

Despite policies providing resources to students with disabilities (SWD), high school and college SWD are diagnosed with co-occurring mental health disorders (D/MH) at higher rates than their peers without disabilities. As these adolescents transition into young adulthood, education professionals become increasingly important in providing support and resources. As such, the purpose of this study was to examine high school and higher education professionals’ perceptions related to factors exacerbating mental health among students with D/MH and barriers in supporting students with D/MH. Using a basic interpretive approach, researchers analyzed data from interviews and focus groups. Participants identified (a) missed diagnosis and unmet needs, (b) academic and social pressure, and (c) high school transition as factors exacerbating student mental health needs. They identified (a) professional tension, (b) limited training and professional development, and (c) structural barriers in schools as barriers limiting ability to support students with D/MH. Implications for practice and future research are discussed.

Keywords: disability, mental health, young adult, college, high school

“I’m not Prepared:” Experiences of Professionals Working with Students with Disabilities and Co-occurring Mental Health Disorders

High school and college students with disabilities (e.g., a person who has a physical or mental impairment that substantially limits one or more major life activities, has a record of such impairment or is regarded as having such an impairment; Rehab Act of 1973) experience co-occurring mental health disorders such as depression, bipolar disorder, and generalized anxiety disorder at higher rates than their peers without disabilities (Blake, 2017; Poppen et al., 2016). The impact of co-occurring mental health disorders often become more significant as children with disabilities enter adolescence and young adulthood (White et al., 2010) and may result in challenges with executive functioning, social interactions, academic achievement, self-regulation, and setting and following daily schedules (Eddy et al., 2015; Pugliese & White, 2014). For some high school and college students with disabilities and co-occurring mental health disorders (D/MH), such challenges result in dropping out of school, experiencing difficulty finding and maintaining employment, and trouble developing meaningful relationships (Anastopoulous & King, 2015).

Secondary and higher education policies are paramount to supporting students with D/MH. The Individuals with Disabilities Education Act (IDEA; 2004) is a federal education law that supports eligible students with D/MH in receiving an Individualized Education Program (IEP) throughout elementary, middle, and high school (IDEA, 2004). However, for individuals with disabilities transitioning to postsecondary education, IDEA no longer applies. As students with D/MH enter higher education they may receive services through Section 504 of The Rehabilitation Act (Section 504; 1973). Section 504 is a federally mandated civil rights law which serves to protect students with D/MH by requiring institutions to provide services and accommodations through a university disability support office.

Despite these laws and provisions, students with D/MH consistently experience diminished outcomes compared to their peers with and without diagnoses, including diminished graduation and completion rates, and fewer employment opportunities (Bureau of Labor Statistics, 2018; Mader & Butrymowicz, 2017; National Center for Education Statistics, 2019). The unique barriers and challenges students with D/MH experience in higher education (e.g., social isolation, executive functioning challenges) may contribute to these disparities. Specifically, a lack of research-based interventions to supporting students with D/MH contributes to these barriers (Francis et al., 2017). 

While there is a growing body of work related to mental health support among high school and college students, there is limited research specifically focused on improving the mental health of students with D/MH (Al-Yagon, 2015; Poppen et al., 2016). Specific gaps in the literature relate to immediate and long-term outcomes of well-being interventions (e.g., mindfulness, exercise, peer social support) (Anastopoulos & King, 2015; Francis et al., 2018) as well as family support for students with D/MH (Al-Yagon, 2015). Additionally, existing research must be implemented by professionals with clinical licensures (e.g., clinical psychologists, social workers; Francis et al., 2019), making it inaccessible to high school and higher education professionals.

As a result, professionals working in high school and higher education settings report feeling unprepared to support students with D/MH in developing meaningful accommodations and coping strategies. This is problematic, as high school and higher education students with D/MH are expected to develop self-determination and advocacy skills, and begin to take responsibility for managing their own lives, including their disability and mental health-related needs (Francis et al., 2020). 

For students with D/MH, unmet needs and growing expectations for independence require ongoing family support and guidance (Francis et al., 2020). As a result, while students with D/MH are expected to transition to the role of self-advocates, family caregivers are simultaneously expected to shift their role from advocates for their adolescents (e.g., making decisions for students) to advisors for their young adults (e.g., making decisions with students or guiding students to make decisions; Francis et al., 2017). However, this transition is stressful and challenging for family caregivers of students with D/MH (Francis et al., 2020; Schiltz et al., 2018). In particular, parents note that supporting the mental health of their adolescents and young adults with D/MH is challenging and that unaddressed mental health needs are exceedingly detrimental to the overall family quality of life (Francis et al., 2020). However, professional guidance and support, including the guidance of education professionals, can ease family stress (Francis et al., 2017).

As adolescents transition into young adulthood and families transition from advocates to advisors for their young adults, the education professionals who work with these students become increasingly important in providing support and resources such as referrals to school-based services, facilitating social supports, and helping students secure accommodations (Grogan, 2015). However, adolescents and young adults with disabilities have described the failure of high schools and universities to provide adequate mental health support for individuals with disabilities (Francis et al., 2019).

For that reason, examining the perceptions of high school and higher education professionals working with high school and college students with D/MH provides potential to better understand existing mental health barriers, resources, and supports for students with D/MH, thus identifying viable solutions and implications for practice. Therefore, the purpose of this study was to examine high school and higher education professionals’ perceptions of (a) factors exacerbating mental health among students with D/MH and (b) barriers experienced in supporting students with D/MH.

Method

Two white, English-speaking female special education faculty members served as principal investigators for this study. The investigators took different approaches to recruit participants, including convenience sampling, purposeful selection, and snowball sampling. All interested participants were offered the option to engage in a private interview or a focus group with other high school or higher education participants, respectively, to increase participant level of comfort sharing information (Cresswell, 2009).

High School Recruitment

High school recruitment involved convenience sampling and purposive selection, as the investigators sent recruitment emails to high school teachers and administrators with whom they had previous discussions regarding the importance of adolescent mental health. The recruitment email included the purpose of the study, contact information for the primary investigators, and a link to a confidential Doodle poll that the investigators used to schedule interviews or focus groups (depending on participant preference indicated on the poll). The investigators also used snowball sampling by encouraging high school participants to distribute the recruitment email to other high school professionals with experience working with adolescents with D/MH. However, no additional high school professionals completed the Doodle poll.  

Higher Education Recruitment

The principal investigators recruited higher education professionals via convenience sampling by selecting one public university and one community college located in the mid-Atlantic region of the U.S. based on existing relationships with the directors of Disability Support Offices (DSO) at these institutions. These DSO “gatekeepers” engaged in previous research activities with the principal investigators related to college students with D/MH (i.e., distributing research information to student listservs). As a result, they were familiar with the needs of young adults with D/MH and had access to other higher education professionals who may be willing to participate. .

For this study, the university DSO director identified four departments that had the largest number of students registered with the DSO (i.e., departments of computer science, nursing, social work, and psychology). The investigators used this information to email university department chairs, asking them to distribute a recruitment email to department faculty. Similar to high school recruitment, the email included the purpose of the study, contact information for the primary investigators, and a link to a confidential Doodle poll that the investigators used to schedule interviews or focus groups. Two department chairs agreed to distribute the email via department listservs. The investigators sent a reminder email, but did not receive a response from the remaining department chairs. Finally, the university DSO director agreed to distribute a recruitment email to other DSO staff members. The community college DSO director was unable to provide information on the highest distribution of students registered with the college DSO across academic programs. However, the director agreed to distribute the recruitment email to other DSO and university life staff.

Participants  

A total of 13 individuals participated in this study. Seven higher education participants completed the Doodle poll, (n= 3 community college staff and n= 4 university staff), indicating their desire to participate in a focus group. Of the 15 high school professionals the investigators contacted, seven completed the Doodle poll to participate (one email was undeliverable). However, one individual later excused herself from the study due to extensive administrative responsibilities, leaving six remaining high school professionals. 

High school participants primarily served as special education teachers, with the exception of two administrators. The length of time participants reported working in their current positions ranged from one to 12 years. All participants reported their gender as female, their first language as English, and their race/ethnicity as White/Caucasian.

All higher education participants served administrative roles at their institutions. Such roles included director of service offices, disability service counselors, and directors of disability-specific programming. The length of time participants reported working in the current position ranged from two to 10 years. Six of the seven participants reported their gender as female, three reported their race/ethnicity as White/Caucasian, one reported Hispanic or Latinx, one reported Black/African American, and one reported Multiple Races or Ethnicities. One participant reported their first language as Spanish, while the rest reported English.

We held three focus groups, one focus group consisting of four high school professionals from four high schools near the university, one focus group consisting of four participants from the university, and one focus group consisting of three participants from a nearby community college. We also held two interviews with high school teachers from two different schools (one preferred to meet one-on-one and one was unable to make the focus group).

Data Collection

The data collection and analysis team consisted of the two principal investigators and a white, English-speaking female doctoral student with a social work background studying education policy. Seeking to understand the lived experiences of professionals working with students with D/MH, the team used a basic interpretive approach (Patton, 2002) to conduct and analyze interview and focus group data. Focus groups were conducted in-person to build rapport and grasp non-verbal communication (Opdenakker, 2006). Individual interviews were conducted via phone at the preference of participants. Focus groups were conducted in a private room on the principal investigators’ university campus and phone interviews were conducted in a private office on the investigators’ university campus. Focus groups and interviews were recorded with participant consent. Interviews lasted an average of approximately one hour, while focus groups lasted an average of approximately two hours. The investigators provided refreshments during focus groups, but did not otherwise incentivize participation.

The principal investigators began focus groups and interviews by reviewing the purpose of the study, including risks and benefits, prior to seeking written consent. They utilized a semi-structured interview protocol, developed from previous research with students with D/MH (Francis et al., 2017; Francis et al., 2019). The protocol included questions related to (a) professional background, (e.g., “Tell us about your work setting and students you work with.”); (b) professional experiences supporting students with D/MH, (e.g., “Can you describe your experiences providing or observing support for students with disabilities and mental health disorders at school?”); (c) effective mental health strategies, (e.g. “Can you discuss successful strategies you have used with your students, or heard about others using?”); (d) barriers to providing mental health support, (“Have you experienced barriers to providing effective mental health supports to students with disabilities and mental health disorders?”); and (e) ideal mental health support, (“What would ideal mental health support look like for students with disabilities and mental health disorders?”).

Focus groups and interviews were facilitated by one principal investigator, while the remaining researchers took field notes about the discussion, including nonverbal cues, major themes that emerged, and participant questions. The research team concluded focus groups and interviews with member checks by utilizing field notes to review major ideas recorded by the co-facilitator. During this time, the facilitators invited participants to clarify or expand on any of the themes presented. In addition, the research team convened after each focus group and interview to discuss and researcher memos, including emerging themes.

Analysis

Focus group and interview recordings were professionally transcribed. Following transcription, the graduate research assistant cleaned the transcripts, reading line-by-line while listening to the original recordings. During this time, the assistant also de-identified and checked transcripts for accuracy and compared the transcripts to field notes and research memos. This process was designed to capture a general sense of the data and ensure the transcripts represented the context of participant information (Creswell, 2009).

The team engaged in basic thematic analysis (Merriam & Tisdell, 2016), beginning with open coding. During this stage of analysis, all team members independently read the same transcript and identified keywords and phrases, as well as descriptive categories. After individual analysis, the team reconvened to discuss instances when keywords, phrases, and categories converged or differed. This process facilitated the development of an initial codebook (Cresswell, 2009). To further develop and verify the initial codebook, the team read another transcript independently, using the codebook as a general guide. They again reconvened to discuss the relevance of subthemes under categories (e.g., if they were still relevant or could be collapsed), if new themes or subthemes emerged, or if the original themes required editing (e.g., phrasing, definitions). During this process, the team developed rich descriptions for each category and subtheme so that additional transcripts could be recoded using a finalized codebook. The team utilized NVivo qualitative software (QSR International, 2020) to recode transcripts using the final codebook. The team also continued to meet weekly to debrief on analysis procedures and findings until all data were analyzed. During this period, the team did not identify new themes or categories.
 

Trustworthiness

The team employed several strategies to ensure trustworthiness of data collection and analysis. First, during the interview process, the team used open-ended questions to encourage participants to discuss their experiences freely and openly. During data collection, the research team recorded conversations and used field notes to conduct member checks with participants. Immediately following data collection, the team discussed initial themes and wrote research memos to enhance an understanding of the data (Wolcott, 1990). Furthermore, during data analysis, the research team ensured accuracy of data by comparing written transcripts to interview recordings and comparing information to field notes and memos. Additionally, the research team engaged all three members in transcript analysis to promote a diverse view of emergent codes and themes and continued to meet weekly to review and discuss interpretations and potential biases (e.g., experiences with mental health, experiences with school professionals; Patton, 2002) until all data we recorded with the finalized codebook.

Findings

Participants described the growing prevalence of mental health needs among high school and college students with disabilities and identified factors that contributed to or exacerbated poor mental health. Generally, participants observed (a) student “anxiety, depression skyrocketing up,” (b) that “there are so many kids with 504s and things for anxiety,” and (c) an increase in suicide: “… over the past four years that I taught there I think we had like three kids commit suicide.” This manuscript reports themes that overlapped among high school and higher education participants, including (a) perceived barriers that exacerbate mental health needs among students with D/MH and (b) barriers experienced by professionals in supporting students with D/MH.
 

Student Mental Health Barriers

Participants speculated several reasons why students with D/MH experienced detrimental mental health needs and outcomes, including three notable barriers: (a) missed diagnoses and unmet needs, (b) academic and social pressure, and (c) transition out of high school.

Missed Diagnoses and Unmet Needs

Participants described high school and college students with D/MH experiencing “an extra hurdle” going through school with co-occurring diagnoses. At the foundation of this extra hurdle was students not receiving proper mental health diagnoses. Participants cited “parental concerns and stigma” related to mental health, leading to many students “not coming in properly diagnosed around mental health” in high school and college. Similarly, participants reported that other professionals (e.g., teachers, school psychologists, school clinicians) often failed to acknowledge that possibility of a dual diagnosis. Rather, these professionals focused on a single primary diagnosis such as autism or intellectual disability, dismissing that “there are some real physiological things going on:” “It can’t be autism and this other mental health thing [sarcasm]. It can only be one or the other [sarcasm]. That’s just not true!” As a result, participants indicated that professionals end up “addressing all of these other [disability] issues except the mental health component…there are so many students in our school that aren’t getting service in the way they need.”

Participants reported that students with more significant support needs (e.g., traumatic brain injury, cerebral palsy) were more likely to be “written off” and not receive mental health services without the presence of strong family advocacy: “From the school I hear it’s just the disability. But from the families, the louder ones…the ones…with a little higher SES and more time to devote to these thoughts and ideas, they are presenting it [mental health] as an idea. They’re seeking out counseling opportunities outside of school.” On the other hand, another participant noted that “some of these kids, especially if they’re high functioning, can kind of stumble through school… we’re just trying to get them through their day because they’re having a panic attack or whatever…” without formalized mental health support.
 

Academic and Social Pressure

Participants described how “so much [academic] pressure” from educators, families, and other students caused “kids to get so distressed over the pressure to succeed- in this [geographic] area especially.” Participants emphasized the affluent areas in which their students lived as a factor magnifying mental health needs due to the culture of achievement, and community pressure to succeed. One participant working in a high school discussed how public demonstrations of valuing achievement were particularly difficult for some students with D/MH:
 

 At the graduation [ceremony] every year they do this thing where they have all the kids stand up that are a 4.0 GPA or higher. And that’s great, but how about the kids that are maybe not as high achievers, but made big strides?
 

Participants noted that students internalized this achievement culture and “family pressure,” feeling that they fall short when not achieving the standards established in and celebrations. Participants stated that in elementary school, students are “so much more engaged and seem happier,” but as they age and learn about their “shortcomings,” they “just kind of feel hopeless” and “give up after a while.” Participants reported that “they just feel like they’re never going to catch up and that’s just adding more stress.”

One participant working in a high school observed that additional stress also manifested when students with D/MH compared themselves to their “Gen[eral] ed[ucation] friends around them doing well or making honor roll.” They agreed that this increased stress presented as “a little bit of an attitude thing” toward teachers because students feel like “what’s the point?” Negative behaviors and stress also seemed to increase as students with D/MH came “close to graduation and probably think….what am I going to do next [after high school]?”

Mental health pressures for students with D/MH were also heightened by social pressures related to “struggles with sexual orientation and gender identity.” Participants reported that while some students are “more comfortable with [negotiating identities],” others “don’t know how to express it or think their parents aren’t going to accept them.” Pressures from these situations caused students to feel especially “anxious and avoid school a lot.” Participants noted that educators sometimes served as a safe space for students to discuss their identities when they felt uncomfortable speaking to their families who were “trying to like funnel [students] into being what they wanted [students] to be.” Beyond sexual orientation and gender identity, participants indicated that some students just wanted “to express themselves in different ways” through music, clothing, or appearance (e.g., hairstyle, clothing). However, as students with D/MH made postsecondary decisions, one high school participant noted that “sometimes it does help them to get away from home a little bit” to find a space where they can explore their identity with greater freedom.

Transition Out of High School

Participants recognized that high school students with D/MH who attend higher education continue to internalize academic, social, and “family pressure to go to college,” causing increased mental health issues such as anxiety and depression. Typical stress associated with transitioning to higher education (e.g., navigating campus resources, adapting to college-level coursework, student loans, selecting a college) were especially stressful for students with D/MH who were the first in their family to attend college. Such uncertainty resulted in additional mental health barriers for many of these students as they “navigate these waters all by themselves and pay for stuff by themselves.” In these situations, participants noted that “sadly, the student usually ends up failing out [of higher education] because they just can’t keep up with the curriculum” and stress of school.

However, higher education participants indicated that DSO staff tried to support students through accommodations such as “priority registration…which is great because students who are taking certain medications for mental health may say…I can’t take a class before 11:00.” That said, participants described the importance of students having the ability to “talk about their disability, how it impacts them, [and] what helps” to ask for and receive appropriate accommodations in school (especially in higher education settings). Unfortunately, higher education participants noted that some students with D/MH did not “know why they received a certain accommodation in high school” or “expected to get the same accommodations [from high school] and they look a little different [in higher education].” Moreover, participants working with students in higher education indicated that students were frequently “surprised” that they had a dual diagnosis (“Oh I see you’re diagnosed with anxiety and depression. ‘No. I’m here for a learning disability.’”). When this occurred, higher education participants had to “do that whole grieving cycle that people go through when they are grieving.”

Barriers Experienced by Professionals

Participants identified barriers they experienced when attempting to provide comprehensive support to students with D/MH. These barriers included: (a) professional tension, (b) limited training and professional development, and (c) structural barriers in schools.

Professional Tension

One participant simply stated, “I’m not prepared. No one else is prepared either” – a sentiment shared by all participants (e.g., “We need more [college] courses in….mental health or counseling…because you’re dealing with that stuff all the time.”). While participants felt woefully underprepared to support the mental health needs of students with dual diagnoses, they reported that school-based clinicians such as school counselors and social workers with training in mental health were rarely prepared to support students with D/MH due to the nature of their disabilities. Participants described a “huge disconnect” between mental health and disability services and the problematic nature of “arbitrarily assigning [school clinicians] to students,” given the need for them to know how to support co-occurring diagnoses. Further, participants became “frustrated” by varying levels of “buy-in” to support students with D/MH from school and clinical staff, as well as inconsistent responses to the mental health needs of students with D/MH.

This lack of preparation created tension among participants and school clinicians. Participants indicated that they “wouldn’t talk” to school clinicians because counselors and social workers “just deferred” students with dual diagnoses back to participants – particularly for students with significant support needs. As a result, participants referring students out for mental health support created a cycle that ultimately delayed or resulted in students never receiving needed mental health support. Further, high school participants reported insecurity approaching clinical staff with mental health concerns for students with disabilities: “I would never say I think [student with a disability] has depression or is depressed…I would never say that in my building to the clinical team, because I have no right. I’m not trained…yeah, I don’t think I’d be heard.”

This tension participants felt between themselves and school clinicians led to deep concerns about their ability to provide adequate support for students with D/MH. For example, one participant noted that “kids with emotional disabilities get more support, whereas the kids that have intellectual disabilities or autism [receive fewer mental health supports]” from clinical staff in school.

Limited Training and Professional Development

Participants desired professional development on how to identify and support students with D/MH: “You don’t have training…there’s no curriculum for you…you’re just kind of put in that position and trying to do the best you can do.”). Participants described how previous college courses and professional training provided perfunctory information on how to react when students exhibit detrimental behaviors (e.g., removing the student from the classroom, counselor referrals). However, such training did not provide participants knowledge or instruction on how to proactively identify mental health needs or prevent student mental health crises: “We kind of wait until a kid is in crisis before we step in.” Further, one high school participant noted:
 

It’s more reactive than proactive because something has to happen before there’s like a significant plan in place or when the team convenes- like last year one of the students threatened another student. And we would do a threat assessment and then come up with a support plan. But there was really no proactive strategies being taught to the teachers of what to do. So it’s definitely…it’s more reactive.
 

Further, while professional development trainings in which they did participate addressed mental health disparities among students of “different races, different SES,” trainings never discussed students with disabilities (i.e., D/MH).

Professionals also described monotonous professional development: “It’s got to be more than a PowerPoint.” Professionals indicated that professional development about students with D/MH needed to include information on mental health strategies “and then how we can integrate it [into existing responsibilities]” to reduce feeling like the strategies are “one more thing” to integrate into their work.
 

Structural Barriers in Schools

Participants described structural barriers (e.g., school policies and processes) that hindered their ability to support students with D/MH. For example, high school participants expressed that current policies and practices to address ongoing behaviors they believe likely stemmed from mental health issues such as in-school suspension were ineffective “because if they’re removed from the situation, not only does it isolate them from the other students, but it….trains them to think I don’t have to deal with everyday life.” However, high school professionals also noted a bond between in-school suspension staff and students with D/MH. “…[in-school suspension] teachers end up forming the strongest bonds with the most difficult students. Those are the strongest relationships you’ll see in the building.” These participants discussed that the in-school suspension space was intended to be a restorative setting rather than therapeutic, however, this is commonly the only space students with D/MH have that is a “safe place,” describing a gap in more effective service provision.

Similarly, one higher education participant noted that counselors were available for students but the “campus didn’t have mental health services.” These counselors assisted with academic planning, however, the mental health counseling provided was “just because they have the skills and care [about the student]…we referred out for all our [mental health] services.” High school participants also reported that they had counselors and social workers on staff to “handle the immediate threat” but that “not really doing therapy.”

Participants also noted a lack of systematic ways to facilitate collaboration across departments and disciplines (e.g., general and special education, DSO and residential staff) to provide the most effective support possible for students with D/MH. Unfortunately, participants also discussed multiple barriers preventing them from achieving such partnerships (e.g., lack of established time to collaborate, a lack of trusting relationships, misinformation about disability and mental health diagnoses).

Further, a lack of qualified school-based clinicians also emerged as a structural barrier among participants. As one high school participant noted: 
 

We have one social worker, one clinical psychologist who’s with us for four days and then two full time school counselors. So the school counselors divide up the grade levels and the social worker and the psychologist work with all grades…But a lot of these situations – like I’m orchestrating everything. So it’s a lot on me as the administrator.
 

Along these lines and as previously discussed in a different context, other professionals stated that they were sometimes “hesitant” to discuss student mental health issues because existing referral services and procedures were disjointed and slow, due to a lack of planning time and resources (e.g., staff).

Participants highlighted an additional structural barrier related to academics. Specifically, a lack of “policies and practices” to ensure that students with D/MH received appropriate accommodations and modifications based on their disability and/or mental health disorder. For example, several high school participants needed mental health interventions that included accommodations and modifications for students with more significant support needs:
 

What if my guy [is] not talking? What if my guy is using a talker or just communicating mental health problems in a different way? How are we reporting that? How do I fill that out in a quick, easy form because we have a lot of the same programs that they roll out for the whole school, but what they roll out for the whole school in all classes is not really the same in a self-contained classroom… I don’t know how to reach out for help if I don’t have clear guidelines…
 

Further, higher education participants indicated that although many faculty were “willing to be lenient” in providing students needed accommodations, staff must first obtain permission from students to share information with faculty and many students with D/MH preferred not to disclose their disability, or, as mentioned, were unaware that they had dual diagnoses. While understanding and respecting this federal policy, many participants suggested that there should be additional systems or processes to address student needs in such scenarios.

Discussion

The purpose of this study was to examine high school and higher education professionals’ perceptions of factors exacerbating mental health needs among students with D/MH, and barriers professionals experience in supporting these students. Participants identified (a) missed diagnosis and unmet needs, (b) academic and social pressure, and (c) transition beyond high school as factors exacerbating mental health needs among high school and college students with D/MH. They identified (a) professional tension, (b) limited training and professional development, and (c) structural barriers in schools as barriers they experienced while attempting to support students with D/MH. Several of these findings reinforce existing literature.

Our findings indicate that existing policies and procedures reactively address students’ behavioral and mental health needs (e.g., in-school suspension, referring students to community mental health services), which has been shown to be less effective in shaping student behavior than preventive or proactive approaches (e.g., professional development to address student needs, reducing mental health sigma; Gonsoulin et al., 2012). Participants shared that high school students with D/MH frequently developed “bonds” with staff with whom they interacted during punishment, such as in-school suspension. Interestingly, seeking “bonds” was also seen in higher education, as professionals shared experiences of students with D/MH seeking emotional support from educators to discuss topics such as gender identity. These findings are consistent with literature sharing benefits of mentorship for students, including improved well-being, executive functioning and use of campus services and resources (Anastopoulos, & King, 2015; Francis et al., 2020). Unfortunately, participants noted a lack of formal avenues for mentorship and creating “bonds” for students with D/MH across high school and college.

Further, findings identified structural barriers such as lack of systems and procedures for professionals to support students with D/MH (e.g., school policies and processes), as well as too few knowledgeable disability and clinical professionals to provide adequate services. These findings reinforce literature documenting the perspectives of students with D/MH in which they identified a lack of school-based services equipped to address both their disability and mental health diagnosis (Francis et al., 2019; Jackson et al., 2017). Further, this is consistent with barriers, such as lack of clinician knowledge or expertise in disabilities such as autism, in which therapists are unable or unwilling to tailor approaches to support individuals with disabilities (Adams & Young, 2020). Whereas previous literature provides perspectives of students or parents (Adams & Young, 2020; Francis et al., 2019; Jackson et al., 2017), the findings of this study are unique as participants (i.e., high school and higher education professionals) identified lack of disability and mental health integration among themselves and colleagues (i.e., clinical professionals) serving students with D/MH. This perspective provides another vantage point toward a more holistic view of supporting students with D/MH.

Information about student-centered approaches was largely absent from participant discussions, which is somewhat incongruent with the intent and provisions of IDEA (2004) and Section 504 (1973). This may lead one to question the degree to which mental health is considered and/or prioritized in IEP or Section 504 plans across high schools and higher education. In addition, study findings also highlighted a lack of comprehensive cross-disciplinary preparation and collaboration to support students with D/MH. To this extent, Figure 1 illustrates (a) the gap in services that exists between participants (i.e., high school and college professionals) and clinical professionals and (b) the problematic cycle of referrals participants described between professionals with expertise in disability and professionals with expertise in mental health. These findings highlight a need for formalized multidisciplinary training and development for both groups of professionals so that they can bridge the gap and provide comprehensive support to students with D/MH.

Participants also shared their desire for professional development that addresses disabilities, mental health needs, and dual diagnoses, indicating that they did not feel prepared to support students with D/MH and lacked collaborative relationships with other professionals. Unfortunately, this finding is consistent with literature documenting the professional need for mental health training (Poppen et al., 2016).

Figure 1. Gap in Services and Referral Cycle Between High School and College Disability Professionals and Clinical Mental Health Professionals 

             

Professionals described how undiagnosed mental health needs prevented high school and college students with D/MH from receiving appropriate support and accommodations, especially in the absence of family advocacy. These findings are consistent with literature documenting the difficulty of individuals with disabilities acquiring appropriate mental health diagnoses and the importance of familial support (Francis et al., 2020; Wark, 2012). Further, the impact of pressure to excel in school on student mental health is well-documented (Clayson, 2015; Hubbard et al., 2018). The same is true of enhanced stress, anxiety, and depression among students with disabilities as they transition out of high school (Poppen et al., 2016). Existing literature documents the mismatch between traditional mental health intervention approaches and the specific needs of individuals with D/MH, thus exacerbating unmet needs among these students (Francis et al., 2020; Milligan et al., 2015).

Our findings contribute to the existing body of research in several ways. First, this study adds to a limited body of research focused on high school and college students with D/MH (Francis et al., 2019). The perspectives and experiences of professionals working with students with D/MH are a vantage point that provides a rarely seen, comprehensive view of factors and barriers that contribute to negative outcomes among these students in high school and college.

Secondly, existing literature documents the impact that family and community pressure have on student mental health, but this study affirms that students with D/MH are also impacted (perhaps more so) by this pressure as they observe their “shortcomings” when they compare themselves to other students, “giv[ing] up after a while.” Additionally, given the importance of rights and services afforded to students with D/MH under IDEA (2004) and Section 504 of the Rehabilitation Act (1973), it was surprising that participants did not discuss IEP or 504 accommodations, services, or goals for students with D/MH, as these plans guide student outcomes, provision of services, and collaboration across multiple stakeholders (e.g., educators, providers, school clinicians, families).

Limitations

Although the goal of qualitative research is not to generalize across populations (Bogdan & Biklen, 2007), this study had a relatively small sample size with 13 fairly homogeneous participants (e.g., gender, race). This diminishes the ability to ensure the findings of this study are consistent with a larger sample of professionals working with high school and higher education students with D/MH. Additionally, while several aspects of the findings were consistent across the two groups, focusing on one of these groups and specific subgroups (e.g., department faculty, residential staff, high school counselors) would establish more focused data that could potentially yield more specific recommendations in high school and/or higher education settings.

Implications for Practice

This study resulted in numerous implications for practice. First, the findings suggest that school systems should consider structural changes (e.g., monthly co-led meetings between clinicians and other professionals) that would provide tiered levels of mental health interventions and support to students with D/MH. Secondly, high school and postsecondary professionals would benefit from professional development opportunities that include engaging and thought-provoking activities (e.g., problem solving, application activities, journaling, team building). All school personnel should participate in order to enhance cross-disciplinary knowledge and collaboration, thereby alleviating the tension described by participants.

Cross-disciplinary preservice coursework that focuses on supporting students with D/MH would enable professionals across disciplines (e.g., social work, higher education, special education, education leadership, counseling) to enter the workforce prepared to collaborate and provide meaningful support to students with D/MH. K-12 school systems should also integrate disability and mental health training information into orientation programs for incoming educators and staff. These trainings could be developed and/or presented in collaboration with community organizations such as mental health providers and regional Parent Training and Information Centers to bridge gaps between school systems and community resources. This type of school-community collaboration has the added benefit of easing some of the stress associated with the transition from school to adulthood, as students begin to learn about and access community resources prior to graduation.

High school and postsecondary professionals should consider infusing the principles of Universal Design for Learning into their work, to ensure that students with varying levels of support needs can access materials and activities (Kennette & Wilson, 2019). Systematic use of practices that focus on multiple methods of representation, engagement, and expression would increase the level of support provided to students with D/MH.

Additionally, school systems should consider creating formal mentoring systems to facilitate more systematic and meaningful “bonds” between students with D/MH and school-based professionals in a positive, non-punitive approach. Schools may also consider developing peer-to-peer support groups for students, including those with D/MH, to offer a safe space to discuss issues such as gender, racial, and disability identities as well as other sensitive topics that adolescents and young adults commonly experience. These mentoring and peer support relationships could also provide support when students with D/MH encounter academic and social pressures

Finally, and most importantly, all intervention and support efforts must be developed in collaboration with high school and higher education students with D/MH.  Student voice and leadership must be incorporated into all planning efforts in order to respect and honor the voices and perspectives of the students themselves.

Future Research

Although research demonstrates the importance of mental health among high school and higher education students (Oswald et al., 2017), there are limited details about the importance of mental health among students with D/MH (Francis et al., 2019). As a result, future research on student mental health should include students with D/MH, as well as the research-based practices that may work best for this group of students. Further, given the limited sample size of this study, future research should include a larger and more diverse sample of professionals to provide a better understanding of the nuances and unique perspectives of participants across geographic location and personal identities. Additionally, there is a need to study high school and higher education professionals separately to uncover the differences in experiences, and student support systems across these settings. High school and higher education settings are structured and governed differently (e.g., Individuals with Disabilities Education Act, Rehabilitation Act, Family Education Rights and Privacy Act), therefore future research focusing on the differing environments, policies and practices would allow for greater precision in practice and policy implications.

Professionals noted the pressure of students with D/MH to attend college and the particular stressors experienced by first generation higher education (e.g., navigating higher education systems, financial costs, decision-making). Given that first-generation students acquire greater student loans than their non first-generation peers (Furquim et al., 2017), future research should explore the financial burdens of higher education costs for students with D/MH and how this may apply additional pressure for students to succeed. Additionally, given the important role of family in students decision-making (Heifetz & Dyson, 2017), future research could explore family influence on college decision-making among students with D/MH and the influence of the decision-making process on student mental health.

Further research on the complex needs of high school and postsecondary students with D/MH and the specialized skills needed by professionals working with these students are needed. Research including case studies, cross case comparisons, and intervention studies would provide a deeper understanding of the needs of and most effective supports for high school and postsecondary students with D/MH. Further, integrating the findings of studies exploring the perceptions of students, family, and professionals will provide a more comprehensive look at high school and college students with D/MH and show where parent and professional perceptions converge and diverge from the perspective of these students. Finally, future research should consider conducting an appreciative inquiry (Cooperrider & Whitney, 2005) at high schools and higher education that effectively address mental health needs among students with D/MH to learn about effective practices and to inform policies and solutions to barriers among professionals serving students with D/MH.

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About the Authors

Megan Fujita, Ph.D., MSWreceived her doctorate in education policy from George Mason University and her Master’s in Social Work from the University of Michigan. Her professional interests include postsecondary decision-making and supports among college students with disabilities. She has several years’ experience as a higher education administrator and social worker, and currently holds a faculty affiliate appointment at George Mason University’s College of Education and Human Development.

Grace L. Francis, Ph.D. is an associate professor of special education at George Mason University. Her research interests include family-professional partnership policies and practices that result in a high quality of life for individuals with significant support needs and their families and transition to adulthood.

Jodi Duke, Ed.D. is an Associate Professor of Special Education in the College of Education and Human Development in the School of Education at George Mason University and serves as the Academic Program Coordinator for the Autism Spectrum Disorders Graduate Program. In these roles she teaches graduate level courses in Special Education and Autism, mentors doctoral students and coordinates the online Autism Spectrum Disorders graduate program. Her research interests include transition, supports and services for college students with Autism Spectrum Disorder including mental health supports.