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For all referrals included in the studied school years, two referral types,
“emotional” and “behavioral,” were most often identified as the reason for referring
a student for school-based mental health intervention. “Emotional” was the most
frequently cited, making up 40% of the overall referrals. A chi-square test found that
there was a statistically significant difference between the means of the six school-
based mental health referral reason groups [F (5, 24) = 24.17, p = 1.21].

Research Question 3: What pattern may be occurring between the number of
students with and those without identified disabilities within the school-based
mental health referrals completed over the 5 (2015 to 2020) consecutive school
years?
RQ 3 examined the number of students identified as having a disability and
receiving special education services or having a Section 504 accommodation plan.
Students being served in special education or with 504 accommodations accounted
for an average of 17.95% of the total student
population over the 5-year period from 2015–
2016 to 2019–2020. The researchers performed
a frequency count to identify the numbers of “Emotional” [referral types were]
these referrals. Referred students identified
as having a disability represented a total of the most frequently cited, making
25% of the overall school-based mental health up for 40% of the overall referrals.
referrals, whereas students not identified as
having a disability represented 75% of all
referrals. The hypothesis for RQ 3 maintained
that there would be equal representation between those referred and identified as
having a disability and their typical, referred peers who were not identified as having
a disability. The null hypothesis was not accepted, and the alternate hypothesis was
accepted as there was a significant difference between the number of referrals made
for students without a disability and those with a disability.

Research Question 4: What patterns may be occurring among students who
were identified as having a disability within the school-based mental health
completed over the 5 (2015–2020) consecutive school years?
For RQ 4, the researchers performed a frequency count to determine the most
frequently referred disability served in special education for the 2015–2016 to
2019–2020 school years. Eight categories—traumatic brain injury (TBI), emotional
disturbance (ED), specific learning disability (SLD), speech impairment (SI),
hearing impairment (HI), other health impaired (OHI), intellectual disability (ID),
and autism (AU)—represented the disabilities found in this analysis. The frequency
count determined that other health impairment and specific learning disability were
the most common disabilities of those identified for special education and referred
for school-based mental health services. Special education eligibility includes
students labelled with attention deficit disorder under the category of other health
impairment. According to a 2016 national survey of parents, six in 10 children
(64%) with ADHD had at least one other mental, emotional, or behavioral disorder
(Danielson et al., 2019). Students with learning disabilities may also present with
co-morbid mental health issues (Sahoo et al., 2015). Table 3 provides a summary of
the frequency and percentages of special education referrals by category.

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