Giving Thought: In-depth care for students and families
Most children have seen a school nurse for a splinter, playground scrape or a persistent cough.
But what if a child has deeper physical or psychological troubles that hamper learning in the long term? That would require a health clinic with real bandwidth to address medical, behavioral and dental health. Such a thing already exists at four schools within the Roaring Fork School District.
Lisa Robbiano, a family nurse practitioner and medical director of the Roaring Fork School Health Centers, says school is an ideal place to provide health care.
“The kids can access the care they really need, and I can follow up with them every day if I need to,” says Robbiano, who works at school but is employed by a separate nonprofit. “I love doing this, even after 12 years.”
Aspen Community Foundation: What’s the current state of Roaring Fork student health?
Lisa Robbiano: Overall, I would say kids are under stress, whether they were born and raised here or just moved here. With social media, especially the high schoolers tend to feel that everyone else is having way more fun than they are and that they can’t do enough to get into the right colleges. Parents in this valley are under stress to simply provide for their families. Prices are astronomical and there’s a ripple effect to that stress.
Overall, Colorado is one of the healthier states, but not necessarily in the realm of mental health. And there’s still a large percentage of obesity and substance abuse. Our district does fairly well when compared with other schools statewide. We have more participation in extracurricular sports, kids feel safe here and there’s less bullying. On the other hand, we have some more vaping and alcohol use than in other places.
ACF: Describe the kids you see. Is there a typical student patient?
LR: Basically, we serve the kids who are uninsured or uninsurable. The typical kid who comes in has been sitting in class, not doing well. The staff is concerned, so they reach out to the parents, who say, “We just moved here.” If the student comes in, we’ll start with a physical and a screening to ask about health risks and adverse events in childhood. We have a lot of newcomers from El Salvador, Nicaragua, Honduras, who have lived with poverty and trauma, so they have both emotional and physical issues. Some have never seen a medical provider.
We try to educate them about their physical well-being and then, if they’re suffering from anxiety or depression, we connect them with a behavioral health person. If they haven’t had their teeth cleaned in the last six months, then we get them an appointment with our dental hygienist. Many children have never seen a dentist and have very poor oral health.
Another example is the kid who wants a wellness check to play sports. While doing that, we’ll find out that the father died of a massive heart attack at 39. We’ll ask, “Have you ever had your heart looked at?” If we find a murmur, we’ll refer them to a cardiologist. That’s a relatively easy case, without the psychosocial elements.
But maybe that kid is being emotionally abused by the mother, who is depressed because the father died. In that case, we’ll get both mom and student into therapy. We collaborate with many agencies and coordinate care for all our patients.
Meanwhile, we’ll make sure the family gets to the appointments and the reports come back to us. We’ll make sure the blood work gets done. We’ll ensure that our dental hygienist, our behavioral therapist and our medical person all speak together about the case.
ACF: Not all schools have health centers. Where do health care and education intersect?
LR: Kids have to be healthy to learn. With our kids, it can be anything from a divorce to a murder in the family to there’s no food for breakfast. It all affects a kid’s ability to learn, so additional resources are needed for successful learning to happen. We provide in-depth care. We can spend two hours with a student, and we often do. We make sure all of our quality measures are met.
ACF: What’s new or on the drawing board for the health centers?
LR: We’re hoping for expansion through the valley. The dream is to have at least one school-based health center in each of our attendance centers (Basalt, Carbondale, Glenwood Springs). Right now Glenwood really wants one.
Kids are incredibly resilient if they have a steady source of support.
Tamara Tormohlen is executive director of the Aspen Community Foundation.
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