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Rural reality

After every class, 13-year-old Isaiah Remington asks fellow students for their notes.

From his desk, he can’t make out the letters and numbers on the white board. It’s why he’s failing science, he said.

Three years ago, his mom bought him a $200 pair of glasses to correct his nearsightedness, but within two weeks, his sister broke them. And he’s gone without ever since.

Isaiah said he’s given up asking his mom for another pair.

“She just can’t really afford it,” he said.

Neither can his school, Rogue River Jr./Sr. High School. While the school has purchased glasses for students using money from its crisis fund, the fund — $200 this year — must also go toward meeting students' immediate needs, such as school supplies, caps and gowns, clothing and college application fees.

Furthermore, the Rogue River School District does not have a school nurse or mental health counselor on staff, nor does it have a school-based health center or even access to one of La Clinica’s mobile health units.

“We can’t do anything,” said Principal Jamie Wright.

The school’s front office staff are trained by a Southern Oregon Education Service District nurse to administer prescribed medications to students. Beyond that, staff are limited to getting students Band-Aids or ice and calling their parents, Wright said.

In Isaiah’s case, a school nurse would be able to refer him to an optometrist or help his family navigate the paperwork necessary to apply for health insurance, Wright said.

Even with health insurance, however, students’ health care options in the rural community are limited. Their health needs and their families’ health needs often go unmet, said Rogue River Superintendent Paul Young.

“Healthy children learn better,” Young said. “That is a simple fact that is inarguable. Children whose families aren’t well don’t receive the same support as children whose families are healthy. From a strictly educational vantage point, increasing the health of the families of this school district will help us to meet our fundamental mission, which is the education of those students.”

Last spring, La Clinica arranged for two Oregon Health & Science University students, Laura Biddle and Vaughn Kelly, to conduct a Rogue River Health Needs Assessment as part of their population-based health class.

The students collected data from an online survey distributed to the Rogue River School District, the Rogue River Community Center, the Rogue River Press and the general public, and conducted focus groups within the community.

According to the 2010 U.S. Census, 19.7 percent of Rogue River’s residents are living below the federal poverty line. While Grants Pass and Medford have slightly higher poverty rates, Rogue River’s results are skewed by a few much higher-income residents, Biddle and Kelly said in their report.

The town’s median household income is $28,344, according to the Census.

Vaughn and Biddle’s assessment revealed that residents were “desperate for mental health resources, healthcare access, and a school-based or community health clinic,” and they noted a lack of transportation as a "major barrier preventing them from obtaining healthcare.”

The town of just over 2,100 people has just one health clinic, Rogue River Family Practice Clinic. Office manager Mary Taylor said three of its four providers are accepting new patients.

However, the clinic only accepts Oregon Health Plan patients on an AllCare Health plan. (AllCare Health is one of the three coordinated care organizations serving Rogue River OHP members. The other CCOs are Jackson Care Connect and PrimaryHealth of Josephine County.)

Because of the lack of health care options in Rogue River, residents must drive 21 miles south to Medford or 10 miles west to Grants Pass for care.

Josephine Community Transit has operated the Rogue Valley Commuter Line from Grants Pass to Medford with a stop in Rogue River since September 2014, thanks to funds provided by the Middle Rogue Metropolitan Planning Organization. However, these funds will run out and need to be replaced in 2018, said Scott Chancey, the transit program supervisor.

The line operates five days a week and offers five northbound times and five southbound times from Rogue River.

But for a single mom with young kids and no car, an appointment in Medford means taking time off work, packing up the whole family, walking to the bus stop, riding the bus 30 minutes to Medford, walking to the doctor’s office, going to the appointment, and then making the long trip home, Young said.

And students making the journey alone miss school.

Of the 360 students enrolled at Rogue River Jr./Sr. High, fewer than 40 drive themselves to school. And many families don’t have a car or share a car, Wright said.

“We can arrange rides for kids into town (through the Maslow Project or another organization), but they have to qualify as a homeless student or be in a crisis situation,” she said. “There are no preventative rides.”

Bailey Bowen, 15, a sophomore, estimated she missed at least two hours of school every week for about two years while she was seeing a mental health therapist, first at Jackson County Mental Health in Medford, and later at Family Solutions in Grants Pass. She said it was about a 30-minute bus ride via Rogue Valley Transportation District’s Translink Medicaid program, an hourlong appointment and a 30-minute trip home.

She stopped seeing a therapist earlier this year because she thought she was doing better and because her OHP lapsed and her dad’s insurance did not cover mental health visits.

Bailey said she has frequent — at least once a week — anxiety attacks and outbursts.

“I punch walls a lot because I get angry,” she said.

In September, she broke her right hand punching a wall. Her friends splinted it for her, but she chose not to tell her parents or see a doctor and, instead, wrapped it herself, popped her pinky finger back in place and tries to exercise it regularly. Fortunately, she’s ambidextrous, so she could still take notes in class.

“I wish I would have went (to the doctor) because now my pinky doesn’t straighten, and I don’t think it’ll ever be straight again,” she said as she tried opening her hand.

Bailey said she also frequently has to leave class because of anxiety attacks.

“I get dizzy and nauseous and can’t breathe and have really short breaths and have to go to a sick room and take my medication,” she said.

The school’s only academic counselor, Erika Ochoa, has a caseload of 360 students.

“When she’s having attacks, sometimes I’m not available,” Ochoa said.

“There is no way I can, with my caseload and all the hats I have to wear, be able to provide the level of mental health support that is needed for some students,” she said.

Wright said the district has worked with Grants Pass-based youth mental health provider Kairos to obtain 10 slots with Jackson County Mental Health, but she can think of about 30 at her school alone in need of a “capable, trained adult” who can devote an hour to counseling them.

“Every kid has a bad day, and it’s nice to have a person there,” Wright said. “Between all the people that aren’t teachers we make it happen, but we’re not trained therapists … and we’ve got to do school in addition to helping them through a crisis.”

While the school doesn’t have an in-house mental health counselor, Wright said she was grateful to OnTrack Inc. for writing a grant for the school to get a drug and alcohol counselor.

Young and Kathy McCollum, who was the district’s director of special programs but retired last June, realized the need in the district and community and began looking for ways to pay for a school-based health center to serve students and their families.

Most school-based health centers are staffed by a sponsoring medical agency with a registered nurse, nurse practitioner or doctor and sometimes a mental health therapist, explained Ed Smith-Burns, La Clinica’s outreach director.

“Grant funding is focused on start-up costs, and there is the expectation that the site become self-sustaining through billing for health services,” Smith-Burns said, adding that there would be a sliding fee scale, based on family income, for individuals without insurance.

“Centers are open to students and siblings (under age 18), regardless of whether they are school-age or at that school,” he said.

Rogue River is the only school district in Jackson County without either a school nurse or a school-based health center. Prospect, Butte Falls, Ashland and Phoenix-Talent school districts each have one school-based health center. Medford, Eagle Point and Central Point school districts each have three.

Medford, Ashland, Central Point, Eagle Point and Phoenix-Talent also have at least one school nurse.

Rogue River, with help from San Diego-based grant writer Jesse Hanwit, applied for a grant in 2014 through the Northwest Health Foundation in Portland. (Hanwit helped to bring school-based health centers to the Central Point School District.)

“(The agency) was looking to set up collaborative relationships between organizations to improve the availability of medical care to people who were underserved,” Hanwit explained.

“We got together with La Clinica, and we thought we had a pretty good proposal because there was a lot of need in Rogue River, but there also was a lot of competition,” she said.

The district did not get the grant.

Earlier this year, the district applied for a $60,000 planning grant through Oregon Department of Health and Human Services that would allow it to begin working with its medical partner, La Clinica, and start making arrangements for the site.

But there was only one grant available to the entire state of Oregon, and it went to a remote county without any school-based health centers, McCollum said.

“I think it was the lack of data that prevented us from getting grants in the past, so I’m hopeful that with this kind of data (the Health Needs Assessment), we’ll be able to get it,” said Young.

In the meantime, the district hopes that there will be an opening for La Clinica’s mobile health unit. Currently, the mobile health unit is being repaired in Iowa, but it should be in working order by the end of the month.

The mobile health unit makes visits to Phoenix High School, Set Free Christian Fellowship, the First United Methodist Church of Ashland, OnTrack’s Home Program, the Jackson County Work Center, the Gospel Rescue Mission and St. Vincent de Paul.

“We really, really would like to provide (Rogue River) services, and they are on our radar to see if we can provide them with mobile health services on a regular basis,” Smith-Burns said.

But first La Clinica would test the site by visiting there a few times to gauge the response.

“If it’s positive, then we would schedule them on a more regular basis,” he said.

April Harrison, the district’s grant coordinator and director of special programs, said there are plenty of students and families needing dental, preventive and primary health care to fill the mobile unit’s schedule.

La Clinica told Harrison that at least five patients needing medical care and six needing dental care would need to visit the unit when it's in town to justify making the site a regular stop.

“In a perfect world, we would have them here every week … but we’ll take whatever we can get,” Harrison said.

The data collected by La Clinica also could help to secure a grant that would allow the district to build a physical structure, she added.

“Right now we’re just waiting for a phone call from La Clinica saying that they got a bunch of money or that there’s been an opening for their mobile health unit,” Young said.

Currently, La Clinica visits the elementary school twice a year as part of its Happy Smiles Dental Outreach Program, which is grant-funded through the Oregon Community Foundation. The first visit is to provide screening, sealant placement and fluoride treatments and includes an education component. The second visit is to do a second application of fluoride treatments.

“We provide dental kits with toothbrushes, toothpaste, dental floss and other oral health preventative materials, to all students at the elementary school,” Smith-Burns said.

“We also provide a letter for parents and give a copy to the school,” he said. “It indicates whatever follow-up services need to be done and explains different ways that they can access those services in the community whether they have a dental provider or not.”

In 2015-16, La Clinica handed out 430 dental kits to Rogue River students, conducted 175 dental screenings and 269 fluoride applications, and sealed 111 teeth.

And for the last two summers, La Clinica’s mobile health unit has visited the elementary school and offered free dental, vision and medical screenings to summer school students and their families, said June Safko, a kindergarten teacher and coordinator of the summer school program.

“So often we’ve got kids coming to our door with fevers or throwing up, but mom and dad have to go to work,” Safko said, adding that many parents don’t have day care or can’t afford day care or staying home.

“The big idea is that if our kids are healthy, they are in school learning,” she said.

Last year, Calvin Bertik, 16, a junior at the high school, estimated he missed between 10 and 15 days of school due to illness or injury.

“I’m quite the klutz,” he said. “I can get hurt from a pencil, and I get sick a lot because there are a lot of family (10 to be exact) at my house.”

This year alone, Calvin has been seriously injured at least three times. About a week ago he had a root canal because he shattered the bone above his teeth rough-housing at home.

Calvin said he is insured, but his mom had to use the money she was saving for his braces to cover the out-of-pocket expenses for the procedure.

Calvin also has broken his arm and pinky and hurt his ankle. He said having a school nurse would be helpful and save his mom a lot of trips from Grants Pass to pick him up or bring him medication for a headache.

“I’m a bit of a hypochondriac,” he admitted. “I’m a momma’s boy and that’s where it got me.”

When Calvin gets sick or hurts himself, he said he goes to the office where they call his mom or send him to his physical education teacher for ice.

In addition to school nurses, Calvin said the school also needs some “cooler-looking Band-Aids.”

“Like Spider-Man,” he suggested.

Reach education reporter Teresa Thomas at 541-776-4497 or tthomas@mailtribune.com. Follow her at www.twitter.com/teresathomas_mt.

Bailey Bowen, 15, a sophomore at Rogue River Jr./Sr. High, has broken fingers from punching a wall. She missed at least two hours of school every week for about two years while going to Medford and Grants Pass for mental health visits. Mail Tribune / Denise Baratta
Rogue River Jr./Sr. High School counselor Erika Ochoa listens as student Calvin Bertik, 16, describes his various mishaps. Without a school nurse, Rogue River staff are limited to administering prescribed medications and providing Band-Aids for students. Mail Tribune / Denise Baratta