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How an Iowa nurse practitioner helps fill state's rural mental health gap

Updated: Jan 5

This article was originally published in the Paragraph Stacker by Daniel Finney

Karla Dzuris sobbed in front of the video conference screen.Sue Gehling, a psychiatric nurse practitioner and owner of Classroom Clinic, was on the other side of the telehealth call.


Karla came to Sue about her son, Mason, a fifth grader at Greene County Elementary School.


Mason struggled with behavior. His mood swings and fits of anger frequently landed him in the principal’s office. Mason hated school. He would do or say almost anything to get out of doing his classwork.


Near the end of Mason’s fourth grade year, the principal called Karla to pick Mason up and take him home.


There was nothing more they could do for her son that day. The news crushed Karla. She worked for the district and often went home in tears when teachers would tell her Mason’s behavior was problematic that day.


“I felt like everyone was judging us as a family and I didn’t know what to do,” Karla said. “I thought I was failing my child and I thought I was going to lose him.”


Karla worried her son’s behavior would get so bad he would grow up to a life of criminal behavior and be at risk for suicide.


Karla lives and works in Jefferson, a city of about 4,300 in rural Iowa where the shortage of mental health professionals is acute.


In all, 89 of Iowa’s 99 counties — including Greene County — are designated mental health professional shortage areas per the Iowa Department of Health.


“I work for the school and my husband works and we couldn’t afford to drive to a big city several times a week for ongoing therapy or medication checks,” Karla said.


Classroom Clinic launched a school-based pilot program with Greene County schools in the fall of 2019, when Mason entered fifth grade. Guidance counselors suggested the service to Karla.


Karla worried about using behavioral therapy and medication. She believed Mason would outgrow his behavioral problems — but that wasn’t happening.


Sue started Classroom Clinic to help fill the gaps in children’s mental healthcare coverage in rural Iowa, where she grew up and still lives and focused on psychiatric needs in schools.

“One of the biggest pain points in schools is dealing with student behavior that is made worse by untreated mental health issues due to a lack of providers,” Sue said. “I live in rural Iowa and it is a wonderful place to grow up and raise kids, but the flipside is we don’t have access that urban areas have.”


Sue wants to help ease school mental health issues by using telemedicine technology to provide psychiatric evaluations via telemedicine conducted in a private room at a school.

Her first clients were Greene County schools and Paton-Churdan schools. Mason and Karla were one of Classroom Clinic’s first families.


Sue listened to Karla describe Mason’s struggles. He slid a chair across a room. He became so disruptive administrators called for a “room clear,” in which all the students leave the room, until Mason calmed down.


When he lost games in P.E., he became angry and inconsolable; he accused others of cheating or not playing fairly.


Sue evaluated Mason via teleconference. She diagnosed Mason with disruptive mood dysregulation disorder, a condition characterized by persistent anger and frequent temper outbursts that are disproportionate to the situation.


Sue prescribed a medication designed to regulate brain chemistry. The medicine brings naturally occurring chemicals in the brain into healthier levels, lessening excessive behavioral outbursts.


Karla noticed the difference right away.


“Almost from the first day he took the medicine, Mason was a different kid,” Karla said. “He was calmer. He got along better at school and home. He wasn’t having outbursts. He was even to the point of liking school.”


Mason, who is entering sixth grade, competes in wrestling and is making friends again. His moods and behavior improved significantly, his mother said.


The next time Karla conferred with Sue by teleconference, Karla was in tears again — the good kind of tears.


“I feel like she gave me my son back,” Karla said. “I was so worried he was on a path that was going to lead to trouble in the future or maybe even suicide. Now he’s doing so well. She saved my family.”

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