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  • Sue Gehling

A helping hand through technology

Updated: Jan 5, 2021

Classroom Clinic uses telehealth to reach rural students

This article originally was published in the Carrol Times Herald by Sage Smith

One in five children will develop a mental health disorder, and those in rural areas may not receive the help they need.

Classroom Clinic, founded by Sue Gehling, works with schools to provide telehealth services — offered via video conferencing on a computer, tablet or smartphone — for children with mental health concerns such as anxiety, disruptive mood dysregulation disorder, ADHD and more.

Gehling is a psychiatric nurse practitioner at a Carroll clinic and has 15 years of telehealth experience. She’s from a rural community, grew up in a small area — that’s “who she is,” she said.

There is a huge need for child psychiatry services in those rural communities, Gehling said.

So she began brainstorming how she could collaborate with those on the educational side and medical providers. She said it felt like everyone was “in their own silo” rather than working together. Telehealth seemed to be the answer to bridging the gap in communication to help kids in rural schools.

“I’m very familiar with telehealth in the mental health world,” Gehling said. “It’s a proven strategy; it’s a proven way of delivering health care. So on the health-care side, it was like, ‘Well, this makes perfect sense.’”

Gehling has consulted Rob Cordes for his advice and experience from an educational perspective. Cordes retired about two years ago after working for 14 years as superintendent of the Carroll Community School District.

“Mental health services, especially in the rural areas, are a very desperate need for schools to have,” Cordes said. “Many times, a student may need mental health services and may not be able to get into either their primary physician or even to a specialist. And sometimes a child psychiatrist might be three or four months out when the child needs some help now.”

Among children diagnosed with a mental health condition by the time they’re about 14, 30 percent or more will drop out of high school if they aren’t treated, Gehling said. The average delay between the start of symptoms and actual diagnosis or intervention is about eight to 10 years.

“During that time, they might be in trouble with the law, might start using drugs, they might not be able to maintain employment,” she said. “So earlier identification, earlier treatment is certainly going to make a huge impact on a child’s ability to grow up and transition into adulthood as a healthy and successful young person.”

Access to telehealth services right at the school could make a difference for students as they can have that early intervention, be diagnosed and attend virtual counseling or start medication if necessary, she said.

Telehealth services also mean guardians won’t miss work and students won’t miss school to drive to meet with a mental health provider, as they’re often not located in rural areas.

The financial side of mental health services also can be a barrier for those living and attending school in rural communities, as some of them have Medicaid insurance, which is not always accepted by providers, Gehling said.

To sustain the Classroom Clinic program while providing affordable services, the clinic looks at the patient’s insurance coverage, available community resources and educational funding streams.

“I’ll accept Medicaid payments, but then to offset the loss that I’m operating at, we’ll have income coming from several other streams, so to speak, based upon what’s available in the community,” Gehling said.

School is a “natural location” to offer services because kids spend a lot of their days there and the buildings already have the technology infrastructure to facilitate the services, she said. The school provides the physical space, and Classroom Clinic provides the telehealth service.

“I just see a lot of benefits,” Cordes said about providing services via telehealth, “primarily being that having the services basically at your fingertips.”

While at a convention, Annie Smith, PK-12 principal of the Paton Churdan Community School District, came across Gehling’s booth.

“We just started talking, and I just said, ‘Oh my gosh, this is something, how soon can you get started? How soon can we make this happen?’” Smith said of her first conversation with Gehling.

Smith also has experience as a guidance counselor and said that the lack of resources in the rural area has always been frustrating throughout her time in the education world, especially when it comes to mental health.

In January, Classroom Clinic’s services found their way into Paton Churdan and Greene County schools.

The students Gehling has worked with range from every grade level, kindergarten through high school, with a ratio of three boys to one girl. The top four diagnoses she has seen are ADHD, anxiety disorder, major depression and disruptive mood dysregulation disorder.

Gehling has every new patient, or guardian of the patient, fill out an Adverse Childhood Experiences (ACEs) screening tool to determine a score of how many childhood traumas a person has gone through, out of 10, including but not limited to abuse, divorce and homelessness.

“There’s a lot of research shows that the more traumatic events that young children are exposed to, the (higher) direct link they will have as an adult with chronic medical diseases,” she said. “So the higher their ACEs score directly correlates with poorer health as an adult.”

How high some of the ACEs scores have been is “alarming,” Gehling said. The calculated average ACEs score of the students she worked with at the Greene County school district alone is 3.84, which she described as “significant” and “scary.”

Within schools, Smith said, a lot of times when kids are struggling, it may look like a behavioral outburst, and therefore the response to those incidents is discipline. There also are kids who, rather than having an outburst, do the opposite, shutting down and not engaging.

“We want to make sure that everybody knows and recognizes that really, that’s just the communication,” she said about the behaviors students with mental health issues might exhibit. “So that is just a kiddo telling us some type of communication. … There’s something going on.”

Students are able to start receiving telehealth services from Classroom Clinic within a few weeks or even a few days after parents or guardians grant permission. Gehling will gather information from individual students and their parents, teachers and counselors to decide how to best assist the children.

The students and teachers are given different strategies, and Smith said school administrators at Paton Churdan sometimes see improvement in the child’s behavior and performance after just one Classroom Clinic interaction.

“All kids want to do well; they want to be successful, and they just haven’t been, so there’s a negative cycle,” she said. “But then when they see we’re all working together, and then when they feel better about themselves, then it’s easier to focus on the academics.”

When attention is devoted to students’ mental health, Smith said, the schools see a “super positive domino effect.” There’s less stress in classrooms and at home.

“I really hope that Classroom Clinic can really be the bridge for rural Iowa students that need that mental health services,” Cordes said.

Parents and guardians who want to access Classroom Clinic services for their children can contact their school’s nurse or counselor. More information also is available at

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