By Katie Kerwin McCrimmon

AURORA — In one of the poorest ZIP codes in the state, children face all sorts of fears and challenges that persistently undercut their health.

Some kids worry that a parent will be deported. Others are afraid to walk home from school because they know about a scary crime that took place in one of the houses they must pass.

Others have a mouth full of cavities and the pain that gnaws at them every day spurs them to act out and misbehave at school.

Many are refugees, brand new to the U.S. and facing a bewildering world of new customs and language barriers.

Today, the Colorado Health Foundation and the Colorado Health Institute released the 2015 Colorado Health Report Card.

Once again, children are lagging, with more than one of every five children living in poverty. In many respects, Colorado is a tale of two starkly different worlds. Adults are thriving: living up to the Centennial-state stereotype of highly educated, skiers and mountain bikers who are lean and healthy.

But the data on children tell a different story. Nearly 22 percent of kids live in poverty, meaning a family of four is struggling to get by on $23,550 a year or less. More than one in 10 children in the state is obese. Colorado ranks 37^th in the nation for providing children with health insurance. While Colorado has been improving on this indicator, 7 percent of kids still lacked insurance in 2013. And almost half of Colorado children didn’t have a medical home — a regular place where they could get care.

Unfortunately, over the nine years that the Health Foundation has released its annual report card, the outlook for young Coloradans has been much the same.

“Babies and kids consistently score in the C range, sometimes dipping into the D range. This isn’t a new trend. We’ve always scored poorly for children,” said Natalie Triedman, a policy analyst at the Colorado Health Institute who led the research for this year’s Health Report Card.

Unhealthy children bode poorly for Colorado’s future.

“Kids just aren’t adopting the same healthy habits that adults are,” Triedman said.

The problems children face are complex and intractable.

Triedman says poverty creates cascading health problems for children.

“If a child is scared to go out and exercise or play on the playground, they’re not getting that physical activity that can also help with mental health, which can help them concentrate at school,” Triedman said.

These same children are at greater risk for obesity, which can lead to hypertension and diabetes later in life.

For elementary school children in northeast Aurora, Crawford Elementary School at 1600 Florence St. provides an anchor in the 80010 ZIP code, a neighborhood that ranks among the state’s worst for the percentage of children from birth to age 17 who are living below the poverty level. According to researchers at the Colorado Health Institute, nearly 50 percent of kids — or 6,853 children — live in families below the poverty line in this part of Aurora. The percentage of children living in poverty in this ZIP code is nearly double the state average.

At Crawford, almost 90 percent of students receive free or reduced-price lunch.

On the north side of the school grounds, a small mobile home that has been converted into a clinic sits nestled along a quiet, tree-lined street. Run by the Rocky Mountain Youth Clinics, the Crawford Kids Clinic provides a remarkable array of services adjacent to school. Children receive integrated medical, dental and behavioral health care. Each child up to age 8 leaves with a book, and families in need of housing or food can get help on the spot from the clinic’s social worker.

Convenience to school is critical.

One immigrant mother burst into tears when she learned she could access all the care she needed for her children right in one small building.

Maria Duron learned about the clinic at her son’s preschool and brought him in for a checkup and immunizations this week. Emmanuel Arroniz, 4, has two sisters who attend Crawford, Avril, 9, and Anel, 6. That makes him eligible to get care at the Kids Clinic as well.

“I’m so happy. The last clinic was too far away from my house,” said Duron, who primarily speaks Spanish. “This is close. I like this clinic. It’s very nice, very personal.”

She was surprised to learn the children also could get dental care and planned to make appointments for all three children.

“I like this because it has everything,” Duron said.

Altogether, Rocky Mountain Youth Clinics sees about 30,000 patients a year at three stand-alone clinics in Denver, Aurora and Thornton, at two school-based clinics in Aurora and through three mobile clinics.

“The Rocky Mountain Youth mission is to get kids health care regardless of their ability to pay,” said Whitney Kerr, manager for the school-based and mobile clinics. “We don’t run like other pediatricians’ offices. If you can’t get to us, we’ll get to you.”

That means the clinics stay open late and have Saturday hours. And now that the school-based clinics are housed in their own modular buildings, they can stay open in the summer.

“The most pivotal thing for our patients is access to care,” said Sherrene Halley, a physician’s assistant who has worked in Aurora for Rocky Mountain Youth Clinics for five years.

“When there’s no transportation in the household — and many don’t have driver’s licenses or are immigrants who walk — poverty affects the ability to get to the doctor’s office,” Halley said.

With such close ties to school, families can more easily get regular health care and follow up when their children are having problems. For instance, Halley recently helped an immigrant family from Myanmar. She said that Karen-speaking refugees tend to be remarkably resilient and optimistic. But when it comes to health, in some cases, they might not worry enough. Halley was caring for a child who had a bad skin infection near her eye. The mother hadn’t had time right away to get a prescription for her child. Easy access to the clinic and help from translators allowed Halley to call the mother in for a follow-up visit and underscore the potential dangers of not treating the infection.

“There’s an optic nerve and we worry about it turning into (something worse). We may have kept the child from going into the hospital, which could ultimately cost hundreds of thousands of dollars,” Halley said. “It’s prevention.”

Prompted by more information, the mother went ahead and filled the prescription.

Halley sees many children who are malnourished. And dental problems are rampant.

“I know it seems obvious. But when a kid has a mouth full of cavities, their ability to concentrate is affected,” she said. “Tooth pain is a gnawing, chronic pain. They’re throwing a desk or yelling at a teacher. It’s pain transferred to behavioral problems.

“You fix the mouth, and all of a sudden, they turn around,” Halley said.

Along with refugees, providers see many children who come from splintered families. Often an aunt or grandmother brings the child to the clinic. The majority of patients are Spanish speaking, but the neighborhood is remarkably diverse. For families who speak another language, providers schedule long appointments so they’ll have time to tap help from translators over the phone.

Halley said she often hears about fears of deportation. Depression and anxiety are common.

For children struggling with behavioral health problems, an expert from Aurora Mental Health is available right in the clinic.

With signs hanging over her head that say, “Be Who You Are,” and “Everyone is a Star,” behavioral health specialist Rachel Castillo describes the nexus between poverty and health challenges.

“I deal with a lot of trauma: community trauma and personal trauma due to poverty,” Castillo said.

Many children come from disjointed families. Substance abuse is a big problem. Some fear being removed them from their parents. Many fear bullies and older children or adults who are in trouble with police.

“A lot of rough things have happened to these kids. A good number of them have been taken away. A lot have attachment problems and difficulty building and maintaining relationships with trust,” Castillo said.

A single trusted adult, whether that person is a teacher, principal, social worker, health care provider or behavioral health expert, can provide a lifeline for a child suffering from trauma.

In addition to working at the Kids Clinic, Castillo also sees children in the school. The link between poor health and lousy educational outcomes is overwhelming, she says.

“In terms of mental health, you can’t learn if you’re thinking of all these other things, if you’re afraid or if you’re thinking about the traumas that have happened to you.”

Castillo has a box of sand and plenty of toys in her office. She finds play therapy gives kids a way to express their fears without ever having to be explicit. For instance, one child created a scene in which there was a child and a big dinosaur. The dinosaur kept trying to attack the child.

“There are nothing but metaphors in the box. Kids will use weapons and say people hurt me. They’ll create fantasy scenes that don’t look like school. But they’re able to address all the same stuff that they’re experiencing.

Castillo tries to help the children resolve their fears “even a little bit,” so they can concentrate more, do better in school and live healthier, happier lives.

“They don’t know how to name what they’re feeling, how to ask for what they need,” Castillo said. “Kids get angry and get in trouble. If we can help them figure out, ‘I got angry because I was scared. If I’m scared, I can ask for something to make me feel safe.’ Then it stops the whole cycle.”

For the experts working on the ground with children in poverty, access to an integrated medical home like the Kids Clinic provides the best avenue to give children as much support as possible.

“This is a really great start,” Castillo said as she pointed to the simple, but warm rooms at the clinic. “We have to have health care that’s available to people regardless of what their barriers are. At a normal doctor’s office, if you don’t show up, you get fired.

“Here, that never happens,” Castillo said. “We allow you to come back. We try to solve the problems that prevented you from getting here.”