Episode Zero

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I layout my goals, reasons, and thoughts for trying to get schools to be open 24/7/365

Welcome to the [oneschool] project. I’m Keevin bybee, MD, a practicing family physician in primary care. I am a womb-to-tomb doctor, have seen and done a bit of most everything. I have delivered babies and then cared for and treated people through terminal conditions. I have witnessed and held space for my patient’s incredible suffering. As i grew as a physician and began to realize that, had there been an appropriate safety net, my patients might have been able to live with more grace and minimize the downstream suffering for years to come. So you might be asking “why is a doctor hosting a podcast about starting a school?”

I’d like to share a story 

Mr K was a 9 year old boy, who came to see me for adhd and aggressive behaviors. Wasn’t seeming to get better with standard stimulant treatment for ADHD. was getting kicked out of school most every day. Mom had a chronic medical condition where she couldn’t walk, and I quickly learned that she was between homes attempting to leave an abusive situation, only to find herself at her abuser’s parents’ home. I never got the specifics of what My young patient has experienced and witnessed, suffice to say it was nothing that anyone should ever have to go through.  I called the university pediatric psychiatric help line, several community family service agencies, and CPS, all to minimal affect. 

A primary care clinic is the one place where anyone can show up for any reason at all. And though my training has given me a few tools to address the psycho/social/spiritual domains, i’m primarily a medical mechanic.I feel impotent to intervene in constructive ways when a chief complaint was not so much “medical” but untenable life circumstances. My tool box is only so big; pills and listening only do so much. My heart breaks for my patients. higher doses or new meds don’t fix these situations. Access to mental health and social services are insufficient for so many peoples’ needs.

Thus I wondered, why don’t we have a better place than the emergency department available for 24 hour social services triage?  Let alone, being able to find or access any of the geographically distributed offices of various services depending on their needs, or to know which one? Especially children, our most vulnerable and simultaneously most valuable members. 

When we consider cumulative lifetime health and wellness outcomes, childhood trauma contributes so much to later illness and morbidity. If you haven’t already heard of it, check out the ACEs, adverse childhood events study by kaiser. If we can prevent diabetes by giving children better coping skills earlier in life then the return on that investment will be huge. 

What if:

  • Children would always have a place with an adult who could help coregulate them
  • Children wouldn’t be kicked out of school for being a behavioral disturbance
  • we could collocate robust social services into the place where most children spend a large portion of their developing years; in school!
  • These Schools were open 24/7/365
  • Children of the appropriate age, ie 5-12 for elementary, could just walk into their school at any time for any reason
  • This school could provide food, clean clothes, medical triage, a place to sleep
  • Provide well child checks, immunizations
  • Counseling
  • Social work

In some circles the terms entitlements are equated with handouts, but what if we frame this more of an investment? Many studies have show how investing in children appropriately will only make the economy stronger in the longer term. Of course this is all going to cost money, but somehow we find enough to have military bases throughout the world. This will also not happen in a vacuum. We need universal health care. I’m in favor of something like a universal basic income. Having a school like this is only one piece of a larger puzzle.

But, dammit, i’m not an educator, policy maker, social worker, lawyer, nor therapist. Yet, i see every day the consequences of my patients not having adequate access to those most important team members. I have the luck and privilege to be a care provider in one narrow way that is highly visible, and want to feed forward the luck I fell into. 

What if:

  • We can tell an interesting narrative about why this is important
  • There are Interviews with those specialist team members to get further insight into how this might become a practical reality
  • This builds a network of passionate multidisciplinary team members
  • We can Develop a detailed blueprint or grant proposal for such a model school
  • We can expand the audience until someone with the foresight and capital can help fund a pilot school 
  • We can show a return on investment or that this school is such an attractive model that more public schools adopt it?

The deck can be stacked, and hands can be dealt that make life challenging in a way that probabilistically leads to unnecessary trauma with long term consequences. We don’t choose the manner, timing, and people to whom we’re born. Luck (both good and bad) are the largest determinants of anyone’s outcome in this world. I was lucky enough to be born into an environment and with the skills to pursue medicine.  I have had to do and still have to do a lot of empathetic learning, which is my goal in these conversations. So, in additional to primary care, i hope to pay it forward and be part of the project that raises the floor of luck for our children. 

There have been school revolution projects many times over, and I approach this with humility, but also a great optimism that something like this can become a reality. So many reform projects were more examples of colonization, and part of my search will be to listen to experts in social justice to make sure this is addressing an existing need and not creating a need to meet. 

So, please join us, listen in, reach out, and ask if this is something you’d like to see in your community.

  1. great reference! the great carl is almost always appropriate. thanks for reading. any place this doesn’t jive with your understandings,…

  2. “If you want to bake an apple pie from scratch, you must first invent the universe” Thanks for this Keevin!