1. Asthma Intervention In and For Schools, Preschools, and After- school Programs APHA 132nd Annual Meeting Elisa Nicholas, MD, MSPH Maura Dwyer, MPH

2. Asthma can significantly disrupt the education process 2-3 children in every classroom are likely to have asthma 14 million school days are lost annually to asthma (leading cause of missed school days due to chronic disease) National survey of nurses found asthma is more disruptive of school routines than any other chronic condition Many staff lack awareness of asthma

3. Federal laws (IDEA 1997 and Section 504 of the Rehabilitation Act of 1973) require schools to promote the health, development and achievement of students where the disease interferes with their learning and to remove “disability barriers,” like poor indoor air quality, which impede health, participation, and academic and/or extracurricular success.

4. Improvement of care for children with asthma must take place where children live, learn, and play. “ Asthma is a multi-faceted medical problem but also a community problem and public health problem. No single intervention is going to decrease rates of asthma...It needs this type of community coalition to have a real impact.” Long Beach Coalition Member

5. Participatory planning process involved stakeholders from : Schools - school nurses, asthma nurses, principals, superintendent, deputy superintendent, parent resource centers, PTA Preschools - Head Start, YMCA After School Programs - YMCA, Parks and Recreation, Boys and Girls Club, Campfire Girls, Scouts Childcare Programs/Networks

6. Engagement  Tiered approach ( top down and bottom up ):  Utilized existing relationships and networks  Coalition leaders engaged Superintendents, Principals and Program Directors  Parent leaders engaged School Parent Resource Centers  Principals/Directors ensured access to lead staff (nurses, health aids)  Presented at multi-site meetings  “On-board” programs/schools influenced others

7. Identified needs  Adequate understanding of asthma  Ability to recognize signs of distress  Plan for responding to an asthma emergency  Plan for children to access medications  Understanding of how to reduce environmental asthma triggers on site  Asthma Action Plans  Coordination and communication between family, provider and community efforts to manage asthma  Policies and procedures for modifying activity on poor air quality days

8. Interventions: Policies, Procedures and Guidelines  Policies/guidelines for responding to an asthma emergency  Policies for accessing medications (on-site, field trips)  Policies for coordinating with family, provider and community efforts  Environmental assessment checklist

9. Interventions: Policies, Procedures and Guidelines  Policies regarding environmental triggers (pets)  Policies for annual staff asthma training  Policies and procedures for modifying activity on poor air quality days  Asthma surveillance in schools

11. Interventions:  Curricula  Open Airways for Schools (ALA)  Alvi’s Awesome Lung Adventure - one-week science based respiratory health curriculum (FAM)  A is for Asthma (ALA)  EZ Breathers (ALA)  Smokeless Homes (PAAA)

12. Interventions: Education  Classes/Training  Asthma 101/Asthma Basics for staff  Asthma Management Training for nurses, clinic staff and health educators (FAM)  Asthma Survival Skills classes for families (FAM)  Exercise and Asthma Training for coaches, PE teachers, and recreation staff (FAM)

13. Interventions:  Special Programs/Activities  Tools for Schools (EPA)  Awesome Asthma School Day field trips (FAM)  Air Quality Flag Program (LBACA)

14. Interventions: Materials  Asthma Jeopardy Game  Asthma Action Plans  “All About Asthma” pamphlet  “Asthma Triggers” pamphlet  “What to do in an Asthma Emergency” posters  “Asthma Control Test”  “Tips for Watching Students at Play”  “What is Exercised Induced Asthma?”

15. Messages to Parents  Notify the classroom teacher, school nurse, PE teacher, babysitter and coach about your child’s asthma  Talk to them about:  your child’s triggers  when to use medicine and how  encouraging participation in physical activities  what to do in an asthma emergency  Only keep your child home if the wheezing is bad or he/she has a fever or sore throat  Take the Asthma Action Plan to your child’s teacher, school nurse, PE teacher, babysitter and coach

17. Developed by: ASTHMA ACTION AMERICA

20. Challenges Confidentiality issues Time Lack of shared vision Differing priorities Specialization Inadequate resources Turf issues Liability Conflicting mandates Divergent professional perspectives

21. Summary 1) Determine common goal 2) Assess your community - where are the kids? 3) What policies, procedures, training and knowledge exist? 4) Tailor the interventions to your community 5) Utilize existing relationships and networks 6) Respect for and recognition of each individual’s expertise, experience and skills

22. Summary 7) Utilize existing resources (i.e. Tools for Schools) 8) Nurture key relationships 9) Engage leadership 10) Constantly re-assess 11) Be observant, patient, persistent and offer quality products and support! 12) Celebrate your successes!

23. The Faces of Asthma For more information: