(Chest. 1999;116:193S-195S.)
© 1999
American College of Chest Physicians
A Collaborative Model to Enhance the Functioning of the School Child With Asthma*
Lenore Coover, RN, MSN;
Charlene Vega, EdD;
Victoria Persky, MD;
Ella Russell, RN, MSN;
Rebecca Blase, RN, MS;
Raoul Wolf, MD, FCCP;
Myrna Garcia, RN, MSN;
Evalyn Grant, MD and
Margaret Dublin, RN
*
From the University of Illinois at Chicago (Ms. Coover and Dr. Persky), School of Public Health, Chicago, IL; Chicago Public Schools (Dr. Vega, Ms. Russell, and Ms. Garcia), Chicago, IL; LaRabida Children's Hospital and Research Center (Dr. Wolf and, previously, Ms. Blase), Chicago, IL; Department of Immunology/Microbiology (Dr. Grant), Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL; and Chicago Health Corps (Ms. Dublin), Illinois Area Health Education Centers Program, University of Illinois at Chicago, School of Nursing, Chicago, IL.
Correspondence to: Lenore Coover, RN, MSN, Pediatric Case Management Services, 8833 Southmoor, Highland, IN, 46322
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Introduction
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The
importance of asthma as a major factor affecting the quality of life in
Chicago school children has been recognized for many years. The
prevalence of asthma is high, with 16% of seventh- and eighth-grade
students from 1994 to 1995 having received diagnoses of the disease,
18% having wheezed in the last year, and 11% of students having
missed school in the last year because of asthma.1
Differences exist among groups, with 13% of Catholic school children,
17% of public school children, and 22% of children in school with
census tracts with > 40% of families below poverty in Chicago having
received diagnoses of asthma. These differences in asthma prevalence,
however, are far less than differences in asthma mortality, suggesting
that some of the factors affecting asthma may be modifiable.
The school environment is particularly important to children with
asthma because acute exacerbations can lead to decreased ability to
concentrate, decreased participation in activities, and high rates of
absenteeism. Identification of children with the disease, communication
with parents and health-care providers, removal of triggers in the
immediate school environment, and maximization of access to medication
when needed are all key factors in managing the disease.
The School Committee is an important component of the Chicago Asthma
Consortium (CAC).2
At its first meeting with the
administration of the Chicago Public Schools (CPS) in June 1996, it was
determined that the focus of the School Committee should be to make the
school environment a place where children with asthma can function and
have access to medication that will ensure the child's safety and
where the staff is prepared for emergencies and aware of policies and
best practices.
The CPS administration and the CAC outlined their interests and
expressed a strong commitment to working together. Areas of need that
were identified included the need for a screening instrument to
identify children with the disease, increased awareness and information
for teachers and school staff, and a resource directory and
quick-reference data sheets for school staff. The need to address
medication issues was also identified. Several subcommittees were
established to address school issues related to data, environmental
factors, education, and medication.
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Data Subcommittee
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In 1996, the CPS identified only a small percentage of students
with asthma, whereas prevalence studies in Chicago suggested that 16%
of students have the disease. One of the key issues was the CPS system
for identifying children with chronic disease, which involved obtaining
extensive documentation from the child's physician. The CAC Data
Subcommittee of the School Committee recognized that the CPS needed an
appropriate screening tool. In August 1996, this subcommittee took the
lead in developing a screening questionnaire for the identification of
children with asthma. This questionnaire has undergone validation
studies3
and is now in use in many schools throughout the
city. During the last 2 years, the subcommittee has also worked with
the CPS administration to modify their forms and procedures to allow
for more rapid identification and documentation of children with
asthma.
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Environmental Subcommittee
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The CAC School Committee recognized that the physical
environment is also an important factor in control of asthma. Chicago
schools, like many others in the country, are in need of structural
repair. Three years ago, the CPS began a large capital improvement
initiative. It is anticipated that, in the long run, many of these
changes will be beneficial to children with asthma. However, the
subcommittee recognized the importance of integrating the needs of
children with asthma into the scheduling of repairs. During the past
few years, the CAC and the CPS, in collaboration with the Safer Pest
Control Project, have been piloting an Integrated Pest Management
approach to eliminating cockroaches in schools. The CAC has been
working closely with the Safer Pest Control Project to develop
legislation that would encourage the use of programs such as Integrated
Pest Management in the schools while requiring notification before the
use of pesticides. Members of the CAC and the Chicago Health Corps, an
AmeriCorps program, are currently testing the effectiveness of
the Environmental Protection Agency's Indoor Air Quality Tools for
Schools4
kit in five schools located in various regions of
the city.
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Education Subcommittee
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At the request of the CPS administration, the Education
Subcommittee of the CAC School Committee, in conjunction with the
American Lung Association of Metropolitan Chicago, gave a half-day
presentation on asthma to 350 school nurses. The information presented
in the program was based on the National Asthma Education and
Prevention Program guidelines5
and included a packet of
information and an asthma video for each nurse. Several groups have
subsequently developed educational programs for use in the schools. One
program includes a set of visually appealing bilingual slides and
transparencies for use in presentation to parents and staff. Other
educational programs such as Open Airways for Schools6
and
Asthma Basics7
provide information specific to the
school's audience (staff, parents, or students). The Education
Subcommittee had also established a speaker's bureau to facilitate
requests for individual school presentations.
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Medication Subcommittee
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Examination of the school medication policy was a top priority for
both the CPS administration and the CAC. In 1996, there was no
provision for students to have ready access to their own medication if
it were deemed medically necessary. Within the CPS system, nurses are
present only 1 day a week in many of the schools. For the child having
acute symptoms, it can be a serious issue when their medication is
locked in an office with limited access.
The most challenging issue was how to address the child's need
for medication and, at the same time, provide mechanisms to prevent
potential misuse of the privilege (ie, sharing of inhalers
with other children). Together, the Medication Subcommittee and the CPS
drafted an amendment to the overall school medication policy. The
amendment states that, with appropriate documentation from a physician
verifying the child's need to have access to medication at school and
his or her ability to self-medicate, the child can be allowed to carry
medication at school. The medicine must be appropriately labeled, and
the child, in conjunction with the school staff, must keep records of
the medication use. The privilege is to be revoked if there is an
abuse—such as sharing of inhalers. The amendment to the Medication
Administration Policy 96–0327-PO4 was approved at the March 1997 CPS
board meeting.
Since the adoption of the amendment, both the CPS and the CAC have
undertaken major efforts to publicize the change. A presentation was
made to school principals at each of the six regional meetings. A
brochure outlining general issues of asthma in the schools and
describing the change in policy is currently in development. This
brochure will be distributed to all Chicago schools. The School
Committee is now working with the CPS preschool program to address the
needs of the early childhood population with asthma. They are also
working to modify the health information forms to facilitate
communication among the school, parents, and health-care providers.
This has been a remarkably successful collaboration, which would
not have been possible without the combined knowledge and vision of the
current CPS administration in conjunction with the collective
experience and commitment of the CAC. All have benefited greatly, not
only from a better understanding of the issues facing a large public
school system, but in the formation of collaborations and ties that
will serve as the infrastructure for initiatives for many years to
come.
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Footnotes
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Abbreviations:
CAC = Chicago Asthma Consortium; CPS = Chicago Public Schools
This project was an activity of the Chicago Asthma Consortium, funded
by the Otho S. A. Sprague Memorial Institute.
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References
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Persky, V, Slezak, J, Contreras, A, et al (1998) Relationships of race and socioeconomic status with prevalence, severity and symptoms of asthma in Chicago school children. Ann Allergy Asthma Immunol 81,266-271[ISI][Medline]
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Naureckas, ET, Wolf, RL, Trubitt, MJ, et al (1999) The Chicago Asthma Consortium: a community coalition targeting reductions in asthma morbidity. Chest 116,190S-193S[Abstract/Free Full Text]
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Wolf, RL, Berry, CA, O'Connor, T, et al (1999) Validation of the brief pediatric asthma screen (BPAS). Chest 116,224S-228S[Abstract/Free Full Text]
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. Environmental Protection Agency, Indoor Air Division (1995) Indoor air quality tools for schools. Environmental Protection Agency Washington, DC.
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National Asthma Education and Prevention Program. Expert panel report 2: guidelines for the diagnosis and management of asthma. Bethesda, MD: National National Institutes of Health, April 1997; Publication No. 97–405
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. American Lung Association. (1992) Open airways for schools. American Lung Association Washington, DC.
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. American Red Cross. (1998) Asthma basics. American Red Cross Washington, DC.
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Introduction
Data Subcommittee
