Children, Asthma and Poverty: School Asthma Care Programs
A couple of years ago, I went to Denver to learn about an asthma program for children in inner-city schools in the area, as well as a sister-school project in Hartford, CT. (Dia and I may have also attempted to sneak into the American Thoracic Society conference without passes, but instead settled for picking up free respiratory journals—although we did have a brief meet-up with researcher Dr. Sally Wenzel in the back of a conference room at the Hyatt hotel!) If you subscribe to any sort of asthma news alerts, you’ll frequently see news about these programs and the impact that they have on children with asthma. (Note: If interested, my disclosures and personal perspectives on the event I attended can be found on my blog.)
Reach out to children and families in school to improve health outcomes.
It’s pretty obvious that children go to school to learn. However 1) children must feel well to learn well, and 2) health education is often a very general overview of things that we do to stay healthy, that apply to everyone. Chronic disease education is a whole other monkey, and fortunately, a variety research and organizations promoting these programs are realizing the importance of reaching out to children and families where they already are at (school!) to improve health outcomes. A metric commonly used in these school-based interventions is decreasing school absenteeism through education and greater asthma control. There are a variety of approaches these school asthma programs take. Note that while not all participants in these programs are of low-income or living in poverty, they focus on geographic areas that are more susceptible to disadvantages caused by low socioeconomic status.
The St. Louis Program
A recent news release on a St. Louis project by the Asthma and Allergy Foundation of America (AAFA) provided greater asthma management tools (including rescue medication) to school nurses, which enabled children to return to class following treatment of an asthma exacerbation at school, rather than being sent to the hospital, or sent home.1 For instance, in most schools, if a child had forgotten their inhaler but was having symptoms, a parent would at the very least be called to bring the child medicine or take them home—in more serious circumstances, an ambulance would be called. The St. Louis program enabled asthma to be dealt with more quickly and improved return-to-class rates.1
Asthma Vans - A Mobile Clinic
“Asthma vans” are also an intervention implemented regularly in such programs. A program in Detroit brings adequate asthma care to schools in the inner city especially, by use of a mobile clinic.2 While studies consistently note higher rates of asthma among children in the inner city, Detroit has the highest inner city asthma rate in the country—more than double the national rate according to the Asthma Initiative of Michigan.2 A program in this area brings care to the child by way of mobile clinics which operates one van in the city, sponsored by an organization called the Children’s Health Fund. In addition, they also have 9 school-based health centers. Children are assessed at school, prescriptions are processed the same day and delivered to the school, where the child is taught how to use their medication and provided a picture-based asthma action plan. This alleviates some of the issues with accessing care—once the management plan is determined to be effective, eventually, the child’s medicines are sent by mail-order pharmacy, reducing the burden on the school clinic staff.2
The Denver Program
The Denver program, Building Bridges for Asthma Care, works to identify students who have asthma, identify uncontrolled asthma and associated risk, monitor children with asthma who are “at risk” as well as those who are newly diagnosed, and provide planning and support for the current and upcoming school year3. The program is facilitated by Denver Public Schools nurses, and provides students and parents with education and support, as well as assist with coordinating asthma care3. The program in Denver is funded by pharma company GlaxoSmithKline.3
School asthma programs are not available to all children who need them. However, hopefully the research that is being done on these types of interventions will lead to more widespread implementation, allowing more children who have barriers to accessing care to receive the asthma treatment and education that they need to be healthy, control their asthma, and be able to focus on the things that kids are supposed to focus on—school, and having fun, not their breathing.
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