School-Based Health Centers as Leaders in the Environmental Management of Asthma

If you are reading this, you may know that asthma threatens children’s health and education. According to the Centers for Disease Control and Prevention, children ages 5–17 with asthma missed 13.8 million days of school in 2013. Children who miss school because of asthma or attend school but are tired from being up at night with asthma symptoms simply cannot learn and thrive.

You also may know that school-based health care is a powerful tool for addressing asthma and reducing health disparities, and that school-based health centers (SBHCs) play a key role in this work. Throughout the country 2,315 SBHCs are serving an ethnically diverse population of more than 2 million children, primarily in low-income areas. Nearly 90 percent of these SBHCs offer chronic disease management, including asthma management, and research shows that SBHCs are already leaders in the clinical management of asthma. SBHC users are less likely to go to the emergency department (ED) or be hospitalized for asthma, have asthma-related restricted activity days, or miss school as a result of their asthma.

RAMP believes SBHCs have an opportunity to be leaders in managing the environmental factors that make asthma worse. (See information about environmental asthma triggers here.) Even children with the best medically managed asthma will continue to suffer from asthma exacerbations if their homes, schools and outdoor environments contain environmental asthma triggers. With support from EPA, RAMP and our partners at the California School-Based Health Alliance and National School-Based Health Alliance work to increase SBHC engagement in the environmental management of asthma. Our core belief is that SBHCs provide an ideal setting to incorporate environmental components into chronic disease management programs because of their role as a strong link between the student, school and home.

One of RAMP’s first activities was to develop the Asthma Environmental Intervention Guide for School-Based Health Centers, which has been shared with more than 3,000 SBHC staff. We also have conducted national trainings, as well as state trainings in four states, reaching 300 SBHC staff.

The most exciting part of our work, however, has been to support 14 SBHCs across the country, each of which has implemented an asthma environmental intervention. Their work shows that SBHCs can be leaders in the environmental management of asthma. Here are just two examples of their success:

Empowering Students to Reduce Environmental Triggers in Their Homes

In the city of Hempstead, New York, the rate of ED visits for asthma is three times higher than the county average and almost twice as high as the rate for the entire state. The school’s health center, established 20 years ago by Winthrop University Hospital, helps students overcome many challenges that they face in managing their asthma, including management of environmental asthma triggers at home.

Gina Galante, Pediatric Nurse Practitioner, shared that the SBHC team understands why working with students is important: “Teenagers enjoy taking command of their health care, and partnering with teens with asthma to educate them and reduce the environmental triggers to improve their asthma will be an asset to their overall quality of life.” Staff empower the teens to conduct their own home environmental trigger assessments. Students and staff look at the results together and focus on what students can control in the environment. The staff then provide students with “Anti-Trigger Kits,” which contain such items as dust mite–proof encasements for pillows and mattresses, asthma-friendly cleaning products, and/or a gift card to a local hardware store to obtain needed heating, ventilation, and air conditioning (HVAC) filters or asthma-friendly pest control products.

Working With Teachers to Reduce Classroom Triggers

Located in Milwaukee County in Southeast Wisconsin, Frances Starms Discovery Learning School has one of the highest prevalence rates (22%) of asthma in the state. SBHC staff educated students and teachers about asthma environmental triggers and worked with teachers to identify and address classroom triggers.

As a result of relationship building and individualized education, teachers previously unaware that asthma triggers existed in their classrooms made immediate changes, such as requesting more regular vacuuming of carpets and keeping a regular schedule for blind/curtain dusting or cleaning. The efforts to reduce environmental asthma triggers among students through comprehensive education and structural changes on campus highlight the dedication of a community to make real, lasting change.

To view more detailed case studies about these two SBHCs, plus many more, visit: www.rampasthma.org/uploads/casestudies.pdf.

Building on Lessons Learned

The experiences of the 14 SBHCs implementing environmental asthma interventions not only helped their local communities, but also provided a wealth of lessons for other SBHCs interested in starting their own asthma-related program. Some of the key lessons are as follow:

• Building relationships is essential and cannot be emphasized enough.
• Understanding and addressing perceived barriers is important when relying on others to make a change.
• Identifying a champion to advance an intervention among her/his colleagues can help move the work forward.
• Partnering with students to lead an intervention can be more effective than having SBHC staff go it alone.
• Framing systems, institutional and policy changes around health impacts can increase buy-in.
• Taking the time to get buy-in upfront ultimately saves time and increases the success of the intervention.

We are continuing to work with six of the SBHCs to expand their projects and build on these lessons. We also look forward to applying these lessons as we launch a new cohort of SBHCs in the Fall of 2018. We encourage all interested SBHCs to consider applying. Click here for more information and an application (Deadline: August 17, 2018). We also plan to disseminate best practices nationally through a “Tips for Success” tool for SBHCs, which will serve as a companion piece to the Asthma Environmental Intervention Guide.