What can physicians do to promote healthier schools? Create a Comprehensive Care and Advocacy Plan
c. 1992 v, 1997 Ellie Goldberg, M.Ed.
A version of this article appeared as "Asthma at School," in the Alliance Newsletter, American Academy of Asthma, Allergy and Immunology (AAAI), 9/92
Many
students with asthma and allergies have no trouble at school. They have
the benefit of good parent-school communication, a full-time school
nurse, knowledgeable teachers, and safe, well-maintained properly
ventilated buildings. Policies provide for convenient access to
medications, appropriate independence and self-care, a variety of
options for physical education and outdoor play, and flexible makeup
assistance for missed class time.
But schools vary widely in their willingness and ability to serve students with asthma and other health management needs.
In
fact, most students attend schools without a full-time nurse.
Inadequate maintenance and poor air quality are common. Policies may
deny or restrict access to medication. Students may have no options for
gym activities or outdoor play even during extreme temperatures or
pollen season. They may be automatically excluded from sports and field
trips. Absences and poor performance may be blamed on "asthma" rather
than on inappropriate school policies, lack of health services, or
moldy carpets.
Thus, even students with mild asthma may face many obstacles to their health and education.
What can the health care team do to promote healthier schools?
First, assess the student's school experience as part of the nursing standard of care. Evaluate school policies and practices.
1. Do parents and school staff meet to exchange information and plan for the student's health management?
2. Is access to medication reliable? Convenient?
3. Who has the authority to administer or assist with medication?
4. What happens if that person is unavailable?
5. Will temporary restrictions in physical education isolate, penalize, or stigmatize the student?
6. Do a child's asthma/allergies get worse at school?
7. Are there individualized procedures for medical emergencies?
8. Is makeup assistance available to students with intermittent absences?
Next,
design a Comprehensive Care and Advocacy Plan (CCAP) based on the
degree of fit between the student's needs and the quality of the
school's cooperation and support. Do school policies and practices
support or hinder asthma management?
The CCAP consists of two
complementary elements: Part I: the Individual Care Plan and Part II:
the Advocacy Plan. The goal of the Individual Care Plan is to meet the
student's need for coordinated care at home and at school by providing
asthma education and support to the family and providing proper
authorizations and technical assistance to the school.
The
goal of the Advocacy Plan is to relieve individual parents of the
intimidating and frustrating burden of addressing school problems
alone.
By documenting systemic barriers to student health such
as inadequate health services, poor air quality, or restrictive
medication policies, health care providers can represent the collective
interests of students and their families by advocating for
comprehensive changes in understanding, attitudes and action that
broaden the path to health and quality education for all.
Part
II: School staff need more than the school health card, standard
medication form, and informal conversations to understand the
complexity and variability of asthma.
For the complete article, write to me at healthykids@rcn.com
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