School-Based Asthma Program
School-Based Asthma Program Sets the Standard for Community Engagement - A Model for Rochester and the Nation
As a school nurse in the Rochester City School District, Ann Marie Perrello has sent children in the throes of an asthma attack to the hospital in an ambulance. She’s held a child’s hand as she administered emergency medication to help them breathe. And she remembers the loss of a child, who, years ago, passed away following an asthma attack that occurred during winter break.
“One loss is one too many,” said Perrello. “Kids here were suffering, and they didn’t need to be.”
More than 10 percent of children in the district suffer from asthma, and in Monroe County, hospitalization rates for asthma are five times higher in the city than in suburban areas. But, because of barriers to care that they may face, children living in the district often don’t receive the daily preventive asthma medication that they need. As a result, children’s symptoms worsen. They miss school, so their parents have to miss work. Some children end up in the emergency room or the hospital.
“After the crisis passes, many of these kids don’t receive follow-up care,” said Christy Lamberton, a nurse at school No. 45. “So they never get on the right treatment plan, and their symptoms never improve.”
Reaching Kids Where They Are
Jill Halterman, M.D., M.P.H., is a general pediatrician, not an asthma specialist. But, when she realized from her work in primary care how asthma disproportionately affected low-income, inner-city children, she saw an opportunity to help.
“My goal was to improve the delivery of care to underserved children who are suffering the greatest burden from asthma,” said Halterman, executive vice chair and associate professor of Pediatrics.
To address the challenges many families face and ensure that children get the treatment that they need, Halterman developed the School-Based Asthma Therapy (SBAT) program in partnership with the Rochester City School District. As part of the initiative, children receive their preventive asthma medication each day at school under the guidance of a school nurse or health aide. The model improved children’s symptoms, reduced absenteeism, and allowed children to be more active.
“We have seen that when kids consistently get their maintenance medication at school, they notice after a time, they feel better and are able to participate more at school,” said Lamberton.
Now, the program also has a telemedicine component, which connects children in schools to primary care providers in the office. Medical providers help to determine the best form of therapy and then stay readily available in a child’s care — all via telemedicine. Halterman’s study of the program found that children who receive both telemedicine support and therapy at school are almost half as likely to need an emergency room or hospital visit for asthma.
Wide-Reaching Impact
Nationally, other organizations are looking to Rochester and adopting Halterman’s program. Nine other sites, including school districts in New York City, Philadelphia, and Columbus, OH, have consulted with Halterman’s team and implemented a similar initiative. In Columbus, Elizabeth Allen, M.D., a pediatric pulmonologist and the medical director for quality, came across the program after she and her team identified asthma improvement as one of their top priorities.
“We started looking into Dr. Halterman’s program and it stood out as effective and well-vetted to work,” said Allen. “It’s effective, because for families who have barriers to receiving quality asthma care, you need to give added assistance to ensure children have the right medications — and that they receive those medications on a regular basis.”
Locally, Halterman and her team plan to take the work further and are now studying whether additional components of the program could be successful. Here’s a look at three ongoing initiatives, each funded by separate $3.5 million grants from the National Institutes of Health:
- Helping children with moderate to severe asthma: Using telemedicine, this project links students who have more asthma to providers who specialize in asthma care. Doctors are then able to prescribe optimal treatments, address related conditions, and make adjustments as needed.
- Providing telemedicine support following an ED visit: As part of this initiative, children who visit the emergency room for asthma are set up with follow-up appointments with a provider. The visits are conducted in the school health office, childcare site, or children’s homes using telemedicine, and are designed to help ensure children receive treatment and hopefully avoid the need for additional emergency visits.
- Targeting teens: This project provides preventive medications to teens while they are at school, along with motivational counseling sessions to help teens adhere to their treatment. Combined, the components are designed to enhance preventative asthma care and promote developmentally appropriate self-management for inner city teenagers.
There’s no doubt that this program has helped children better manage their asthma symptoms and improved their health. But Andrew MacGowan, project administrator in the district, also noted the many other positive effects of Halterman’s work, which extend beyond the walls of the schools in the district.
“This program has created a model for how other organizations can best work with the school district — something that’s not always easy to do — and how to best engage our parents,” he said. “Because of these initiatives, we’ve been able to forge new connections with parents so that we can work together for the good of our kids.”
In addition to being adopted by other city school districts, Halterman’s model is being expanded for other programs at URMC as well. Through funding from the Department of Pediatrics, the Nephrology division will pilot an initiative with the Rochester City School District to provide telemedicine treatment for children with hypertension.
“We’re using the infrastructure of the asthma program, which has had real success preventing barriers to care,” said Marc Lande, M.D., Ph.D., chief of Pediatric Nephrology, “we’re hoping that we’ll really be able to help families who have trouble bringing their children to the hypertension clinic.”