Regina H' Norman

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Working Together to Create a Healthy School
Environment APHA Annual Meeting Washington,
DC November 8, 2004 Young Adults Health N
Wellness Awareness Project HIV STEPPs

• Regina H. Norman
• Program Manager, YAHNWA
• (NAFEO)
• rnorman_at_nafeo.org

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Objectives

• To present strategies for reaching African
  American college students with HIV/AIDS health
  wellness information.
• To provide an overview of YAHNWA and HIV STEPPs.

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Overview of Program

• NAFEO
• Represents 118 HBCUs
• Young Adults Health N Wellness Awareness
  (YAHNWA) Project
• 5-year Cooperative Agreement (2000)
• Funded by CDC/DASH
• Conduct assessment with HBCU students
• What College Students Want and Need to Know to
  Change Attitudes and Enhance Knowledge about
  HIV/AIDS and Wellness
• HIV Strategies and Tools for Enhancing Prevention
  Programs (HIV STEPPs)

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Program Rationale

• To develop more effective outreach.
• address youth culture and practice and solicit
  their input.
• Empower youth
• personal responsibility for their own health by
  adopting healthy lifestyle choices
• Assess and increase knowledge/identify resources
• for both students and campus health educators
• To foster behavior change

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YAHNWA/HIV STEPPs Program Design

• Gather information on HIV/AIDS wellness content,
  delivery formats, and venues needed to influence
  young adults to change risky behaviors.
• Provide opportunities for youth and young adults
  to have input into the design and development of
  HIV/AIDS programmatic activities.

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A RESOURCE GUIDE

• Developed from focus groups and student
  assessment administered at 21 HBCUs.
• Serves as a resource and planning tool in
  implementing youth driven prevention programming.

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HIV STEPPs

• Developed from results of Assessment
• CDC Clearance Process
• Outlines
• Summarized Student Responses
• Sexual Health Concerns
• Elements to include in HIV prevention programming
  for college students
• Strategies for developing effective HIV
  interventions for students
• Tips for Instructors
• Resources

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HIV STEPPs Strategic Planning Technical
Assistance Sessions

• Overview of HIV STEPPs
• Project Methodology
• Summarized results of HBCU Assessment
• Discussion
• HIV prevention activities and efforts on campus
  relative to findings in assessment
• Strategic Plan
• Develop 3/6/9/12 month plan
• Eligible for 1,000 implementation stipend

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Program Successes

• Conducted 14 HIV/STEPPs Sessions
• Dispensed 12 strategic planning implementation
  stipends
• Abstinence Conferences (Bowie St., Shaw
  University, Langston University)
• 2 Health Matters Youth Summits
• HBCU Reported Youth-Driven Activities
• Peer Health Education Programs (New Peer Health
  Manual)
• Freshman orientation activities
• World AIDS Day recognition
• Collaboration with SGA, fraternities/sororities
• CBOs, other HBCUs

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Schooled in Asthma Physicians and Schools
Managing Asthma Together
American Public Health Association 132nd Annual
Meeting and Exposition Working Together to
Create a Healthy School Environment November 2,
2004
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Schooled in Asthma Physicians and Schools
Managing Asthma Together

• COOPERATIVE AGREEMENT
• between
• American Academy of Pediatrics
• and
• The Centers for Disease Control and Prevention
  Division of Adolescent and School Health

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GOALS OF PROJECT

• Health Care Providers routinely assess and
  manage school-age children with asthma
• taking a school-relevant clinical history
• coordinating and collaborating with local
  school-based personnel
• AAP Chapters and Pediatricians actively promote
  Coordinated School Health Programs in local
  schools and districts
• with a focus on asthma.

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GOALS OF PROJECT

• American Academy of Pediatrics integrate
  Coordinated School Health Program concepts
  throughout the Academy
• educational programs for members, patients, and
  parents
• including but not limited to asthma
• AAP will continue to pursue projects that
  strengthen coordinated school health, with a
  focus on asthma management.

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Assessment of Current Practices

• 3 Questions
• What percentage of school age patients on asthma
  medication have you sent the school a written
  asthma management plan?
• For what percentage of your patients with
  persistent asthma do you elicit absenteeism
  information from the school?
• For what percentage of your school-age patients
  using MDIs (metered dose inhalers) have you
  asked a school nurse to verify its proper use?

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2002 National Survey (AAP fellows)3500 surveys
sent out 1713 responded
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2002 National Survey (AAP fellows)3500 surveys
sent out 1713 responded
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2002 National Survey (AAP fellows)3500 surveys
sent out 1713 responded
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2 Parts of Overall Project

• Practice Level Change
• Hx taking of school-age children with asthma will
  include school-specific questions
• Matters related to asthma management at school
  will be discussed at doctor office visits
• Arrangements will be made so that schools receive
  Asthma Management Plans
• Actions that facilitate communication with
  schools will be taken

• Chapter Level
• Chapter activities surrounding school health
  topics and asthma examples include
• Participation in school health advisory councils
  (local/state level)
• Develop list of schools (state/local) with
  contact information of school and nurse
• Involve pediatricians in educating local or
  statewide decision makers surrounding school
  health and asthma issues

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Training Seminar Day 1

• Changing Office Practices Proven Methodology
• Assessing your Own Practice through Chart Review
• Practice Change Case Study
• Chapter Project Brainstorm

• Introduction
• Review of Asthma Management
• Coordinated School Health Programs
• Supporting School Programs in the Community
• Case Studies

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Training Seminar Day 2

• What can I do by next Tuesday?
• Changing Your Practice A Quick Sheet for
  Planning
• Resources
• Explanation of mini Chapter stipends
• Chapter Collaboration (develop action plan for
  chapter activity)

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3 Pilot Seminars

• Pilot 1
• April 2003
• Alabama Chapter
• 9 Pediatricians,
• 1 Executive Director
• Washington Chapter
• 6 Pediatricians
• 1 Nurse Practitioner
• 1 Executive Director

• Pilot 3
• October 2004
• Maine Chapter
• 1 Pediatrician
• 1 Nurse Practitioner
• 2 RNs
• 1 Executive Director)
• New York 3 Chapter (NYC)
• 8 Pediatricians
• 1 Executive Director

Pilot 2 October 2003 Idaho Chapter 9
Pediatricians 1 Executive Director Oregon
Chapter 6 Pediatricians 1 Nurse
Practitioner 1 Executive Chapter Staff
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Quality Improvement Data Collection
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Preliminary Baseline Data Summary Chart Reviews
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Challenges/Solutions to Practice Change
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Challenges/Solutions to Practice Change
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Sample Tools
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Lessons Learned Practice Change

• Pediatricians are ready and willing to improve
  quality of care
• Respond well to specific tasks and timelines
• Enthusiastic during pilot seminars and site
  visits
• Follow up is important
• Easier to implement a method of change rather
  than step by step approach

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Highlights Chapter Activities

• ALABAMA
• Provided CME opportunities for pediatricians,
  school nurses, and pediatric nurse practitioners
  around school health and asthma topics
• Educational articles mailed to membership on
  topics asthma overview, role of nursing in
  asthma education, and psychosocial aspects of
  asthma in children

• WASHINGTON
• Successful partnership with the Kitsap County
  pediatricians and regional school nurses
• Chapter staff have participated in Educational
  Service District meetings to promote
  collaboration
• There is now WA chapter representation on the
  ALAW Asthma Management in Educational Settings
  (AMES) reorganization committee

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Highlights Chapter Activities

• IDAHO
• All participants have connected with their local
  Asthma Prevention and Control Committees
• A school nurse directory and an asthma inhaler
  label is in the process of being developed and
  will be sent to the entire membership
• The Idaho state legislature passed legislation to
  allow school-aged children to carry their inhalers

• OREGON
• Plans to work with the Oregon Asthma program and
  Asthma Demonstration program to promote
  coordinated school health within the statewide
  program

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Highlights Chapter Activities

• MAINE
• Plans to provide a day seminar for Pediatricians
  to become leaders in regional area
• Each leader will be responsible for hosting a
  collaboration meeting with the local school
  nurses. It is hoped that communication will be
  increased and school histories can be taken more
  accurately

• NEW YORK 3
• An educational day is being planned for the New
  York City Council, Board of Education and
  Department of Health
• The chapter plans to show
• the importance of enforcing the No Idling Law
• making schools greener,
• Encourage the council to value the communication
  between the department of health and education
  regarding school absenteeism

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What to do differently

• Quality Improvement
• Promote implementing tools rather than
  individual goals
• Provide more individualized technical assistance
• Study practice workflow

• Chapter Projects
• Allow more time at training seminar to develop
  work plan
• Provide more technical assistance during planning
  of chapter activities
• Keep things simple and doable

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Schooled in Asthma Physicians and Schools
Managing Asthma Together
CONTACT INFORMATION
Principle Investigator Howard Taras, MD,
FAAP University of California, San Diego Division
of Community Pediatrics 9500 Gilman Drive, Dept.
0927 La Jolla, CA 92093-0927 Phone
619681-0665 Email htaras_at_ucsd.edu
Program Manager Lori Morawski, MPH,
CHES American Academy of Pediatrics 141 Northwest
Point Blvd Elk Grove Village, IL 60007 Phone
847434-7638 Email lmorawski_at_aap.org
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Improving Life, One Breath at a Time
1-800-LUNG-USA
www.lungusa.org
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Asthma-Friendly Schools Initiative (AFSI)

• Funded by CDC Division of Adolescent and School
  Health
• Based on Kaiser/ALA report from November of 2000
• Developed tools using input from
• ALA locals
• National Partners
• Federal Government
• National Experts

www.lungusa.org
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AFSI Goal

• To assist local communities and community
  organizations in planning and implementing
  comprehensive asthma management programs within
  their local schools and existing school structure

www.lungusa.org
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Asthma-Friendly Schools Toolkit

• Intended to be used to plan and implement a
  comprehensive school asthma management program
• Not intended to be a program in a box or to be
  distributed to schools for implementation
• Each community picks which pieces apply to it and
  utilize those pieces

www.lungusa.org
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Sections of the Toolkit

• Community Asthma Planning
• Maximizing School Health Services
• Building Asthma Education and Awareness
• Providing a Healthy School Environment
• Physical Education
• Resources

www.lungusa.org
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Asthma Incident Reporter Database

• Developed for use in schools
• Free
• Uses the case management form in the toolkit
• Tracks students with asthma within a school
• Download from the AFSI Website www.lungusa.org/afs
  i or included on the toolkit CD-ROM

www.lungusa.org
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Database Reports

• Three quick reports
• Individual Student Report
• School Nurse Case Management Detection Report
• School Summary of All Students with Asthma
• Sort by school and date and can print with or
  without names
• Data can be exported for more complete analysis

www.lungusa.org
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Current Activities

• Starting Year 4 of a 5 year cooperative agreement
  with CDC
• Year 1-3 was development of the tools
• Year 4 and 5 are a pilot project to evaluate how
  well the tools assist local communities in
  achieving their goals around comprehensive asthma
  management in schools

www.lungusa.org
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AFSI Pilot Sites

• Phoenix, Arizona
• San Bernardino, California
• Sonoma, California (funded by Kaiser Permanente)
• Wichita, Kansas
• Flint, Michigan
• Eastern Shore, Maryland
• Cleveland, Ohio (funded by Kaiser Permanente)
• Spokane, Washington

www.lungusa.org
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AFSI Evaluation

• Conducted by the national American Lung
  Association
• First year program planning
• Evaluation is mostly process (how is the
  implementation going) vs. outcome (what are the
  results of the implementation) for year 1

www.lungusa.org
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Early Evaluation Findings

• Year 1 of pilot project will be completed in
  December of 2004
• First year primarily planning
• Early Interesting Findings
• Strong project manager
• Strong commitment by schools
• State health department participation

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Early Evaluation Findings

• Unintended Outcomes and Uses
• Saved nurses jobs
• Increased communication on health insurance
  issues
• Increased education of medical community on
  asthma in schools

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Evaluation Findings

• Pilot project will be completed December of 2005
• Publication of results should be in Spring of 2006

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Improving Life, One Breath at a Time
Lung disease is the third leading cause of death
in America. Over the last decade, the death rate
from lung disease has been growing faster than
the rate from almost any other leading
killer. Since 1904, the American Lung
Association has been fighting lung disease
through education, community service, advocacy,
and research. We are working to help those who
suffer from lung disease today, and to stop the
spread of lung disease tomorrow. To succeed, we
need your support. Contact your local Lung
Association to find out how you can join the
fight.
www.lungusa.org
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School Health Successes and Challenges Working
Together for a Healthy Environment

• American Public Health Association Conference
• November 8, 2004
• Washington, DC
• 
  
• Rebecca Nelson, MS
• Project Manager
• American Association of School Administrators

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Agenda

• Who is AASA?
• Background Why the health of children is a
  concern to AASA
• Resources available to address the issues AASA
  programs
• Challenges
• Success Stories

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Who is AASA?

• School system leaders association since 1864 with
  affiliates representing 50 states, Canada, and
  overseas educators
• AASA has unique access to the gatekeepers of the
  American public school system
• AASA has worked for the past 30 years on health
  related efforts centering on identifying the
  needs of children (Youth risk behaviors, HIV,
  IAQ, asthma)
• AASAs focus Stand Up for Public Education
  getting schools ready for children, children
  ready for schools and children ready for
  democracy.

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The Impact of Asthma in the Classroom

• Nearly one in 13 school-aged children have
  asthma this translates into an estimated 14
  million missed school days and lost educational
  opportunities per year.
• Asthma is the third leading cause of
  hospitalization in children under 15 years of
  age, resulting in classroom time lost

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School Facilities, Student Health Achievement

• Environmental triggers exacerbate asthma and
  other respiratory ailments.
• 50 of schools serving over 20 million children
  have unsatisfactory environmental conditions such
  as poor ventilation, heating, lighting, etc.
• Studies support the link between poor indoor air
  quality and the decline in student achievement.

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School Facilities Achievement

• According to a 1996 study, student achievement in
  Washington, DC schools would be 5 percent to 11
  percent higher if the physical conditions of
  their schools improved.
• Students in schools in poor condition can be
  expected to fall 5.5 percentage points below
  those in schools in fair condition and 11
  percentage points below those in excellent
  condition.
• 90 of schools in U. S. were built before 1980,
  and 50 before 1960.

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Challenges Building Design, Custodial Awareness
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Challenges School Design, Awareness
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Challenges- Teacher Awareness
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Resources
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Resources

• AASAs Indoor Air Quality Asthma initiatives
• Schoolhouse in the Red 2004 edition
• Tools for Schools Design Tools for Schools
• Indoor Air Quality Symposium
• School Governance and Leadership Spring 2003
  edition Frequently Asked Questions

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Indoor Air Quality Clearing the Air

• Since 1997, AASA has worked with EPA to inform
  schools about the effects of poor indoor air
  quality on childrens health and continues to
  encourage the adoption of the IAQ Tools for
  Schools Program.
• Been intimately involved in improving the school
  environment since 1992, when we published
  Schoolhouse in the Red, which examined the extent
  of deferred maintenance of school buildings, we
  introduced issues of indoor air quality to our
  members.
• Ongoing work with group of urban districts as
  part of the AASA Urban Resource Coalition to
  exchange ideas and discuss issues and solutions
  related to indoor air quality, asthma and the
  school environment.

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Schoolhouse in the Red
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IAQ Tools for Schools Symposium
IAQ Tools for Schools December 2-4, 2004 5th
Annual National Symposium 2004 Grand Hyatt Hotel,
Washington, D.C.
For information on the symposium please visit
www.iaqsymposium.com.
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Keeping Children with Asthma in School and
Learning

• Five-year cooperative agreement from the CDC to
  reduce the burden of asthma among children and
  youth, and to keep children with asthma in school
  and learning.
• AASA provides support to school leaders as they
  seek to reduce the burden of asthma in their
  districts
• Provide opportunities for participation of school
  districts and their leaders via presentations at
  state and national conferences
• Working with partner school districts to develop
  and test a set of Powerful Practices for asthma
  management which will be able to be used as an
  assessment tool by districts to gauge where they
  are and where they need to be in their work
  addressing asthma

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School Governance Leadership

• Publication that focused on asthma management
  policies procedures, indoor air quality, and
  liability issues
• Published spring 2003
• Mailed to every superintendent and school board
  president in the country

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School Governance Leadership
Download this document at http//www.aasa.org/pub
lications/sgl/Spring2003.pdf FAQ document
created as a companion to SGL
http//www.aasa.org/issues_and_insights/healthy/as
thma_SGL_FAQ.htm.
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Powerful Practices

• Assessment/checklist for school districts to help
  them gauge their current district efforts
  addressing asthma
• Produced original draft with the input from a
  national workgroup
• Piloted during the last two years by partner
  school districts

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Challenges
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Challenges

• Lack of Buy-in from Principal for Asthma Program
• Lack of Student Support Compliance
• Disseminating Information in Large Urban
  Districts to Grassroots Level (i.e. individual
  teachers, nurses)
• Lack of Follow-Through by Staff

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More Challenges.

• Lack of Internal/Administrative Support for Tools
  for Schools
• Planning for Design and Construction in Old and
  New Buildings, Incorporating IAQ and Asthma
  concerns
• Change in Administration
• Receiving Back Asthma Care/Action Plans
• Parental Involvement

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Lack of Buy-in from Principal for Asthma Program

• Must have a board policy (or other administrative
  policy)
• Educate the principal regarding policies and the
  merit for policy
• Have principal on the school health advisory
  council
• Provide data - of asthmatics, hospital visits,
  and absences
• Identify the principals needs and priorities and
  develop a plan to match

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Lack of Student Support Compliance

• Incentives such as CDs, books, games, food
  certificates (for things such as using their
  inhalers pre PE, etc.)
• Dont give food as incentives!
• Adopt-A-Asthma Student (mentors)
• Teach self-management Powerbreathing, Open
  Airways (group support)
• CD games Quest for the Code
• Communicate with health care provider to
  coordinate care/problem solve
• Support groups including peer support/buddies

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Lack of Follow-Through by Staff

• Make staff really part of the decision making
  process
• Value their contributions
• Provide feedback about accomplishments and
  improvements
• Call schmooze empathize with them
• Positive reinforcement Im counting on you
• Provide instructions, creative ideas, incentives
  (gift certificates, )
• Staff testimonials (personal) and recognition
• Accountability responsibility
• Remind staff of the positive difference they can
  make it the life of a child teaching is more
  than just books

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Change in Administration

• Attend board meetings, volunteer for committees,
  get time on the agenda to emphasize asthma/health
  be visible!
• School health advisory council involve the
  administration
• Emphasize the link between health and academic
  achievement
• Show the money! (e.g. improved attendance,
  grants, safer buildings)
• Be mindful of not putting more demands on the
  administrator
• Help them find their stakeholders to support the
  process need to building a team and delegate
  responsibility
• Use local health/achievement data

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Receiving Back Asthma Care Plans

• Incentives for parents and children
• Follow-up by phone, letter, in person
• Have nursing staff available at parent/teacher
  conferences or other school functions for on-site
  in-person follow-up
• Have a generic plan available for the students
  without a specific plan
• Alternate methods of returning the form (have
  doctors office fax it back when complete)
• Have it in a language that the parents can
  understand
• Home visits do in pairs or with a security
  officer bring someone culturally appropriate
• Develop a relationship with primary care
  providers

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Success Stories

• East Dubuque School District, East Dubuque, IL
• Hawthorne School District, Hawthorne, CA
• East Valley School District, East Valley, WA
• Grandview Consolidated School District,
  Grandview, MO

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For more information

• Rebecca Nelson, project manager
• 703-875-0759
• rnelson_at_aasa.org

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School Asthma Program Information and Lessons
Learned
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School Asthma Program Materials Quest for the
Code

• An interactive CD-ROM that uses high end graphics
  and animation to teach kids asthma management
  skills

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School Asthma Program Materials Implementation
Guide

• Provides additional information, quizzes and
  other materials to help school professionals use
  Quest for the Code as part of a coordinated
  school health program

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School Asthma Program Materials Additional
CD-ROMs

• Free CD-ROMs to provide to students for home use
  are available at www.slsb.org or by calling (800)
  315-2580.

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Quest for the Code CD-ROM

• For kids ages 7 to 15
• Based on NHLBI guidelines for managing asthma in
  children
• Includes information for caregivers
• Each CD-ROM in English and Spanish
• Free to children with asthma, parents, health
  care professionals and schools
• Senior Medical Advisor Gary Rachelefsky, MD

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Quest for the Code CD-ROM Goals

• For children with asthma ages 7 to 15
• Decrease school absences due to asthma
• Decrease asthma episodes and exacerbations
• Learn key asthma management concepts in a fun way

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Quest for the Code CD-ROM Goalscontinued

• Develop decision-making and self management
  skills
• Increase self-esteem and confidence
• Learn how to talk about asthma with others
• For healthcare professionals and parents
• Provide a consistent, comprehensive tool that can
  be used in a variety of settings

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Implementation Guidefor Schools

• Provides detailed instructions for installing and
  using Quest for the Code
• Explains CD-ROM educational goals
• Includes a kid-friendly glossary of asthma
  terms for children and parents
• Provides short cuts for adults

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Implementation Guidefor Schools contd

• Includes quizzes for children to take after
  completing each of the seven educational modules
• Includes one sheets for parents that correspond
  to each of the seven educational modules
• Explains how to save and retrieve a childs game
• Explains the educational value of the CD-ROM and
  provides tips for integrating Quest for the
  Code into a curriculum for interested teachers
• Provides sample letters to send home to parents
  about what their child learned from the CD-ROM

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Quest for the Code How to Use

• Place a copy in the library for children and
  teens with asthma to play during recess, study
  hall, or alternative PE
• Install the game on a computer in the
  nursing/health office for children and teens to
  play while medications take effect or while
  undergoing nebulizer treatment
• After playing, have children take the quizzes
  provided in the Educational Modules section of
  the Implementation Guide, and take home the One
  sheets for parents provided in the same section

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Quest for the Code How to Use contd

• Ask the health or science teacher to install the
  game in the classroom or computer lab and use the
  game to illustrate lung functioning and blood
  oxygenation
• Ask the health or classroom teacher to use the
  game in the classroom or computer lab to educate
  peers about asthma
• Send the game home with a child and have them
  complete the quizzes in the Implementation Guide
  for extra credit

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Quest for the Code How to Use Contd

• Ask the Spanish teacher to install the Spanish
  version of the game in the classroom or computer
  lab for use during Spanish class
• Give a copy to each child with asthma for the
  child and family to use repeatedly at home

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Milestones

• Pilot completed Summer 2002
• Materials Approved September 2003
• First mailing to 45,000 participants September
  2003
• Second mailing to 25,000 participants May 2004
• Evaluate utilization beginning fall 2004

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Lessons Learned

• Collaborate and Partner with Key Groups
• School Nurses Rule!
• Projects can take a long time, be generous when
  giving projected completion dates to partners
• Early adopters make great trainers and promoters
• Dont expect everyone to use the program
• Build on your strengths
• Collaborate with others who have complimentary
  strengths