Unplanned visits to school nurses by Hartford students with asthma dropped in recent years, thanks to a partnership between the Health Center and Hartford public schools.
Experts in occupational and environmental health and clinical care joined forces with the city’s school nurses, custodial staff, teachers, and administrators in a campaign to improve schools’ indoor air quality, and hence the health of the people inside.
The program has worked so well that the U.S. Environmental Protection Agency has recognized the Hartford Public School District for two years in a row with an award for its indoor air quality initiative and by naming it a
mentor for other urban school districts.
“We began in 2001 with a small pilot project to evaluate the effectiveness of indoor air quality management in schools and its effect on the respiratory health of students at Dwight Elementary School, which is housed in the city’s oldest school building,” says Paula Schenck, assistant director of the Center for Indoor Environments and Health, part of the Health Center’s Section of
Occupational and Environmental Medicine.
“Illness, especially asthma symptoms, can be prevented by improvements to overall air quality that reduce exposures to asthma agents and sources of irritation,” she says.
“The burden of asthma in urban school districts, including Hartford’s, is significant, and goes beyond the direct costs associated with asthma care. It is difficult for staff to teach
sick or absent children, and for children with asthma symptoms to learn.”
The initiative began by teaming with Dwight’s school nurse and principal, who worked with Health Center staff to enlist parents in the program, Schenck says.
“Our task was to test breathing function of the youngsters with asthma in the school and to initiate a program that provides a plan to improve indoor air quality. We worked with Hartford public schools’ facilities staff to monitor and improve conditions in the building, from replacing carpet with tile, eliminating area rugs, and installing window screens to repairing leaking pipes and cleaning up boiler rooms,” she says.
At the same time, Dr. Michelle Cloutier, professor of pediatrics at the Health Center and director of the Asthma Center at Hartford’s Connecticut Children’s Medical Center, began a training program for school nurses on the clinical management of asthma, including the best way for children to use inhalers and nebulizers to take their medications.
To inform others in schools throughout the city, Schenck collaborated with Pam Clark, the school district’s clinical nursing and support supervisor, and Al Hinds, the chief of building operations.
“We talked to teachers, nurses, custodians and administrators about asthma and school attendance,” says Clark.
“We showed statistics that proved the link, and described steps that could limit missed school days and avoid children being taken out of school by ambulance.”
With another small grant from the EPA, the group launched a train-the-trainer program to educate teams from each school.
By last October, 30 of 40 Hartford schools had teams that had completed the training; 28 school teams had begun the program in their schools; 24 teams had completed surveys and walk-through assessments; and 22 had identified and reported priorities and implemented improvements.
Some of the improvements required little investment, such as cleaning rugs, moving dumpsters, or cleaning vents.
Others were more substantial, such as repairing roofs or heating and air-conditioning systems.
“Resources are always a problem, but we targeted our efforts
to the improvements the school-based teams prioritized,” says Hinds.
“That way, team members saw the results and were inspired to keep working.”
The number of unexpected asthma nursing visits has decreased by more than 2,500,
or 22 percent.
“We continue to try to expand and improve the program,” says Schenck.
“This past year, Pam Clark began training pre-school staffs, and we want to begin to provide information and resources to parents so they can begin to make some changes in their homes.”