When day care also means caring for asthmatic kids
SC group’s program focuses on prevention
A South Carolina managed care trade group is developing a program to teach workers how to take care of the asthmatic children who come to their day care centers. The hope is to help the youngsters stay in control of their condition when parents can’t be on hand.
"The cornerstone of managed care is prevention," says Larry Marchant, executive director of the South Carolina Business and Health Alliance for Managed Care, which is organizing the program. "We want to save costs in health care by putting more money up front in prevention."
The program’s curriculum focuses on identifying asthma triggers in the day care facility. Things as common as mold and cockroaches can make the day care setting hostile to kids who are sensitive to these triggers.
The advice is simple and inexpensive, such as advising employees to be careful about children carrying around crackers and cookies that can spread crumbs and attract roaches.
"I really believe this is something that needs to be done," says Laura Szadek, RN, BSN, and master’s degree candidate who oversees the program for the alliance.
Second-hand smoke can also be a problem. Szadek advises not only avoiding smoking around the children but also wearing a "smoker’s jacket." This is an item of clothing worn over an aide’s outfit to absorb the lingering smoke, much like a smock for finger painters. The garment can be removed after the cigarette break so the trapped smoke never comes in contact with the kids.
Workers also learn how to recognize asthma attacks and when to call a physician. They learn to ask if children have been using their medicine and get a basic understanding of how it works.
Szadek also is compiling a range of written materials and a Web site where directors of day care centers can access information and review it with their staff. Manuals and posters are being designed to hang onsite as reminders to be aware of asthmatic kids.
Szadek says she spends an hour or two at each center. "We’re going out and hand-delivering this education," Szadek says.
The pilot project has taken training to employees at about 50 day care centers around Columbia, SC, the state’s capital. So far, the hands-on training isn’t available in other areas of the state, but Szadek hopes eventually to train nurses in other regions who can teach the classes.
But employees from 51 centers across the state recently got an earful about asthma at the day care association’s annual meeting, which includes time for continuing education that employees must receive.
In South Carolina, the only health-related education child care workers must receive is in first aid and CPR. That’s why Szadek is pushing to make asthma education part of that course. "This whole other area isn’t getting addressed," Szadek says. But Szadek recognizes this will be an ongoing process because child care workers tend to turnover quickly.
Szadek says she is focusing first on day care centers that care for low-income or minority children because they are more at risk for developing asthma. Because it’s funded by a $30,000 grant from Merck and Co., the training is free to the centers.
She worked with the state’s ABC (day care for low-income families) voucher system that provides funding for low-income children to attend day care. The ABC program gave Szadek a list of approved providers in their system, which she used to contact facilities directly.
For now, she doesn’t know if the program will have the means to track outcomes. Instead, she gives workers a test before and after the training and then makes follow-up phone calls to see how the training is helping.
The South Carolina program is modeled after a similar effort in Maryland, where the state chapter of the Allergy and Asthma Foundation of America wants to take its initiative nationwide. The Maryland effort began in 1994 and so far has taken training to about 400 licensed day care providers in the state.
That training counts as three credits toward licensure requirements. The training takes three hours and includes hands-on education about anatomy and physiology, environmental controls, emergencies, and information to get from parents, says Maryanne Ellis, executive director of the Maryland chapter.
About half of the Maryland program’s funding comes from Merck and half from U.S. Environmental Protection Agency. Each donated about $25,000. This year, the chapter will launch 16 pilot programs that target at least 25 providers each. Individual pilots will be aimed toward different audiences, such as child care centers and Head Start programs, in various regions of the state.
"We want to touch on different types of environments," Ellis says. "We’d like a good mix."
After the pilots have begun, providers will receive a survey to gauge changes they made as a result of the training and retention of the material taught. The pilots should run through next April or May. After that, Ellis hopes to take the effort nationwide where it’s not available now.
"We’re trying to see what’s out there," says Ellis, who has heard from other states interested in programs aimed at day care centers. "We don’t think there are any really very organized ones." Yet, she stresses the importance of training for those who care for children under age 5.
"They kind of get lost," Ellis says, "but it’s important to target them. The earlier on there’s better control then there is better compliance."
According to the American Lung Association, the estimated annual number of emergency room visits for children under age 5 is 120.7 per 100,000 children, the highest of all age groups. That’s a major reason why managing the disease is so important.
Yet, when the managed care alliance went in search of programs that target these younger children, Marchant and Szadek found none. Instead, programs were aimed at school-aged kids.
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