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Meet the team: South Tees Asthma Working Group, Teeside University

Also:

  • Dr Victoria Ononeze, Consultant in Public Health
  • Dr Rosemary Thwaites, Consultant Paediatrician and Strategic lead for children, adolescents and young adults South Tees NHS foundation trust.
  • Carol Barwick, Asthma Nurse
  • Other Members of the South Tees Asthma Working Group

Asthma is the most common long term medical condition in children and young people (CYP). It is estimated that about 12.5%, 1 in 11 children (1.4 million children) aged under 16 years in the UK are affected by asthma(1).

In South Tees, (Middlesbrough and Redcar and Cleveland) about 5,500 CYP have asthma. Asthma is a common cause of large numbers of A& E attendances and emergency admissions in CYP. Teeside have higher asthma admission rates for CYP than the regional and the national average. In 2016/17, the crude admission rates were 406 per 100,00 people in Middlesbrough and 277.1 per 100,000 people in Redcar and Cleveland, compared with average England of 202.8 per 100,000 people(2).

THE ROLE OF SCHOOLS

Asthma UK estimates that there are approximately three children with asthma in every classroom in the country, and these children will miss an average of 1.5 more school days per year compared to those without asthma(1).

Schools, play a major role in making the school and related environments asthma safe, assisting CYP with daily management of their asthma, and promoting acceptance and understanding amongst children and staff for the condition. The National Review of Asthma Deaths (NRAD) identified primary care and schools have a significant role in improving asthma care for CYP(3). Schools are also required to have polices for the management of children with health needs(4).

Children and young people spend a significant proportion of time at school, therefore support with their asthma management is imperative. Evidence suggests teachers lack knowledge of asthma care, which can impact negatively on a CYP’s ability to effectively manage their condition(5).

Traditionally, school nurses provide care and education for children with asthma and other long-term conditions. However, changes in the school nurses role and reduction in their numbers have meant that they do not have the skills and confidence to appropriately support children with asthma with their care.

THE PROPOSAL: 

We propose community-based interventions to help improve health and well-being outcomes for children with asthma in primary/ secondary schools in Teeside

The proposal is to develop these interventions under an ‘Asthma Friendly Schools Programme’ to help provide schools with the knowledge and skills to create a supportive and facilitative environment for CYP to maximise self-management and self-care. This will involve increasing awareness of asthma in school staff and pupils and families and carers, by providing information, training and support.

The programme uses an asset-based approach, utilising staff with existing relationships to facilitate positive behaviour change in CYP. Previous public health interventions have shown schools to be an effective setting (6)and current provision is limited.

ASTHMA FRIENDLY SCHOOLS PROGRAMME: 

The following initiatives will be undertaken under the umbrella of an ‘Asthma Friendly Schools Programme’:

• Baseline survey of what schools currently have in place to support CYP with asthma

• Promote the adoption of a model school asthma policy in schools in Teeside

• Identify children with frequent asthma exacerbations and work with schools and families/carers to provide tailored support

• Training, advice and support for school governing boards, teaching and non-teaching staff

• Training for school nurses and health visitors to a generic level in line with Primary Care Respiratory Society UK (PCRS-UK) recommendations to be able to support CYP children at home or in school to maximise daily care

• Asthma awareness campaign and recruit Young Asthma Champions-develop peer support amongst Young people with Asthma

• Dedicated nurse to provide specialist support to school nurses and schools and coordinate asthma friendly schools programme.

• Academic research input – data analysis, monitoring and evaluation

Asthma Friendly School Programme Coordinator:

In order to implement programme, a part-time school nurse with expertise/interest in asthma and the knowledge and skills to lead the project, would be required. The coordinator will provide specialist support to peers, support children in schools with asthma and liaise with GPs/practice nurses and secondary care. Collaboration with Teeside University will help develop baseline and post intervention qualitative/ quantitative data to measure service impact.

Service Impact:

The impact on service activities will be measured in the medium and longer term.

Short-term

• Better awareness of asthma standards in schools

• Increase in school nurses and health visitors confidence and skills in advising schools and supporting CYP with asthma

• Increase in teachers confidence in supporting CYP with asthma

Medium and Longer-term

Improvements in the quality of care/management of CYP with asthma which should lead to:

• More appropriate use of primary and secondary care

• Improved use of inhalers and less waste

• Prevent or reduce the number of A&E attendances and hospital admissions

References

1. Asthma UK. Asthma Facts and Figures. [Internet]. 2016. @Asthma UK. Available from: https://www.asthma.org.uk/about/media/facts-and-statistics/ [Cited: 21st September 2017].

2. https://fingertips.phe.org.uk/profile-group/child-health/profile/child-health-long-term.

3.Royal College of Physicians. Why Asthma Still Kills: National Review of Asthma Deaths London; 2014. Available from: https://www.rcplondon.ac.uk/projects/outputs/why-asthma-still-kills.

4.Department of Education. Supporting pupils with medical conditions at school. 2017. London @Crown Copyright. Available from: https://www.gov.uk/government/publications/supporting-pupils-at-school-with-medical-conditions

5.Kew KM, Carr R, Donovan T, Grodon M. Asthma education for school staff (Review). Cochrane Database of Systematic Reviews. 2017 (4).

6.Langford R, Bonell CP, Jones HE, Pouliou T, Murphy SM, Waters E, et al. The WHO Health Promoting School framework for improving the health and well-being of students and their academic achievement. Cochrane Database of Systematic Reviews. 2014(4

How you can contribute

  • Share ideas to strengthen evaluation, measuring and sharing impact- especially the role of young asthma Champions and impact of peer support
  • To recognize the challenge in expanding this to a national arena - could the Q Community support this roll out, or how would we influence policy or other key stakeholders ?
  • Examples of similar schemes to learn from and understand sustainability model

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