Tyra Bryant-Stephens, a pediatrician at CHOP’s West Philadelphia outpatient clinic, did everything she was supposed to do when she diagnosed a patient with asthma. She prescribed medicine to treat and prevent symptoms; taught families how to use inhalers; told them how to reduce triggers in their homes, by limiting smoke, dust, cockroaches and mold; helped them to develop action plans for keeping their children healthy. But the young doctor quickly realized that wasn’t enough.
“There was a disconnect between what we asked families to do, and what they would do at home,” Bryant-Stephens says. “Often I saw them after they’d had to rush their children to the emergency room, and knew they weren’t doing what we’d agreed. I knew I needed to try another approach.”
That was in 1992, when the treatment for asthma was less standard than it is now. But it was already the number one chronic disease in children, and the most common reason they went to the emergency room and were admitted to hospitals. What’s more, Bryant-Stephens knew that asthma was connected to another common problem among her low-income patients: Success at school.
35,000 students in Philadelphia suffer from the asthma, more than half of whom have ended up in the emergency room in the last year to treat an attack. As in other parts of the country, the city’s poorest children are most vulnerable.
Asthma is the leading cause of chronic absenteeism around the country, amounting to almost 13 million missed days every year, according to the Environmental Protection Agency. An estimated 35,000 students in Philadelphia suffer from the lung disease, more than half of whom have ended up in the emergency room in the last year to treat an attack. As in other parts of the country, the city’s poorest children are most vulnerable. They more often live in houses that carry triggers, like dust, mold and cockroaches. They are often in more heavily-polluted neighborhoods, near refineries and factories. And they often have parents with asthma, which puts them more at risk. Bryant-Stephens says asthma attacks often happen at night, disrupting sleep. “So even if they come to school, they tend not to learn as well,” she says. “They have worse concentration and memory, and are less on point with tasks. That negatively impacts their academic performance.”
Since 1997, Bryant-Stephens has worked to break this pattern through the Community Asthma Prevention Program at CHOP. Through CAPP, Bryant-Stephens sends community health workers directly into patients’ homes to work with families over the course of a year on the best methods to prevent and treat asthma. The workers bring supplies, like pillow covers and roach traps; teach families how to administer medicine; remind children of the warning signs of an asthma attack; and advise them how to keep their homes trigger-free. Each year, CAPP workers see more than 200 families in their homes. Currently, Bryant-Stephens also has two workers in CHOP clinics, who see around 50 patients a month.
Bryant-Stephens is working with the District on a detailed asthma plan for teachers and administrators. But it comes too late to save 12-year-old Laporshia Massey, who died in 2013 after suffering an asthma attack on a day when there was no nurse at her school.
Bryant-Stephens has found results: CAPP patients have significantly fewer asthma symptoms, ER visits and hospitalizations. Caregivers are more likely to bring their children into the clinic to see the health worker, instead of the ER. And students in the program miss significantly fewer days of school. In a report she released last year, Bryant-Stephens noted that the number of children in her study with zero asthma-related absences rose from 36 percent to 48 percent. Bryant-Stephens doesn’t follow the families once their year-long participation ends, but she says the lessons learned are ones that can change a child’s life—and pass down to further generations.
“I have always believed there is untapped expertise in the community,” Bryant-Stephens says. “Peer education is more effective in changing behavior than perceived authoritarian instructions. There are things I say to my patients that they don’t listen to, but they do listen when a community health worker tells them.”
Over the last 15 years, CAPP has worked with the School District to train nurses on the standard treatment for asthma, and how to give medicine. “We found early on that parents felt like school nurses weren’t treating their children properly,” says Bryant-Stephens. “Nurses, meanwhile, said they didn’t get enough information from home. We helped them develop a system.”
Now, when most public schools don’t even have a nurse every day, CAPP is working with the District on a detailed asthma plan for teachers and administrators. Bryant-Stephens says it will include a poster to hang in every classroom on First Aid for asthma, as well as training for school employees on how to treat an asthma attack. In his Action Plan, Superintendent Hite this year also said the District will work to keep school buildings clean and free of mold, to prevent asthma flare-ups. All of this comes too late to save 12-year-old Laporshia Massey, who died in 2013 after suffering an asthma attack on a day when there was no nurse at her school. But Bryant-Stephens says that need not happen again.
“I was working with the schools for a long time before she died,” Bryant-Stephens says. “But they never had this detailed a plan before. School nurses are not on the horizon, so we’ve had to change our approach. We’re trying to create a better way for teachers to help so we can keep children healthy and in school.”
To sign up for asthma prevention home visits, visit CAPP.
