Kansas: Creative Efforts Across the Plains

A unique blend of remote training, staffing and volunteer support has resulted in Open Airways For Schools penetration in Kansas since 1995. The American Lung Association of Kansas has modified its approach to program implementation as economic and political forces have changed and continue to work with school districts across 80,000 square miles. From 1997-2004, 4998 students have graduated from Open Airways For Schools.

Kansas’ Open Airways For Schools efforts have developed and been modified considerably since initial efforts, but the long-term program has directly and indirectly impacted other American Lung Association efforts. Staff has created efficient training opportunities that extend beyond this program, and has developed focused promotional strategies for approaching nurses and principals.

Open Airways For Schools is the only asthma education program currently being used in Kansas. Although there is no state policy mandated asthma education, Open Airways For Schools has laid the groundwork for asthma management focus within the State of Kansas.

Site Background

Pediatric asthma data in Kansas was collected and is being analyzed for the first time in 2005; previous data analysis estimated that 57,881 children under age 18 had asthma in 2002.1 School nurses in the three largest school districts (Wichita, Kansas City, and Topeka), with whom the American Lung Association of Kansas works closely, report anecdotally that up to 30 percent of elementary school students are diagnosed with asthma or suffer from asthma-like symptoms. Primarily rural, Kansas presents several challenges when working with stakeholders and nurses at widespread locations situated hundreds of miles from core staff. Work with Kansas school districts stems from relationships with school nurses, who have become the point of impact responsible for implementing Open Airways For Schools. Nurses are the primary gatekeepers to approaching school administrators with the program.

School nurse staffing varies across the state, but schools rarely have the commodity of a dedicated nurse position, with the exception of very large high schools. Recent budget cuts have decreased nursing hours and slashed positions throughout the state. District-employed schools nurses, who may be full- or part-time, typically cover more than one school. Under another model, a district contracts nursing services from its county health department to administer federal- and state-required screenings for vision, hearing, scoliosis and immunizations. These nurses may drive more than 200 miles in a given day between schools or may be present in a school for only one day per week, for example; no time is allotted to provide wellness or prevention programs.

Program Implementation & Evolution

The American Lung Association of Kansas’ long-term goal is to implement Open Airways For Schools in every Kansas elementary school district that maintains at least one full-time nurse position. The short-term goal is to achieve full Open Airways For Schools implementation in at least 30 schools per year. Some of these schools continue the program annually; in 2004-2005, for example approximately half of the participating schools are new to the program.

The state’s largest metropolitan areas—Garden City, Junction City, Kansas City, Lawrence, Topeka, and Wichita—remain priority areas for Open Airways For Schools. These six largest metro areas comprise 155 elementary schools. The remainder of the state, however, is much less densely populated, as reflected in the fact that 172 school districts have only one elementary school; 76 other districts have only two or three elementary buildings. District sizes and rural locations have been major challenges.

Administrators are receptive to Open Airways For Schools when they make the critical connection between absenteeism among students with asthma and their probable poor understanding of the disease process and poor disease management by the student and family. Administrators’ related priorities are to increase test scores mandated by “No Child Left Behind” and to secure as much federal and state funding as possible by having consistent attendance. Open Airways For Schools is positioned as a tool for helping achieve those priorities.

Training

The American Lung Association of Kansas’ unique training component has become the lynchpin to the program’s ongoing success. In Kansas, Open Airways For Schools is implemented primarily by school nurses, yet training them and other volunteers is a formidable task given the state’s geographic width and depth. Long travel distances make on-site training expensive and available to a limited number of participants for any single date or location. The American Lung Association of Kansas, however, tapped into a statewide technical infrastructure that bypasses the challenges of distance and is a cost-effective training strategy.

The State of Kansas Board of Education funds a two-way interactive television (I-TV) network that reaches all 304 school districts statewide through 11 strategically-placed educational service centers. These centers are equipped with state-of-the-art audio and video production equipment that operates by satellite telecommunication. The I-TV system may connect up to five sites effectively for two-way interaction by video and audio. I-TV has been ALA of Kansas’ primary training tool for Open Airways For Schools since 1999 and is the key to implementation.

The American Lung Association trainer teaches the course from Topeka. Nurses and other volunteers gather in small- to medium-sized meeting rooms at centrally-located centers; meeting rooms accommodate 10-50 participants, which are ideal for both the general sessions and smaller breakout rooms required by Open Airways For Schools trainings. On-site coordinators, employed by the State of Kansas, function as facilitators to assist with enrollment, provide refreshments, distribute handouts and collect evaluation forms. The I-TV Open Airways For Schools trainings are limited to three hours, and staff offer additional follow-up telephone training support. Between 1999 and 2004, 594 school nurses and other Open Airways volunteers have been trained via I-TV.

In addition to increasing outreach to rural areas and minimizing volunteers’ travel time, I-TV trainings are extremely cost- and time-effective for the American Lung Association of Kansas. While on-site trainings must absorb costs of travel, lodging and meals, the Lung Association’s I-TV costs reflect a per-session fee for the facilities and equipment. I-TV costs are the same, no many how many individuals are participating statewide. Costs of materials and other incidental expenses vary with the number of participants. The trainer travels to a local I-TV site, rather than an area that might require 24 hours’ travel. Depending on the distance of a would-be on-site training, costs can be cut by 60 percent.

Staffing & Funding

The American Lung Association of Kansas manages Open Airways For Schools with the work of a part-time, off-site staff member who is focused on two interrelated programs: Open Airways For Schools and Tools for Schools. Staff is in continuous contact with school nurses and other key contacts involved in indoor air quality (IAQ) issues. By combining these two program responsibilities, the association keeps the issues woven together logistically and is able to leverage IAQ and Tools for Schools work as an entrée to Open Airways For Schools within districts. From a day-to-day perspective, the one off-site staff member can remain focused on school asthma and IAQ priorities and is not pulled into other office activities.

Open Airways For Schools was funded initially by Stormont-Vail Regional Medical Center in Topeka and several small donations. Ongoing implementation has been funded primarily through grants, including American Lung Association Childhood Asthma and IAQ Initiative grants, which support satellite trainings. Grants from hospital foundations in Lawrence, Junction City and Kansas City are used to purchase peak flow meters, spacers and provide I-TV trainings. A CDC Asthma-Friendly Schools Initiative grant is funding current Open Airways For Schools work in 12 Wichita schools.

Challenges

Three major issues are affecting schools throughout Kansas and are presenting new challenges to Open Airways For Schools implementation. The first is the day-to-day result of No Child Left Behind efforts: teachers and principals are very reluctant to allow students to leave the classroom and miss test-focused instruction. Second, the State of Kansas Supreme Court ruled in November 2004 that Kansas schools were grossly under-funded and charged the state legislature with developing a formula for adequate funding of all schools. This fiscal crisis has resulted in school boards, administrators, faculty and staff being focused full-time on the crisis and the pressing threat of consolidating districts. Third, the state’s budget shortfall has led to a cut in school nursing positions, as well as reduced hours in existing nurse positions.

Despite those major challenges, the American Lung Association of Kansas continues to implement Open Airways For Schools in at least 30 elementary schools throughout the state per year. As a result of the current economic and education testing-based barriers, Open Airways For Schools often is introduced to schools through successful IAQ Tools for Schools relationships.

Impact

Open Airways For Schools has reached children throughout Kansas, but its total impact is reaching beyond those immediate families and specific elementary schools. As an outgrowth of the program, the American Lung Association has successfully prioritized asthma management throughout communities, is working closely with the State of Kansas on data collection and other issues, and has developed additional program partnerships.

More than 4000 children have graduated from Open Airways For Schools statewide since it was initiated in Kansas in 1995. The American Lung Association of Kansas’ major areas of focus are currently in the six largest metropolitan areas, which represent 14 school districts with a student population of 106,359. The program has taken hold in these six areas. Since 1999, 98 schools in the six metro areas have adopted the program, which is implemented by more than 167 nurses whom the Lung Association has trained; these nurses have graduated 1,112 students over four school years. Many schools repeat the program and sustain it with minimal support from the Lung Association (provide materials, etc.) Open Airways For Schools also has provided entrée to local hospitals in metropolitan areas where the American Lung Association is seeking program partnerships.

Statewide Asthma Management Issues

The maturation of Open Airways For Schools in Kansas has been coupled with the expansion of indoor air quality programs, particularly IAQ Tools for Schools, the movement of a key trainer into a pivotal health position within state government, and the Asthma-Friendly Schools Initiative. Together, the three have shifted focus and momentum to the broader spectrum of asthma management issues.

First, while the combined effects of No Child Left Behind and state budget cuts have forced new strategies for maintaining and expanding Open Airways For Schools, IAQ Tools for Schools has been highly successful. Tools For Schools is promoted to grantees of the Kansas Department of Education’s Coordinated School Health Program. Staff has leveraged these Tools for Schools relationships and schools’ increasing understanding of asthma and the environment to introduce Open Airways For Schools in districts and schools who otherwise would not be receptive to an “outside” health curriculum.

Second, the American Lung Association nurse consultant who developed the I-TV training program eventually moved into the position of State of Kansas School Health/Child Health Coordinator. She has continued to serve on American Lung Association committees and advocates within the state for Open Airways For Schools and IAQ Tools for Schools. Through her work, Open Airways For Schools is recognized as the only asthma education program that school nurses should be using.

Third, the CDC grant-funded Asthma-Friendly Schools Initiative, which incorporates Open Airways For Schools, is directly impacting statewide asthma policies. The Initiative is managed by the Kansas Asthma Coalition, which involves representatives of major hospitals, student nurses, municipal health departments, pharmacists, pharmaceutical companies, and parish nurses; the American Lung Association of Kansas is the coalition’s lead agency. The Kansas Asthma Coalition and the American Lung Association of Kansas have advocated since 1999 for the State of Kansas to collect pediatric-specific asthma data on the state’s Behavioral Risk Factor Surveillance Survey (BRFSS). That goal is accomplished. The Kansas Department of Health & Environment is collecting pediatric-specific asthma data on the 2005 BRFSS for the first time. Furthermore, CDC is considering the 18 questions developed by the Kansas BRFSS staff as model questions for pediatric asthma nationwide.


  1. Estimated Prevalence and Incidence of Lung Disease by Lung Association Territory 2004. American Lung Association. September 2004.