Developing a Holistic Approach to Asthma Care Management

The Early Head Start team at CNE believes that caring for infants and toddlers requires a holistic approach involving teachers, parents, and local community services.

"Early Head Start (EHS) is not just about early care," said Mary Lee Swiatowiac, CNE's EHS director. "It's about health, nutrition, education, community services, and parent involvement." This means engaging a multitude of people dedicated to the same vision - providing for the health and well being of children so they can learn.

"Children don't learn in isolation. Their well being and academic potential is the result of a program's ability to implement a multi-faceted system."

An example of this holistic approach to early care is CNE's comprehensive asthma care management plan. Asthma is one of the most common diseases observed in Head Starts. An estimated 4 percent of children enrolled has asthma and receives treatment at the program. Head Starts can play an important role in helping families manage asthma through the development of an asthma care plan.

Sue Patel, CNE's health services manager, emphasizes that education is a critical component of the plan. Parents are given handouts, brochures, and are even encouraged to attend workshops. But sometimes, extra measures are necessary to ensure parents take the time to understand the importance of the condition and medication compliance.

"Most are single parents who work and may not have the time to sit and attend our education programs," noted Sue. So in addition, she offers one-on-one training with parents. Sue also works closely with teachers because of their daily contact with parents.

CNE is a strong proponent of professional development. In addition to training educators how to observe and evaluate a child's behavior (e.g., wheezing at post play or how a cold may affect breathing), Sue also spends time demonstrating how to use devices, such as a nebulizer. These types of training give teachers the confidence they need to run the nebulizer when the child needs it. Because printed instructions can sometimes be overwhelming and confusing for both parents and teachers, Sue may turn to the manufacturers or other outside sources for training on the appropriate use of devices.

Initially, establishing an asthma care management plan can be consuming, especially when the health services manager is assessing and evaluating a large number of children. That's why close collaboration with the program director is important.

Mary Lee, CNE EHS director, oversees EHS content managers who monitor the classrooms and communicate with teachers regularly. Teacher logs and observations on the children are reviewed. Are the children reaching their developmental milestones? Are there any potential environmental issues that may have triggered an asthma attack? Mary Lee compiles the monthly monitoring reports and meets with each EHS program partner to make a plan for compliance with the Early Head Start Performance Standard expectations.

If a specialist is involved in the care of the child, such as a pediatric speech pathologist or occupational therapist, a meeting is held to discuss the child's condition and ability to participate in certain activities. The health services manager also may reach out to the clinic or the child's physician to share findings and find out if the parent has forgotten to attend a follow-up appointment.

With so many individuals involved in the early care of each infant and toddler, communication is a priority in CNE's holistic asthma management plan. It allows the team to connect the dots in meeting the needs of a child.

Once a plan is in place, the CNE team knows they've built a system that can meet the rigorous performance standards set by Head Start.

"Early Head Start is very strict about having systems in place for managing conditions, such as asthma," said Martha Arntson, CNE's executive director. "With 4 centers, 4 family child care homes, 40 weekly home visits, and 8 communities to monitor, we need a carefully developed asthma care management plan that we can apply efficiently and consistently across the board to all the families."

Martha believes that CNE's holistic approach is distinct. But what makes their asthma plan - or any of their systems and services - truly successful is the team of individuals who have dedicated themselves to keeping the CNE Early Head Start children healthy enough to grow and learn.

An Asthma Care Management Plan should include:

• Parent information
• A brief history of the child's asthma
• List of potential asthma triggers (e.g., food, allergen, environment)
• A list of the medicines and medical device
• Educating parents, teachers and/or other team members on appropriate steps for administering medicine or use of nebulizers
• Peak flow numbers
• Communication internally and with outside services, such as the speech therapist, occupational therapist, or audiologist

For the treatment of asthma, shop our Asthma Category.