The Other 60 Percent

Coping with asthma leaves schools gasping

Castle Rock mom Heather Clark was so concerned that her 13-year-old daughter, Sami, would have an asthma attack at school and that no one would know what to do, she took to sneaking an inhaler into her daughter’s backpack, just in case. She calls it her “don’t ask, don’t tell” policy.

She didn’t realize that there was no need to treat the inhaler as if it were contraband. In fact, since 2005, Colorado law has given students with asthma the right to carry their inhalers with them and to self-administer their asthma medication, as long as they have a care plan on file with the school.

Last year, the legislature amended that law to remove the requirement for the care plan. But students and their parents are required to sign a contract with the school stating that the student knows how to properly administer the medication.

Douglas County schools, where Sami is a student, have adopted a policy in line with state law.

“I didn’t know that, but I’m excited to know it now,” said Clark, who also had asthma as a child. But she’s pretty sure that stated policy and actual practice don’t always coincide.

“The school doesn’t allow it,” the mom said. “I’ve gotten calls saying she couldn’t have it with her. I’m going to print out a copy of this law and make sure Sami has it in her backpack, along with her inhaler.”

Sami says she’s only had to sneak a puff on her inhaler a couple of times in the past two years, but she likes the security of knowing it’s there.

“At school, if you’re having a problem, you have to go down to the nurse’s office,” the teen said. “Unfortunately, for me that’s a couple of staircases away. That’s kind of scary, to be honest.”

The law is one thing, reality something else

Sami’s situation illustrates a greater problem confronting Colorado students with asthma, their parents and their schools:

The law is one thing. The realities confronting overworked doctors, spread-too-thin school nurses, perplexed school secretaries and anxious parents may be something else altogether.

Asthma facts

  • A CDC study shows 34 million Americans, or 1 in 9, have been diagnosed with asthma at some point in their lifetimes.
  • An estimated 22.9 million Americans – including 427,000 Coloradans – currently suffer from asthma.
  • Asthma prevalence is highest among blacks at 10.2 percent, followed by whites at 7.6 percent, and Hispanics at 6.8 percent.
  • Nearly a third of all children with asthma will miss three or more days of school this year.

“This is a topic that just needs more attention,” said Cindy Liverance, vice president of programs for the American Lung Association in Colorado. “One out of four people in Colorado has asthma. It can be viewed as commonplace. But people can die from asthma. If you don’t access to your medications, or you don’t know how to use them properly, you can end up in the emergency room.”

While Colorado law empowers children to carry asthma medication with them, health educators are now pushing for every school to develop an asthma action plan for every affected student.

That action plan would start with a long conversation between the student, their parents and the school nurse or health care provider. The school should have a list of all medications the child is taking, what the child’s symptoms are, what medications should be used and when, and at what point emergency medical responders should be called.

“Does that happen every time for every child? Sometimes not,” acknowledged Kathy Patrick, assistant director of the Office of Health and Wellness for the Colorado Department of Education and a state school nurse consultant.

“I’m coming from the perspective of a school nurse,” Patrick said. “When you have 4,000 or 5,000 students, how do you get to sit down with a student with asthma and make sure they know how to use their inhaler, make sure they know how to access help when needed?

“Nurses do what they can with the limited time they have available. But the nurse to student ratios, as they are, it’s unfortunate.”

Doctors, too, are often too busy to insure newly diagnosed young asthma patients get the education they need to stay out of trouble. The youngsters need to be made aware of things that will trigger their asthma, what to do if they start having trouble, and, above all, how to properly use their inhaler.

“If the doctor is well-versed in having these conversations, it takes five minutes tops,” said Eliza Lanman, senior director of programs for the American Lung Association in Colorado. “But if they’re not used to doing it, these conversations can take longer, and they just don’t see it as a priority.”

As a result, she said, newly diagnosed children with asthma typically end up in the emergency room an average three times in the first year after their diagnosis, because they don’t know how to minimize an oncoming asthma attack.

Lack of education in proper use can have devastating results

Sami Clark says she didn’t know how to properly use her asthma inhaler for the first two years she had it.

“Because I was never taught,” she said. “I finally learned the right way to use it at asthma camp. I sat down with a nurse there, and it took me two days to learn it.”

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This lack of education can also lead to situations such as an incident in January in Monument involving two middle school girls. One of the girls loaned her asthma inhaler to the other girl because she thought her friend was having an asthma attack. When school officials found out, both girls were suspended because school policy prohibits sharing of any prescription drug. The girl who borrowed the inhaler was eventually expelled.

“These two girls are a perfect example of why students need to be educated,” Liverance said. “To think you can just hand an inhaler to a friend is wrong.”

Some Colorado school districts already have asthma policies in place and do a good job of making sure every student with asthma has a care plan on file in the office.

Denver Public Schools, in particular, has partnered with National Jewish Hospital to provide asthma education across the district. Liverance cites Cherry Creek and Aurora as other model districts for asthma care.

But she can’t say how many districts have policies in place, let alone how many actually follow them.

“It’s hard to figure out,” she said. “That’s something we’ve been working on since the bill went into effect last year. It’s in flux. The more districts we talk to, the more interested they are in implementing this.

“But it not only means more work for schools, it also means more work for doctors, more work for parents. It’s understanding that asthma isn’t something you can take lightly.”

Adopting and implementing asthma care policies isn’t something just limited to large districts. Jody Stroh, the school nurse in Creede, is a certified asthma educator. She’s traveled around southern Colorado training her peers in best practices when it comes to managing students with asthma.

“Our goal is to improve asthma literacy among all the school nurses in Colorado,” Stroh said. “But I know that it will probably be a school secretary doing the education about asthma with a child, so we’ve designed a file system with all the different worksheets about what asthma is, what medications you’d use, how to exercise without triggering asthma.”

“A tremendous amount of thought has gone into making sure kids have their medicines available to them immediately,” she said. “We find out who has asthma, who is carrying an inhaler, and those who’ve had any problems in the past year will get a care plan. If you have a child old enough to carry an inhaler, we have a document that we have them sign, and have their parents sign, that says they understand that they’re not to share that inhaler and that they’re must have it labeled.”

raising the curtain

Aurora high school students started rehearsing a musical about an earlier time — and discovered ‘harsh truths’ about today

Ebony Nash, left, sings during a rehearsal of Ragtime at Hinkley High School. (Photo by Yesenia Robles, Chalkbeat)

Nine weeks ago, more than 50 theater and choir students at Aurora’s Hinkley High School came together to begin work on a musical set in turn-of-the-20th-century New York.

At first, the kids did what high school students often do — cluster into familiar cliques, or self-segregate by race. Then the students started immersing themselves in the material.

The musical, “Ragtime,” intertwines the stories of a white family, a Jewish immigrant family and an African-American couple to spotlight differences and commonalities in the American experience.

At the urging of their teachers and directors, the Hinkley students began to use the plot and characters to examine their own actions, prejudice and biases. About 92 percent of Hinkley’s more than 2,100 students are students of color, the vast majority of them Latino.

The cliques and segregation slipped away. The production began taking shape.

“Ragtime” gets its Hinkley High School debut on Thursday and will be performed again on Friday and Saturday.

Chalkbeat sat down with a group of students involved in the production as they were in final preparations to learn about what their experience had taught them. The following is a portion of that conversation, slightly condensed and rearranged for clarity:

Janelle Douglas, a 17-year-old senior who portrays a friend of one of the story’s main characters, said the first time she saw and read through Ragtime, “it was intense.” She often cries as she rehearses her solo, sung during a funeral.

DOUGLAS: “I thought, this is powerful. This is overwhelming. This is amazing.”

Pamela Arzate, 17, plays the role of Evelyn Nesbit, a real model and actress who is incorporated into the fictional story and accused of being shallow.

ARZATE: “It’s very eye-opening because you look at it and it’s just a simple musical, but if you take a step back and go to the real world, it’s the exact same thing that’s going on today.”

Hodaly Sotelo, 17, plays the role of Mother, a woman whose attitudes toward her identity as a wife and woman evolve throughout the story.

SOTELO: “It reminds me of when I was younger and I was like, ‘Oh yeah, we’re over all that racism.’ But now, I look back and I think, what the heck? This stuff is still going on and we thought it was way over.”

Brianna Mauricio-Perez, 17, is one of two student directors.

MAURICIO-PEREZ: “It talks about all of the harsh truths that no one wants to talk about.”

DOUGLAS: “I think it’s safe to say it shows the true colors of our history.”

MAURICIO-PEREZ: “Even within our cast we did have to have a talk about how we were so separated because we were at the very beginning. Everyone was in their little groups and with their friends. You just want to keep to yourself.”

DOUGLAS: “It was literally ‘Ragtime.’”

MAURICIO-PEREZ: “We had a big talk with everybody. Things have gotten so much better. By the end of Act Two, we were all mixed up.”

Brenda Castellanos, 17, plays the role of Emma Goldman, drawn from a real-life political activist and anarchist.

CASTELLANOS: “Now that we’re closer, now that we’re all comfortable, we put in more effort.”

After nearly every rehearsal, teachers and directors give students a talk, urging them to immerse themselves in the feelings of their characters, relating to them if necessary through their parents, grandparents or ancestors who were immigrants, or through current events.

“What if you saw someone beaten, and bloodied and killed in front of you?” one director asked.

They also remind students of why the play should be impactful. “You have to figure out how for two-and-a-half hours you can give hope to that audience,” Marie Hayden, Hinkley’s choir director told students last week.

CASTELLANOS: “I think it it helps us. Every day, we get more into it and more into it until we actually believe it. You actually feel it — like how Janelle feels when she’s singing and she starts crying and makes everybody cry. We all feel connected.”

Students say they have different scenes that impact them the most, but they don’t hesitate to find how the scenes relate to their life despite the story being set in the first decade of the 1900s. Hayden’s class and the practice for the musical are safe places where they can discuss those parallels, they said.

Shavaun Mar, 16, is a junior who plays the main character of Coalhouse Walker Jr., a ragtime piano player who is the target of racial attacks and struggles with revenge and forgiveness.

MAR: “I feel like that is crucial that we give people those opportunities to talk because a lot of people have very valid things to say but they just don’t have a way to get it out.”

CASTELLANOS: “The shootings.”

ARZATE: “The racism. They help us discuss it because there’s so many things that are going on. Pretty much everyday there’s a tragedy going on. And so, in a way, we can use that sentiment, that emotion that we feel with the real world and convey it when we’re doing this show. We use those feelings and we try to think about it in that way. To display that emotion. To display it to everyone else. And not directly represent what’s going on today but just to give them that ‘aha’ moment, like ‘wow.’”

Ebony Nash, 17, plays the character of Sarah, an innocent girl who wants to help her boyfriend settle his problems.

NASH: “It just makes us want justice in real life because these things are still going on even though it’s not out there. It just makes us want justice for our community. This musical showed me that I need to become better within myself because I’m not perfect.”

SOTELO: “It opened my eyes a lot more for sure. This kind of just makes me realize the problems I have. It makes me realize yea, I’m having immigration issues with my father right now, but that also my friends, you know, they’re going through the same thing too. This DACA stuff or this coming out stuff. I became more accepting of what other people might be going through and how I can help.”

MAR: “The past few years, I have been in a bit of a shell. So putting myself in this situation and pushing myself to be this other person has really shown me what I’m capable of and it’s helping me break out of that shell and realize who I am as a person.”

NASH: “Basically, this is our getaway from real life because we get to come on stage and be somebody else. It also makes us want to put the story out right so people can understand. So people can feel what we want them to feel.”

CASTELLANOS: “That there’s hope after all this corruption that’s going on.”

DOUGLAS: “That even in your bad times you can still laugh, cry, dance.”

NASH: “What I want people to get from this is change. To learn how to change and learn how to forgive and learn how to come together as a community and just, like their worth.”

SOTELO: “And to be strong. To stand up for what’s right.”

ARZATE: “And it might sound weird, but I feel like they should feel a certain level of uncomfort because that means that they’re going to look at themselves while seeing the musical. Maybe they’ll go ‘I’m uncomfortable because I do that’ or ‘I have that prejudice’ or ‘I feel that certain way,’ so if they come out and they feel uncomfortable and then at the end they’re like, ‘Wow. There’s that hope for change.’ Hopefully that like…”

DOUGLAS: “… It inspires them to do better.”

ARZATE: “Like, you can do it.”

SOTELO: “It’s kind of like a water droplet. One small move can domino-effect to something bigger.”


Taking attendance

Want to make middle school admissions more fair? Stop looking at this measure, parents say

PHOTO: Monica Disare
Middle school students write their names down at a high school fair in Brooklyn.

Parents across New York City have pushed for changes in the way selective middle schools pick their students, saying the process is unfair.

Now, a group of Manhattan parents has come up with a novel solution: Stop looking at students’ attendance records.

The parent council in District 2 — where about 70 percent of middle schools admit students based on their academic records — points to research showing that students from low-income families are far more likely to miss school. Those children are at a distinct disadvantage in the competition for the district’s top middle school seats, the council argues, even though factors beyond the control of any fourth-grader — especially family homelessness — often account for poor attendance and tardiness.

“This outsized focus on attendance disproportionately impacts students who don’t have secure housing and may not have secure healthcare, and that is troubling to me,” said Eric Goldberg, a member of the community education council in District 2, which includes stretches of Lower Manhattan and the Upper East Side. “There are many factors that should not impact a student’s educational opportunities — and the way the system is set up, it does.”

Eighteen of the district’s 24 middle schools are “screened,” meaning they rank applicants based on factors including test scores, grades, and interviews. Of those, all but one school also considers how often students were late or absent in fourth grade, according to the parent council.

Most of the schools assign points to each factor they consider. Some give absences 10 times more weight than science or social studies grades, the council found, while others penalize students for even a single absence or instance of tardiness.

Disadvantaged students are especially likely to miss school.

A recent report by the city’s Independent Budget Office found that homeless students are more likely than other students to be chronically absent — typically defined as missing about 10 percent of the school year.

Schools with the highest chronic absenteeism are in communities in “deep poverty,” which have the highest rates of unemployment and family involvement with the child-welfare system, according to a 2014 report by the New School at the Center for New York City Affairs.

“We can use chronic absenteeism as a good guess of all the other things kids are dealing with,” said Nicole Mader, a senior research fellow at the New School and a co-author of the report. “If these middle schools are using absenteeism to weed kids out, that means they’re going to automatically weed out those kids who have the most barriers to academic success already.”

The attendance requirement can put pressure on any family, regardless of their financial status or housing situation.

Banghee Chi, a parent of two children in District 2, said she sometimes sent her younger daughter to school with a fever when she was in fourth grade rather than have her marked absent.

Her daughter would show up to class only to be sent to the school’s health clinic — which would call Chi to pick her up. Chi was thinking ahead to middle school, when a missed day of class could hurt her chances of getting into the most sought-after schools.

“It was something I was really conscious and aware of during my child’s fourth-grade year,” she said. “I think it’s unfair.”

The education council’s resolution, which will be put to vote in December, is nonbinding because middle schools set their own admissions criteria. But a show of support from parents could lead to action from the education department, which has been prodded by integration advocates to make other changes in high school and middle school admissions.

This summer, the department announced it would end the practice of “revealed rankings,” which allowed middle schools to select only those students who listed them first or second on their applications. The city is also appointing a committee of parents, educators, and community leaders in Brooklyn’s District 15 to come up with a proposal for making that district’s middle school applications process more fair.

“We’re collaborating with communities across the city to make school admissions more equitable and inclusive, including in District 2,” said department spokesman Will Mantell in an email. The department looks forward “to further conversations about this resolution and other efforts to improve middle school admissions in District 2.”