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.”

How I Help

Students were obsessed with social media. Here’s what this middle school counselor did about it.

PHOTO: Hero Images | Getty Images

In our “How I Help” series, we feature school counselors, social workers, and psychologists who have been recognized for their work. You can see other pieces in the series here.

Students at Eagle Valley Middle School in western Colorado were spending lots of time on social media, and too often their comments turned mean. Counselor Kayleen Schweitzer decided things needed to change, so last year she spearheaded a schoolwide campaign urging students, staff and parents to take a five-day break from social media. More than 150 people signed the pledge.

The results were encouraging. Participating students reported that they had more free time and were getting to bed earlier. Some even said the break made them realize they had been addicted to social media.

Schweitzer, who was named 2018 Middle School Counselor of the Year by the Colorado School Counselor Association, talked about how campaign organizers got students to participate, what she wants parents to know about middle-schoolers, and why she wants students to regard visiting a counselor as normal.

This interview has been condensed and lightly edited.

Why did you become a school counselor?

When I was 15, I lost my father. It was very unexpected and I found out at school. When I returned to school no one checked on me or followed up to see if I was doing OK. I remember wishing I had more support at school. That was the first time I realized that one day I wanted to be someone who could be there for students going through a hard time or transition.

When I was in college my favorite classes had to do with child development. I went on to pursue a degree in family and human services and a graduate degree in school counseling. I’m definitely happy with my decision to be a school counselor and I look forward to going to work every day.

Tell us about an effort or initiative you spearheaded at your school that you’re particularly proud of?

In the 2016-17 school year, my principal Katie Jarnot and I identified a need for something that would help with some of the conflicts occurring at our school. Katie came across a national program called No Place For Hate. It was just what we were looking for. In the 2017-18 school year, we brought No Place For Hate to our school. It has been amazing and powerful.

We noticed a lot of mean behavior on social media and that our students were spending so much time online. Also, with a surge of recent research into the detrimental effects of screen time, social media, and the correlation to depression and anxiety, it was clear there needed to be a change. So Eagle Valley Middle School’s No Place for Hate Coalition created a schoolwide activity that attempted to give students, staff, and parents a glimpse into positives that can come from limiting social media use and taking back control of our lives. We asked our school community to commit to giving up social media for five days.

During those five days, everyone who took the pledge was asked to do a daily reflection on the differences that they noticed. We offered a chance to win prizes as an incentive. To our surprise, we had 110 students (about one-third of our school), 18 staff, and 30 parents sign up.

Though not everyone completed the five days, we felt we brought some awareness to this problem. Students noticed how much more time they had when not using social media and they were able to get to bed earlier. Some actually admitted this activity helped them realize that they are addicted to social media. A few parents reported they were able to be more present with their family at night and have fewer distractions.

Is there a tool, curriculum or program you couldn’t live without in your job?

The tool I couldn’t live without is Google forms. Students can fill out a form to let me know they need to see me. When they fill out the form it notifies me with an email and I can see who is requesting to see me. It also allows me to keep data on what issues my students need support with. This helps me plan what supports I need to put in place through classroom guidance lessons, small groups, and individual counseling.

What’s the biggest misconception you’ve encountered about your role in the school where you work?

The biggest misconception I have encountered is that it’s a bad thing to go to the school counselor and that you need to have a huge problem. I have noticed that some middle school students are embarrassed to be seen going to the school counselor. I have worked really hard to make it normal to come to me and teach them that the strongest, most successful people need help sometimes.

You spend lots of time with students. Knowing what you know, what advice would you give to parents?

I would remind parents that students’ frontal lobes are not fully developed and when they say they don’t know why they did something, they are probably being honest. I would also let them know that even if a student says they want parents to give them space and leave them alone, it’s not really what they want or need.

Tell us about a time when you managed to connect with a challenging student or a student facing a difficult situation. How did you do it?

I have a student who is now in eighth grade and has been coming to see me on a regular basis when she needs support. As a sixth-grader, she was so closed off and worried about being seen coming to talk to me. I have been very consistent with her and kept reminding her that I’m always here if she needs anything. I ended up running a group with her and a lot of her friends. She saw that her friends loved coming to see me and were willing to talk to work through some of their problems. I also spent time with her and showed her it was a safe place to talk. Over time she broke down her walls and was able to trust me. Today, she stops by when she is doing well and when she is struggling. She loves to come and eat lunch with me. She has grown so much and I’m going to miss her dearly when she goes to high school.

What is the hardest part of your job?

The hardest part of my job is going home and worrying about my students. You always wish you could do more or make students see things can get better and they are enough. Middle school is such a hard time for students as they struggle to find where they fit in and deal with personal changes.

Tell us about a memorable time — good or bad — when contact with a student’s family changed your perspective or approach.

In my first years as a school counselor, I had a student who was consistently falling asleep in class and missing a ton of school. When I had a meeting with his family, I found out that his mother was a single mom and his grandma, who also lived in the house, was very sick. The student was staying home to help take care of his grandma and his siblings so his mom could work and make money for the family. His father was an alcoholic who was in and out of rehab.

I realized that different cultures have unique values and priorities. It also taught me that you never know what someone is going through so we need to really take time to talk to kids to figure out what is happening in their personal lives before jumping to conclusions.

You spend your days trying to help students and staff with any number of things. How do you wind down after a stressful day?

The way I wind down after a stressful day is to come home and spend time with my children. They are still young and innocent. I try to really enjoy this precious time with them when they have fewer worries and just want to have fun. I also love spending time with friends and clearing my mind of the worries of my job. Last, I enjoy catching up with email and work-related tasks as every time I scratch out something on my to-do list I seem to get stress relief.

Chilling effect

Five ways a proposed immigration rule could impact Colorado students and schools

PHOTO: JGI/Jamie Grill | Getty Images

Advocates for immigrant families fear that a proposed federal rule governing green card decisions could lead to more children going hungry and losing housing and health care. That, in turn, could pose challenges for educators and schools.

The proposed rule would allow the government to penalize some legal immigrants who have used public benefits by denying them permanent residency — a possibility that could prompt families to forgo any kind of government help. For children in those families, many of them citizens, the result could be hunger pangs, untreated illness, or outsized worry that their parents won’t be able to stay in the U.S. Inside schools, the new rule could mean more time and energy spent addressing students’ basic needs and the loss of funding from some public programs.

Fear that immigrants will shy away from benefit programs is nothing new. Stricter immigration rules since President Trump took office — stepped-up raids, efforts to discontinue the DACA program, and family separations at the U.S.-Mexico border — have already led to a chilling effect on the legal use of public benefits by immigrants. Advocates say changes to the so-called “public charge” rule will only exacerbate the problem.

The rationale behind the proposed rule, a stricter version of one that’s been in place for years, is to prevent immigration by people who will end up dependent on government help. Opponents of the rule say it punishes working-class immigrants who may need short-term aid, but contribute much more to the country’s economy over the long term.

The existing public charge rule penalizes immigrants for using programs such as Temporary Assistance for Needy Families or long-term care. The proposed version adds several more to the list, including Medicaid, food stamps, and housing vouchers. Free and reduced-price school meals aren’t included in the existing or proposed rule.

Mónica Parra, program manager of the Denver school district’s migrant education program, said families she works with are reluctant to sign up for any kind of help, even assistance heating their homes during the winter.

“They’d rather struggle or find other ways to get support,” she said. “It’s going to be very challenging to keep students motivated, but also safe. Maybe they’re going to be cold. Maybe they’re going to get sick.”

The proposed public charge rule doesn’t apply to refugees and asylum-seekers, and doesn’t penalize immigrants for public benefits used by their children. Still, like other advocates, Parra said she hears anxiety about the proposed rule from all kinds of immigrants, including citizens and those who already hold green cards.

They worry that using public benefits could get their own legal status revoked or hurt their chances to sponsor family members who want to immigrate to the U.S.

“The fear has always been there in these communities,” she said. “Now, people are even more afraid.”

The new public charge rule likely won’t take effect for months. First, there will be a 60-day public comment period, scheduled to start Wednesday, and then Trump administration officials will consider the comments and decide whether to make any adjustments.

Here’s a look at some of the ways the proposed rule could affect Colorado schools and students.

More kids come to school hungry

There are at least two ways schools could see more hungry students walking through their doors due to the public charge rule. First, families may be afraid to take advantage of food stamps — either by deciding not to enroll, or by dis-enrolling current recipients, such as citizen children.

Both Denver and Adams counties have seen dips in the number of people participating in the program over the last couple years. In Denver, about 2,000 fewer children receive the benefit now than in November 2016 when President Trump was elected. However, city officials caution that it’s hard to make a direct connection between falling participation and federal immigration policies since historically low unemployment rates may also be contributing to the trend.

While free and discounted school lunches are not part of the public charge rule, some advocates report that immigrant parents have been wary of enrolling their kids since Trump’s election. By law, public schools must serve students regardless of their immigration status and can’t ask for information regarding a family’s or student’s status.

A week after the Department of Homeland Security released a draft of the new public charge rule on its website, the Eagle County school district emailed parents asking them to help squash the rumor that signing children up for free or reduced-lunches “will inform ICE,” a reference to the U.S. Immigration and Customs Enforcement agency.

The letter concluded, “There is NO RISK in applying for free and reduced lunch, help us spread the word.”

So, what happens when kids go to school hungry? They may have trouble paying attention, misbehave more easily, or suffer from headaches or stomach aches. In short, less learning.

More children without health insurance, more student absences

The public charge rule’s chilling effect could have a major impact on child health, according to a recent Colorado Health Institute analysis. An estimated 48,000 Colorado children — the vast majority of them citizens — could be disenrolled from one of two public health insurance programs, Medicaid or Child Health Plan Plus. That would double the state’s rate of uninsured children from 3 percent to 6.7 percent, according to the institute.

The reason for so much dropoff is that health insurance is typically a family affair. So even when different rules govern adults and children in the same family, they tend to be enrolled as a group or not at all.

When students don’t have health insurance, school attendance and performance can suffer. For example, children may be absent more if they lack help managing chronic conditions like asthma, or if they’re not getting treatment for acute illnesses or painful dental problems.

Loss of health-related funding for schools and school-based clinics

School districts stand to lose two health-related funding streams if the number of uninsured children swells. The first would impact the state’s 62 school-based health clinics, which would likely see a drop in Medicaid and Child Health Plan Plus reimbursements if fewer students enroll in those programs.

Such an enrollment decline, which some clinic leaders have already reported, could make it harder for school-based clinics to stay afloat financially, said Bridget Beatty, executive director of the Colorado Association for School-Based Health Care.

With more uninsured students, “The need will go up,” she said, “but conversely the ability to financially sustain them will get more challenging.” 

In addition, 53 Colorado school districts receive funding through a program that could be affected by the proposed public charge rule. It’s called the School Health Services Program and allows districts to seek Medicaid reimbursements for services provided to low-income students with disabilities. That money can be used for health-related efforts that benefit all students, such as the addition of school nurses, wellness coordinators, or suicide prevention programs.

Funding received through the program ranges from a couple thousand dollars in small districts to a few million in large districts.

High-poverty schools have a harder time offering universal free meals

Nearly 40,000 students in 20 Colorado school districts can eat school meals for free because their schools participate in a federal program designed to make breakfast and lunch easily accessible to low-income students. But that number could drop if the public charge rule decreases food stamp participation.

The special meal program, called Community Eligibility Provision, is open to schools or districts where at least 40 percent of students come from families that use certain public benefits, including food stamps or Temporary Assistance for Needy Families. Unlike in traditional school lunch programs, parents don’t have to fill out applications for free or reduced-price meals.

“Any time when you have eligible families not participating in SNAP, it does have a negative impact on community eligibility,” said Crystal FitzSimons, director of school programs at the national nonprofit Food Research and Action Center.

Even if schools or districts remain eligible for the program, a drop in students getting public benefits could mean a change in how schools are reimbursed for the free meals, she said. That, in turn, could make the program less financially viable for schools or districts to participate.

Immigrants could turn away from publicly funded early childhood programs

Crystal Munoz, who heads the nonprofit Roots Family Center in southwest Denver, worries that the Spanish-speaking families her program serves will stop using programs like Head Start, state child care subsidies, and the Denver Preschool Program, which provides tuition assistance to the city’s 4-year-olds.

Even though those programs aren’t part of the proposed rule, there’s still trepidation, she said. It’s because of the constant flurry of rule changes and the generally negative tone around immigration right now.

“We find ourselves very afraid to even give out resources or referrals to certain programs because we’re not sure,” she said. “For us, it’s waiting and seeing.”

She said if families do drop out of Head Start or other child care programs, it could push children — many of them citizens — into unlicensed care with relatives or neighbors, or force parents to cut back work hours to stay at home with them.