Viewpoints and Findings from the REL Mid-Atlantic

American Rescue Plan Funds May Help Kids with Chronic Health Conditions, Like Asthma
By Joanne Pfleiderer and Carmen Ferro

Chronic health conditions such as asthma make it harder for students to learn. And differences by gender, race, ethnicity, socioeconomic status, or residence in the prevalence of these conditions raise issues of equity. The COVID-19 pandemic has elevated the public's awareness of the connections between health problems, learning challenges, and environmental factors at the same time that revised guidance and funding from the federal government may ease the process of addressing these issues for students across the country.

A new report and infographic from REL Mid-Atlantic examine chronic health conditions among students enrolled in District of Columbia Public Schools (DCPS). Although DCPS records show more than a quarter of students with a health condition, other data sources (such as the National Survey of Children's Health) suggest that the true rate is probably even higher. Asthma is the most prevalent health condition, reported by 16 percent of students in DCPS, which is double the national average.

According to the report, a higher percentage of Black students have at least one health condition, including asthma, when compared with other race/ethnicity groups. In fact, health conditions generally are most common in DCPS students who are male, Black, living in lower-income neighborhoods, and attending school outside their ward of residence. Furthermore, DCPS students with health conditions, including asthma, are less likely to be proficient in math and reading and are more likely to be chronically absent. They are more likely to experience behavioral problems and be suspended from school when compared to their peers.

Recognizing the importance of addressing these challenges, DCPS partnered with REL Mid-Atlantic to study this issue and inform recommendations for supporting students with health conditions. The REL Mid-Atlantic report provides recommendations for DCPS that are relevant for other school districts too, including:

• — To address challenges related to potential undercounting rates of health conditions, educators and school leaders should work with school health centers, nurses, physicians, and other community partners to increase health screenings and develop data sharing agreements.
• —Districts should address asthma triggers within school buildings, including poor air quality, mold or asbestos.
• — Schools can organize support groups for students with chronic health challenges and their families to help them better understand and manage asthma by learning from each other.
• — School nurses can provide students with asthma education and resources, such as inhaler techniques and lists of asthma triggers, to avoid or decrease these triggers when at home and at school.
• — Counselors can share information about ways parents can enroll children in specialized services for children with special needs, such as individualized education programs or Section 504 plans.

A year after the pandemic began, we're also still trying to understand the role environmental factors such as air quality play in preventing or spreading illness in schools across the country. We do know that for children with chronic health conditions such as asthma, the state of their school's physical plant can contribute in a positive or negative way to their well-being. Before the pandemic, many children with chronic health issues living in urban areas attended school in facilities that lacked proper heating and cooling systems, as well as efficient air ventilation. Distance learning is not a viable long-term solution for these students, particularly in areas like Washington DC, Chicago, and Los Angeles, where Black and Latinx students have experienced disproportionate learning gaps for decades and are less likely to have home internet service and parents who were able to telework.

The good news is that more money is now available to help schools clean their facilities, purchase personal protective equipment, and upgrade poorly functioning ventilation systems to promote healthier environments for students with chronic health conditions as well as the student body at large. Federal funding for COVID-19 response, including $122 billion provided to states through the American Rescue Plan and $82 billion for education in the Coronavirus Response and Relief Supplemental Appropriations Act, creates an opportunity to improve school facilities so they will not only be safer from an infection perspective but also less triggering of asthma. Additional guidance on improving ventilation from the Centers for Disease Control and Prevention offers school leaders an unprecedented opportunity to tackle challenges related to cleaner air filtration. For example, the guidance includes ideas for installing child-safe fans to increase the airflow from open windows, offering outdoor activities, and ensuring ventilation systems are up to code may help address asthma triggers in schools.

Similarly, the National Association of School Nurses has established a resource center with recommendations for creating healthier school environments and promoting evidence-based practices for children with health conditions. Educators and policymakers, in collaboration with state and local health officials, can review these resources to see if they address the unique circumstances of local schools. Additional information about our insights from DCPS can be found in this infographic. REL Mid-Atlantic will continue to partner with stakeholders to shine a light on these issues and links between equity, health outcomes, and overall well-being.