Asthma Care Training (ACT) for Kids

A program of the Asthma and Allergy Foundation of America, implemented in Providence ‘Alaska’ Medical Center, Anchorage, Alaska.

Asthma Care Training for Kids: Description of Replicated Program

ACT for Kids program has been taught at Providence Alaska Medical Center (hereafter referred to as Providence) in Anchorage, Alaska, since March 1999. Anchorage is located at the base of the Chugach Mountains along the coast of Cook Inlet in south-central Alaska. It is as far north as Helsinki, Finland, and as far west as Honolulu, Hawaii. Anchorage encompasses 1,955 square miles and, with 258,000 people, is Alaska’s largest city. The city is ethnically diverse, with a minority population of 27 %. The approximate percentages are Native Americans, 7.5%; African Americans, 7%; Asian/Pacific Islanders, 6.5%; and Hispanics, 6.2% (1998 estimates by Alaska Department of Labor are based on the U.S. Bureau of Census data for 1990).

Dr. Jeff Demain, a pediatric allergist, and Jill Barnes, an advanced nurse practitioner who taught the ACT for Kids program at Providence, previously taught the program at MacDill Air Force Base in Florida and Elemendorf Air Force Base in Alaska. During the tenure of Dr. Demain and Ms. Barnes at Providence, the need for a comprehensive asthma education program to improve asthma management for children and adults became apparent. After consulting with the hospital administration and gaining the cooperation of the other local pediatric allergists, Dr. Demain and Ms. Barnes began ACT for Kids at Providence as part of a larger asthma education initiative that includes an adult asthma management program known as Adult Asthma Education. Elise Strauss serves as the coordinator of both asthma programs and a pulmonary rehabilitation program.

Goals of the Replicated Program

Similar to the goals of the intervention research, the aims of ACT for Kids at Providence are to improve children’s understanding of asthma, its symptoms and triggers, and proper medication use so that they can play a central role in their own asthma management. Tables 1 to 3 outline the overall objectives of Providence’s ACT for Kids program and its specific objectives for children and parents, respectively.

Overall Program Objectives of ACT for Kids at Providence

• To reduce the frequency and severity of asthmatic episodes
• To increase childrens’ and parents’ knowledge of symptoms, causes, and treatment regimens
• To explore attitudes and feelings about asthma and its treatment
• To improve decision making skills in preventing asthma episodes
• To encourage parents to reinforce their children’s self-care behaviors

Objectives for Children Participating in ACT for Kids at Providence

• To increase the children’s knowledge and awareness of the symptoms and causes of asthma
• To assist children in identifying the factors which precipitate or aggravate asthma
• To increase children’s knowledge of the actions and side effects of asthma medications
• To increase children’s ability to apply the decision making process in preventing episodes and caring for themselves
• To help children explore their feeling and attitudes about having asthma and their medication treatment plans
• To apply knowledge, skills, and attitudes learned to reduce the frequency and severity of asthma episodes and to decrease unnecessary restrictions on activities of daily living

Objectives for Parents Participating in ACT for Kids at Providence

• To encourage parents to permit children to engage in self-care behaviors
• To encourage parents to examine their attitudes regarding roles of children versus parents in the care of asthma
• To give parents the same course content presented to their children, and to create a forum for them to explore and exchange concerns and questions regarding their children’s illness

Recruitment and Characteristics of the Target Population

ACT for Kids at Providence is offered to children ages 7 to 12 and their families. Siblings are also encouraged to participate whenever possible. Participants are recruited primarily by physician referral, but participants can also learn about the program from brochures, newspaper advertisements, and word-of-mouth. Although participants can self-refer to the program, they must obtain a physician referral before they are allowed to join the class. This requirement is in accordance with the idea that ACT for Kids is designed to be a supplement to good medical care and encourages families to work in concert with their physicians to manage the child’s asthma.

If the physician does not refer the patient directly, then the program coordinator sends the physician a letter to let him/her know that a patient is interested. The letter also explains the purpose, content, and format of the program and requests the physician’s permission. A blank referral form and a program brochure is sent with the letter. Once a completed referral form is received, the program coordinator calls the parent and informs him/her of the date and course time. If the parent and child agree to attend, they are sent a confirmation letter and a brochure describing the program. A reminder phone call is placed to the family prior to the class date. When the parent and child complete the class, a discharge summary is sent to the referring physician within 3 weeks of the end of the course. The discharge summary is a letter to thank the physician for the referral to the program. The letter also informs the physician that each patient was given a peak flow meter and spacer and that a physician associated with the program reviewed the patient’s medications.

Since the program’s inception in March 1999, 34 children and their families have participated in ACT for Kids at Providence.