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: Operation of Replicated Program
ACT for Kids is in its third year of operation at Providence Alaska Medical Center. The program is taught by an interdisciplinary team of physicians, registered nurses, and a respiratory therapist.
After a child’s referral order has been processed, the program coordinator organizes the time and place for the educational sessions. The duties of the ACT for Kids program coordinator at Providence are quite extensive. She is responsible for public relations and marketing for the program, distributing and receiving the physician referral orders, contacting all participants by both letter and phone, booking rooms for the program, scheduling physicians and nurses to teach the sessions, and coordinating the logistics for each session, which includes setting up materials and equipment.
Providence staff use the updated AAFA ACT for Kids program and teach the classes in two 3-hour sessions held on a Friday evening and a Saturday morning covering the content of all three lessons. A light meal is provided each day, with special consideration given to children with identified food allergies. The staff at Providence have found through parent surveys that this time is most convenient for the families, many of whom have to travel long distances to attend the class. The provision of food also facilitates families’ participation since they do not have to take time out to eat before attending class.
Ten families is the maximum allowed in each class. With assistance from a nurse, a doctor conducts both sessions for parents, and in a separate room, two nurses teach the children the same information, tailored to their age and abilities. In addition to asthma management and education, the last hour of the program is spent reviewing each child’s medications and their use in a one-on-one format with the family. Also addressed in this one-on-one session is the use of inhalers, spacers, and peak flow meters and their role as aids in asthma management. Furthermore, all families are given a “graduation bag” filled with toys, candy, additional asthma information, and a new peak flow meter.
The staff believes that using separate classrooms for the parents and children facilitates age- appropriate learning. Furthermore, children realize, sometimes for the first time, that they are not alone in living with asthma. They slowly become more comfortable and open during the session, which enables more concrete and substantive learning. Parents have a similar experience. They see other parents in similar situations that arise when one is coping with a child living with a chronic lung disease. Gradually there is increased understanding and acceptance of the disease and an eagerness to learn techniques that will help their children live a full life.
The training for future ACT for Kids instructors consists of a 2-hour session conducted by AAFA staff via telephone. This training is required to maintain the quality of the program and to ensure that the program is implemented as it was developed. The staff for ACT for Kids at Providence have received this training.
Instructors of the educational sessions must be trained healthcare professionals such as nurses, respiratory therapists, health educators, or social workers. Instructors of the medications portion of the program must be physicians, pharmacists, or registered nurses qualified to teach and answer questions about medication concepts.
Initially, the funding for ACT for Kids at Providence was problematic. Prior to the program’s implementation, the staff calculated a cost per class by estimating a budget that included staff hours, room costs, and refreshments for 10 participants per class. The cost for the program was estimated to be approximately $600 per patient. This figure was presented to and authorized by the hospital administration. The program was approved for implementation on a trial basis with the stipulation that ACT for Kids was to be self-sustaining.
After the first two classes, referring pediatric physicians heard from families that $600 was too expensive. As a result, physicians became reluctant to refer patients to the program. Despite the availability of scholarships, the $600 fee was a disincentive, and many families were unwilling to participate. Therefore, the decision was made to bring the program under the umbrella of the hospital’s cardiovascular unit. The cost for the program is absorbed into the cost of the pulmonary rehabilitation program. The hospital’s financial officers endorsed the move. The actual cost of the program did not change, but the cost charged was lowered to $100 per family. To defray operational expenses, the physicians in the program donate their time, and the ACT for Kids staff solicit donations and additional scholarships. Since this reconfiguration, pediatric physicians have become more comfortable with referring patients, and patients have become more willing to participate. However, this arrangement makes it difficult to identify funds spent exclusively to operate ACT for Kids.
AAFA does not conduct or require evaluations of the implementation of the program once it has been acquired by interested parties. AAFA welcomes opportunities to work collaboratively with organizations interested in implementing ACT for Kids to document effectiveness of the intervention. Providence staff members are currently gathering data for evaluation and publication. They will work jointly with UCLA to develop outcome data that include pre-post follow-ups, hospitalizations, emergency room visits, medication use, and missed school days.