Reimagining Schools as a Place for Improving the Health of Chicago’s Children

Asthma, the most common chronic childhood condition, has been linked to poor academic and health outcomes.

Among the one in 12 affected children in the US, over half had an exacerbation in the past year, resulting in 13.4 million missed school days, 1 million emergency department (ED) visits, and 140,000 hospitalizations annually. The school environment represents an important venue for providing resources and programs to optimize children’s health and wellness. School-based asthma programs have been demonstrated to improve knowledge, self-efficacy, and at times health outcomes, but these programs are often transient and rely on grants and external organizations to deliver programs.

School nurses have also played a critical role in delivering health programs and supporting systems of care in schools, demonstrating positive impact on health and educational outcomes. Despite this, currently, approximately half of US schools do not have a full-time school nurse, contrary to national recommendations. In Chicago, the large and diverse Chicago Public School (CPS) district employs 300 staff nurses and contracts with about 250 “agency” nurses for over 361,000 students in 640 schools across 800 buildings. The result is that each CPS nurse is assigned to 3-5 schools and is present at each school less than one day per week. This insufficient school nursing ratio and the structural problem of funding for school nursing are important barriers to chronic illness care.

Fully integrating and evaluating community health workers in schools

To address the wicked problem of asthma disparities, in the context of significant school nurse shortages, our team will create an innovative and scalable model that integrates CHWs in school settings. While our long-term vision is to apply the school-based CHW model to support children broadly, we will first integrate CHWs into the schools by focusing on asthma care. In this way, we will develop, test, and refine this care model to optimize its feasibility for use deployed to address a high prevalence and high morbidity chronic condition among children. 

Our team, with input from a diverse Steering Committee, will develop a model to integrate CHWs in two Chicago Public Schools (CPS) located within neighborhoods characterized by high burdens of asthma, namely African-American and Hispanic/Puerto Rican communities. The CHWs, hired by CPS and trained by Sinai Urban Health Institute, will be integrated into the daily lives and operations of these two schools. CHWs will focus on six areas:

1. Outreach
2. Navigation
3. Education
4. Advocacy
5. Informal counseling
6. Social support