Updated: July 2019

Author: Division of Maternal and Child Health, Vermont Department of Health

The Division of Maternal and Child Health (MCH) at the Vermont Department of Health (VDH) continues to promote the use of the Vermont Asthma Action Plan (AAP) by students and schools in partnership with the medical home.  Promotion of the AAP occurs in multiple ways through partnerships with school and providers. Health Department School Liaisons are Public Health Nurses located in each of the Office of Local Health (OLH) districts throughout the state.  They work closely with schools and school nurses in their areas. The State School Nurse Consultant (SSNC) also has a role in supporting the School Liaison and school nurses in this work. 

Vermont School Nurses in public schools are asked each year to report the number of students with a diagnosis of asthma and the number of students with a Vermont Asthma Action Plan (or equivalent) on the Vermont School Nurse Report. This data is often collected by school nurses using annual student health update forms completed by their parent or caregiver, and through receipt of an AAP completed by the student’s medical provider. The AAP must be current (less than one year old) for the school year. Having this on file can indicate a positive link between the medical home and the family.   

The percentages of students with asthma that have a current AAP continues to increase gradually over time. School Liaisons continue to work with School Nurses and provider offices to increase their understanding of the importance of having an asthma action plan on file at the school, decrease barriers to their completion, and ultimately, their arrival in the school health services office.

It is important to note that the School Nurse Report captures information at a single point in time. The report is due January 1st each school year but may be completed prior to this date. If a school nurse chooses to enter their information earlier in the school year, the data may not capture their ongoing effort to pursue delinquent plans throughout the school year.

• The Vermont Department of Health Divisions:
  • Maternal and Child Health and Health Promotion
  • Disease Prevention
  • Office of Local Health (specifically the VDH School Liaisons located in each of the 12 district offices)
• Agency of Education
• Vermont Chapters of the American Academy of Pediatrics
• Vermont Academy of Family Physicians
• Vermont schools and local education agencies

Asthma action plans (AAP) are demonstrated to improve health outcomes by providing a consistent reminder of how to monitor and treat an individual with asthma. School nurses link students and their family or caregiver with their medical home to manage asthma and obtain a current AAP. The Vermont Asthma Action Plan is a form that serves as a written asthma management plan in a simple and user-friendly format, and acts as a communication tool for those sharing in the individual’s asthma management.

People with asthma should routinely check-in with their medical home to assess the current status of their asthma and ensure their plan for managing their diagnosis is working well. These visits help students and caregivers identify and minimize asthma triggers in the environment, to recognize symptoms of an asthma flare up, and to know the best way to use medications and seek medical help. 

In the school setting, these tools are used by school nurses to communicate to school personnel how to help the student manage their asthma, and to provide instructions about what to do in an emergency (including in the school, during sports practice or events, and on field trips). Since the vast majority of Vermont’s school-aged children are in public schools, school nurses are important partners in our asthma related work. They work closely with students and families to develop strong connections with the student’s medical home to ensure consistent and effective management of a student’s asthma. School nurses may also assist families with identifying and connecting with a medical home if needed.

School Liaisons and the State School Nurse Consultant work with school nurses and provider offices to increase the use of the AAP. They assist with quality improvement efforts to increase the collection and use of high-quality data and to improve student outcomes. Proper management of an asthma diagnosis helps to decrease asthma related absenteeism and keep students ready for learning.

Ongoing promotion of the use of the Vermont Asthma Action Plan is part of Vermont’s Health Department School Liaison’s work. The School Liaisons provide guidance and assist school nurses with improving communications with local provider offices. They link school personnel with the latest Health Department resources.  These efforts and more contribute to improved asthma action plan rates at the school setting.

Additionally, the State School Nurse Consultant (SSNC) reminds school nurses three times years to use and promote Vermont’s AAP via the weekly SN Bulletin that goes to every School Nurse. School Liaisons and the SSNC provide opportunities as the local level to enhance provider, school, and family or care giver communication around the use of the AAP.

Vermont’s Standards of Practice: School Health Services Manual is the standard of care for all students, and those with chronic health conditions. The Manual, maintained by the State School Nurse Consultant’s (SSNC) and the School Nurse Advisory Committee, identifies the school nurse as care coordinator for students with chronic health conditions. Care coordination includes using school health records (including electronic health records) to help students manage their health needs, ensure they have obtained or created a current student individualized health care plans and/or emergency care plans, teach students about self-management, and to ensure that relevant staff have had appropriate training needed to assist in the student’s care. Students with chronic health conditions such asthma are more ready for learning when they can receive the care and support, they need every day, all day

The Division of Maternal and Child Health (MCH) continues to coordinate with the Asthma Program in the Division of Health Promotion and Disease Prevention (HPDP) on several asthma-related efforts. School nurses must use a standardized set of questions on the school’s annual student emergency or health update form. School Liaisons and SSNC continue to identify schools that need help implementing the standardized asthma questions. The following questions reflect validated questions provided by the Centers for Disease Control and Prevention which align with questions used for the Behavioral Risk Factor Surveillance System.

The questions are:

• Has a doctor, nurse or other health professional EVER said that your child has asthma?
• If yes, does your child STILL have asthma?

Response Categories: “yes”, “no”, “don’t know/not sure”, and did not answer the question

Response Categories: “yes”, “no”, “don’t know/not sure” and did not answer the question

Additionally, the MCH and HPDP with the Asthma program to promote the Envision Program and Asthma-Friendly Schools Award. The Envision Program and SSNC partnered with the Vermont State School Nurses Association in the Fall of 2018 to present on Indoor Air Quality and to promote the Envision Walk Through School [Self] Assessment process for identification and mitigation of asthma triggers. The SSNC continues to promote the Asthma Program’s Asthma-Friendly Schools Award which includes acknowledging local education agencies for high rates of Asthma Action Plan compliance. Increasing the use of AAPs is just one more way to help students with asthma be available and ready for learning, every day, all day.