title: Sustaining school-based asthma interventions through policy and practice change.
abstract: BACKGROUND
  Schools are an ideal setting for implementation of asthma interventions for children; however, sustaining school-based programs can be challenging. This study illustrates policy and practice changes brought about through the Childhood Asthma Linkages in Missouri (CALM) program to sustain such programs.
  
  
  METHODS
  Researchers analyzed caregiver-reported quantitative data regarding asthma-related outcomes in preintervention and postintervention surveys and qualitative data regarding sustainability efforts in schools reported by CALM grantees. A grounded theory approach was used to identify key concepts and themes that emerged.
  
  
  RESULTS
  In 330 children, significant improvements were seen in asthma symptoms, rescue inhaler use, health care utilization, school absenteeism, and activity limitations. Overall, 27 school-based policy and practice changes supporting program sustainability were reported, with policy changes most often concerning the assessment and/or monitoring of children with asthma in the school setting, and practice changes most often regarding institution of regular asthma education programs for students and school personnel.
  
  
  CONCLUSIONS
  Sustaining school-based asthma programs is challenging, but can be realized through the participation of diverse partners in enacting policy and practice changes that support the institutionalization of programs into the day-to-day processes of the schools.
authors.affiliation: Senior Research Associate, (lauriemc@umich.edu), Center for Managing Chronic Disease, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109.
authors.forename: Laurie M
authors.initials: LM
authors.lastname: Carpenter
authors.forename: Laurie
authors.initials: L
authors.lastname: Lachance
authors.forename: Margaret
authors.initials: M
authors.lastname: Wilkin
authors.forename: Noreen M
authors.initials: NM
authors.lastname: Clark
mesh_terms: D000041:Absenteeism; D001249:Asthma / Q000628:therapy*; D057191:Capacity Building / Q000458:organization & administration; D003142:Communication; D019468:Disease Management; D004363:Drug Utilization; D006266:Health Education / Q000458:organization & administration; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008923:Missouri; D012572:School Health Services / Q000458:organization & administration*
keywords: child and adolescent health; chronic diseases; evaluation; policy; school health services; school nurses