Strategies for Identifying Students in Need of School-Based Asthma Services: Challenges and Questions That Emerged From a Rapid Evaluation of a School-Based Asthma Program

Charlotte-Mecklenburg Schools (CMS), with assistance from the Centers for Disease Control and Prevention (CDC), conducted an evaluation of the CMS Asthma Program. Data were collected during the 2007-2008 school year through surveys of students with asthma (n = 286), interviews with school nurses (n = 11), and reviews of administrative records that included service provision and nurse ratings of the need for asthma services (based on a set of clinical indicators and symptom frequencies) for each student with asthma. Ninety percent of high-need students, 75.8% of medium-need students, 45.3% of low-need students, and 21.4% of nonrated students were enrolled in student-level services. Given the large number of students without a nurse rating for need, asthma management difficulties (AMD; a set of questions completed by all students on the student survey) were examined as a proxy indicator of need for student-level services. When looking only at need based on AMD, 46.0% of high-need students, 48.0% of medium-need students, and 35.2% of low-need students were enrolled in any student-level service. A Pearson χ² revealed that nurse ratings of need and need based on AMD were not significantly related (χ² = 4.1888, df = 4, P =.381); of students with nurse ratings for need, more were classified as medium and high need based on AMD than were rated medium and high need by school nurses. This suggests that many students were experiencing AMD but not coming to the attention of school nurses. Among students with asthma, additional resources and systematic procedures are needed to identify those who need student-level services, particularly for students who do not otherwise present with symptoms to the school nurse.