Holyoke Schools Spotlight: Collaboration Between School Nurses and Custodians

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Nurses and custodians are perfect collaboration partners! Even before the pandemic, Cynthia Carbone, MEd, MSN, RN, Director of Health, Wellness, and Nursing for Holyoke Public Schools, and her nursing team worked closely with the facilities team and were looking at how school nurses could work more effectively with facilities management. They ramped this up during COVID – proving to be an invaluable asset to improving conditions for student and staff health within their schools.

Cynthia shared, “Custodians are everywhere in the building – and see things that nurses may not. So, to have a healthy school environment, school nurses and custodians need to interact daily. To help promote this, at the start of each school year the school nurses reach out to each member of the building’s custodial team, introduce themselves to new staff, provide contact information, and reacquaint themselves with returning custodians. Each nurse regularly meets with her lead custodian who is their go-to for facilities concerns. Likewise, nurses are available for consultation with the custodial team. During the pandemic, we created a multidisciplinary checklist for each positive COVID case in the district, and the nurse notified the building principal, custodian, and HR (for staff) and each had action steps to follow. The nurses and custodial staff regularly connect to discuss cleaning procedures and best practices to maintain a healthy school environment. The facilities team is constantly looking to improve practice and has done a lot of work around green cleaning. They are always willing to share information and demonstrate products for the nurses.”


Cynthia continued, “This has been possible because of the generous spirit of our facilities team and their willingness to actively collaborate with health services. The custodial team is our go-to for setting up and conducting our annual flu shot clinics for staff and multiple COVID vaccine clinics that we have held since the spring of 2021. The facilities team members have regularly presented at our school nurse meetings and Districtwide School Community Health Advisory Council. They have spoken about COVID-19 management concerns and mitigation strategies, cleaning products, ventilation, air quality, and other environmental health issues. In turn, I am invited to Senior Custodian meetings to discuss topics of concern or interest. These actions have helped us to build strong relationships and practices. We see our roles as interdependent in keeping schools safe and healthy for students and staff.”


This year, schools face an unusually high flu season, as well as possible COVID resurgences, but Cynthia stated that she’s confident in her team’s ability to tackle this, and much more.

We applaud Holyoke for taking this collaborative approach!

From left to right: Brian Harris, Facilities Manager, and Cynthia Carbone, Director of Health, Wellness, & Nursing


Member Spotlight: Massachusetts Coalition for Occupational Safety and Health (MassCOSH) and Teens Lead @ Work (TL@W)

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Teens Lead @ Work (TL@W) peer leaders with their thermometers, trained and ready to collect classroom temperature data.

Teens Lead @ Work (TL@W) peer leaders with their thermometers, trained and ready to collect classroom temperature data.

This summer, MassCOSH’s Teens Lead @ Work Program (TL@W) was featured in the National Council for Occupational Safety and Health (COSH) e-newsletter for organizing around the impacts of heat stress in schools. Teens Lead @ Work (TL@W) is a program of MAAP’s partner, the MassCOSH. TL@W helps youth develop organizing skills, connect with other teen workers, and promote safe, healthy work. TL@W chose to tackle heat stress and climate change in Boston schools after fellow students developed rashes, headaches, and dehydration due to extreme heat in their classrooms.

Last year, a study from the National Bureau of Economic Research found that student performance drops when temperatures rise, with a clear connection between decreased learning and a lack of air-conditioning in classrooms. The impact of heat on student achievement is three times greater for low-income, Black and Hispanic students as for White students.  Environmental health research also shows that extreme heat events – projected to become more and more frequent – can significantly worsen childhood asthma, and are associated with increased hospitalization for asthma attacks.

Ilannysh Rodriguez, a recent Boston high school graduate and TL@W peer leader, has asthma. “We learned about different asthma triggers – clutter, lack of ventilation, poor climate control and indoor air quality – and we realized we could list them looking around our own schools,” she shared. “In Boston, many of the school buildings are older and not kept up to date, with holes in the walls and floors. These collect dust and lead to leaks – and more asthma triggers.”    

“Although you are young, and people don’t think you’re important, you are doing important work. These issues that affect young people, especially young people of color, are not getting the attention they need. Don’t give up.”
— Ilannysh Rodriguez, TL@W Peer Leader

Ilannysh and her fellow TL@W leaders noted that students from low-income communities and students of color are most often affected by these conditions, and by extreme heat. “We’ve had days where the classroom temperature climbs to 100 degrees,” Ilannysh says. At some schools, she recalls, water fountains were non-functional on those same days, and students suffered from dehydration.

TL@W has been working hard on their campaign to address heat stress in Boston schools, building partnerships with school professionals, other students, and the Boston Teachers’ Union. In early June, they testified in support of Bill H.530, an act creating a commission to study allowable temperatures in schools. They’ve been collecting classroom temperature data as part of an in-depth research project supported by a Tufts University Tisch Scholar, as well as developing proposals for policies they see as crucial. “If not air-conditioned classrooms, we think schools should have ‘heat days’ and early dismissal the way they do for snow days,” Ilannysh says. TL@W students know this is possible - in Baltimore, schools without air-conditioned classrooms dismiss students early if room temperatures climb to 85°F by 10:30am. This winter, TL@W will also conduct a comprehensive analysis of school heat policies and strategies around the country to help inform their organizing.

While TL@W’s efforts are local, MassCOSH has received calls from several school districts hoping to replicate their work nationwide. When asked about advice that she would give youth interested in social justice organizing, Ilannysh takes a deep breath before speaking. “Although you are young, and people don’t think you’re important, you are doing important work,” she says. “These issues that affect young people, especially young people of color, are not getting the attention they need. Don’t give up.”  

Member Spotlight: Expansion of the Springfield Healthy Homes Asthma Program

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Regrettably, Springfield, MA has been designated  the top Asthma Capital for the second year in a row by the Asthma and Allergy Foundation of America. It is one of 100 most challenging place to live in with asthma, in the nation. Many unfavorable circumstances contribute to the greater Springfield area’s high asthma prevalence and burden, including:

  • Geographical location in a valley where both pollen and carbon dioxide collect;

  • Heavy interstate traffic and commercial pollution;

  • Old housing stock;

  • Lack of access to short- and long-term healthcare services; and

  • Poverty.

The Springfield community has a long history of combating asthma, and over the years, has been able to develop diverse partnerships, combine resources and build capacity to address the high rates of asthma. Most recently, Baystate Health Care Alliance/BeHealthy Partnership ACO received a SHIFT-Care Challenge grant award from the Health Policy Commission to expand the Springfield Healthy Homes Asthma Program. The program’s goal is to improve the quality of life for people living with asthma and reduce asthma health care costs by reducing hospitalization and emergency department visits through implementation of an evidence-based home visiting and home remediation service.

The health and housing sectors have been working together for many years but have not had significant funding to do something at a broader level. This new funding brings partners together to form an innovative collaborative to implement an evidence-based intervention. BeHealthy Partnership, an Accountable Care Organization, is joining together with community organizations from the greater Springfield area to refer patients for the Springfield Healthy Homes Asthma Program’s home education and remediation services. Revitalize Community Development Corporation is the lead housing service provider that will be providing critical repairs and rehabilitation to homes with additional support and services from other community partners. Other partners in the collaborative include:

  • University of Massachusetts Medical School – Baystate;

  • Public Health Institute of Western Massachusetts;

  • Pioneer Valley Asthma Coalition;

  • Baystate Medical Center’s Pulmonary Rehabilitation Department;

  • City of Springfield Office of Housing;

  • Springfield Partners for Community Action; and

  • Green & Healthy Homes Initiative.

The expansion of the Springfield Healthy Homes Asthma Program will serve 150 families with home-based asthma education and self-management support (e.g., proper use of medications), as well as home assessment and repair for conditions that contribute to asthma flare-ups. The new funding enables Baystate’s Pulmonary Rehabilitation Department to hire two community health workers to conduct the home visits and asthma education. Over the 18-month project, patients will receive 3-4 home visits and families will also receive supplies such as anti-allergen pillows, mattress protectors, and green cleaning kits. BeHealthy Partnership patients who have been hospitalized or have had multiple emergency room visits in the last year for asthma, are eligible for the services.

Springfield has one of the largest and oldest housing stocks with a high need for remediations. The cost of housing repairs and maintenance can be prohibitive for families and overtime the housing stock has significantly deteriorated due to moisture, mold, pests and other housing conditions that can trigger asthma and lead to other health problems. Through the expansion of the Springfield Healthy Homes Asthma Program, the collaborative is hoping to address unhealthy homes as one of the root causes of poor asthma outcomes. Through a series of data collection and evaluation, they are hoping to show the sustainability of this intervention and make the case to keep it going. By leveraging its community assets and persistence in combating poor asthma outcomes, Springfield has become an active leader in mobilizing communities and continues to find innovative ways to improve asthma outcomes for families.

Congratulations Springfield!

Member Spotlight: Parent Asthma Network

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Parents and Youth Taking Control of the Asthma Epidemic in Boston

Background: The Boston Public Health Commission (BPHC) created the Parent Asthma Network (PAN) to develop a support network for and between parents/caregivers who may be facing similar successes and challenges in managing asthma. PAN participants can connect with others who live in the same vicinity and increase their ability to provide each other with critical peer support.

Over the decades, BPHC has been a leader in convening community and key stakeholders to address the root causes of Boston’s heavy asthma burden as well as model prevention and control initiatives. Even though there have been tremendous medical advances in asthma control, and much is now known about medical and non-medical ways to prevent and control asthma, there is still opportunity for more to be done. Asthma rates, emergency room visits, hospitalization stays and deaths due to asthma persist at an unacceptably high rate. Asthma remains a complex issue and can be very confusing for anyone to understand and manage. While BPHC, partner agencies and community members continue working to address the systemic and environmental contributors to asthma, we also need to ensure the immediate burden at hand is being addressed.

PAN Overview: Through PAN and related initiatives, BPHC’s goal is to ensure the wide spread of accurate information about asthma, encourage individuals and communities to learn about and use effective asthma management practices, and make use of the numerous resources and supports available throughout Boston. PAN was piloted from the Fall of 2017 to Spring 2018 with great interest and success and continues with funding support from the MA Department of Public Health (MDPH). MDPH and BPHC’s seasoned community health workers (CHWs) provide key mentorship and three experienced Parent Asthma Leaders (PALs) through Health Resources in Action (HRiA) also provide support. To date, PAN has engaged over 150 individuals. BPHC aims to expand the network of parents and support the training of more PALs who can be a resource to their communities and networks.

How PAN Works: PAN is run as facilitated group sessions that focus on key topic areas with guest speakers and opportunities for sharing experiences and ideas. PAN sessions are currently being hosted by the ABCD Head Start Geneva Ave site in Dorchester and East Boston Neighborhood Health Center (run in Spanish).  Each site runs multiple sessions during the academic year and features a range of topics and activities, including asthma basics, asthma medication, asthma and nutrition, asthma and back to school prep, asthma and environmental health, MassHealth/asthma, and emergency preparedness.

During these sessions, participants learn from each other and dialogue with guest speakers from agencies including Boston Inspectional Services, BPHC’s Office of Public Health Preparedness and the Mayor’s Health Line, East Boston Neighborhood Health Center, and Partners Asthma Center.

A pre/post-quiz is given to participants at the beginning and end of each session to help them in their learning process. An evaluation is conducted at the end of each session to ensure participants are contributing to the design and shape of successful meetings and activities. Participants also get to voice what topics they would like to see at future sessions.

When asked what they found most meaningful about workshops, participants said:

“Now I have a better understanding of the asthma action plan. I find this information useful and appropriate. Thank you.” – PAN participant

“There was time for questions and answers, love this workshop well informed, other parents, much knowledge was shared in this room. Thank you!” – PAN participant

“Great workshop. Very interesting and interesting topic” – PAN participant

PAN was conceived and is coordinated by Nathalie Bazil, BSW, CCHW, Senior CHW and Coordinator for the BPHC Asthma Prevention and Control Program. The three PALs from HRiA are also instrumental in the success of PAN. The PALs are dedicated members of the community who took a stand over 20 years ago to ensure the city was taking responsibility for the high asthma rates in Boston. Since then, the PALs have been part of efforts and conversations with a range of key city agencies and sit on numerous advisory boards. Through PAN, BPHC hopes to see a new generation of PALs who can be mentored by the current representatives. PAN has been a tremendous success, and we hope to see it only expand further into communities as an effective model for collective awareness and action. BPHC is currently working with partners on a new network for and by youth and young adults. For more information contact asthma@bphc.org.