Holyoke Schools Spotlight: Collaboration Between School Nurses and Custodians

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

Update on MA Statewide Asthma Strategic Planning

A snapshot of some participants from MAAP Strategic Planning Session 1

Over the past several months, the MA DPH Asthma Prevention and Control Program (APCP) and MAAP, led a planning process to inform the development of the Strategic Plan for Asthma for MA: 2021-2026, facilitated by Health Resources in Action. This plan is meant to provide guidance and inspiration for asthma work focused on prevention and control across the Commonwealth over these five years.

It includes broad goals and strategies focused on four priority areas: schools, housing, outdoor air quality, and clinical care & linkages. Promoting racial and health equity were guiding principles for the plan, designed for the entire state and prioritizing the following communities: Boston, Brockton, Chelsea, Holyoke Lawrence, Lowell, Lynn, New Bedford, Southbridge, Springfield, and Worcester. These eleven cities were identified as having the highest burden of asthma in Massachusetts based according to higher asthma hospitalization/ED rates, higher prevalence of COVID-19, and lower ICE scores (Index of Concentrations at the Extremes), a ratio of the concentration of the most privileged to the concentration of the most deprived in a given community.

Many of these strategic planning discussions focused on how we can foster effective partnerships to advance work to address asthma across the state. For example, one objective for outdoor air quality is “By 2024, implement quarterly communications about real time local air quality and related public health threats to the 11 targeted communities and other vulnerable neighborhoods near major sources of mobile/point sources of pollution”. Through this process, MAAP has learned about local monitoring efforts starting and led by community-based organizations with residents. This includes in Chelsea led by GreenRoots, with assistance from the MA Department of Environmental Protection, and in Codman Square led by the Codman Square Neighborhood Development Corporation and in Lynn, in collaboration with EarthWatch Institute. We look forward to lifting up their efforts, and helping to spread best practices and lessons across the State.

When completed, the plan will be posted on both MA DPH APCP’s and MAAP’s website. We thank everyone who participated and appreciate the level of thoughtfulness and respect put into this process; there were 65 participants, representing more than 40 institutions (community-based organizations, health care, schools and academia, government agencies, etc.), who donated their time and mental energy to develop the plan! After nearly a year of Covid-19 disruption and loss, we are feeling hopeful in the New Year and excited to press forward to tackle this work together.

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

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.”  

Launching New Resource! Clearing the Air: An Asthma Toolkit for Healthy Schools

MAAP, the Massachusetts Department of Public Health’s Asthma Prevention and Control Program, and Health Resources in Action are delighted to announce the release of a new resource: Clearing the Air: An Asthma Toolkit for Healthy Schools. This toolkit contains sample policy language, best practices, and curated resources and tools to help schools create an asthma-friendly learning and working environment. Nine policy and practice areas have been identified as target areas to help improve air quality inside and around school buildings:

• School-wide environmental health and safety management

• Green cleaning and environmental purchasing programs

• Integrated pest management

• Leaks and moisture

• Clutter

• Outdoor air pollution

• Fragrance

• Tobacco

• Clinical asthma management in the school setting

Asthma is one of the most common chronic diseases in childhood. In any given classroom, it is likely that two or three students have asthma, and in larger classrooms and in some urban settings, that number is likely to be even higher. When children experience asthma symptoms, they often stay home from school, or they might have a hard time participating when they are in school. Research shows that children who have a lot of absences in preschool, kindergarten, and first grade are much less likely to read at grade level by the third grade. These students are also four times more likely to drop out of high school. 

Since children spend a lot of their time in school, an asthma-friendly environment means healthier students who are ready to learn. The benefits of an asthma-friendly school can include:

• Better attendance

• Improved academic performance

• Improved focus and physical stamina

• Enhanced student and staff productivity

• Fewer restrictions on participation in physical activities

• Fewer symptoms and medical emergencies

By taking action together, we can help to ensure that all of our students have a better opportunity to thrive in school and beyond. Everyone – including families, school staff, students, and community groups – has an essential role to play. The school community can help by:

• Educating children, parents, and staff about asthma and the school environment

• Identifying and reducing potential asthma triggers in the school

• Developing and implementing policies that create a supportive, asthma-friendly environment

Whether your school is considering a comprehensive wellness policy that includes environmental health and safety, or if you want to start on more modest projects, you’ll find guidance and resources throughout the toolkit – from building administration buy-in to identifying issues around the school to implementing best practices and policies to address the issues. Case studies are also available to show how schools and school districts across MA are making advances to improve the health of students, especially those with asthma. Take action together to make school a place where staff and students can work, learn, and play in the healthiest environment – use the Clearing the Air toolkit for guidance and inspiration.

STAY TUNED! MAAP and the MA DPH are planning a walk-through webinar. We’ll show you how to navigate this toolkit and its resources and discuss different ways to use the toolkit in your own school. More information to come!

SPREAD THE WORD! Click here for our promotion kit, which includes ready-to-share email, web and social media copy as well as graphics to download and send with your messages. We’ve been working hard on this toolkit, and we encourage you to share it with your members and networks!