Hassenfeld Child Health Innovation Institute

Asthma Initiative Goes Virtual to Help Kids with Asthma during COVID-19

When the coronavirus pandemic forced schools to shut down and businesses to send employees home in March, the Hassenfeld Institute’s Asthma Initiative team knew they had to act quickly to continue to provide services to children with asthma and their families.

The Asthma Initiative, led by Elizabeth McQuaid, Ph.D., and Daphne Koinis-Mitchell, Ph.D., implements a number of projects across the state that engage children and families in school and at home. Dr. McQuaid is the director of the Brown Clinical Psychology Training Consortium, and Dr. Koinis-Mitchell directs the Community Asthma Program at Hasbro Children’s Hospital. Both teach at the Warren Alpert Medical School of Brown and are psychologists at Rhode Island Hospital.

“The biggest challenge was when it became clear that this was going to be a long-term situation,” McQuaid said. “We had to focus a lot on transitioning to virtual programs.”

For example, the RI-Asthma Integrated Response (RI-AIR) initiative, a comprehensive system of identification, screening, and intervention for pediatric asthma, is typically implemented in schools and at home. For this critical project, the team was able to quickly transition from in-person visits to remote visits for children who were already enrolled in the program to continue to keep children and their parents engaged.

“We’ve transitioned everything to a virtual format without changing the content,” McQuaid said.

Almost immediately, McQuaid, Koinis Mitchell and their team began to review data on how the coronavirus pandemic was affecting the behavior of children and families with asthma, such as the frequency of hospital visits and medication management. The data show that ER visits among children with asthma dipped in the spring, likely because people were anxious about going to the hospital due to COVID-19.

However, McQuaid and Koinis Mitchell found that because children were staying home from school, it’s possible they were around fewer triggers and data indicate that people were taking their asthma medication more regularly as a result of being home more.

“It became clear right away that health outcomes would be affected by COVID-19,” McQuaid said.

For example, prior to the pandemic, the Asthma Initiative had been working on investigating the impact of pediatric asthma on school absenteeism. However, school attendance has been hugely impacted by COVID-19, which forced most schools to switch to virtual learning.

“Schools rely on our partnership now, given we also may have frequent contact with children at risk and in need of asthma services,” Koinis Mitchell said. “Now that our school asthma management program is remote, we have direct access into how children are managing their asthma, and school nurses teachers are appreciative of these efforts. We have always worked in partnership with our school collaborators to optimize children’s asthma outcomes in the school setting and enhance students’, caregivers’, and staffs’ knowledge on how to respond to students’ symptoms in the school setting.”

The Asthma Initiative is tracking how school personnel, students and caregivers are managing asthma during the pandemic in an effort to respond to the changing needs of students and families.

One of the key projects of the Asthma Initiative is implementing Rhode Island’s Home Asthma Response Program, or HARP, a program managed by the state Department of Health that helps families with children who have severe asthma by providing in-home classes on finding, managing, and fixing asthma triggers in the home.

But in the midst of the coronavirus pandemic, in-home sessions are out of the question.

After several months of strategic planning, the Asthma Initiative rolled out its virtual format for HARP in September. Now, families who may be eligible for the program are screened online. Once a family qualifies, they attend a virtual session where they are instructed on how to identify and photograph potential asthma triggers around the home and then upload those photos to be evaluated by educators. Supplies for trigger remediation are then dropped off with families based on the evaluation.

Even though it’s remote, HARP is still very professional and tailored to the family’s needs, McQuaid said.

“The silver lining is that we had discussed before the pandemic how to disseminate HARP to rural communities,” McQuaid said, “and now we know how.” 

Learn more about the Asthma Initiative