The Roaring Adventures of Puff (RAP): A Childhood Asthma Education Program

Implemented in Edmonton, Alberta, Canada by MAS Consultants Inc., P.O. Box 5130 Aiken, South Carolina 29804.

The Roaring Adventures of Puff (RAP): Description of Replicated Program

Implementation in several communities

Although the Roaring Adventures of Puff is implemented in numerous locations within Canada, this case study focuses on its implementation in Alberta.

RAP requires its instructors to be health professionals, often registered nurses or respiratory therapists. RAP instructors are employed by the health region in sectors such as public health and clinical medicine. The Canadian health-care system authorizes one health-care provider within a given health region of a province. The provider has a strong incentive to educate asthma patients to better self-manage their asthma to reduce the costs of unscheduled doctor’s visits, emergency department visits, and hospitalizations.

RAP is primarily delivered in elementary schools in Canada. The community selected for this case study is the RAP course provided by the Capital Health Region, Community Rehabilitation Program, Alberta’s regional health authority for the Edmonton area, region number 10.

The health-care system in Alberta comprises 17 regions. Within each region, one health-care provider receives funding from the provincial government for the care of all Canadian citizens within the region. Capital Health is responsible for hospital and continuing care, home and community care, diagnostic imaging, and laboratory services. Region 10 covers the cities of Edmonton (pop. 625,000), St. Albert, Le duc, the bedroom community of Sherwood Park, and the rural population of Le duc and Strathcona counties. A total of 828,000 people reside in Region 10. Educating children with asthma to properly self-manage their condition reduces medical costs for Capital Health and the taxpayers, as well as improving school children’s quality of life.

Edmonton, in north-central Alberta, has nearly 300 elementary schools. The population is predominantly white, with pockets of Asian minorities. Three types of schools operate within Edmonton: 1) public schools, 2) separate schools (Catholic School Services), and 3) private schools. Both public and Catholic schools are funded by the government and are supported by taxpayer dollars. Parents can choose where they want their school tax dollars spent and in which type of school they want their children educated. Private schools are relatively new phenomena in Alberta. During the 2001-2002 school year, the Capital Health-Community Respiratory Rehabilitation group took the RAP program into 10 of the Edmonton schools, covering all three types.

The manager of the Capital Health Community Respiratory Rehabilitation program, Mike Ernscliff, and the RAP instructional staff, all registered respiratory therapists with strong teaching experience, have been conducting RAP in Edmonton schools for more than 3 years. Capital Health selected RAP to educate region 10 health district school children with asthma because of the program’s unique appeal. Instructors call the program "highly engaging, very interactive, and fun for the kids." Children look forward to education day, they say, and are disappointed when the sessions end. The program includes reinforcement tools such as the take-home workbook that the child uses to tell his/her parents what he/she learned and in-class activities conducted each time the children meet. RAP also is convenient to administer – the participants already are assembled in a learning environment, the school. These facilities are provided without cost, and transportation, safety, and security issues are eliminated.

Goals of the Replicated Program

The overarching goal of RAP for Capital Health is to assist children with asthma to develop self-confidence, self-management skills, and attitudes that will promote healthy decision-making. RAP instructors work toward specific asthma management goals to help children to achieve and maintain control of their condition to avoid exacerbations that require unscheduled doctor visits, hospital, or emergency medical care. These goals are to:

Promote healthy actions aimed at maintaining and improving health, quality of life, and well being Encourage effective partnership between the person or family with asthma and health professionals Improve understanding of their condition

Recruitment and Characteristics of the Target Population

Recruitment for RAP program participants predominantly depends on the approval and support of individual school principals. Capital Health RAP instructors collaborate with Capital Health, public health, and school nurses who help promote RAP. These relationships have been vital to acquiring the principals’ approval to conduct the asthma education program in the schools. After receiving approval of the school principals, the RAP instructor acquires the names and addresses of children with asthma from the school office administrator.

When interest is sufficient, a parent and teacher asthma orientation and RAP introduction meeting are conducted during an evening at the school. Following the meeting, parents complete consent forms for their children to receive RAP education at school. When the parent and teacher meeting is not used, an information sheet about RAP and how it can help children learn ways to better control asthma is sent to the parents of identified children along with a consent form. Only children with parental consent are enrolled in the course. Class usually begins within 3 weeks after initial approval from the principal or his/her designee.

The target population within the elementary schools includes all the children with asthma attending the school (grades 1-6). In general, children range in age from 6 to 12 years. No attempt is made to limit participation or to attract a given sub-set of the school population with asthma, such as children from lower income families or children with severe asthma. The only limitation is class size. With just one instructor, sessions are limited to 12 participants. At times, two separate classes may be needed at a school. By opening the class to all children with asthma, two obvious positive outcomes result. The instructors are competent to refer a family to its physician upon discovery that the child is not taking the asthma medications or is otherwise having difficulty with asthma in school. Furthermore, some children such as those with mild asthma, who would otherwise not receive education or assistance, receive some education that improves their asthma care.