Healthy Schools

Tackling food allergies at school

For parents of children with food allergies, school can sometimes seem like a minefield, with danger lurking everywhere.

Some students at Aurora's Park Lane Elementary eat lunch. The cafeteria pizza - unlike most pizzas - is made with whole wheat and lowfat cheese, so it's a "Slow" food. The lowfat milk is a "go" food.
PHOTO: Hayleigh Colombo
Students at Aurora’s Park Lane Elementary eat lunch.

It’s not just the peanut butter and jelly sandwiches that pop out of lunchboxes in the cafeteria. It’s the constant stream of food in the classroom, for snacks, parties, rewards, and even crafts like paper maché planets or peanut butter bird feeders.

Colorado Springs parent Katie Prichard knows the feeling. Her kindergarten daughter is allergic to peanuts, eggs, soy, sesame, green peas and apples, and while Pritchard is very pleased with the precautions in place at her charter school, Rocky Mountain Classical Academy, she said there are always worries. Sometimes about safety and sometimes about her daughter’s inevitable sense of being different.

“At school you should get to be like your friends…to have equal access to your classroom,” she said. “It’s kind of a barrage for a young kid in kindergarten.”

Pritchard, who leads Colorado Springs Mosaic, a group for parents of children with severe food allergies, said despite the challenges, she believes schools are moving in the right direction when it comes to accommodating food allergies.

“I’ve heard so many struggles other parents had before I came along,” she said “I definitely feel like things have improved.”

Kathleen Patrick, assistant director of student health services at the Colorado Department of Education, agreed, saying state laws and policies have enabled several key measures, such as allowing students to self-carry epinephrine auto-injectors, ensuring school districts have allergy policies and educating school staff about allergies.

Today, about 8 percent of children have food allergies, an average of two per classroom.

Patrick said when she was a school nurse years ago, she sometimes heard stories about school staff not taking a student’s food allergy seriously.

Today, she said, “We’re on the right road in terms of the education and getting the information out there…I think food allergy awareness is very high.”

Precautions vary

Nicole Smith, co- founder of the AllergicChild website and mother of a teenage son with food allergies, said the landscape for Colorado students with food allergies can vary depending on their school and district.

“Even within a school district you can have different levels of awareness,” she noted.

Patrick said sometimes the successful dissemination of food allergy information can hinge on how school nurses are deployed in a district. Compared to schools with a full-time nurse, there may be less overall awareness about allergy precautions, not to mention fewer trained staff members to administer epinephrine injections in an emergency, in schools where nurses work part time because they cover multiple buildings.

Another factor in how schools and districts measure up, she said, can be the presence of a parent, nurse or other staff member who serves as a champion for food allergy awareness and preparation.

Despite the differences between schools and districts, state policies and resources have created some uniformities in the last several years. Under a state law Smith helped pass in 2009, school districts are required to have policies to accommodate students with food allergies.

In Academy School District 20, which has a Food Allergy Task Force and is widely considered a leader on food allergy issues, the district’s five-page policy weighs in on food allergy issues large and small, from training staff to choosing field trip chaperones. (It’s recommended that parents of students with food allergies get preference.)

“Academy School District 20 is amazing, just plain and simple,” said Smith, whose son attends high school there. “They have long looked at the safety of every child.”

Often, food allergy measures depend on the number of students with food allergies at a school, the severity of their reactions, what precautions are requested by parents and what is deemed feasible by administrators.

For example, at some schools cafeteria tables are set aside for students with food allergies and there are strict rules about sanitation procedures as well as hand-washing guidelines for students.  This is the case at Ralston Elementary in Golden, where peanut and tree nut products are banned in all classrooms, but are permitted at designated cafeteria tables.

Even when schools have comprehensive plans in place and staff are attentive, allergens sometimes slip through the cracks. Patrick started tracking the number of students who experienced anaphylaxis and needed epinephrine at Colorado schools in the 2011-12 school year.

There were about 30 cases reported that year, and so far this school year, there have been 24. The causes include students sharing food, which is prohibited at most schools, but can be hard to enforce. In one case, a parent brought in cupcakes containing peanut products after signing up to bring something else. In another, a student with a latex allergy touched a balloon while she was helping decorate a friend’s locker.

“You can be as careful as possible and something may still happen,” Patrick said.

House Bill 13-1171

In case something does happen, many in the food allergy community are hoping that a bill currently under consideration in the legislature will lead to additional potential safeguards for children with allergies. Bill 1171, also called the stock epinephrine bill, would allow schools to keep epinephrine auto-injectors on hand for trained staff to use on students experiencing anaphylaxis even if they don’t have their own prescription.

The idea is to allow teachers or other school staff to immediately curb a life-threatening reaction during the crucial minutes before paramedics arrive. In part, the measure would protect students who have undiagnosed allergies that are triggered at school.

“Twenty-five percent of first-time [allergic] reactions occur in the school setting,” said Jennifer Jobrack, director of major gifts and regional advocacy for Food Allergy Research and Education, a national advocacy group.

Christianna Fogler, principal at Rocky Mountain Classical Academy, knows firsthand how that scenario plays out. Last fall, a first-grader at the school’s elementary campus came in from the playground and began experiencing anaphylaxis. The girl had no known allergies but her throat was closing and her breathing was labored, said Fogler, who will testify before the state Senate in favor of Bill 1171 this week.

After school staff called 911, paramedics arrived in just a couple minutes because they happened to be at a building down the street. They treated the girl, who may have reacted to a bug bite, and she recovered.

Fogler, who worries about what would have happened if the paramedics had taken 10 or 15 minutes to arrive, said the bill would empower school staff to do the right thing without worrying about liability or other legal issues. The school already trains all teachers, substitute teachers and lunchroom monitors how to recognize anaphylaxis and administer and EpiPen.

Currently, 17 states have laws covering stock epinephrine in schools, though the language and requirements range widely. Only Nebraska, Virginia and Maryland require schools to stock epinephrine auto-injectors. In most states, as would be the case in Colorado, the practice is voluntary.

Among the objections to the law are the expense of the auto-injectors, which typically cost $180 for a two-pack, and the extensive training needed to ensure school staff besides the nurse know what anaphylaxis looks like and how to use the auto-injectors.

Jobrack noted that Mylan Speciality, the distributor of EpiPens, has a program providing free and discounted EpiPens to schools, and that her organization has training resources available.

Trends toward protection and prevention

As a result of the Americans With Disabilities Act Amendments Act of 2008, students with severe food allergies are also increasingly getting 504 plans, which provide children with disabilities accommodations to fully participate in school.

Holly Camp, administrator for food service operations for JeffCo Public Schools and a registered dietician, said she helped execute the first food allergy-related 504 plan in 2009. Today, about 50 students in the 85,000-student district have such plans, usually because of allergies or intolerances to gluten, dyes or casein, a protein found in milk.

As part of the plans, the students’ parents, physician and often the school nurse make a list of accommodations, which may range from using extra sanitizer at the student’s lunch spot to allowing them to be first through the cafeteria line to ensure their food is prepared and wrapped first.

Patrick believes the increasing use of 504 plans for food allergies is a good development. In addition to helping individual students who have the plans, it can raise awareness overall, she said.

“What they are doing for one, they will very often understand that it’s important for another student with a recognized food allergy,” she said.

Smith, of AllergicChild, said another encouraging trend she’s noticed is that school wellness initiatives aimed at reducing obesity are being coupled with efforts to reduce allergy risks. Thus, many schools are getting away from using food as rewards or as the focal point of class parties.

For example, a few elementary schools in the Thompson School District in Loveland  adopted regulations this year eliminating edible treats for student birthdays and sometimes communal snacks where every child gets a portion from a large box of crackers or cookies. Wellness coordinator Kathy Schlepp said the changes came because school staff were trying to respond to food allergy concerns and also “the extra calorie piece.”

The district’s wellness plan, which is currently being revised, will also include some version of these restrictions next year.

“It will definitely be trying to cut down on unhealthy classroom snacks or treats,” she said.

Funding fight

Colorado poised to slash funding for controversial student health survey

Two years after a controversial student health survey sparked protracted debate at the State Board of Education, questions about the survey’s value have moved to the state legislature — and could mean a loss of $745,000 in state funding for the biennial data collection effort.

Funding for the Healthy Kids Colorado Survey, which comes primarily from the state’s Marijuana Tax Cash Funds, was not included in the proposed state budget earlier this spring and may not return despite requests by the state health department to restore the money.

The health survey is given to a sample of Colorado middle school and high school students in scores of districts every other year. It asks about topics ranging from nutrition to risky behavior, and proponents say it’s crucial for tracking trends and crafting interventions when trouble spots arise.

In addition to $745,000 in state dollars, the survey is funded with $89,000 in federal money. State health department officials said determining whether the survey could continue in a slimmed-down form if state money is stripped away depends on the federal budget.

“The Healthy Kids Colorado Survey is the only comprehensive survey on the health and well-being of Colorado youth,” Dr. Larry Wolk, executive director and chief medical officer of the Colorado Department of Public Health and Environment, said in a statement. “Without funding, we won’t be able to provide the kind of credible health information schools, community groups and local public health agencies need to improve the health of the young people they serve.”

The state Senate is expected this week to debate the state’s budget. The House will debate the budget after the Senate completes its review.

The health survey became the focus of a debate by the State Board of Education and dueling opinions from the state attorney general’s office in 2015 after some parents raised concerns about the explicit nature of questions on sexual behavior, drugs and suicide.

In addition, critics argued that parents should have to give advance written permission — called active consent — in order for their children to take the survey. Over the survey’s 26-year history, most districts have chosen passive consent, which means students are asked to take the survey unless parents sign a form opting them out.

Ultimately, neither the state board nor State Attorney General Cynthia Coffman mandated substantive changes to the survey or consent rules. State officials emphasized throughout the controversy that the survey is anonymous and voluntary. After the state board uproar over the survey, most districts continued to participate.

On Monday, Rep. Bob Rankin, a Carbondale Republican who helped write the state’s budget, said of the survey, “I think enough of us felt that it was just intrusive. I just don’t think it collects good data.”

Not all on the budget committee agreed.

“I support the survey,” said Rep. Millie Hamner, a Frisco Democrat. “Our school districts rely on that information for other grant programs. It is possible in the budget process we’re able to restore that.”

Chalkbeat Colorado’s deputy bureau chief Nic Garcia contributed to this report. 

red zone

Traffic pollution: an invisible health risk for dozens of Denver schools

PHOTO: Google Maps - Street View
Interstate 70 is clearly visible from the playground outside Swansea Elementary School in Denver.

Just a few hundred feet from the front doors of Highline Academy Charter School’s southeast Denver campus is Interstate 25, where more than 200,000 vehicles rush by each day.

At Swansea Elementary School in north Denver, kids frolic near the busy Interstate 70 overpass that abuts the playground. Three miles west, at a charter school called STRIVE Prep – Sunnyside, the same highway looms just past a chain link fence next to the school.

The three schools are among 29 in Denver Public Schools — 10 of them charters — that sit near high-traffic roads and the invisible air pollution those routes generate daily. Experts say such pollution can stunt lung development, aggravate asthma and contribute to heart disease, but there’s little public awareness about the problem and mitigation efforts are sparse.

A new online mapping tool, part of a joint investigative project by two nonprofit news organizations, the Center for Public Integrity and Reveal, puts the issue in stark relief. Residents across Colorado and the nation can easily check which schools fall into red zones where traffic volume, and the accompanying air pollution, is worst, and orange zones where traffic volume is lower, but still potentially problematic for kids and staff who may spend long hours at their schools.

PHOTO: Center for Public Integrity and Reveal
This screen shot of the mapping tool shows Highline Academy’s proximity to Interstate 25 with a blue pin.

The Center for Public Integrity provided Chalkbeat with raw data for schools with Denver addresses. While most were DPS schools, a couple dozen were schools in neighboring districts, including Cherry Creek, Aurora, Westminster, Mapleton, Sheridan and Jefferson County.

Eleven DPS schools — educating more than 8,000 students — fell into the red zone, which means they sit within 500 feet of roads carrying more than 30,000 vehicles a day on average. Those include charters such as Highline and Strive Prep – Sunnyside, and traditional public schools such as Swansea and Steele elementaries and George Washington, Lincoln and East high schools.

Another 18 district schools, plus one in the Cherry Creek district and one in the Adams 12 district, fall into the orange zone, which includes schools that are within 500 feet of roads carrying more than 10,000 vehicles and more than 500 trucks daily. The 18 DPS schools include two additional STRIVE – Prep locations, two schools inside the downtown administration building and the district’s magnet school for students designated as highly gifted: Polaris at Ebert Elementary.

DPS officials say air pollution resulting from schools’ proximity to busy roadways hasn’t been discussed previously and that mitigation measures — such as high-grade air filters — aren’t in place at most affected schools.

“We haven’t had this conversation before,” said district spokeswoman Alex Renteria.

Sometimes schools end up near busy roadways because that’s where districts can buy cheap land. But population growth, development trends and major transportation projects can also dramatically change the fabric of a school neighborhood. Swansea Elementary, for example, was built in 1957, before I-70 sliced through north Denver in the 1960s.

The problem of traffic-related air pollution near schools is not exclusive to big cities like Denver. It can be found in suburban and rural areas around the state and the rest of the country. Many school districts across Colorado — from Montrose to Steamboat Springs to Greeley — have at least one school within 500 feet of high-traffic routes.

Charters harder hit

The investigation by the Center for Public Integrity and Reveal, which looked at trends nationwide, found that charter schools are more likely than traditional public schools to be located close to busy roads.
That’s true in Denver, where 22 percent of the district’s charter schools were located near a busy road during the 2014-15 school year, compared to 13 percent of other district schools. Nationwide, about 9 percent of schools are near busy roads, according to the analysis.

Officials at the most impacted Denver charter schools had little to say about the issue of traffic pollution.

Christine Ferris, executive director of Highline Academy, wrote in an email: “We can’t really do much about our location and although it would be obvious to anyone who visits us, having the information highlighted on Chalkbeat isn’t my favorite idea.”

She canceled a subsequent interview with Chalkbeat.

Chyrise Harris, senior director of communications and marketing for the STRIVE Prep charter group, said via email, “STRIVE Prep operates all of its schools in district facilities and works collaboratively with the district to ensure that all students, regardless of where they live, have access to a safe, high quality school near them.”

Jessica Johnson, general counsel and director of policy for the Colorado League of Charter Schools, said in growing cities like Denver there’s limited inventory when it comes to school sites. Charter schools may end up along high-traffic routes because that’s where the chartering district has vacant space and also because such roads provide needed proximity to bus or train stops.

Of the 10 Denver charter schools near busy roads, seven are in district-owned buildings. The three that aren’t are Highline, Cesar Chavez Academy and Justice High School.

While Johnson said being close to busy roads is a fact of life for urban charter schools, she noted the impact of traffic-related air pollution is an important health and wellness issue — one that hasn’t been on the charter community’s radar.

“This isn’t an issue that we’ve seen a lot of research into locally or a lot of conversation on,” she said.

Mitigation measures

Vehicle exhaust contains a variety of harmful components, including small particles, carbon monoxide and carcinogenic compounds. While outdoor areas like school playgrounds and sports fields pose an obvious risk, the air inside buildings can suffer, too, because particles, vapors and gases often seep inside.
High-grade air filters — those rated MERV 16 — can make a big difference. According to the Center for Public Integrity and Reveal investigation, MERV 16 filters installed in California schools caught about 90 percent of fine and ultrafine particles, which are key contributors to traffic-related health problems.

Denver schools use lower-grade filters, those rated either MERV 8 or MERV 10, according to district officials.

Air-conditioning can also help somewhat, allowing schools to keep some pollution at bay by shutting doors and windows in hot weather. Of the 29 DPS schools most impacted by roadway pollution, only four don’t have at least partial air-conditioning. Those are Valverde and Steele elementaries, Polaris at Ebert Elementary and STRIVE Prep – Sunnyside. While a handful of the 29 schools will get additional air-conditioning with funds from Denver’s recent voter-approved bond, those four are not on the list.

Swansea Elementary, the second most impacted Denver school after the southeast Highline Academy location, will be getting short-term and likely longer-term relief from traffic pollution.

Renteria said as part of a project underway now, the school is getting a new heating, ventilation and air-conditioning system that will include MERV 16 filters. It will also get new doors and windows.

Additionally, a planned highway widening project will convert the current overpass next to Swansea to a covered below-grade route. Research from the Environmental Protection Agency suggests vehicle emissions are lower near below-grade roads with steep walls. The same is true for routes with certain kinds of sound barriers or roadside vegetation.

The city will monitor air quality on Swansea’s grounds during and after construction.

Here is the list of schools classified as “red” or “orange:”

Red Zone Schools

SCHOOL DISTRICT CHARTER STATUS
Highline Academy (southeast) Denver charter
Swansea Elementary School Denver
STRIVE PREP – Sunnyside Denver charter
Compassion Road Academy Denver
Steele Elementary School Denver
George Washington High School Denver
Respect Academy at Lincoln Denver
Abraham Lincoln High School Denver
College View Elementary School Denver
Valverde Elementary School Denver
East High School Denver

These “red zone” schools are within 500 feet of roads carrying more than 30,000 vehicles a day on average.

Orange Zone Schools

SCHOOL DISTRICT CHARTER STATUS
STRIVE Prep – Federal Denver charter
Columbian Elementary School Denver
Denver Center for International Studies Denver
Colfax Elementary School Denver
Cheltenham Elementary School Denver
The Odyssey School Denver charter
Contemporary Learning Academy Denver
STRIVE Prep – Ruby Hill Denver charter
Cesar Chavez Academy Denver charter
Girls Athletic Leadership School Denver charter
Bruce Randolph School Denver
Downtown Denver Expeditionary School Denver charter
Emily Griffith Technical College Denver
Dora Moore ECE-8 School Denver
Justice High School Denver charter
Polaris at Ebert Elementary School Denver
Bromwell Elementary School Denver
Rocky Mountain School of Expeditionary Learning Denver charter
Challenge School Cherry Creek
North Star Elementary School Adams 12

These “orange zone” schools are within 500 feet of roads carrying more than 10,000 vehicles a day and more than 500 trucks on average.