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): Strengths/Challenges

The Capital Health staff agree about how success should be defined for RAP and what factors contribute to that success. RAP’s success is determined by the program’s ability to:

• Improve asthma management behavior so children have fewer limitations in activity and missed school days
• Improve the quality of life for children with asthma and their families as the child learns to recognize his/her asthma clues, avoid asthma triggers, and adhere better to the medication regimen.

Although Capitol Health has not formally evaluated RAP’s success, respondents identified several key strengths of the program that appear to contribute to its believed success.

Strengths

RAP implements the principles of child-appropriate education.
The instruction promotes concrete, hands-on activities for the children that are fun. It includes peer support activities that relate to the children’s experiences. It is delivered over time in short intervals and allows children to learn through play. The Capital Health RAP team has developed some of its own board games that work extremely well with children, and the team has refined other games used in the program. The children love these games, and the staff have strong ownership. The program is positive and simple. Feedback from parents and children indicate that it is effective in teaching asthma self-management to elementary-aged children.

RAP kit is pre-packaged.
The instructor’s manual is a "tool box" of resources and ideas. It provides specific guidance for the novice, yet provides flexibility for instructors to select or develop new games and activities that meet the needs of the school or the group without disrupting the lesson objectives. The program is well written and easy for instructors to deliver. It entices both first graders and sixth graders. The manual espouses principles of good asthma self-management.

RAP is low tech, low cost, and very portable.
Being able to put the contents of the program in an artist’s portfolio carrier and transport it into a rural area school 30-40 miles from town in – 20o weather in ice and snow is a real plus.

The children’s homework book, ("Fun Book") appeals to the children.
It is full of pictures and attractive cartoons that children like to work in and to color and customize. It is an effective instructional vehicle that also shows children how to use the peak flow meter, record their asthma clues and triggers, and use an inhaler; and it reinforces the children’s use of their asthma action plan diaries. The Fun Book is effective in helping the children communicate with their parents about what they have learned about asthma.

Challenges

Some schools present challenges.
It was customary a few years ago to place carpets in the classrooms in Edmonton schools. At times, the only rooms available for RAP education are in environmentally unhealthy locations within the school in which dust from carpets could trigger an attending child’s asthma. Finding appropriate spaces for holding classes continues to be a challenge in some schools.

Some school administrators are not receptive to sponsoring RAP at school.
In Alberta, families are not required to send their children to the neighborhood school. School principals are accountable for all aspects of their budgets, including the physical plant repairs and maintenance, cleaning, supplies, staffing, lunch programs, out-of-school programs, school priorities (e.g., a new roof or new band instruments). Some principals, especially those in the inner city, admit they are under a great deal of pressure. Some principals are less willing to consider allowing outside programs into their schools perhaps because of their focus on day-to-day administrative issues or a lack of understanding of the impact of asthma on individual children.

Parent-teacher asthma orientation and RAP introduction are valuable.
Although inviting the parents of children with asthma and the children’s teachers for a 1-hour asthma orientation and RAP introduction one evening at school is a great idea, such a gathering is not always possible because of lack of interest among parents and teachers. The RAP instructors constantly are searching for ways to make this element of the RAP program more successful.

RAP requires on-going monitoring to demonstrate the appropriate application of the program.
The Capital Health RAP director is able to track health outcomes because all RAP-educated children are attended by doctors in clinics or hospitals that are managed by Capital Health. The ethical and legal protocols for actually carrying out this task have yet to be fully developed and approved; however, this is a program goal for the future.