Little Simon Serrano's asthma flare-ups -- the coughing and the wheezing -- have become a routine part of life.
The 7-year-old's mother, Ronda Serrano, estimates the family has visited the emergency room or urgent care a least five times in the past year because of Simon's illness.
Simon's attendance at Thorner Elementary School has suffered, too. Serrano said she sometimes can send him after he's been up all night, but other times he's still not breathing right and the rescue inhaler kept at school can't control his asthma.
"Last year he missed more days than he should have just because of his asthma," Serrano said.
A new pilot program between the Bakersfield City School District and Kern Health Systems -- which administers one of two Medi-Cal managed care plans in the county -- aims to help kids like Simon keep their asthma in check.
It could save the district and the agency a lot of money as well.
On Sept. 24, Bakersfield City School District trustees unanimously approved a one-year contract for an asthma case management pilot program. Kern Health Systems (KHS) will reimburse the district up to $39,500 for school nurses to make home visits to families of children with asthma and to teach small groups of students about managing their asthma.
KHS will only pay the district for serving children enrolled in its plan, Kern Family Health Care, but the program will also be open to students not on that plan.
While she couldn't say for certain how many of the district's 29,700-plus students have asthma, Debbie Wood, BCSD coordinator of school health, said it's estimated at about one in nine. She believes asthma is one of the leading causes of absences in the district.
Keeping those kids in school would keep dollars in the district. Every time a student misses a day of school, it costs the district $38.77. With more than 1,100 students absent each school day, absences cost the district an average of $46,000 daily, said district spokesman Steve Gabbitas.
The program could also save KHS money.
Isabel Silva, manager of health education and disease management for KHS, said urgent care, emergency room and hospitalizations tied to asthma for children age 3 to 12 living in five zip codes served by the school district totaled more than $585,000 in 2012.
KHS estimates the program will save it about $112,000 by reaching 65 children.
But Wood and Silva said the program has bigger goals than saving money -- to help families and children improve their quality of life.
"This kind of thing is what excites us. This is the system working," said Dr. Remington Brooks, KHS's medical director. "(If the program is successful), hopefully it will be a blueprint for not only asthma but for other health care issues as well."
The school district also hopes to see academic improvements. If kids are having trouble breathing or are exhausted from a night spent waiting in the emergency room, they will have a hard time listening to their teacher, Wood said.
"(This illness) can rob them of a lot of opportunity to be in school, to be alert and to be in their best learning mode," said Lillian Tafoya, BCSD's school board president.
Wood and Silva are now looking for children to enroll.
KHS is identifying BCSD students who have had two or more emergency room visits, one or more hospitalizations and who haven't used their medication appropriately.
School district staff will contact the families and explain the program. Parents can decide whether to join. If they say yes, a nurse will make an initial home visit offering education and an assessment of things that could trigger a child's asthma.
"There are all sorts of things that can set (asthma) off, anything from pet dander to smoking, to feather pillows, to cleaning products. Even being too cold or exercise can set (asthma) off sometimes," Brooks said.
After the first visit, students will attend six small-group sessions to learn the basics of their disease, how to recognize and manage symptoms, and how to use their medications properly. Wood said the district's 16 school nurses have all been trained in the curriculum and parents can attend an optional class as well.
Nurses will make a follow-up home visit to check that parents understood what they were taught and have done what they can at home. Wood said the nurses will also offer help navigating the health care system, which can be intimidating for parents who don't want to challenge health care providers.
The district will monitor students' absences, medication use at school and test scores to see if the program's making a difference, Wood said.
The district hopes to recruit 65 children in the first quarter of the school year, which ends in December. This time of year is a "perfect storm" for asthma problems with the start of cold and flu season and the plentiful appearance of dust and mold tied to crop harvesting, Wood said. It's hoped the pilot will help keep young asthma sufferers healthy through the holidays, the nurse said.
"We're hoping to start off with a bang," she said.
This is the first intensive asthma case management program in Kern County that Wood knows of, but similar programs have been pioneered in school districts around the country.
A study of the Los Angeles Unified School District's asthma case management/home visitation program found that students' mean number of absences decreased from a baseline of nearly 12 days over the last 12 months to just shy of four days a year months later.
Yolanda Cuevas, lead nurse for the LAUSD Nursing Services Asthma Program, said getting parents on board is key to controlling a child's asthma.
"Involving the parent, it just makes sense. It's more successful," Cuevas said.
For Ronda Serrano, more resources are always welcome, even though she feels like her son's asthma is pretty well-managed. He has a rescue inhaler that he uses at school and a maintenance inhaler that he uses at home, his mother said. When Simon plays soccer, Serrano makes sure an inhaler is in her purse or his bag.
"The weather hasn't changed too much since soccer started, but I'm anticipating this weekend he might need (his asthma treatments) a little more because of the dust and the weather changing," she said.
Serrano said she wouldn't mind learning more about how to manage her son's asthma and what his triggers are. She said her children are covered by Kern Family Health Care and she thinks the new program between KHS and the district could be "very beneficial."
"I'm always open to learning about more options or things that can help him," she said.