Breathing Easier in Schools: Enhancing Adoption, Fidelity, and Effectiveness of the SAFE School Program through Innovation Implementation Strategies

PROJECT SUMMARY Asthma contributes to chronic absenteeism and learning loss in U.S. school children and respiratory distress is the leading cause of 9-1-1 calls from schools. When students with asthma experience respiratory distress, an essential aspect of symptom management is the administration of albuterol sulfate, a short-acting beta agonist.

Despite laws allowing students to self-carry albuterol inhalers in all 50 U.S. states, access to life-saving medications for emergency respiratory distress during school hours remains limited. This issue has far- reaching consequences, contributing to chronic absenteeism and increased healthcare utilization. However, a

stock inhaler program that allows schools to maintain a single inhaler for use by any student who experiences respiratory distress is a low-cost solution. The Stock Albuterol for Every “SAFE” School Program is a school- based stock albuterol program in the state of Arizona. Although the program has shown effectiveness,

challenges in its implementation persist, particularly in rural areas. The innovation here lies in exploring three implementation strategies that vary in their intensity and resource requirements to support program adoption, maintenance potential, implementation fidelity, student reach and effectiveness. The first two of these

implementation strategies (toolkit, toolkit+nurse coach) have been widely used in Arizona schools and the third (toolkit+practice facilitation+nurse coach), which includes practice facilitation, is hypothesized to increase program adoption and implementation maintenance. We aim to adapt the nursing principles of

practice facilitation to a school-based stock albuterol program. By conducting a Hybrid Effectiveness Implementation (HEI) Type 3 Design, this research aims to provide evidence-based recommendations, including relative cost-effectiveness of the individual and combined strategies that can be applied in the other

17 additional U.S. states with stock inhaler laws. The proposed research represents a significant opportunity to empower policymakers, healthcare providers, and educators to improve student health and safety, ultimately bridging the gap in access to life-saving medications and safeguarding the well-being of our youth.