Practitioner and site characteristics that relate to fidelity of implementation: The Early Risers prevention program in a going-to-scale intervention trial.

Abstract

Despite the increased availability of evidence-based prevention programs targeting serious mental health problems, an ongoing challenge within the field of prevention science is transporting prevention programs into real-world settings where their health impact can be fully realized. As part of a going-to-scale study, we examined how context, namely the characteristics of the practitioners and organizations, promotes or impedes fidelity of implementation of prevention efforts. Practitioners delivered Early Risers, an intensive, multicomponent, indicated prevention program across 27 geographically dispersed elementary schools and recorded 3 indexes of fidelity—exposure, adherence, and quality of implementation. As predicted, practitioner characteristics, including personality traits (low neuroticism, high extraversion, openness, and conscientiousness), beliefs (pre-implementation beliefs about program success), and use of flexible coping strategies (reappraisal coping) were related to various fidelity indexes. Contrary to predictions, teachers’ negative perceptions of the organizational structure were positively related to fidelity. Follow-up regression analyses suggested that practitioner characteristics differentially predict fidelity for child and family programming.