Fidelity Measures Research Articles

Virtual practice facilitation as an implementation strategy for launching opioid safety committees for quality improvement in primary care: feasibility, acceptability, and intervention fidelity

BackgroundPractice facilitation (PF) is an evidence-based multicomponent in-person implementation strategy. COVID-19-related lockdowns caused many implementation initiatives to rapidly shift to virtual settings, but there is limited evidence on PF deployed exclusively using virtual meeting platforms. Our objective was to assess the feasibility and acceptability of virtual PF used in a primary care setting to implement interdisciplinary opioid safety committees (OSCs) to improve care for patients using opioid medicines for persistent pain and reduce high-dose opioid prescribing. We also describe alignment of virtual PF with the core functions of PF and fidelity of participating clinics to the OSC intervention.MethodsWe applied qualitative and quantitative methods to evaluate virtual PF used to implement a quality improvement project at Kaiser Permanente Washington, an integrated health system in Washington State. We established interdisciplinary OSCs in primary care clinics using virtual PF. OSCs were tasked with promoting opioid safety and high-quality pain care through population management and chart reviews. We used administrative data to calculate feasibility measures including attendance and retention. Acceptability data came from interviews with OSC members conducted by evaluators. Measures of fidelity to the OSC intervention were abstracted from meeting notes and administrative data. We used qualitative methods to assess the adherence of virtual PF to the core functions of PF.ResultsFacilitators carried out a comprehensive PF approach virtually and demonstrated adherence to the core functions of PF. We established OSCs in eight clinics and conducted an average of 17.5 virtual PF meetings over eight months of PF for each clinic. Average attendance was 75% and we had 84% retention. OSC members were highly satisfied with virtual PF. Facilitators effectively supported teams through implementation and technical challenges and OSC members gained skills through virtual PF. We implemented OSCs with high fidelity, suggesting virtual PF is an effective implementation strategy.ConclusionsWe found virtual PF is a feasible and acceptable implementation strategy for this intervention and identified strategies to support care teams through challenges. Our findings can help inform future implementation efforts, especially those hoping to engage geographically dispersed clinics or remote clinical staff.Trial registrationNot applicable.

28-country global study on associations between cultural characteristics and Recovery College fidelity.

Recovery Colleges (RCs) are learning-based mental health recovery communities, located globally. However, evidence on RC effectiveness outside Western, educated, industrialised, rich, and democratic (WEIRD) countries is limited. This study aimed to evaluate associations between cultural characteristics and RC fidelity, to understand how culture impacts RC operation. Service managers from 169 RCs spanning 28 WEIRD and non-WEIRD countries assessed the fidelity using the RECOLLECT Fidelity Measure, developed based upon key RC operation components. Hofstede's cultural dimension scores were entered as predictors in linear mixed-effects regression models, controlling for GDP spent on healthcare and Gini coefficient. Higher Individualism and Indulgence, and lower Uncertainty Avoidance were associated with higher fidelity, while Long-Term Orientation was a borderline negative predictor. RC operations were predominantly aligned with WEIRD cultures, highlighting the need to incorporate non-WEIRD cultural perspectives to enhance RCs' global impact. Findings can inform the refinement and evaluation of mental health recovery interventions worldwide.

Implementing peer support into practice in mental health services: a qualitative comparative case study

BackgroundPeer workers are people with personal experience of mental distress, employed within mental health services to support others with similar experiences. Research has identified a range of factors that might facilitate or hinder the introduction of new peer worker roles into mental health services. While there is mixed evidence for the effectiveness of peer worker delivered interventions, there are no studies exploring how implementation might be associated with effect.MethodsThis was a qualitative comparative case study using data from interviews with 20 peer workers and their five supervisors. Peer workers delivered peer support for discharge from inpatient to community mental health care as part of a randomised controlled trial. In the trial, level of participant engagement with peer support was associated with better outcome (hospital readmission). Study sites with higher levels of engagement also had higher scores on a measure of fidelity to peer support principles. We compared data from sites with contrasting levels of engagement and fidelity using an analytical framework derived from implementation theory.ResultsIn high engagement-high fidelity sites, there was regular work with clinical teams preparing for working alongside peer workers, and a positive relationship between staff on inpatient wards and peer workers. The supervisor role was well resourced, and delivery of peer support was highly consistent with the intervention manual. In low engagement-low fidelity sites peer workers were employed in not-for-profit organisations to support people using public mental health services and in rural areas. Supervisors faced constrained resources and experienced barriers to joint working between organisations. In these sites, peer workers could experience challenging relationships with ward staff. Issues of geography and capacity limited opportunities for supervision and team-building, impacting consistency of delivery.ConclusionsThis study provides clear indication that implementation can impact delivery of peer support, with implications for engagement and, potentially, outcomes of peer worker interventions. Resourcing issues can have knock-on effects on consistency of delivery, alongside challenges of access, authority and relationship with clinical teams, especially where peer workers were employed in not-for-profit organisations. Attention needs to be paid to the impact of geography on implementation.Trial registrationISRCTN registry number ISRCTN10043328, registered 28 November 2016.

Methodological Components for Evaluating Treatment Effectiveness of the SOS Approach to Feeding: A Feasibility Study

Abstract Date Presented 03/23/24 This feasibility study offers tools and procedures for researchers and clinicians for implementation of an effectiveness study of the Sequential-Oral-Sensory (SOS) Approach to feeding. A fidelity measure was created and sensitive outcomes identified for future studies. Primary Author and Speaker: Sarah A. Schoen Contributing Authors: Rachel Balderrama

Utilizing the Summer Treatment Program Model to Promote School Readiness in Young Children Living in Urban Poverty: An Initial Effectiveness Open Trial

ABSTRACT Access to, and engagement in, quality mental health care for young children with externalizing behavior problems (EBPs) who are living in urban poverty is limited. Innovative efforts to engage families in early intervention are needed to ensure school success. The goals of the current study were to transport the Summer Treatment Program for Prekindergartners (STP-PreK, an adaptation of the Children’s Summer Treatment Program and evaluate the implementation and initial program promise for children living in urban poverty via an open trial. Participants were 115 preschool children (68.7% male; 84.3% Black) with EBPs and their caregivers. Nearly all the participating families were living with low to extremely low incomes. Participants received a 7-week STP-PreK, including a daily school readiness program and weekly behavioral parenting training. Implementation outcomes were measured via attendance records, satisfaction ratings, and fidelity measures. Program promise was measured via caregiver ratings and child assessments, collected pre-, post-, and at 6 months following the intervention. On average, results demonstrate strong feasibility and acceptability with high child attendance (90.56%) and caregiver satisfaction with services. Intervention effects across domains of child functioning reveal medium-to-large effects on academics (d’s = 0.46–1.95), overall impairment (d = 0.79), behavioral functioning (d’s = 0.38 – 0.84), and executive functioning (d = 0.58). Effects were largely maintained at 6-month follow-up (d’s = 0.13–1.86). Overall, the results support the promise of the STP-PreK model in enhancing school readiness outcomes for young children at-risk. Directions for continued adaptation and future research are discussed.

The Impact of Implementation Fidelity of a School-Based Multi-Component Smoking Prevention Intervention on Vocational Students’ Smoking Behavior: A Cluster-Randomized Controlled Trial

Preventing young people’s cigarette smoking is a major public health priority, and smoking is especially prevalent in vocational schools. Well-enforced comprehensive school tobacco policies accompanied by preventive efforts show potential to reduce smoking, but the implementation process is crucial to achieve the intended effect. We investigate whether and how implementation fidelity of a multi-component smoking prevention intervention impacted student smoking outcomes after 4–5 months among students in Danish vocational education and training (national age range 15–65 years, mean 25.6) and preparatory basic education (national age range 15–25 years, mean 17.6) institutions using questionnaire data from a cluster-RCT. The intervention included a smoke-free school hours policy, educational curriculum, and class competition. We calculated an overall implementation fidelity measure combining staff-reported school-level delivery (fidelity) and student-reported receipt (participation, responsiveness), and used multilevel regression models to analyze associations with smoking outcomes (smoking daily, regularly, and during school hours). We supplemented the analysis with restricted cubic spline regression. Additionally, we stratified the analyses by school types and analyzed associations between implementation fidelity of the separate intervention components and smoking outcomes. High implementation was associated with lower odds of regular smoking (OR: 0.37, 95% CI: 0.18–0.78) and smoking during school hours, but not daily smoking, and these associations varied between the school settings. When analyzed separately, implementation fidelity of the components did not affect the outcomes significantly. Our findings underline the need to support the implementation process of school tobacco policy interventions to ensure the intended effects of reducing students’ smoking.

A Peer-Supported School Engagement Intervention for Youth with Attention Problems: Development and Implementation

Youth with attention problems are at increased risk for school disengagement (Booster et al., JAD 16:179–189, 2012; DuPaul & Langberg, in: Barkley (ed), Attention-deficit/hyperactivity disorder: A handbook for diagnosis and treatment, Guilford, New York, 2014), which portends risk for poor outcomes (Bond et al., JAH 40:357.e9–357, 2007; Carter et al., JA 30:51–62, 2007; Fredricks et al., RER 74:59–109, 2004). Interventions that target school engagement may benefit from peer delivery because peers are widely available in schools and potentially more credible than adults. In this study, a peer-supported school-based school engagement intervention for middle school students with attention problems, Together Engaging and Achieving Meaningfully (TEAM) was developed with educators and students. In initial development (Study One), community development team meetings with partners (N = 9 school staff and students) were conducted. Thematic analysis was used to identify themes used to refine TEAM. In Study Two, a single-case pilot with one student with attention problems and one peer coach was conducted. Measures of fidelity, attendance, acceptability, and satisfaction were collected. Results were used to refine TEAM. Then in pilot implementation (Study Three), a non-randomized pilot was conducted with 10 fifth- through seventh-grade students with attention problems (n = 6 in the intervention group) and six eighth-grade coaches. Measures of fidelity, attendance, acceptability, satisfaction, and clinician-required time for implementation were collected. Cohen’s d mean difference effect sizes were calculated between and within groups over implementation. Feedback from partners highlighted barriers and aspects that were acceptable and feasible. Results from implementation suggested high attendance, high coach fidelity with revised implementation support, and low clinician-required time. Lessons learned and avenues for future development and research are discussed.

Implementation of a Co-Design Strategy to Develop a Dashboard to Support Shared Decision Making in Advanced Cancer and Chronic Kidney Disease.

Background: Shared decision making (SDM) is the process by which patients and clinicians exchange information and preferences to come to joint healthcare decisions. Clinical dashboards can support SDM by collecting, distilling, and presenting critical information, such as patient-reported outcomes (PROs), to be shared at points of care and in between appointments. We describe the implementation strategies and outcomes of a multistakeholder collaborative process known as "co-design" to develop a PRO-informed clinical dashboard to support SDM for patients with advanced cancer or chronic kidney disease (CKD). Methods: Across 14 sessions, two multidisciplinary teams comprising patients, care partners, clinicians, and other stakeholders iteratively co-designed an SDM dashboard for either advanced cancer (N = 25) or CKD (N = 24). Eligible patients, care partners, and frontline clinicians were identified by six physician champions. The co-design process included four key steps: (1) define "the problem", (2) establish context of use, (3) build a consensus on design, and (4) define and test specifications. We also evaluated our success in implementing the co-design strategy using measures of fidelity, acceptability, adoption, feasibility, and effectiveness which were collected throughout the process. Results: Mean (M) scores across implementation measures of the co-design process were high, including observer-rated fidelity and adoption of co-design practices (M = 19.1 on a 7-21 scale, N = 36 ratings across 9 sessions), as well as acceptability based on the perceived degree of SDM that occurred during the co-design process (M = 10.4 on a 0 to 12 adapted collaboRATE scale). Capturing the feasibility and adoption of convening multistakeholder co-design teams, min-max normalized scores (ranging from 0 to 1) of stakeholder representation demonstrated that, on average, 95% of stakeholder types were represented for cancer sessions (M = 0.95) and 85% for CKD sessions (M = 0.85). The co-design process was rated as either "fully" or "partially" effective by 100% of respondents, in creating a dashboard that met its intended objective. Conclusions: A co-design process was successfully implemented to develop SDM clinical dashboards for advanced cancer and CKD care. We discuss key strategies and learnings from this process that may aid others in the development and uptake of patient-centered healthcare innovations.

Dissecting the components of error in analogue report tasks.

Over the last two decades, the analogue report task has become a standard method for measuring the fidelity of visual representations across research domains including perception, attention, and memory. Despite its widespread use, there has been no methodical investigation of the different task parameters that might contribute to response variability. To address this gap, we conducted two experiments manipulating components of a typical analogue report test of memory for colour hue. We found that human response errors were independently affected by changes in storage and maintenance requirements of the task, demonstrated by a strong effect of set size even in the absence of a memory delay. In contrast, response variability remained unaffected by physical size of the colour wheel, implying negligible contribution of motor noise to task performance, or by its chroma radius, highlighting non-uniformity of the standard colour space. Comparing analogue report to a matched forced-choice task, we found variation in adjustment criterion made a limited contribution to analogue report variability, becoming meaningful only with low representational noise. Our findings validate the analogue report task as a robust measure of representational fidelity for most purposes, while also quantifying non-representational sources of noise that would limit its reliability in specialized settings.

Implementation of training and coaching to improve goal planning and family engagement in early childhood home visiting

Early childhood home visiting services aim to support child and family health and development, yet challenges engaging and retaining families persist. One promising strategy to improve family engagement involves enhancing the capacity of the home visiting workforce to partner with families to set and implement service goals that align with families’ needs and preferences. This study examined implementation of ‘Goal Plan Strategies’ (GPS), a training and coaching innovation designed to improve family-centered goal planning. Aims were to evaluate (1) the extent to which training and eight sessions of audio-based coaching were implemented with fidelity, (2) whether coaching fidelity was associated with home visitors’ perceptions of coaching and confidence using goal planning strategies, and (3) whether GPS was perceived as feasible, acceptable, and useful by coaches and home visitors. Home visitors (N = 22) and coaches (N = 10) took part in GPS and completed surveys, session logs, and interviews. Training and coaching sessions were observed and coded for fidelity (e.g., dose, adherence, quality). GPS was implemented with high levels of fidelity. Findings support feasibility, acceptability, and usefulness of GPS, overall, and suggest the need to examine coaching dosage and overlap with other implementation supports more closely. Findings highlight the benefits of audio-based coaching, mentoring of coaches, and observational measures of implementation fidelity.

Realist process evaluation of occupational performance coaching: protocol

IntroductionA cluster randomised controlled trial, the Meaning, Agency and Nurturing Autonomy (MANA) study, is underway comparing the effects of occupational performance coaching (OPC) and usual care on the social participation,...

Infrared-Visible Synthetic Data from Game Engine for Image Fusion Improvement

Limited by the shooting scenes and angles of fixed cameras, the existing datasets generally lack many detailed pedestrian models in diverse scenarios. Existing deep learning-based image fusion methods, for this reason, bring about overfitting or insufficient information of fusion results in varying degrees. To address this challenge, A new infrared-visible pedestrian synthetic dataset (GIVF) with a synthetic data tagger (GSDT) is constructed and an improved end-to-end image fusion network (FSGAN) is proposed to validate infrared and visible fusion. In the model, the method uses an auxiliary network to extract features that complement the cascade network of the main path, effectively improving the ability to extract pedestrian texture details. Experimental results show that FSGAN can be well applied to GIVF. By conducting extensive comparative experiments with eight state-of-the-art image fusion methods. FSGAN shows better performance than those comparison methods, especially in the two evaluation indexes visual information fidelity (VIF) and structural similarity measurement (SSIM). Besides, by comparing the quantitative analysis results of various methods, and evaluating the fusion results of real images in complex environments on other three datasets, we conclude that FSGAN can be better applied to GIVF datasets than other popular methods, and has outstanding performance in generalization.

Capturing Local Temperature Evolution During Additive Manufacturing Through Fourier Neural Operators

Abstract High-fidelity, data-driven models that can quickly simulate thermal behavior during additive manufacturing (AM) are crucial for improving the performance of AM technologies in multiple areas, such as part design, process planning, monitoring, and control. However, complexities of part geometries make it challenging for current models to maintain high accuracy across a wide range of geometries. In addition, many models report a low mean-square error (MSE) across the entire domain of a part. However, in each time-step, most areas of the domain do not experience significant changes in temperature, except for the regions near recent depositions. Therefore, the MSE-based fidelity measurement of the models may be overestimated. This article presents a data-driven model that uses the Fourier neural operator to capture the local temperature evolution during the AM process. Besides MSE, the model is also evaluated using the R2 metric, which places great weight on the regions where the temperature changes significantly than MSE. The model was trained and tested on numerical simulations based on the discontinuous Galerkin finite element method for the direct energy deposition AM process. The results shows that the model maintains 0.983−0.999 R2 over geometries not included in the training data, which is higher than convolutional neural networks and graph convolutional neural networks we implemented, the two widely used architectures in data-driven predictive modeling.

Standardizing Fidelity to Evidence-Based Practice in the Early Psychosis Intervention Network.

This study investigated variations in the measurement of fidelity to coordinated specialty care (CSC) within the Early Psychosis Intervention Network (EPINET), a learning health system that consists of 101 CSC programs within eight hubs. The study investigated the degree to which five fidelity scales could be mapped onto a standard scale. The investigators identified six fidelity scales in use by EPINET participants; examined their item content, scoring, and data sources; and mapped five scales onto the First Episode Psychosis Services Fidelity Scale (FEPS-FS), which is the most widely used scale. Mapping five fidelity scales onto the FEPS-FS showed that the percentage of FEPS-FS components successfully mapped ranged from 42% to 81%. Mapping five scales onto one that uses dichotomous scoring identified the degree of variation in measures and reduced the amount and quality of usable fidelity data. Identifying variations in fidelity measurement is a core function of a learning health system.

Collaborative Safety Planning with Youth during a Suicide-Related Emergency: Developmental and Family Considerations

ABSTRACT Suicide is a leading cause of death among youth, yet many risk reduction interventions have been designed for and tested with adults. The Safety Planning Intervention (SPI) is widely used by child-serving clinicians; however, little formal guidance exists about how to conduct the SPI in a developmentally tailored or family centered manner. This study aimed to 1) describe the content of youth safety plans to elucidate the range of strategies that youth find helpful in managing suicide risk, 2) apply operational definitions of SPI fidelity (completeness, personalization, consistency) developed with adults to SPI fidelity measurement with youth, and 3) explore the extent to which quality SPI implementation, including collaboration with parents, was related to parents’ perceived readiness and behavioral engagement in supportive behaviors following a psychiatric emergency. A mixed methods approach was used to examine safety plans completed by 54 youth ages 12–17 (79.6% female; 88.9% White) during a psychiatric emergency department visit. Common preferred coping strategies included listening to music, spending time with supportive individuals, creating art/music, and exercise. Youth safety plans were of moderate quality (M = 3.09, SD = 1.34, range = 0–5), with 61% demonstrating evidence of personalization and 35% mostly personalized. Parent ratings of developmentally appropriate and family centered care were associated with both perceived readiness (β = .67, p < .001) and behavioral engagement (β = .51, p = .003) with safety plan recommendations in the days following ED discharge. Implications of these findings for clinical practice are discussed.

Implementing Safewards on Children and Young People’s Wards: A Process and Outcomes Evaluation

Safewards reduces conflict and containment on adult inpatient wards but there is limited research exploring the model in Children and Young People (CYP) mental health services. We investigated whether Safewards can be successfully implemented on twenty CYP wards across England. A process and outcomes evaluation was employed, utilizing the Integrated Promoting Action on Research Implementation in Health Sciences (i-PARiHS) framework. Existing knowledge and use of Safewards was recorded via a self-report benchmarking exercise, verified during visits. Implementation of the 10 Safewards components on each ward was recorded using the Safewards Organizational Fidelity measure. Data from 11 surveys and 17 interviews with ward staff and four interviews with project workers were subject to thematic analysis and mapped against the four i-PARiHS constructs. Twelve of the 20 wards implemented at least half of the Safewards interventions in 12 months, with two wards delivering all 10 interventions. Facilitators and barriers are described. Results demonstrated Safewards is acceptable to a range of CYP services. Whilst implementation was hindered by difficulties outlined, wards with capacity were able and willing to implement the interventions. Results support the commissioning of a study to evaluate the implementation and outcomes of Safewards in CYP units.

Validity Evidence for an Observational Fidelity Measure to Inform Scale-Up of Evidence-Based Interventions.

As evidence-based interventions are scaled, fidelity of implementation, and thus effectiveness, often wanes. Validated fidelity measures can improve researchers' ability to attribute outcomes to the intervention and help practitioners feel more confident in implementing the intervention as intended. We aim to provide a model for the validation of fidelity observation protocols to guide future research studying evidence-based interventions scaled-up under real-world conditions. We describe a process to build evidence of validity for items within the Session Review Form, an observational tool measuring fidelity to interactive drug prevention programs such as the Botvin LifeSkills Training program. Following Kane's (2006) assumptions framework requiring that validity evidence be built across four areas (scoring, generalizability, extrapolation, and decision), confirmatory factor analysis supported the hypothesized two-factor structure measuring quality of delivery (seven items assessing how well the material is implemented) and participant responsiveness (three items evaluating how well the intervention is received), and measurement invariance tests suggested the structure held across grade level and schools serving different student populations. These findings provide some evidence supporting the extrapolation assumption, though additional research is warranted since a more complete overall depiction of the validity argument is needed to evaluate fidelity measures.

Response of vulnerable karst forest ecosystems under different fire severities in the Northern Dinaric Karst mountains (Slovenia)

BackgroundThis study deals with wildfires in marginal areas of the Mediterranean climatic and biogeographical regions (Northern Mediterranean) where fires were not common. The aim of the research was to determine the differences in floristic composition and traits at different intensities of fire damage and to analyze the changes in forest ecosystems during the wildfires that took place in the summer of 2022. The study included both the zonal forests and non-native black pine (Pinus nigra) forests. Remote sensing techniques linked to the vegetation data sampled in the field during the 2023 vegetation season, the very first season after the fires, were also used in the fire assessment.ResultsThe study confirmed that satellite data analysis, orthophoto interpretation, and on-site vegetation sampling provide equivalent information on fire severity, opening up the possibility of transferring knowledge to similar post-fire sites without field sampling in the future. TWINSPAN classification analysis divided the sampled plots into clusters based on tree species prevalence and fire severity. The diagnostic species of the clusters were calculated using a fidelity measure. Ordination revealed that the first axis on the detrended correspondence analysis (DCA) correlated with wildfire severity. Ecological conditions and strategies, life forms, chorotypes, seed dispersal classes, and regeneration traits were analyzed along this gradient. We found that post-fire sites became warmer, drier, and lighter, which favored the growth of ruderal, theropytic, cosmopolitan, anemochorous and post-fire emergent species. After the fire, a “wave” of annual ruderal species was observed.ConclusionsThe results indicate that post-fire recovery can be left to natural processes without human intervention, except in the case of non-native pine stands where planting or seeding may be necessary. Otherwise, it is essential to control the possible occurrence of invasive species. Isolated adaptations of species to fire have also been observed, such as heat-stimulated germination. Such adaptations could develop in regions exposed to frequent fires and where fires act as an evolutionary factor.

Promoting Healthy Screen Media Use in Young Children With Externalizing Behavior Problems Through an Adapted Parenting Intervention: Results of an Open Trial

In this article, we describe the development of an adapted parenting intervention for caregivers of preschoolers with externalizing behavior problems, which integrates content around screen media use into an existing evidence-based parenting intervention. We also present results of an open trial examining the feasibility, acceptability, and initial outcomes of the adapted intervention in a sample of 10 low-income caregivers of children with externalizing behavior problems who were attending a community-based therapeutic summer program. Caregivers attended a once weekly (1.5-hour) intervention group, which was embedded in an 8-week community-based therapeutic program for children with externalizing behavior, and completed questionnaires at pretest, posttest, and 1 month following the intervention, and completed interviews about their experiences. Caregiver satisfaction with the adapted intervention was high, and fidelity and attendance measures suggested the intervention was feasible. Preliminary results showed postintervention improvements in caregivers’ skills in managing screen media use, including increases in caregiver self-efficacy to manage and set limits around screen media use. Results suggest that leveraging existing parenting interventions to promote healthy media use habits may be a promising avenue to maximize reach to families with children with externalizing behavior.

Evidence-Based Program Implementation Variability in New Contexts: The Head Start REDI Program

AbstractThis study involved a pilot implementation of an evidence based school readiness intervention in new community contexts. The Head Start Research Based, Developmentally Informed (REDI) program was implemented in preschools on and near a Native American reservation with both indigenous and non-indigenous students and teachers. The REDI curriculum involved 5 subcomponents targeting children’s literacy skills and social-emotional development. Teachers were provided with inperson and on-line training and in-person implementation support from a REDI coach. Implementation fidelity included ratings of of curriculum dosage and child engagement, as well as coach ratings of teaching quality using a modified version of the Classroom Assessment Scoring Scale (CLASS). Teachers indicated which adaptations they made to the curriculum and the reasons for these adaptations. Teachers also completed qualitative, post-implementation interviews to obtain their impressions of REDI and the need for planned modifications in their context. Analyses included measures of implementation fidelity and qualitative evaluation of adaptations. Results indicated that teachers found the REDI program both feasible and helpful for their students. Suggestions for planned adaptations included more STEM activities and the freedom to choose the dialogic reading books. Many spontaneous adaptations were noted. Teachers indicated that pragmatic issues, such as lack of time, were the main reasons for adapting the program, and deletions and substitutions of curricular activities were the most common types of changes. Implementation of program subcomponents improved gradually over the course of the school year. Some subcomponents were more likely to be adapted than others.