Search

Purpose: The effectiveness of the 14-component evidence-based whole-school reform Success for All (SfA) has been well established, but research on its implementation is limited although fidelity of implementation is vital for the effectiveness of such a program. This review sheds light on this issue. Design/Approach/Methods: A systematic literature review was conducted to acquire an overview of qualitative and quantitative aspects of SfA's implementation in primary schools as well as to identify stimulating and hindering factors when implementing SfA. Sixteen studies, conducted in the United States and the United Kingdom, were included in this review. Findings: Results indicate that 48% of schools implemented SfA at the minimal level, 45% at a more advanced level, and 7% at an insufficient level. Information on the implementation for each of the 14 components was rare. Most of the factors that affected implementation were hindering factors rather than stimulating ones. For successful implementation of this evidence-based program, the crucial factors appear to be leadership, fulfilling organizational conditions, staff development, and relentlessly implementing all 14 components together. Originality/Value: This review shows that for an evidence-based program to be effective, implementation fidelity is a very serious concern, which needs to be addressed systematically.

Purpose: The purpose of this study was to carry out a systematic review of intervention programs that have addressed affective learning outcomes within physical education and to explore pedagogical practices in alignment with teaching, lesson content, and learning outcomes. Method: The literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Included were 26 peer-reviewed pedagogical studies of physical education programs that addressed affective outcomes and reported fidelity of implementation. Results and Discussion: Affective outcomes were grouped into four themes: motivation, emotional responses, self-concept, and resilience. The findings showed that offering choice, encouraging peer feedback, asking deductive questions, focusing on personal improvement, and differentiating are effective teaching strategies that were widely used to support affective learning in children and adolescents. This review highlights the importance of fidelity of implementation to understand how intervention programs are delivered.

This qualitative study aimed to develop theory about psychological constructs relevant to spiritual development in diverse adolescents. Exemplar and Consensual Qualitative Research methods were used to explore 30 interviews of adolescents aged 12 to 21 years ("M" = 17.73 years) representing eight religions and six countries from around the world. Participants were nominated for living with profound spirituality within their own culture and completed semistructured interviews in their country of origin. After several iterations of analysis, participants' discussions of spirituality in their lives were explored in terms of three dimensions of spirituality present in their lives: transcendence, fidelity, and behavior. Findings are considered in light of existing developmental theory, and implications for adolescent development are discussed.

Although Eriksonian theory suggests that adolescents' sense of fidelity is a key component of healthy development, research on this psychosocial construct has been limited. The current study developed an index of youth fidelity, examined the developmental course of this construct, explored the influence of contextual factors on different fidelity trajectories, and tested if trajectories were associated with later indicators of adolescents' positive development. Participants included 1,941 ethnically diverse youth (61% female) participants in the 4-H Study of Positive Youth Development who were recruited from schools and youth development programs across the United States. Results suggested that three types of developmental trajectories existed among youth: "high and increasing," "moderate and increasing," and "low and decreasing." Fidelity group membership varied in relation to social relationships and psychosocial and behavioral characteristics (i.e., contribution, substance use, and delinquency). Girls were more likely than boys to be in the highest fidelity trajectories. Directions for future research and implications for enhancing the thriving of adolescents are discussed. (Contains 1 figure and 5 tables.)

This study investigated teachers' efficacy and implementation in the context of a supplemental intervention for struggling adolescent readers. It examined teachers' efficacy at the start of their intervention training and investigated relationships among teachers' efficacy, implementation, and students' reading progress. The efficacy and implementation of 9 sixth-grade teachers and 11 ninth-grade teachers were compared, and student achievement gains were explored. Sixth-grade teachers had higher levels of efficacy, while ninth-grade teachers had higher levels of implementation. Findings indicated teacher efficacy was positively related to students' reading comprehension and overall reading achievement. Implementation was positively related to students' growth in vocabulary. (Contains 6 tables.)

As a global cyberinfrastructure, the Internet makes authentic digital problem spaces like educational virtual environments (EVEs) available to a wide range of classrooms, schools and education systems operating under different circumstantial, practical, social and cultural conditions. And yet, if the makers and users of EVEs both have a hand in what can be initially achieved and subsequently repeated, then replication is not only a matter of precise repeatability but also specific variation. In this light, the study enlists one EVE in order to examine both classroom learning and educational research methodology. Two Singapore secondary school enactments of the "Quest Atlantis" Taiga curriculum are compared with one another and with previously published US enactments. Statistically significant learning gains precisely repeat Barab and colleagues' findings while classroom practices specifically vary from its design narratives. Descriptions of the progressive development of Singapore enactments illustrate a methodological tack for understanding continuity and change within Singapore classrooms and between Singapore and US classrooms as necessary functions of diversity. The juxtaposition of these analyses characterize tensions between replication and implementation fidelity and, in turn, frame EVEs as a tool for understanding and leveraging precise repeatability and specific variability of curricula. (Contains 2 tables.)

Background: This study consisted of a formative evaluation of an after-school health education program designed for adolescent females, entitled Girls on Track. Evidence-based after-school programs have potential to supplement the traditional school day, encourage social and emotional skill development, improve the quality of student health, and contribute to a healthier school environment. Implementing comprehensive programs outside of the classroom, however, is challenging and gaps exist in the literature regarding implementation fidelity. Methods: The national program was in a cohort of adolescent females from 11 Girls on Track locations in fall 2008 and 10 locations in spring 2009. Mixed-method analyses evaluated fidelity of lesson implementation, described curricular and programmatic characteristics associated with implementation fidelity, and assessed coach perceptions toward program quality and feasibility. Results: Specific lesson characteristics associated with higher rates of implementation fidelity and favorable coach perceptions toward program feasibility included improved lesson clarity, more time to process health topics, teaching and learning objectives that were well aligned with lesson activities, incorporation of alternative activities for less-motivated participants, and provision of resources on key health topics for coaches. Conclusion: Girls on Track is currently being implemented across the United States and Canada, reaching over 5000 adolescent females annually. Identifying and incorporating specific curricular and programmatic characteristics associated with high levels of implementation fidelity can enhance the quality and benefits of after-school programs. (Contains 1 table.)

Following the Department of Education's announcement of the $3.5 billion in Title I funding, 831 of the nation's "persistently lowest-achieving schools" received federal funding during the 2010-11 school year to embark on significant change in the form of a School Improvement Grant (U.S. Department of Education, 2010). The Department of Education was not interested in slow, incremental change. Rather, the goal was for immediate change. In nearly every case, the school came under new leadership, and, in some instances, a large number of the staff was replaced. The nation has an extensive track record with comprehensive school reform. There are more than 8,000 elementary and secondary schools adopting some form of a comprehensive school reform model, and results are pending. A major shortcoming of nearly all of these studies, however, is that they fail to account for the extent to which schools have actually implemented their chosen model. Thus, the question: What ingredients are needed for comprehensive school-based reform that is both positive and sustainable? This paper discusses the ingredients of sustainable change and cites examples of schools making early success happen.

Background: Treatment implementation is not just one thing but rather is a multifaceted process that includes treatment delivery, treatment receipt, and treatment adherence. As such, local variations in implementation and service delivery of interventions are an inevitable. Purpose: To assess implementation fidelity of a multi-site experiential nutrition education program. Setting: Multiple sites throughout the continental United States. Intervention: An experiential nutrition education program. Research Design: A concurrent mixed methods design was used to assess implementation fidelity. Data Collection and Analysis: Multiple methods of data collection and analysis were used including observations, interviews, survey questionnaires, and extant data. Findings: Although implementation fidelity varied over program sites, overall implementation fidelity was very good and when it varied, it varied to local site needs and context. (Contains 4 tables.)

Objective Most pragmatic trials follow the PRagmatic Explanatory Continuum Indicator Summary (PRECIS-2) criteria. The criteria specify unobtrusive measurement of participants' protocol adherence and practitioners' intervention fidelity but suggest no special monitoring strategies to assure trial integrity. We present experience with adherence/fidelity monitoring in the Pain Management Collaboratory (PMC) and provide recommendations for their monitoring in pragmatic trials to preserve inferences of treatment comparisons. Methods In November 2021, we surveyed 10 of 11 originally funded PMC pragmatic trials to determine the extent to which adherence and fidelity data were being monitored. Results Of the 10 PMC trials, 8 track adherence/fidelity. The electronic health record is the most frequent source for monitoring adherence (7/10) and fidelity (5/10). Most adherence data are used to monitor participant engagement with the trial intervention (4/10) and are reviewed by study teams (8/10) and often with a data and safety monitoring board (DSMB) (5/10). Half of the trials (5/10) reported using fidelity data for feedback/training; such data are not shared with a DSMB (0/10). Only 2 of 10 trials reported having prespecified guidance or rules around adherence/fidelity (eg, stopping rules or thresholds for corrective action, such as retraining). Conclusions As a best practice for pragmatic trials, we recommend early and regular adherence/fidelity monitoring to determine whether intervention delivery is as intended. We propose a 2-stage process with thresholds for intervening and triggers for conducting a formal futility analysis if adherence and fidelity are not maintained. The level of monitoring should be unobtrusive for both participants and those delivering the intervention; resulting data should be reviewed by an independent DSMB. [ABSTRACT FROM AUTHOR]

Background: This study is a cost-effectiveness study of two implementation strategies designed to train therapists in college and university counseling centers to deliver interpersonal psychotherapy. Costs of implementing a train-the-trainer (TTT) strategy versus an expert consultation strategy were estimated, and their relative effects upon therapist outcomes were calculated and compared. Methods: Twenty four counseling centers were recruited across the United States. These centers were randomized to either a TTT (experimental) condition, in which an in-house therapist trained other center therapists, or an expert consultation condition, in which center therapists participated in a workshop and received 12 months of ongoing supervision. The main outcome was therapist fidelity (adherence and competence) to interpersonal psychotherapy, assessed via audio recordings of therapy sessions, and analyzed using linear mixed models. Costs of each condition were quantified using time-driven activity-based costing methods, and involved a costing survey administered to center directors, follow up interviews and validation checks, and comparison of time tracking logs of trainers in the expert condition. Mean costs to produce one therapist were obtained for each condition. The costs to produce equivalent improvements in therapist-level outcomes were then compared between the two conditions. Results: Mean cost incurred by counseling centers to train one therapist using the TTT strategy was $3,407 (median = $3,077); mean cost to produce one trained therapist in the control condition was $2,055 (median = $1,932). Therapists in the TTT condition, on average, demonstrated a 0.043 higher adherence score compared to therapists in the control condition; however, this difference was not statistically significant. For the competence outcome, effect size for therapists in the TTT condition was in the large range (1.16; 95% CI: 0.85–1.46; p <.001), and therapists in this condition, on average, demonstrated a 0.073 higher competence score compared to those in the expert consultation condition (95% CI, 0.008–0.14; p =.03). Counseling centers that used the TTT model incurred $353 less in training costs to produce equivalent improvements in therapist competence. Conclusions: Despite its higher short run costs, the TTT implementation strategy produces greater increases in therapist competence when compared to expert consultation. Expanding resources to support this platform for service delivery can be an effective way to enhance the mental health care of young people seeking care in college and university counseling centers. Trial registration: ClinicalTrials.gov Identifier: NCT02079142. [ABSTRACT FROM AUTHOR]

Objective: To assess the effects of an evidence-based family caregiver training program (implementation of Helping Invested Families Improve Veteran Experiences Study [iHI-FIVES]) in the Veterans Affairs healthcare system on Veteran days not at home and family caregiver well-being., Data Sources and Study Setting: Participants included Veterans referred to home- and community-based services with an identified caregiver across 8 medical centers and confirmed family caregivers of eligible Veterans., Study Design: In a stepped wedge cluster randomized trial, sites were randomized to a 6-month time interval for starting iHI-FIVES and received standardized implementation support. The primary outcome, number of Veteran "days not at home," and secondary outcomes, changes over 3 months in measures of caregiver well-being, were compared between pre- and post-iHI-FIVES intervals using generalized linear models including covariates., Data Collection/extraction Methods: Patient data were extracted from the electronic health record. Caregiver data were collected from 2 telephone-based surveys., Principal Findings: Overall, n = 898 eligible Veterans were identified across pre-iHI-FIVES (n = 327) and post-iHI-FIVES intervals (n = 571). Just under one fifth (17%) of Veterans in post-iHI-FIVES intervals had a caregiver enroll in iHI-FIVES. Veteran and caregiver demographics in pre-iHI-FIVES intervals were similar to those in post-iHI-FIVES intervals. In adjusted models, the estimated rate of days not at home over 6-months was 42% lower (rate ratio = 0.58 [95% confidence interval: 0.31-1.09; p = 0.09]) post-iHI-FIVES compared with pre-iHI-FIVES. The estimated mean days not at home over a 6-month period was 13.0 days pre-iHI-FIVES and 7.5 post-iHI-FIVES. There were no differences between pre- and post-iHI-FIVES in change over 3 months in caregiver well-being measures., Conclusions: Reducing days not at home is consistent with effectiveness because more time at home increases quality of life. In this study, after adjusting for Veteran characteristics, we did not find evidence that implementation of a caregiver training program yielded a reduction in Veteran's days not at home., (Published 2024. This article is a U.S. Government work and is in the public domain in the USA.)

Evidence-based practice (EBP) implementation represents a strategic change that requires alignment of leadership and support throughout organizations. Leadership and Organizational Change for Implementation (LOCI) is a multifaceted implementation strategy that aims to improve implementation leadership and climate within organizations through iterative cycles of leadership and climate assessment and feedback, leadership training and coaching, and strategic planning with upper-level leaders. This study tested the effects of LOCI on transformational and implementation leadership, implementation climate, implementation citizenship behavior, and EBP reach. A multiple cohort, cluster randomized trial tests the effect of LOCI in 60 clinics across nine behavioral health organizations in California and Arizona, USA. The study randomized clinics within organizations to either LOCI or a leadership training webinar control condition in three consecutive cohorts. Repeated web-based surveys of direct service providers (n LOCI = 201, n Control = 179) assessed leadership, implementation climate, and implementation citizenship over time. Multilevel autoregressive modeling was the primary statistical analysis such that providers (level-1) were nested within clinics (level-2). The study predicted between-condition differences at 4-, 8-, and 12-month follow-up assessments. Provider engagement in a fidelity monitoring process assessed reach of motivational interviewing (i.e., number of sessions recorded/submitted for fidelity coding). An independent sample t -test explored between condition differences in motivational interviewing reach. Results indicated between condition differences at 4 months for implementation leadership, implementation climate, and implementation citizenship behavior such that greater improvements were evidenced in the LOCI condition compared to the control condition. Reach of MI was significantly greater in the LOCI vs control condition such that LOCI providers were significantly more likely to engage in the fidelity monitoring process (chi-square (1, n = 370) = 5.59, p =.018). LOCI was developed based on organizational theories of strategic leadership and climate to affect organizational change processes that communicate that innovation implementation is expected, supported, and recognized as a value of the organization. The LOCI implementation strategy resulted in more positive hypothesized outcomes compared to the control condition. Organizational change strategies have utility for implementing health innovations in complex, multilevel contexts and for greater sustainment of facilitative leader behaviors, strategic implementation climate, and improved implementation outcomes. This study is registered with Clinicaltrials.gov gov (NCT03042832, 2 February 2017; retrospectively registered). • The LOCI multilevel implementation strategy improves organizational context for evidence-based practice implementation. • The LOCI strategy resulted in more positive organizational and implementation outcomes compared to the control condition. • Organizational change strategies can improve implementation of evidence-based behavioral health interventions. [ABSTRACT FROM AUTHOR]

Coordinated Specialty Care (CSC) is a multidisciplinary team approach to providing care for young and emerging adults having their first episode of psychosis. CSC programs have expanded rapidly throughout the United States going from 12 programs in 2008 to over 160 programs a decade later. The purpose of this historical review is to document the process and conditions that led to the accelerated dissemination of these programs across the country. CSC models began in the US in the early 2000s, but nationwide expansion followed the 2008 Recovery After an Initial Schizophrenia Episode trial. As programs have grown, debates have risen about fidelity to CSC models. The challenges facing CSC programs today include lack of evidence on what are the core components of CSC and how fidelity monitoring relates to positive client outcomes. [ABSTRACT FROM AUTHOR]

The purpose of this longitudinal study was to examine patterns in implementation of Tiers 2 and 3 school-wide positive behavioral interventions and supports (SWPBIS) systems to identify timings of installation that led to higher implementation of advanced tiers. Extant data from 776 schools in 27 states reporting on the first 3 years of Tier 2 implementation and 359 schools in 23 states reporting on the first year of Tier 3 implementation were analyzed. Using structural equation modeling, we found that higher Tier 1 implementation predicted subsequent Tier 2 and Tier 3 implementation. In addition, waiting 2 or 3 years after initial Tier 1 implementation to launch Tier 2 systems predicted higher initial Tier 2 implementation (compared with implementing the next year). Finally, we found that launching Tier 3 systems after Tier 2 systems, compared with launching both tiers simultaneously, predicted higher Tier 2 implementation in the second and third year, so long as Tier 3 systems were launched within 3 years of Tier 2 systems. These findings provide empirical guidance for when to launch Tiers 2 and 3 systems; however, we emphasize that delays in launching advanced systems should not equate to delays in more intensive supports for students. [ABSTRACT FROM AUTHOR]

Background: Process data, data generated by a user's interaction with a web‐based application, is an emerging tool in educational research. The current study explores using process data as a measure of implementation fidelity to a randomized control trial (RCT) of the Read It Again Mobile (RIA‐M) curricular supplement. Objectives: To determine the extent to which teachers implemented RIA‐M and to assess the utility of using process data in the assessment of fidelity. Methods: The RCT involved 30 pre‐kindergarten classrooms with a sample of n = 216 students. RIA‐M provides a curricular supplement which teachers may incorporate into classroom instruction and is delivered via a tablet computer. Pre and post literacy assessments are used to determine treatment effect. Process data, produced from teacher interactions with the tablet, and classroom observations are used to assess fidelity. Results and Conclusions: Our findings indicate no difference between treatment and control students in the RCT. Yet, we find that process data provides unique fidelity information concerning treatment exposure, adherence, and quality of program delivery. Specifically, process data indicated that teachers did not demonstrate the same level of fidelity that was captured in classroom observations. This finding provides some evidence for the absence of an intervention effect. Major Takeaways: The current study improves our understanding of how web‐based interventions may be assessed for implementation fidelity using process data. Further, process data offers a potentially reliable and scalable measure of fidelity for other web‐based educational interventions. Lay Description: What we know about the topic: Mobile technology‐based interventions are on the rise in many educational settings.Fidelity to educational interventions can be difficult to reliably assess.Teachers may be resistant to implementing technology in classrooms. What this paper adds: Examines a pilot study of a mobile technology‐based curricular intervention for teachers designed to improve early reading and literacy.Examines a new method for assessing fidelity of mobile technology‐based interventions.Compares the new method to traditional methods of assessing fidelity to educational interventions. Implications for practice and/or policy: The presence of technology in the classroom does not assure that the technology will be used effectively.Mobile technology‐based interventions may require additional monitoring and coaching to assure use as intended.Process data, generated in the use of technology‐based interventions, may provide a unique way to measure fidelity to the intervention. [ABSTRACT FROM AUTHOR]

The "what works" movement has increasingly gained recognition among correctional practitioners and traction within correctional settings. It is now well established that in order to obtain meaningful recidivism reductions, programs must maintain fidelity to the principles of effective interventions. After more than four decades of research supporting the Risk-Need-Responsivity model, little is presently known about how well correctional programs have adopted and implemented evidence-based correctional practices on a larger scale. The current study examines the results from an extensive collection of correctional program assessments completed across the United States over the course of 14 years. Results offer practitioners and researchers insight into the current state of fidelity to evidence-based practices and highlight areas for improvement in correctional programming. [ABSTRACT FROM AUTHOR]

In the field of quantum communication, quantum steganography is an important branch of quantum information hiding. In a realistic quantum communication system, quantum noises are unavoidable and will seriously impact the safety and reliability of the quantum steganographic system. Therefore, it is very important to analyze the influence of noise on the quantum steganography protocol and how to reduce the effect of noise. This paper takes the quantum steganography protocol proposed in 2010 as an example to analyze the effects of noises on information qubits and secret message qubits in the four primary quantum noise environments. The results show that when the noise factor of one quantum channel noise is known, the size of the noise factor of the other quantum channel can be adjusted accordingly, such as artificially applying noise, so that the influence of noises on the protocol is minimized. In addition, this paper also proposes a method of improving the efficiency of the steganographic protocol in a noisy environment. [ABSTRACT FROM AUTHOR]

Research Summary: The Florida Department of Juvenile Justice has implemented a process to evaluate the treatment quality of interventions provided statewide in all long‐term residential programs. In the current study, we examine the predictive validity of this treatment quality component in the prediction of recidivism of youth ( N = 2,397) who completed juvenile justice residential programs from July 1, 2013 to June 30, 2014. We use hierarchical linear modeling to assess the effects of treatment quality (as youth are nested within programs), controlling for demographic and criminal history factors. The results indicate that higher average treatment quality scores of interventions received within a residential program decreased the likelihood of subsequent arrest, conviction, and reincarceration, whereas the highest treatment quality score of any specific intervention provided within the program decreased the odds of reincarceration only. Policy Implications: In this study, we confirm the importance of fidelity and implementation quality in the provision of crime prevention treatment interventions to serious, deep‐end juvenile offenders. Additionally, our results shed light on the ability of a juvenile justice agency to measure treatment quality in a substantively meaningful way with the use of limited additional resources. The services provided to keep communities safe, prevent future offending, and rehabilitate juvenile offenders must be held accountable for producing such outcomes, and one method of measuring such compliance is to evaluate the quality of the interventions with respect to staff training, fidelity adherence, evaluation, and corrective action processes. [ABSTRACT FROM AUTHOR]

Objective: We examine how frontline workers and supervisors delivering a research-supported intervention (RSI) to reduce child neglect negotiated system-related challenges, the pragmatics of RSI implementation, and their professional identities and relationships with clients. Methods: We conducted semi-structured interviews, small group discussions, and focus groups with frontline workers and supervisors in one large county over two time periods. We used iterative coding to analyze qualitative data. Results: Frontline workers navigated several aspects of RSI implementation and sustainment: (1) contract requirements and information dissemination, (2) fidelity, (3) competing demands and crises, (4) structure versus creativity, and (5) relationships with clients. Conclusions: Workers dynamically negotiated multiple system- and provider-level (or outer- and inner-contextual) demands influencing RSI provision for clients with complex service needs. Results affirm the need to attend to the unintended consequences of implementing new contract, reimbursement, and other system or organizational processes and to address the “committed work” supporting RSI delivery. [ABSTRACT FROM AUTHOR]

Background: We evaluated a facilitation strategy to help clinical sites likely to experience challenges implement evidence-based Primary Care-Mental Health Integration (PC-MHI) care models within the context of a Department of Veterans Affairs (VA) initiative. This article describes our assessment of whether implementation facilitation (IF) can foster development of high quality PC-MHI programs that adhere to evidence, are sustainable and likely to improve clinical practices and outcomes.Methods: Utilizing a matched pair design, we conducted a qualitative descriptive evaluation of the IF strategy in sixteen VA primary care clinics. To assess program quality and adherence to evidence, we conducted one-hour structured telephone interviews, at two time points, with clinicians and leaders who knew the most about the clinics' programs. We then created structured summaries of the interviews that VA national PC-MHI experts utilized to rate the programs on four dimensions (overall quality, adherence to evidence, sustainability and level of improvement).Results: At first assessment, seven of eight IF sites and four of eight comparison sites had implemented a PC-MHI program. Our qualitative assessment suggested that experts rated IF sites' programs higher than comparison sites' programs with one exception. At final assessment, all eight IF but only five comparison sites had implemented a PC-MHI program. Again, experts rated IF sites' programs higher than their matched comparison sites with one exception. Over time, all ratings improved in five of seven IF sites and two of three comparison sites.Conclusions: Implementing complex evidence-based programs, particularly in settings that lack infrastructure, resources and support for such efforts, is challenging. Findings suggest that a blend of external expert and internal regional facilitation strategies that implementation scientists have developed and tested can improve PC-MHI program uptake, quality and adherence to evidence in primary care clinics with these challenges. However, not all sites showed these improvements. To be successful, facilitators likely need at least a moderate level of leaders' support, including provision of basic resources. Additionally, we found that IF and strength of leadership structure may have a synergistic effect on ability to implement higher quality and evidence-based programs. [ABSTRACT FROM AUTHOR]

Background: Incorporating evidence-based integrated treatment for dual disorders into typical care settings has been challenging, especially among those serving Veterans who are homeless. This paper presents an evaluation of an effort to incorporate an evidence-based, dual disorder treatment called Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking-Veterans Edition (MISSION-Vet) into case management teams serving Veterans who are homeless, using an implementation strategy called Getting To Outcomes (GTO).Methods: This Hybrid Type III, cluster-randomized controlled trial assessed the impact of GTO over and above MISSION-Vet Implementation as Usual (IU). Both conditions received standard MISSION-Vet training and manuals. The GTO group received an implementation manual, training, technical assistance, and data feedback. The study occurred in teams at three large VA Medical Centers over 2 years. Within each team, existing sub-teams (case managers and Veterans they serve) were the clusters randomly assigned. The trial assessed MISSION-Vet services delivered and collected via administrative data and implementation barriers and facilitators, via semi-structured interview.Results: No case managers in the IU group initiated MISSION-Vet while 68% in the GTO group did. Seven percent of Veterans with case managers in the GTO group received at least one MISSION-Vet session. Most case managers appreciated the MISSION-Vet materials and felt the GTO planning meetings supported using MISSION-Vet. Case manager interviews also showed that MISSION-Vet could be confusing; there was little involvement from leadership after their initial agreement to participate; the data feedback system had a number of difficulties; and case managers did not have the resources to implement all aspects of MISSION-Vet.Conclusions: This project shows that GTO-like support can help launch new practices but that multiple implementation facilitators are needed for successful execution of a complex evidence-based program like MISSION-Vet.Trial Registration: ClinicalTrials.gov NCT01430741. [ABSTRACT FROM AUTHOR]

Background: Large-scale implementation of evidence-based psychotherapies (EBPs) such as cognitive processing therapy (CPT) for posttraumatic stress disorder can have a tremendous impact on mental and physical health, healthcare utilization, and quality of life. While many mental health systems (MHS) have invested heavily in programs to implement EBPs, few eligible patients receive EBPs in routine care settings, and clinicians do not appear to deliver the full treatment protocol to many of their patients. Emerging evidence suggests that when CPT and other EBPs are delivered at low levels of fidelity, clinical outcomes are negatively impacted. Thus, identifying strategies to improve and sustain the delivery of CPT and other EBPs is critical. Existing literature has suggested two competing strategies to promote sustainability. One emphasizes fidelity to the treatment protocol through ongoing consultation and fidelity monitoring. The other focuses on improving the fit and effectiveness of these treatments through appropriate adaptations to the treatment or the clinical setting through a process of data-driven, continuous quality improvement. Neither has been evaluated in terms of impact on sustained implementation.Methods: To compare these approaches on the key sustainability outcomes and provide initial guidance on sustainability strategies, we propose a cluster randomized trial with mental health clinics (n = 32) in three diverse MHSs that have implemented CPT. Cohorts of clinicians and clinical managers will participate in 1 year of a fidelity oriented learning collaborative or 1 year of a continuous quality improvement-oriented learning collaborative. Patient-level PTSD symptom change, CPT fidelity and adaptation, penetration, and clinics' capacity to deliver EBP will be examined. Survey and interview data will also be collected to investigate multilevel influences on the success of the two learning collaborative strategies. This research will be conducted by a team of investigators with expertise in CPT implementation, mixed method research strategies, quality improvement, and implementation science, with input from stakeholders in each participating MHS.Discussion: It will have broad implications for supporting ongoing delivery of EBPs in mental health and healthcare systems and settings. The resulting products have the potential to significantly improve efforts to ensure ongoing high quality implementation and consumer access to EBPs.Trial Registration: NCT02449421 . Registered 02/09/2015. [ABSTRACT FROM AUTHOR]

Background: The Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program is one of the largest initiatives to end Veteran homelessness. However, mental health and substance use disorders continue to reduce client stability and impede program success. HUD-VASH programs do not consistently employ evidence-based practices that address co-occurring mental health and substance use disorders. This paper presents a study protocol to evaluate the implementation of an evidence-based, co-occurring disorder treatment called Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking--Veterans Edition (MISSION-Vet) in HUD-VASH using an implementation strategy called Getting To Outcomes (GTO). Methods/design: In three large VA Medical Centers, this Hybrid Type III trial will randomize case managers and their clients by HUD-VASH sub-teams to receive either MISSION-Vet Implementation as Usual (IU--standard training and access to the MISSION-Vet treatment manuals) or MISSION-Vet implementation augmented by GTO. In addition to testing GTO, effectiveness of the treatment (MISSION-Vet) will be assessed using existing Veteran-level data from the HUD-VASH data monitoring system. This project will compare GTO and IU case managers and their clients on the following variables: (1) fidelity to the MISSION-Vet intervention; (2) proportion of time the Veteran is housed; (3) mental health, substance use, and functional outcomes among Veterans; and (4) factors key to the successful deployment of a new treatment as specified by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model. Discussion: This project is an important step for developing an implementation strategy to increase adoption of evidence-based practice use in VA homeless programs, and to further examine efficacy of MISSION-Vet in HUD-VASH. This project has important implications for program managers, policy makers, and researchers within the homelessness field. VA Central IRB approval for this study was granted in October 2011. The three sites were trained on MISSION-Vet and GTO in the first half of 2013. The first GTO planning meetings began after training occurred, between January 2013 and November 2013, across the three sites. The data collection--via a fidelity measure embedded into the VA Computerized Patient Record System--began as each site initiated MISSION-Vet, between April 2013 and January 2014. [ABSTRACT FROM AUTHOR]

Purpose - The current study aims to examine the influence of contextual and provider-level factors on the implementation fidelity of a research-based substance abuse prevention program. Also, it aims to investigate whether two provider-level factors, self-efficacy and beliefs about the value of the program, statistically moderate and mediate the effects of a provider training intervention on implementation fidelity. Design/methodology/approach - Using generalized mixed-linear modeling, the authors examine relationships between program provider-, organizational, and community-level factors and implementation fidelity in a sample of 50 high school teachers from 43 high schools in eight states across the USA. Fidelity of implementation was assessed utilizing an observation procedure. Findings - Implementation fidelity was negatively associated with the urbanicity of the community and the level of teachers' beliefs about the value of the program, and positively predicted by the organizational capacity of the school. Comprehensive training significantly increased teachers' self-efficacy, which resulted in an increase in implementation fidelity. Research limitations/implications - School-based prevention program implementation is influenced by a variety of contextual factors occurring at multiple ecological levels. Future effectiveness and dissemination studies need to account for the complex nature of schools in analyses of implementation fidelity and outcomes. Practical implications - The authors' findings suggest that both provider- and organizational-level are influential in promoting implementation fidelity. Before implementation begins, as well as throughout the implementation process, training and ongoing technical assistance should be conducted to increase teachers' skills, self-efficacy, and comfort with prevention curricula. Originality/value - The present study is one of the few to examine contextual and provider-level correlates of implementation fidelity and use mediation analyses to explore whether provider-level factors mediate the effects of a provider training intervention on implementation fidelity. [ABSTRACT FROM AUTHOR]

Background: The Housing First Model (HFM) is an approach to serving formerly homeless individuals with dually diagnosed mental health and substance use disorders regardless of their choice to use substances or engage in other risky behaviors. The model has been widely diffused across the United States since 2000 as a result of positive findings related to consumer outcomes. However, a lack of clear fidelity guidelines has resulted in inconsistent implementation. The research team and their community partner collaborated to develop a HFM Fidelity Index. We describe the instrument development process and present results from its initial testing. Methods: The HFM Fidelity Index was developed in two stages: (1) a qualitative case study of four HFM organizations and (2) interviews with 14 HFM "users". Reliability and validity of the index were then tested through phone interviews with staff members of permanent housing programs. The final sample consisted of 51 programs (39 Housing First and 12 abstinence-based) across 35 states. Results: The results provided evidence for the overall reliability and validity of the index. Conclusions: The results demonstrate the index's ability to discriminate between housing programs that employ different service approaches. Regarding practice, the index offers a guide for organizations seeking to implement the HFM. [ABSTRACT FROM AUTHOR]

Background: The US Department of Veterans Affairs (VA) has over 15 years of experience in delivery of evidence-based psychotherapies (EBPs). This paper describes strategies for using clinical documentation and administrative data to understand adherence and modifications to EBPs for Posttraumatic Stress Disorder (PTSD)., Methods: This study focused on two EBPs for PTSD, Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE). The sample included VA therapists from across the US who provided CPT and PE and the patients they treated over a 1-year period. The data sources for this study were templated EBP chart notes and VA administrative data. We used a manual review of note content and administrative data rules to code therapy adherence and modifications in 7,297 EBP sessions for 1,257 patients seen by 182 therapists. Two trained coders rated each therapy note and resolved discrepancies through consensus. To contextualize and explain variation in adherence and modifications, we conducted brief 30-45-min semi-structured interviews with a purposive subsample of these therapists ( n = 32)., Findings: Combining manual chart review and administrative data allowed for identification of 11 types of modifications. Raters disagreed on adherence for 30% of notes. The disagreement stemmed from the presence of therapy modifications that were not clearly documented, necessitating the development of decision rules and strategies for modification coding. Both therapists and patients contributed to the variance in the extent to which different modifications occurred. Therapist interviews demonstrated therapist awareness of modifying the protocols in the ways identified through chart review., Conclusion: Healthcare systems can use data collected as part of routine care to understand how and when EBPs are modified but need to develop scalable strategies to document adaptations and modifications to EBPs in routine care., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Wiltsey Stirman, La Bash, Nelson, Orazem, Klein and Sayer.)

Background: Each year, millions of Americans receive evidence-based psychotherapies (EBPs) like cognitive behavioral therapy (CBT) for the treatment of mental and behavioral health problems. Yet, at present, there is no scalable method for evaluating the quality of psychotherapy services, leaving EBP quality and effectiveness largely unmeasured and unknown. Project AFFECT will develop and evaluate an AI-based software system to automatically estimate CBT fidelity from a recording of a CBT session. Project AFFECT is an NIMH-funded research partnership between the Penn Collaborative for CBT and Implementation Science and Lyssn.io, Inc. ("Lyssn") a start-up developing AI-based technologies that are objective, scalable, and cost efficient, to support training, supervision, and quality assurance of EBPs. Lyssn provides HIPAA-compliant, cloud-based software for secure recording, sharing, and reviewing of therapy sessions, which includes AI-generated metrics for CBT. The proposed tool will build from and be integrated into this core platform., Methods: Phase I will work from an existing software prototype to develop a LyssnCBT user interface geared to the needs of community mental health (CMH) agencies. Core activities include a user-centered design focus group and interviews with community mental health therapists, supervisors, and administrators to inform the design and development of LyssnCBT. LyssnCBT will be evaluated for usability and implementation readiness in a final stage of Phase I. Phase II will conduct a stepped-wedge, hybrid implementation-effectiveness randomized trial (N = 1,875 clients) to evaluate the effectiveness of LyssnCBT to improve therapist CBT skills and client outcomes and reduce client drop-out. Analyses will also examine the hypothesized mechanism of action underlying LyssnCBT., Discussion: Successful execution will provide automated, scalable CBT fidelity feedback for the first time ever, supporting high-quality training, supervision, and quality assurance, and providing a core technology foundation that could support the quality delivery of a range of EBPs in the future., Trial Registration: ClinicalTrials.gov; NCT05340738 ; approved 4/21/2022., (© 2022. The Author(s).)

Quality of recently used foraging areas is likely an important predictor of fidelity to specific locations in the future. We monitored movement and habitat use of 58 adult female American woodcock Scolopax minor at three study areas in Minnesota, Wisconsin and Michigan, USA, during autumn 2002 and 2003, to assess the relationship between foraging habitat use decisions and environmental conditions at previously used foraging locations. We assessed whether habitat variables which related to food and weather were related to distance between locations on subsequent days of individual woodcock that choose diurnal foraging locations when they return from night-time roosting locations. We predicted that woodcock would return to foraging locations used on the previous day (i.e. shorter distances between daily foraging locations) when environmental conditions on the prior day were favourable. Woodcock generally made short (i.e. 48% <50 m and 91% <400 m) between-day movements, but also occasionally (∼7%) abandoned prior foraging areas. The primary determinants of woodcock movements during autumn (prior to migration) were low local food availability and potential for increased food availability elsewhere. The quality of foraging locations was an important predictor of future foraging habitat use for woodcock, consistent with the hypothesis that woodcock movement behaviour balances the risks associated with movement with the potential benefits of increased energy intake in new foraging areas. [ABSTRACT FROM AUTHOR]

Abstract: This commentary on the special section, “Implementation research in early childhood education,” discusses 10 major conclusions drawn from implementation research and 7 additional issues needing clarification. Some major conclusions are that: (1) the level of implementation achieved can have a strong influence on program outcomes, (2) implementation is a multi-dimensional construct, (3) adaptation occurs frequently and may improve outcomes, and (4) many factors present across multiple ecological levels can affect the implementation process. Some of the major issues needing attention in future research involve determining what are the best ways to (1) measure the multiple aspects of implementation, (2) evaluate the relative importance of factors affecting implementation, and (3) clarify which participant characteristics may influence the relationship between implementation and different outcomes. [Copyright &y& Elsevier]

Abstract: Preschools provide a promising setting in which to conduct preventive interventions for childhood problems, but classroom programs can only be effective if teachers are willing and able to implement them. This study is one of the first to investigate predictors of the frequency of teacher participation in a classroom-based, randomized controlled trial of an integrated prevention program for preschoolers. The intervention was designed to promote school readiness with an integrated social and academic program, to be implemented by teachers with the support of classroom consultants. The current study is part of a larger project conducted with Head Start and community child care centers that serve primarily economically disadvantaged families; 49 teachers from 30 centers participated in this study. Overall, teachers conducted approximately 70% of the program activities. Participation decreased significantly over time from the first to the final week of the intervention, and also decreased within each week of the intervention, from the first to the final weekly activity. Teachers working at community child care centers implemented more intervention activities than did Head Start teachers. Teacher concerns about the intervention, assessed prior to training, predicted less participation. In addition, teachers’ participation was positively related to their perception that their centers and directors were supportive, collegial, efficient, and fair, as well as their job satisfaction and commitment. Teacher experience, education, ethnicity, and self-efficacy were not significantly related to participation. In multi-level models that considered center as a level of analysis, substantial variance was accounted for by centers, pointing to the importance of considering center-level predictors in future research. [Copyright &y& Elsevier]

The diffusion of school-based preventive interventions involves the balancing of high-fidelity implementation of empirically-supported programs with flexibility to permit local stakeholders to target the specific needs of their youth. There has been little systematic research that directly seeks to integrate research- and community-driven approaches to diffusion. The present study provides a primarily qualitative investigation of the initial roll-out of two empirically-supported substance and violence prevention programs in two urban school districts that serve a high proportion of low-income, ethnic minority youth. The predominant ethnic group in most of our study schools was Asian American, followed by smaller numbers of Latinos, African Americans, and European Americans. We examined the adaptations made by experienced health teachers as they implemented the programs, the elicitation of suggested adaptations to the curricula from student and teacher stakeholders, and the evaluation of the consistency of these suggested adaptations with the core components of the programs. Data sources include extensive classroom observations of curricula delivery and interviews with students, teachers, and program developers. All health teachers made adaptations, primarily with respect to instructional format, integration of real-life experiences into the curriculum, and supplementation with additional resources; pedagogical and class management issues were cited as the rationale for these changes. Students and teachers were equally likely to propose adaptations that met with the program developers’ approval with respect to program theory and implementation logistics. Tensions between teaching practice and prevention science—as well as implications for future research and practice in school-based prevention—are considered. [ABSTRACT FROM AUTHOR]

One of the important research issues in the emerging area of research on dissemination of prevention programs relates to the type and extent of training needed by program providers to prepare them to implement effective programs with fidelity. The present paper describes the immediate outcomes of a dissemination and implementation trial of Project Toward No Drug Abuse, an evidence-based prevention program for high school students. A total of 65 high schools in 14 school districts across the USA were recruited and randomly assigned to one of three experimental conditions: comprehensive implementation support for teachers, regular workshop training only, or standard care control. The comprehensive intervention was comprised of on-site coaching, web-based support, and technical assistance, in addition to the regular workshop. Students ( n = 2,983) completed self-report surveys before and immediately after program implementation. Fidelity of implementation was assessed with a classroom observation procedure that focused on program process. Results indicated that relative to the controls, both intervention conditions produced effects on hypothesized program mediators, including greater gains in program-related knowledge; greater reductions in cigarette, marijuana and hard drug use intentions; and more positive changes in drug-related beliefs. There were stronger effects on implementation fidelity in the comprehensive, relative to the regular, training condition. However, seven of the ten immediate student outcome measures showed no significant differences between the two training conditions. The implications of these findings for dissemination research and practice are discussed. [ABSTRACT FROM AUTHOR]

Experiments test ‘new’ ideas about interventions that might produce better outcomes. Re-entry requires that the intervention should be offered at the transition point (from prison to community) and in the community. In general, the experiment requires the researchers to differentiate the ‘new’ approach from usual practice. The answer lies in the design and measures of the experiment. It is important to make sure that the intervention will be designed and implemented in such a manner that makes it operationally different from traditional services. Each experiment must include measures to determine the content and dosage of the new intervention as well as the traditional practice. This special edition is devoted to examining how these issues are handled in four different experiments, as well as comments from members of a Data Safety Monitoring Board (DSMB) on the efforts to monitor studies. Together, the articles point to the need to measure the fidelity and adherence of new innovations. [ABSTRACT FROM AUTHOR]

Demonstrating the efficacy and effectiveness of prevention programmes in rigorous randomised trials is only the beginning of a process that may lead to better public health outcomes. Although a growing number of programmes have been shown to be effective at reducing drug use and delinquency among young people under carefully controlled conditions, we are now faced with a new set of obstacles. First, these evidence-based programmes are still under-utilised compared to prevention strategies with no empirical support. Second, when effective programmes are used the evidence suggests they are not being implemented with quality and fidelity. Third, effective programmes are often initiated with short-term grant funding, creating a challenge for sustainability beyond seed funding. We discuss each of these challenges, and present lessons learned from a large-scale dissemination effort involving over 140 evidence-based programme replications in one state in the US. [ABSTRACT FROM AUTHOR]

The Rogue River, Oregon represents one of three important spawning systems for green sturgeon, Acipenser medirostris, in North America. In this paper we describe the spawning migration, spawning periodicity, and size at maturity for green sturgeon caught in the Rogue River during 2000–2004. Green sturgeon were caught by gill net or angling; 103 individuals were tagged with radio or sonic transmitters (externally or internally). Green sturgeon caught by gill net and angling ranged from 145 cm to 225 cm total length. Histological and visual examinations of gonad tissues indicated that most green sturgeon were spawning or post-spawning adults that entered the Rogue River to spawn. Ripe individuals were caught when water temperature was 10–18°C. Specimens carrying transmitters migrated 17–105 km up river; reaches consisting of likely spawning sites were identified based on sturgeon migratory behavior. Most green sturgeon remained in the Rogue River until late fall or early winter when flows increased, after which they returned to the ocean. Eight green sturgeon (males and females) returned to the Rogue River 2–4 years after leaving, entering the river during March, April, and May when water temperatures ranged from 9°C to 16°C. None of the 103-tagged individuals entered the Rogue River during successive years. There appear to be few known natural threats to adult green sturgeon in the Rogue River. However, our data suggest that a high percentage of adults that spawn in the Rogue River (particularly males) were susceptible to harvest by commercial, Tribal, and sport fisheries after leaving the system because they were not adequately protected by maximum size limits during the period of this study. The implications of maximum size limits (or lack of size limits) to green sturgeon are discussed, and recent actions taken by Oregon and Washington Fish and Wildlife Commissions to manage green sturgeon more conservatively are presented. [ABSTRACT FROM AUTHOR]

We examined the potential for localized management of white-tailed deer (Odocoileus virginianus) to be successful by measuring movements, testing site fidelity, and modeling the effects of dispersal. Fifty-nine females were radiomarked and tracked during 1997 through 2000 in Irondequoit, New York, USA, a suburb of Rochester. We constructed home ranges for those deer with ≥ 18 relocations/season. Fifty percent minimum convex polygons (MCP) averaged 3.9 (SE = 0.53) ha in the summer and 5.3 (SE = 0.80) ha in the winter. Deer showed strong fidelity to both summer and winter home ranges, and 30 of 31 females showed overlap of summer and winter home ranges. Annual survival was 64%; the major cause of mortality was deerautomobile collisions. Average annual dispersal rates were <15% for yearlings and adults. Using matrix population modeling, we explored the role of female dispersal in sustaining different management objectives in adjacent locales of approximately 1,000 ha. Modeling showed that if female dispersal was 8%, culling would have to reduce annual survival to 58% to maintain a population just under ecological carrying capacity and reduce survival to 42% to keep the population at one-half carrying-capacity. With the same dispersal, contraception would need to be effective in 32% of females if the population is near carrying capacity and 68% if the population is at one-half of carrying capacity. Movement behavior data and modeling results lend support to the use of a localized approach to management of females that emphasizes neighborhood-scale manipulation of deer populations, but our research suggests that dispersal rates in females could be critical to long-term success. [ABSTRACT FROM AUTHOR]

Measuring fidelity of delivery and engagement in the methods of a trial helps us to understand whether planned interventions were effective. Treatment fidelity is critical in proving that change in study outcomes is due to the intervention itself and not to variability in its implementation or measurement. Existing reviews of oropharyngeal dysphagia (OD) interventions for Parkinson's disease (PD) have not systematically scrutinized fidelity within clinical trials. This study aimed to examine treatment fidelity in behavioral interventions for OD in PD and provide information about the reliability of existing study findings on behavioral interventions. All published and unpublished randomized controlled trials (RCTs) regarding behavioral interventions for OD in PD were sought. A comprehensive search of eight electronic databases was performed from inception to January 2019 and updated in April 2020. Gray literature was explored to minimize publication bias. No language or date restrictions were applied. Data were extracted by two independent reviewers with a third mediator. The National Institutes of Health Behavior Change Consortium Treatment Fidelity checklist was used to assess fidelity. From the 4998 references identified, eight studies met the inclusion criteria. Behavioral interventions in the included studies varied. The level of treatment fidelity was rated as low across all studies included in the review. The review concluded that low levels of treatment fidelity adherence in RCTs on dysphagia interventions in PD undermine the interpretation of the validity and reliability of study findings along with successful replication of these interventions in research and clinical practice., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: To evaluate the sustainment of Housing First (HF) implementation in a permanent supportive housing program for homeless-experienced veterans, 5 years after practice implementation., Study Setting: From 2016 to 2017, primary data were collected from providers and veterans in the Department of Housing and Urban Development-VA Supportive Housing (HUD-VASH) program at Los Angeles., Study Design: Guided by the integrated sustainability framework, we performed a mixed-methods study to evaluate the sustainment of HF, an evidence-based practice implemented to improve housing outcomes. To assess sustainment, we measured fidelity to HF in six of seven HUD-VASH teams. These data were integrated with qualitative interviews with providers and veterans who described perceived sustainment to HF and contextual factors that supported or impeded sustainment., Data Collection: Fidelity to HF at 5 years after practice implementation, as a proxy for sustainment, was quantified via surveys with HUD-VASH teams. HUD-VASH providers (n = 51) and 31 veterans participated in semi-structured interviews. Team-based template analyses were used to develop an emergent understanding of stakeholder perspectives on HF sustainment., Principal Findings: Overall, HUD-VASH teams reported HF sustainment. The lowest fidelity scores were found in the domains of client-to-staff ratios, frequency of client-provider contact, and time to housing. Qualitative findings indicated that outer contextual factors (e.g., housing scarcity) and organizational factors (e.g., staff turnover) impacted HF sustainment. Providers identified changes in leadership and unmet resource needs as impediments to practice sustainment. All stakeholders identified positively with the HF practice and believed that the approach benefited veterans., Conclusions: This snapshot of HF sustainment demonstrates that this practice can be sustained over time. However, strong leadership, organizational resources, and community partnerships are needed. Adaptations to HF in response to outer contextual factors and organizational capacity may result in practice sustainment while allowing for flexibility in service provision., (© 2021 Health Research and Educational Trust.)

Mothers and Babies (MB), a perinatal depression preventive intervention, has proven effective in decreasing depressive symptoms and preventing onset of major depression. An ongoing cluster-randomized trial is comparing the effectiveness of the six-session MB group intervention led by paraprofessionals versus mental health professionals. Twenty percent of all audio-recorded intervention sessions were randomly selected for fidelity checks. Analyses assessed mean facilitator adherence and competency overall, by study arm, and by session; and, examined site, facilitator, and client-specific effects. There were no significant differences found between study arms. Findings show paraprofessionals can deliver MB with similar fidelity as mental health professionals.

Background: The Childhood Obesity Research Demonstration project aimed to deliver evidence-based obesity prevention interventions to at-risk families at three demonstration sites. The interventions were delivered in multiple settings, including early childhood education centers (ECECs), public schools, and primary care clinics. An evaluation center conducted cross-site process, impact, and sustainability evaluations. Results of the cross-site process evaluation for the ECECs will be described. Methods: Reach (proportion of the target population who participated), dose delivered (materials and interventions that were distributed), and fidelity (proportion of planned intervention components delivered) were assessed at two levels (researcher-to-provider and provider-to-family levels). Standardized data forms were completed by research team members at each demonstration site with assistance from the evaluation center. Results: The Childhood Obesity Research Demonstration project reached 5174 children and 390 teachers in 58 ECECs. The centers delivered an average of 3.9 hours of training to teachers. A total of 1382 different types of materials were distributed to providers, and from 1.3 to 4.3 hours of technical support were delivered to centers monthly. For fidelity at the researcher-to-provider level, 49.5% ( n  = 370) of eligible teachers completed all training sessions. Considerable variations across demonstration sites in reach, dose delivered, and fidelity across were observed. Conclusion: The Childhood Obesity Research Demonstration project reached large numbers of children, families, teachers, and ECECs. Maintaining intervention fidelity while reaching large numbers of at-risk individuals proved to be a challenge.

In this paper we compare the fidelity of a Peer-Led Asthma Self-Management Program for Adolescents (PLASMA) and its attention control. A randomized controlled trial involving two groups-the PLASMA group and the attention control group-was conducted between 2015 and 2018. Adolescents 12-17 years old (N = 259) in three cities in the United States received asthma self-management education implemented at a day camp, followed by bi-monthly, follow-up contact for 12 months. Thirty-five peer leaders and six adult educators implemented education sessions for the PLASMA and the attention control groups, respectively. The intervention was the peer-led delivery of the content instead of the educational content itself. This study compares the extent to which the education sessions and follow-up contacts were implemented in accordance with the study protocol by the peer and adult educators. Most topics on asthma knowledge and skills (85-95%) were delivered as intended at an adequate pace in both groups. Peer leaders missed more content in the psychosocial domain than adult educators-14% versus 0%, respectively (t = -3.7; p = .010). PLASMA participants reported high content and time fidelity for all education sessions (94% to 97.6%). Greater success in bimonthly follow-up contacts was reported in the attention control groups, with 4.6 ( ± 1.5) contacts on average compared to 2.6 (±2.02) in the PLASMA groups (t = 9.02; p < .001). Most components of the asthma self-management program were implemented with high fidelity in both groups. The relatively low fidelity in delivering psychosocial content and performing follow-up contacts in the PLASMA groups underscores the need for intensive training to enhance peer leaders' competency with managing these aspects of PLASMA to maximize fidelity. Peer leaders can implement asthma self-management educational components of the intervention with high fidelity similar to adult educators., (© 2019 Wiley Periodicals, Inc.)

Background: Effective implementation strategies might facilitate patient-centered medical home (PCMH) uptake and spread by targeting barriers to change. Evidence-based quality improvement (EBQI) is a multi-faceted implementation strategy that is based on a clinical-researcher partnership. It promotes organizational change by fostering innovation and the spread of those innovations that are successful. Previous studies demonstrated that EBQI accelerated PCMH adoption within Veterans Health Administration primary care practices, compared with standard PCMH implementation. Research to date has not documented fidelity to the EBQI implementation strategy, limiting usefulness of prior research findings. This paper develops and assesses clinical participants' fidelity to three core EBQI elements for PCMH (EBQI-PCMH), explores the relationship between fidelity and successful QI project completion and spread (the outcome of EBQI-PCMH), and assesses the role of the clinical-researcher partnership in achieving EBQI-PCMH fidelity., Methods: Nine primary care practice sites and seven across-sites, topic-focused workgroups participated (2010-2014). Core EBQI elements included leadership-frontlines priority-setting for QI, ongoing access to technical expertise, coaching, and mentoring in QI methods (through a QI collaborative), and data/evidence use to inform QI. We used explicit criteria to measure and assess EBQI-PCMH fidelity across clinical participants. We mapped fidelity to evaluation data on implementation and spread of successful QI projects/products. To assess the clinical-researcher partnership role in EBQI-PCMH, we analyzed 73 key stakeholder interviews using thematic analysis., Results: Seven of 9 sites and 3 of 7 workgroups achieved high or medium fidelity to leadership-frontlines priority-setting. Fidelity was mixed for ongoing technical expertise and data/evidence use. Longer duration in EBQI-PCMH and higher fidelity to priority-setting and ongoing technical expertise appear correlated with successful QI project completion and spread. According to key stakeholders, partnership with researchers, as well as bi-directional communication between leaders and QI teams and project management/data support were critical to achieving EBQI-PCMH fidelity., Conclusions: This study advances implementation theory and research by developing measures for and assessing fidelity to core EBQI elements in relationship to completion and spread of QI innovation projects or tools for addressing PCMH challenges. These results help close the gap between EBQI elements, their intended outcome, and the finding that EBQI-PCMH resulted in accelerated adoption of PCMH.

Despite widespread use of learning collaboratives in health care, few randomized trials have evaluated their effectiveness. The primary aim of this cluster randomized implementation trial is to evaluate the effectiveness of a virtual learning collaborative (VLC) in the implementation of a lifestyle intervention for persons with serious mental illness (SMI) in routine mental health settings, compared to standard individual technical assistance. Forty-eight mental health provider organizations from across the United States will be recruited to participate in the trial. The evidence-based practice to be implemented is the InSHAPE health promotion intervention for persons with SMI. Sites will be stratified by size and randomized to receive an 18-month intensive group-based VLC with monthly learning sessions or individual technical assistance with four scheduled conference calls over 18 months. Sites will be enrolled in three blocks of 16 sites each. The primary outcomes are InSHAPE program participation and fidelity, and participant weight loss; secondary outcomes are program operation, program uptake, participant health behaviors of physical activity and nutrition, organizational change, and program sustainment. Implementation outcomes are measured at 3, 6, 12, 18, and 24 months after the program start-up. Participant-level outcomes are measured at fixed intervals every 3 months after each participant enrolls in the study. This study will determine whether VLCs are an effective implementation strategy among resource-limited providers when the new practice necessitates a shift in mission, scope of practice, type of services delivered, and new financing. ClinicalTrials.gov identifier: NCT03891368 Registered 25 March 2019, retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT03891368?term=NCT03891368&rank=1 [ABSTRACT FROM AUTHOR]