Journal of Abnormal Child Psychology, Vol. 33, No. 6, December 2005, pp.

665–679 (

C 2005)

DOI: 10.1007/s10802-005-7646-2

Sustainability of Teacher Implementation

of School-Based Mental Health Programs

Susan S. Han1,3 and Bahr Weiss2

Received October 6, 2003; revision received April 16, 2004; accepted June 21, 2005

Evidence-based prevention and intervention programs are increasingly being implemented in schools
and it therefore is becoming increasingly important to understand the complexities of program
implementation under real-world conditions. Much research has focused on the contextual factors that
influence program implementation but less work has attempted to provide an integrated understanding
of mechanisms (e.g., teacher-training processes) that affect teachers’ program implementation. In this
paper, we review literature on factors related to teachers’ implementation of school-based prevention
and intervention programs, then from this review abstract what we believe are four basic ingredients
that characterize potentially sustainable teacher-implemented classroom programs. Finally, we present
a sequential model, based on these ingredients, of the naturalistic processes underlying sustainability
of teachers’ program implementation and describe how this sustainability can be enhanced through
provision of teacher training and performance feedback from a classroom consultant.

KEY WORDS: program sustainability; program implementation; school-based mental health; teacher training.

There is substantial evidence indicating that, when
properly developed and implemented, school-based men-
tal health programs can produce positive effects on chil-
dren’s behavioral and emotional functioning (Durlak &
Wells, 1997; Greenberg, Domitrovich, & Bumbarger,
2001; Wilson, Lipsey, & Derzon, 2003). As psychoso-
cial factors play a significant role in influencing aca-
demic learning (Wang, Haertel, & Walberg, 1997), many
programs targeting socioemotional functioning also note
benefits for children’s academic functioning as well
(Durlak & Wells, 1997; Ialongo et al., 1999; Tremblay,
Pagani-Kurtz, Masse, Vitaro, & Pihl, 1995). Thus, there
is growing recognition that enhancing children’s social
and emotional competencies also facilitates their ability
to learn and achieve academically (Adelman & Taylor,
2000; Greenberg et al., 2003; Zins, Weissberg, Wang, &
Walberg, 2004). At the same time, increased confidence
1 Institute for Public Policy Studies, Vanderbilt University.
2 Department of Psychology and Human Development, Vanderbilt Uni-
versity.
3 Address all correspondence to Susan Han, Vanderbilt Institute for
Public Policy Studies, 1207 18th Avenue South, Nashville, Tennessee
37212; e-mail: susan.han@vanderbilt.edu.
in the basic efficacy of school-based mental health pro-
grams has led to more wide-spread program implementa-
tion (Clayton, Ballif-Spanvill, & Hunsaker, 2001; Elliot,
1998). One consequence of this movement toward the
dissemination or scaling up of evidence-based programs
is that more attention is being directed to understanding
the complexities of program implementation under “real-
world” conditions (Domitrovich & Greenberg, 2000;
Elias, Zins, Graczyk, & Weissberg, 2003; Pentz, 2004).
The literature on scaling up of innovative practices
in schools (e.g., Adelman & Taylor, 2000, 2003; Connell
& Klem, 2000; Elmore, 1996; McLaughlin & Mitra,
2001) has tended to focus on “big picture” contextual
factors, such as the development of the organizational
infrastructure necessary to support and sustain change
over time (e.g., capacity building, redeployment of re-
sources, integration of services). However, research on
teacher/classroom factors that increase teachers’ imple-
mentation fidelity and the sustainability of quality pro-
gram implementation by teachers has been relatively
limited, particularly with regard to the integration of
underlying processes into an inclusive model. Although
they have received less attention, the processes that oc-
cur within the classroom that lead teachers to implement,

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666
and continue to implement, an innovative program with
fidelity are no less critical (Kealey, Peterson, Gaul, &
Dinh, 2000; Rohrbach, Graham, & Hansen, 1993). The
purpose of the present paper is to discuss teacher-level fac-
tors that influence program implementation and sustain-
ability, with respect to classroom-based prevention and
intervention mental health programs that are implemented
by teachers.
We focus on teacher-implemented mental health pro-
grams because it is teachers who often serve as pro-
gram providers for school-based programs and because,
given the limited resources available for mental health
services relative to the number of children in need of
such services (Tuma, 1989; U.S. Department of Health
and Human Services, 1999), implementation of effective
programs by existing school personnel such as teachers
or school counselors represents one approach to mak-
ing programs fiscally sustainable (Atkins et al., 1998).
In addition, teacher-implemented programs can be inte-
grated into the general classroom curricula and focused
on the whole classroom. Thus, as central change agents
with a consistent presence in the classroom environment,
teachers can promote children’s positive development and
generalization of positive skills through their ability to
provide children with frequent opportunities to practice
new skills (e.g., Grossman et al., 1997; Hawkins, Von
Cleve, & Catalano, 1991; Weissberg, Barton, & Shriver,
1997).
Most programs that have been evaluated and re-
ported in the literature are research projects, financially
supported by federal research grants or other sources of
funding external to the school system that are not avail-
able on an ongoing basis (Wilson et al., 2003). When
the research project is completed and external resources
supporting program implementation are withdrawn, it be-
comes unclear whether an effective classroom-based pro-
gram will continue to be implemented by teachers who
have been trained and previously monitored by the re-
search project with regard to their program implementa-
tion. Several studies do suggest that providing adequate
training with implementation feedback can increase the
likelihood that teachers will continue to implement a pro-
gram, but degradation in implementation is a recurring
problem (McCormick, Steckler, & McLeroy, 1995; Noell,
Witt, Gilbertson, Ranier, & Freeland, 1997; Rohrbach et
al., 1993). It therefore is essential that researchers ex-
amine mechanisms that can be integrated into the train-
ing process in order to increase the fidelity with which
evidence-based mental health programs are, and continue
to be, implemented by teachers (Adelman & Taylor, 2003;
Altman, 1995; Elliott & Mihalic, 2004). The examination
of factors in the training process that increase teachers’
Han and Weiss
knowledge of program principles and that sustain a high
level of implementation fidelity is important also for the
scaling up of programs (Coburn, 2003; McLaughlin &
Mitra, 2001), as maintaining quality implementation be-
yond the training phase is crucial for achieving the pos-
itive student outcomes promised by innovative programs
as they are adopted and institutionalized by schools.
In this paper, teacher program sustainability is used
to refer to teachers’ continued implementation of an in-
tervention or prevention program, with ongoing imple-
mentation fidelity to the core program principles, after
supplemental resources used to support initial training
and implementation are withdrawn. It is important to note
that program sustainability does not simply imply that
teachers continue to implement a program, but rather that
they continue to implement the program with fidelity and
adherence to program principles. Poor implementation or
failure to achieve treatment fidelity has often been cited
as a major factor underlying the failure of a treatment
program to produce desired effects (e.g., Botvin, Baker,
Dusenbury, Tortu, & Botvin, 1990; Henggeler, Melton,
Brondino, Sherer, & Hanley, 1997; Ialongo et al., 1999;
Rohrbach et al., 1993). If program fidelity cannot be
achieved and maintained by teachers, the program’s ef-
fects likely will be diminished even if teachers continue
to implement it.
CONTEXTUAL FACTORS OVERLYING
TEACHER PROGRAM IMPLEMENTATION
Before presenting our conceptual model of the pro-
cesses underlying teachers’ fidelity in the implementation
of classroom-based mental health programs, it is impor-
tant first to review the broader contextual factors that may
support, or inhibit, efforts by teachers at program imple-
mentation. Teachers’ program implementation does not
occur within a vacuum, but rather reflects and is strongly
influenced by school reforms and initiatives that occur
within a shifting landscape of sociopolitical priorities and
policies at the county, state, and federal levels (e.g., Safe
and Drug Free Schools Act, No Child Left Behind Act).
This political and legislative landscape to some extent
shapes the district- and school-level policies, priorities,
and resources that in turn influence what teachers teach
in the classroom (Coburn, 2003; Elmore, 1996). More
proximally, district policies and priorities define the con-
ditions under which schools are governed, through the
assignment of principals, allocation of resources, and the
types of in-service training provided to teachers. In ad-
dition, the translation of district policies into curricula
selection, reform initiatives, accountability mechanisms,
and evaluation and promotion strategies for principals and
Teacher Program Implementation
teachers communicate values, priorities, and expectations
to teachers (McLaughlin & Mitra, 2001). This backdrop
shapes the types of intervention programs and initiatives
that schools select to implement and support, and the
alignment between the policy context and the prevention
or intervention program under consideration is an impor-
tant factor in a program’s sustainability (Coburn, 2003);
i.e., the amount of administrative and instrumental support
provided to implement and sustain a program will be, in
part, determined by its perceived function and importance
in promoting the district’s and school’s mission.
From this perspective, program sustainability is
likely to occur only in the context of institutionalization
of systemic changes in attitudes, expectations, support
mechanisms, and infrastructure (Adelman & Taylor, 2003;
Elmore, 1996). In order for a program to be sustainable
when external or supplemental funding ends, a program
must be integrated into existing school improvement ef-
forts. That is, when the larger system is mobilized to cre-
ate reinforcing mechanisms to support teachers’ efforts at
multiple levels, teachers are better able to sustain change
(Bol et al., 1998; Coburn, 2003); this is applicable whether
the innovation is a program developed from a demonstra-
tion/research project or part of a program scale-up effort.
Thus, critical steps for program sustainability are the link-
ing of the program’s objectives to the mission and priori-
ties of the district and school, and building consensus and
support among key stakeholders at multiple levels to cul-
tivate institutional readiness and support for the program
or initiative (Adelman & Taylor, 2003; Elias et al., 2003).
By ensuring a high level of policy commitment from key
stakeholders, appropriate resources can be garnered for
capacity building and infrastructure development to fa-
cilitate and sustain program implementation. However,
the fact that a reform or program has been mandated by
the district or school does not by itself ensure that the
innovation actually will reach the classroom (Rohrbach
et al., 1993). Even under ideal conditions, with district and
school support for an innovative program, there remains
substantial variability in terms of implementation quality
and quantity of the new program delivered at the class-
room level (Domitrovich & Greenberg, 2000; McCormick
et al., 1995; Rohrbach et al., 1993). Thus, the present paper
examines teacher-level processes that underlie the imple-
mentation of innovative programs in the classroom—and
their long-term sustainability.
Another reason why it is important to investigate
classroom-level factors is that it is at this level that an
innovative program is adapted, by teachers, to fit the local
classroom context. Such changes usually are necessary,
but they often occur after initial training and supervision
resources are withdrawn, without consultation from pro-
667
gram developers or trainers. This raises the question as to
whether a program will retain its effectiveness in the new
setting (Elliott & Mihalic, 2004), since positive outcomes
for students exposed to these programs are very dependent
on the extent to which the program is implemented with
fidelity (Botvin et al., 1990; Dane & Schneider, 1998;
Rorhbach et al., 1993). Thus, it is important to inves-
tigate teacher-level factors related to the likelihood that
teachers will maintain a high level of implementation
fidelity. More generally, this highlights the importance
of not only examining the broader district- and school-
level infrastructure that supports and sustains innovative
programs, but also the lower-level structural and training
mechanisms that enhance their implementation fidelity.
Focusing on this more local—but no less critical—level
of the classroom, the present paper examines mechanisms
for enhancing teachers’ program fidelity in implementa-
tion as one aspect for increasing program sustainability. In
the next section, we review research on factors proximal
to teachers’ program implementation, research that serves
as the foundation for our model.
RESEARCH ON FACTORS RELATED
TO TEACHER PROGRAM IMPLEMENTATION
In reviewing factors related to teachers’ imple-
mentation of school-based prevention and intervention
programs, we focus on characteristics of the school,
teacher, and program that are related to the quantity
and quality (i.e., program fidelity) of teachers’ program
implementation.
School- and Teacher-Specific Factors
Studies in the educational and prevention literatures
indicate that teachers’ implementation of new programs
is related to certain characteristics of the teacher and the
school system in which the new program is to be imple-
mented (in contrast to characteristics that are specific to
the program to be implemented). These teacher and school
characteristics represent “preimplementation” factors that
are present prior to initial training or implementation of a
new program by teachers. As noted earlier, other factors
in the broader school system (i.e., at the district level) also
contribute to program implementation and sustainability,
such as the alignment between institutional policy and
the program’s objectives, flexibility in procedural options
to enact certain policies, allocation of resources, and the
like. But at a more proximal level, the immediate school
context directly defines the conditions that facilitate or
impede teachers’ efforts and motivation to implement a
program. Although a fairly broad range of variables has
668
been researched in this area, the following review focuses
on factors most directly related to teachers’ program im-
plementation, including (a) support of the program by the
school principal, (b) teachers’ self-efficacy beliefs, and
(c) professional burnout. In addition, (d) teachers’ beliefs
about the acceptability of the program, (e) the compati-
bility of the program with their own beliefs about student
behavior, and (f) the anticipated effectiveness of the pro-
gram appear to influence teachers’ initial motivation to
implement a new program, and hence are reviewed.
Administrative Support by the School Principal
In their role as leaders of the school, principals serve
as “gatekeepers” for new curricula and programs that are
introduced and implemented in their schools (Hallinger
& Heck, 1996). Hence, it is not surprising that their atti-
tudes and behavior can significantly affect teachers’ im-
plementation of new programs (Fullan, Miles, & Taylor,
1980; Gottfredson, Fink, Skroban, & Gottfredson, 1997;
Gottfredson & Gottfredson, 2002). Knowledgeable and
supportive school leadership can be instrumental in mak-
ing a program a priority within the school, as reflected in
the time, resources, incentives, and training allocated for
the program as well as the expectation of accountability.
In the dissemination of empirically validated programs in
natural conditions, both principal support and a high de-
gree of teacher implementation quality appear to be nec-
essary to produce intervention effects (Kam, Greenberg,
& Walls, 2003). Further, when principals are made aware
of the importance of their support for implementation and
are explicitly requested to encourage and monitor teach-
ers’ implementation, teachers’ program implementation
has been found to correspondingly increase (Rohrbach
et al., 1993). Thus, principal support, whether measured
in instrumental support or through affective stance, is an
important factor in teachers’ implementation.
Teacher Self-Efficacy Beliefs
Teachers’ beliefs about their teaching efficacy are
an important form of intrinsic motivation that appear
to strongly influence at least their initial interest in
implementing a new instructional program (Berman,
McLaughlin, Bass, Pauley, & Zellman, 1977; Guskey,
1988; Stein & Wang, 1988). As they relate to academics,
such efficacy beliefs represent a self-judgment of the
teacher’s capability to affect student performance and
have a strong influence on behavioral output (Tschannen-
Moran, Hoy, & Hoy, 1998). Expectations of personal effi-
cacy in a specific task determine an individual’s initiation
Han and Weiss
of coping behavior, the amount of effort expended on the
task, and persistence on the task despite setbacks; there-
fore, individuals who perceive themselves as efficacious
tend to produce sufficient effort to generate successful
outcomes when their pertinent actions are also compe-
tently executed, whereas those with low self-efficacy are
likely to cease their efforts prematurely and fail in the task
(Bandura, 1997; Bandura, Adams, & Beyer, 1977).
As measured by different scales assessing the con-
struct, teachers’ sense of efficacy has been found to re-
late to educational outcomes such as instructional behav-
ior (Allinder, 1994), persistence in a teaching situation
(Gibson & Dembo, 1984), enthusiasm (Allinder, 1994;
Guskey, 1988), and commitment to teaching (Coladarci,
1992), as well as student outcomes such as achievement
(Ashton & Webb, 1986), motivation (Midgley, Feldlaufer,
& Eccles, 1989), and students’ own sense of efficacy
(Anderson, Greene, & Loewen, 1988). Moreover, teachers
with a strong sense of efficacy appear more open to new
ideas and more willing to experiment with new meth-
ods to better meet their students’ needs (Berman et al.,
1977; Guskey, 1988; Stein & Wang, 1988). For exam-
ple, in a study of federally funded programs introducing
innovative practices in schools, teachers’ efficacy beliefs
were positively associated with the percentage of project
goals achieved, the amount of teacher change, and the
continued use of project materials and methods after the
project had ended (Berman et al., 1977). Thus, teachers
with a strong sense of efficacy show a higher likelihood
of implementing innovative educational practices and sus-
taining their effort to produce positive outcomes for their
students, compared to teachers with lower levels of self-
efficacy (Berman et al., 1977; Gibson & Dembo, 1984;
Guskey, 1988; Stein & Wang, 1988). Given the empirical
link between self-efficacy and the amount of effort and
persistence expended on a task (Bandura, 1997), teachers
with a greater sense of self-efficacy seem to actually invest
greater effort in program implementation, which in turn
is more likely to lead to successful experiences with new
strategies (if executed competently).
Professional Burnout
Conversely, teachers’ program implementation ap-
pears to be negatively correlated with their sense of pro-
fessional burnout. The construct of educator burnout in-
cludes three components that appear relevant to program
sustainability. The first is emotional exhaustion, “the tired
and fatigued feeling that develops as emotional energies
are drained” (Maslach, Jackson, & Schwab, 1996, p. 28),
which can detract from teachers’ engagement in their
Teacher Program Implementation
work with students and undermine their interest in new
and innovative practices. A second component of teacher
burnout is depersonalization, wherein educators no longer
have positive feelings about their students and display in-
different or even negative attitudes toward their students.
The third component is a sense of low personal accom-
plishment from the job, when educators feel that they no
longer are contributing to students’ development. Teach-
ers’ level of professional burnout has been found to corre-
late with turnover intentions, absenteeism, and somatic
problems (Belcastro & Gold, 1983; Jackson, Schwab,
& Schuler, 1986), as well as attributions about students’
misbehavior (Bibou, Stogiannidou, & Kiosseoglou, 1999)
and negative interactions with students (Lamude, Scudder,
& Furno-Lamude, 1992). Moreover, in examining teach-
ers’ attitudes toward implementing an innovative school
program, Evers, Brouwers, and Tomic (2002) found that
teachers with higher levels of burnout endorsed more
negative attitudes about implementing a new program.
Although there is not yet evidence indicating a direct link
between burnout and program adherence per se, its asso-
ciation with other negative teacher outcomes suggests that
teachers who feel burned out are likely to have low self-
efficacy and/or invest low effort in instructional behavior,
which likely would adversely affect the implementation
and sustainability of any program.
Program Acceptability and Preimplementation
Attributions about the Program
Teachers’ initial implementation efforts also may
be influenced by their perceptions and beliefs about a
new program prior to implementation. More specifically,
teachers’ judgments of the acceptability of an intervention
program significantly influence their interest and willing-
ness to implement a program and the degree to which they
implement the program with fidelity (Reimers, Wacker, &
Koeppl, 1987). “Treatment acceptability” refers to clients’
or laypersons’ judgments of whether treatment procedures
are “appropriate, fair, and reasonable for the problem or
client” (Kazdin, 1981, p. 493). In earlier research on the
acceptability of treatments designed for use in clinical
settings, ratings of acceptability were higher for more
effective treatments and when the child problem being
addressed was more serious, but were lower when adverse
side effects were reported (Kazdin, 1981; Kazdin, French,
& Sherrick, 1981).
In educational settings, several contextual and
program-specific variables seem to affect teachers’ preim-
plementation judgments of a treatment’s acceptability.
These factors include (a) the severity of the student target
669
problem being addressed, (b) the type of treatment, and
(c) the amount of time required to implement the interven-
tion procedures (Elliott, 1988; Reimers et al., 1987). In ad-
dition, preimplementation attributions about (d) the com-
patibility of the program with teachers’ own beliefs about
children’s behavior and classroom management (Kealey
et al., 2000), and (e) the anticipated effectiveness of the
program (Von Brock & Elliott, 1987) also appear to influ-
ence teachers’ ratings of a program’s acceptability—and
ultimately the effort that they invest in program imple-
mentation.
In general, the severity of students’ problems, opera-
tionalized as either the degree to which a student behaves
inappropriately or the number of children who exhibit be-
havior problems in a classroom, is associated with greater
acceptability for any given treatment (Elliott, 1988). On
the basis of experienced teachers’ acceptability ratings
for different behavioral interventions, the severity of a
student’s target problem also influences how complex
an acceptable treatment can be, with the most complex
treatment (such as token economy) being rated as the
most acceptable intervention for the most severe behav-
ior problem (such as destroying property), and the least
complex intervention (such as praise) being rated as the
most acceptable treatment for the least severe problem
behavior (such as daydreaming; Elliott, Witt, Galvin, &
Peterson, 1984). Thus, teachers are more likely to judge
a relatively complex intervention to be more acceptable
when students’ problems are more severe.
In addition, the type of treatment program also in-
fluences teachers’ ratings of treatment acceptability, with
positive treatment procedures being consistently rated as
more acceptable than negative or reductive treatment pro-
cedures, such as time-out, response cost, and ignoring
(Elliott et al., 1984; Martens, Peterson, Witt, & Cirone,
1986). Teachers also tend to perceive positive intervention
methods, such as those involving praise, verbal redirec-
tion, and differential reinforcement, as the most effective
and easiest to use (Martens et al., 1986).
Another salient factor influencing teachers’ ratings
of treatment acceptability is the amount of time required
to implement an intervention program (Elliott et al., 1984;
Martens et al., 1986; Witt, Martens, & Elliott, 1984). In
rating descriptions of treatment methods that required
varying amounts of teacher time for implementation,
teachers generally preferred treatment methods that were
time-efficient (Witt et al., 1984). However, in judging
intervention strategies for students with severe problems,
teachers’ allowances for the complexity of a successful
treatment—and consequently the time involved to change
the problem behavior—shifted upwards correspondingly
with the severity of the problem. Thus, although several
670
independent variables contribute to teachers’ acceptabil-
ity ratings, teachers’ expectations about an intervention
program appear to center around contextual appropriate-
ness (i.e., the extent to which the program matches the
problem).
Teachers’ familiarity with an intervention’s princi-
ples also appears to positively influence their ratings of
the program’s acceptability. Although an inverse relation
has been found between years of teaching experience and
treatment acceptability ratings (Witt & Robbins, 1985),
teachers with a higher level of knowledge of behav-
ioral principles were found to rate behavioral treatment
techniques (e.g., reinforcement of incompatible behav-
ior, positive practice) as more acceptable than teachers
with a lower level of knowledge (McKee, 1984, as cited
in Elliott, 1988). Moreover, greater teacher implemen-
tation of a school-based substance use prevention pro-
gram was associated with less teaching experience but
with more experience in the specific teaching methods
espoused by the intervention program (Rohrbach et al.,
1993). In addition, higher levels of program implementa-
tion were demonstrated by teachers with more favorable
attitudes toward a conflict resolution program (Thorsen-
Spano, 1996) and whose beliefs were congruent with a sex
education program’s objectives (DeGaston, Jensen, Weed,
& Tanas, 1994). Hence, judgments of acceptability—and
consequently the degree of program implementation—
may align more with the compatibility between program
principles and teachers’ beliefs about behavior change or
their experience in specific techniques, rather than level
of teaching experience or knowledge per se.
In order to make a fair judgment of a treatment pro-
gram’s acceptability even before they have implemented
the intervention, teachers must understand what the pro-
gram entails. In their conceptualization of the impact
of treatment acceptability on program implementation,
Reimers et al. (1987) proposed that improved acceptabil-
ity and potentially increased use of treatment procedures
may be facilitated through increased familiarity with the
intervention’s principles. In a similar vein, training proce-
dures that aim to increase teachers’ understanding of an
intervention’s principles and that focus on building upon
teachers’ extant experiences and skills that are relevant to
the intervention program may be useful for capitalizing
on teachers’ positive expectations of a new program and
thus enhancing their motivation to implement and adhere
to the program.
Finally, an intervention program’s reported effective-
ness appears to influence teachers’ ratings of acceptability,
with teachers judging interventions that are described as
strong and successful to be more acceptable than those that
are described as weak and relatively unsuccessful (Clark
Han and Weiss
& Elliott, 1988). Conversely, when teachers judge an in-
tervention to be less acceptable, they also rate it as less
effective (Von Brock & Elliott, 1987). Given this relation
between acceptability and perceived effectiveness, pro-
viding program effectiveness information may improve
teachers’ perceptions of the program’s acceptability and
thus increase their intention to implement the program.
Akin to outcome expectancies regarding the likely conse-
quences of performing a task at the expected level of com-
petence (Bandura, 1977), teachers’ positive attributions
about an intervention program’s anticipated effectiveness
can serve as a strong incentive for initial implementation
and adherence to the program.
Overall, attention to teachers’ preimplementation
judgments of an intervention program’s acceptability is
important because of their potential to influence imple-
mentation intentions. Teachers’ preimplementation per-
ceptions regarding a program significantly affect their
initial motivation to implement a new program, which
will in turn affect the amount of effort that teachers invest
in program implementation and ultimately their level of
program fidelity and sustainability.
Program-Specific Factors
In contrast to the first set of factors reviewed above
that are related to extant characteristics of the school
system and its teachers, the second set of factors fo-
cuses on structural and procedural characteristics that
are specific to the program to be implemented. Two im-
portant program components that appear to be related to
teacher program implementation are teacher training and
the provision of performance feedback.
Teacher Training
An important factor in enhancing the quality as well
as quantity of program implementation, and a major de-
terminant of success in school program implementation,
is the amount and quality of the training that teachers
receive in regard to the program (McCormick et al., 1995;
Perry, Murray, & Griffin, 1990; Rohrbach et al., 1993).
Implementation studies of prevention programs indicate
that when teachers are the program implementers, the
provision of adequate training increases the likelihood
that they will implement the curriculum fully and with
integrity (McCormick et al., 1995; Perry et al., 1990). For
example, subsequent to receiving training on the imple-
mentation of a school-based smoking prevention program,
trained teachers were more likely to implement, and to im-
plement more of, the curriculum than untrained teachers
Teacher Program Implementation
(McCormick et al., 1995). In addition, trained teachers
were more likely to continue implementing the program
1 year later than teachers who received program materials
but were not trained by the project (McCormick et al.,
1995).
However, even among teachers who receive train-
ing, degradation in program implementation over time
is a problem often encountered in otherwise effective
programs. Studies of school-based programs to prevent
smoking and substance use indicate that although over
70–90% of teachers who receive training (but no on-
going consultation support) may initially implement at
least some of the program, teacher implementation rates
can drop by 20–60% 1 year after training (McCormick
et al., 1995; Rohrbach et al., 1993). Thus, the provision of
teacher training may not be sufficient by itself to maintain
teachers’ program implementation over the long term,
even when the dissemination of a prevention program is
supported by the school district.
Performance Feedback
An important lesson from research on the training
of classroom academic instruction is that the strongest
effects of training are found when classroom practice is
combined with performance feedback (Rose & Church,
1998), which typically consists of feedback (provided
through oral comments, written notes, or graphs) on ways
to improve teachers’ classroom use of the skills targeted
in training. In their review of studies using direct ob-
servation procedures to train teachers, Rose and Church
(1998) found that the provision of feedback consistently
produced the strongest training effect, suggesting that
performance feedback probably is a necessary compo-
nent for training programs aimed at changing teachers’
classroom behavior. A number of studies indicate that
performance feedback provided by a consultant regard-
ing teachers’ implementation of behavioral plans can
increase teachers’ use of the intervention program, im-
prove treatment fidelity, and produce greater improvement
in children’s outcomes (Farmer-Dougan, Viechtbauere,
& French, 1999; Jones, Wickstrom, & Friman, 1997;
Mortenson & Witt, 1998; Noell et al., 1997; Witt, Noell,
LaFleur, & Mortenson, 1997).
These studies typically have used multiple baseline
designs, wherein teachers initially are taught each step of
a behavioral plan outside of the classroom and then, to
ensure accurate initial implementation, the consultant ob-
serves and prompts the teachers as they administer the in-
tervention procedures in the classroom. Although teachers
often initially demonstrate full treatment fidelity, fidelity
has been found to rapidly decrease when teachers were left
671
to administer the program without the consultant; how-
ever, the subsequent provision of ongoing performance
feedback from a consultant results in substantial increases
in fidelity (Mortenson & Witt, 1998; Noell et al., 1997;
Witt et al., 1997), which suggests that consultation support
needs to be of sufficient duration to achieve depth in teach-
ers’ skills. Other studies of behavioral consultation with
teachers in regard to instructional techniques also show
that direct training procedures in the classroom involving
modeling, rehearsal, and feedback regarding intervention
plans lead to higher treatment fidelity (Sterling-Turner,
Watson, & Moore, 2002). Although in-service workshops
lead to little change in teachers’ instructional behavior,
the provision of in-classroom performance feedback has
been found to result in change in teacher behavior that is
maintained even after performance feedback is withdrawn
(Leach & Conto, 1999). Although the use of multiple
baseline designs with small sample sizes limits the gen-
eralizability of these findings, these studies suggest that
performance feedback during the implementation phase
may be an important component for achieving sustained
program fidelity.
It should be noted that some studies that have investi-
gated the effects of different intensities of teacher consul-
tation have not produced significant effects for intensity or
duration of teacher consultation (e.g., Botvin et al., 1990).
However, most of these studies have used relatively weak
manipulations. For instance, in a substance use prevention
study in which teachers either received a 1-day training
workshop with 15 min of implementation feedback and
reinforcement or watched a 2-hr videotape without any
feedback or reinforcement, there was no significant dif-
ference in the level of program implementation between
these two groups of teachers (67% vs. 68%) or in their
students’ outcomes (Botvin et al., 1990). These investi-
gators speculated that the intensity and type of training
and consultation provided to the two groups might not
have been sufficiently different to produce any differen-
tial effects; i.e., these findings suggest that the provision
of 15 min of implementation feedback is functionally no
different from no implementation feedback. However, the
minimum amount of ongoing consultation time necessary
to produce increases in fidelity is not yet clear, and further
research is needed to examine the additive effects of dif-
ferent intensities of ongoing consultation provided during
the training and initial implementation phase.
INGREDIENTS OF A SUSTAINABLE
SCHOOL-BASED PROGRAM
From the above literatures, we have abstracted
out four higher-order factors, what might be called
672
“essential ingredients” that characterize potentially sus-
tainable teacher-implemented classroom mental health
programs: A sustainable program must be (a) accept-
able to schools and teachers, (b) effective, (c) feasible to
implement on an ongoing basis with minimal (but suffi-
cient) resources, and (d) flexible and adaptable. Although
these ingredients are important in sustaining teachers’ im-
plementation at the classroom level, these characteristics
by themselves are not sufficient to make a program sus-
tainable. As others have noted (e.g., Adelman & Taylor,
2003), political, bureaucratic, and systemic factors that
define contextual strengths and potential barriers to suc-
cessful implementation (Ikeda, Tilly, Stumme, Volmer, &
Allison, 1996; Levenson-Gingiss & Hamilton, 1989) also
determine whether a program can and will be sustained
within a particular setting. Thus, when considering imple-
mentation of a program, it is important to lay the ground-
work to cultivate institutional understanding, readiness,
and support for the program at the school and district
levels (Adelman & Taylor, 2003; Connell & Klem, 2000;
McLaughlin & Mitra, 2001). But fundamentally, any ef-
fort to achieve long-term program sustainability must be
based on an effective program with room for adapta-
tion that meets the needs of the school and its students
and is feasible to implement. These essential ingredi-
ents that characterize a sustainable program are discussed
below.
Acceptability to Teachers
In order for a new program to be effective in the
classroom, teachers first must be willing to make a sin-
cere effort at implementing it. Thus, teachers must view
the program as acceptable, and the program’s structure
and content need to motivate and inspire teachers to want
to implement the program. Before implementation, teach-
ers’ judgments of program acceptability are influenced by
a myriad of contextual and program-specific variables,
including school and district support for the program, the
severity of their students’ problems, the type of interven-
tion techniques espoused by the program, the amount of
time required to implement the program, the compatibil-
ity of the program with their own beliefs about children’s
behavior and classroom management, and the reported
effectiveness of the program (Elliott, 1988; Kealey et al.,
2000; Reimers, Wacker, & Koeppl, 1987; Von Brock &
Elliott, 1987). In evaluating the potential benefits of a
program and their interest in implementing it, teachers
must perceive the program as not only meeting the needs
of their students but also complementing their teaching
style. Only then will potentially effective programs be
given the opportunity to actually be effective in the class-
Han and Weiss
room by teachers who implement it with fidelity and
commitment.
Program Effectiveness
A basic requirement of a sustainable school-based
program is that the selected program and its intervention
techniques must have the ability to change children’s emo-
tional and behavioral functioning. This is best achieved
by selecting programs that have been demonstrated to be
effective via empirical evaluation. Then, in order for the
program to achieve its potential outcomes, program im-
plementers (i.e., teachers) must achieve program fidelity
in these techniques (e.g., Botvin et al., 1990; Ialongo et al.,
1999; Rohrbach et al., 1993). To increase the likelihood
that program fidelity will be sustained beyond the train-
ing period, program fidelity needs to be achieved to an
acceptable-to-superior level during the training period to
ensure that program implementers learn to implement, and
do implement, the program as it was intended (Henggeler
et al., 1997; McCormick et al., 1995). To achieve this stan-
dard, training needs to be of sufficient intensity and incor-
porate in-classroom feedback to establish both depth and
breadth in teachers’ knowledge and application of the core
principles of the program (Coburn, 2003; McLaughlin &
Mitra, 2001).
Although a program’s reported effectiveness should
be an important aspect in its selection for implementa-
tion, teachers’ perceptions of the program’s effectiveness
for their students after implementation has begun also are
an important component via their effect on motivation
(Kealey et al., 2000). Teachers must believe that there
is a compelling reason for them to practice differently
in their classrooms, and the best direct evidence in this
regard is their perception that their students are behaving
and learning better as a result of their classroom prac-
tices (Elmore, 1996). Thus, as they implement a program,
teachers need to observe change in their students’ behav-
ior, and they also need to attribute this positive change
in their students to their implementation of the program
(Datnow & Castellano, 2000). This experience of suc-
cess, correctly attributed to their use of the program, is
critical in reinforcing teachers’ implementation efforts.
Provision of ongoing feedback during the training and
initial implementation phase may be necessary to facil-
itate this link between teacher program implementation
and improved student outcome (Leach & Conto, 1999;
Rose & Church, 1998). In sum, there are three elements
in the “effectiveness” ingredient: (a) effective techniques,
(b) implementation fidelity, and (c) teacher attributions
linking their teaching practice (i.e., program implementa-
tion) to positive effects for their students.
Teacher Program Implementation
Feasibility of Ongoing Implementation,
With Minimal But Sufficient Resources
Sustainable programs need to be not only accept-
able to teachers and demonstrably effective, but also must
be practical and feasible to implement in the school set-
ting. A key component to this is that sufficient resources
be available for ongoing program implementation. The
availability of ongoing resources differs across two situa-
tions to which program sustainability applies: (a) research
project pull-out, when a demonstration or research project
ends and pulls out of a school system; and (b) program
scale-up, when a program or initiative is disseminated or
scaled up in a school system. In regard to research project
pull-out, funding resources that were available for initial
training and implementation supervision during the active
phase of the research project often are not available when
the project ends; hence, mechanisms and functions to sup-
port ongoing implementation need to be planned from the
start of the project, and developed and integrated into the
extant school infrastructure before external training re-
sources are withdrawn (Adelman & Taylor, 2003). In the
case of program scale-up, resources are typically provided
by the district for initial and ongoing implementation, but
in order for the scale-up program to be cost-effective, the
amount of resources required for ongoing implementation
after each set of teachers has been fully trained needs to
level off as the program is sequentially phased in and
replicated in more schools (Taylor, Nelson, & Adelman,
1999).
In both situations, however, initial support for train-
ing may be funded from an external source (i.e., a research
project or grant) or supplemental resources (for scaling
up), but subsequent critical program functions that serve to
reinforce ongoing implementation and fidelity need to be
subsumed by the extant school infrastructure. For sustain-
ability under both circumstances, programs should require
minimal additional resources for ongoing implementation
after the initial training phase (Atkins et al., 1998), and
the program needs to be suitable for integration within the
school’s operations and infrastructure (Adelman & Taylor,
2003). In the current context of limited fiscal resources,
one approach to making a program sustainable is to use
existing school personnel, such as teachers or school coun-
selors, to implement the program. Therefore, to ensure that
school personnel such as teachers implement the program
with fidelity and continue to maintain program fidelity,
teacher training that is of sufficient intensity and that
incorporates classroom practice with performance feed-
back may be necessary investments (Huberman & Miles,
1984; McCormick et al., 1995; Rose & Church, 1998),
whether teacher training on implementation is embedded
673
within a demonstration/research project or a scale-up ef-
fort. By focusing on the skill development and motivation
of a community of teachers within a school, the initial
influx of training and support resources can be used to
establish self-reinforcing mechanisms to fuel continued
high-quality implementation when this resource for initial
intensive support is diminished.
Flexibility and Adaptability
Classroom circumstances change across the school
year, as students progress or encounter emotional, behav-
ioral, or academic difficulties, and each new school year
brings a new set of students, with different strengths and
needs. Hence, for a program to be sustainable teachers
must be able to adapt the program so that it is appropri-
ate for these changing circumstances and diverse class-
rooms. This requires two things: (a) the program must be
developed and structured with sufficient flexibility such
that it can be adapted to changing circumstances, and
(b) teachers must understand the program well enough
so that they are able to modify it without sacrificing
the core principles and central intervention techniques.
Thus, during the initial training phase, teachers must not
only achieve a superior level of program fidelity but also
develop an in-depth understanding of the core princi-
ples underlying the program and its effectiveness, so that
they can understand the limits within which the program
can be modified (McLaughlin & Mitra, 2001). This will
most likely be achieved by providing direct supervision
in program adaptation during the initial training process
(McCormick et al., 1995; Rose & Church, 1998; Sterling-
Turner et al., 2002). In order to maintain adherence to
the core program principles, relatively intensive teacher
training and close initial supervision regarding implemen-
tation are imperative, so that teachers fully understand the
program’s principles and objectives and can have experi-
ence in adapting the program without sacrificing program
fidelity.
PROCESS MODEL OF ENHANCED
SUSTAINABILITY
In this final section of the paper we present a sequen-
tial model, based on these ingredients, of the naturalistic
processes underlying sustainability in teachers’ program
implementation, and describe how this sustainability can
be enhanced through provision of teacher training and
performance feedback from a program consultant. In this
model (see Fig. 1), naturally occurring implementation
674 Han and Weiss

PHASE I PHASE II

P R OJECT
SU P P OR T
Teacher
Training

P H A S E
Consultant
Feedback

Implementation
I M P L E M E N T A T I O N

Activities

Attribution
ONGOIN G I M P LEMENTATION P R OCESSES

S U S T A I N A B I L I T Y
ONGOIN G I M P LEMENTATION P R OCESSES
of Student
Functioning
Experience of
to the Program
Success

Motivation SKILLS
to Understanding of
Implement Program Principles,
the Implementation
S U P P O R T E D

Program Techniques

P H A S E
PROGRAM IMPLEMENTATION
Program Delivery
Program Fidelity
Generalized Use of Program Principles

CHANGES IN
STUDENT BEHAVIOR

Fig. 1. Process model of sustained program implementation by teachers.

processes create a (potentially) self-sustaining feedback The likelihood of this feedback cycle being estab-
loop. When teachers implement the program correctly lished and sustained may be increased through several
(Program Implementation), given an efficacious program, training mechanisms, including provision of (a) intensive
this results in improved or maintained appropriate stu- Teacher Training and (b) in-classroom Consultant Feed-
dent behavior (Changes in Student Behavior), which in back focused on implementation issues, lasting for a suffi-
turn generates teachers’ Experience of Success in imple- cient period of time for the teacher to internalize the core
menting the program. In part through resultant efficacy program principles (Leach & Conto, 1999; McCormick
beliefs and their Attribution of Student Functioning to et al., 1995; Rose & Church, 1998). Subsequent discon-
the Program, teachers’ experiences of success in using the tinuation of these training activities then marks the shift
program leads to increased Motivation to Implement the to the sustainability phase, by which point the feedback
Program and increased Skills in implementing the pro- cycle must have become self-sustaining (although ongo-
gram as teachers learn through experience what is effec- ing support from colleagues, etc. remains important) if the
tive in their classrooms, and what is not. This feedback program is to continue to be implemented.
loop is completed as teacher motivation and skill in pro- The sustainability of the program depends on contin-
gram implementation lead to continued correct Program ued implementation with ongoing program fidelity, even
Implementation. beyond the training or supported implementation period.
Teacher Program Implementation
Teachers’ adherence in implementation is the aim of the
feedback cycle, which is facilitated by the training and
consultation activities. As such, when evaluating sustain-
ability it is important to assess teacher program implemen-
tation at three levels: (a) program delivery, the “quantity”
of program lessons and activities that teachers deliver
to their students; (b) program fidelity, the “quality” of
program implementation, or the degree to which these
program techniques and activities are implemented as
intended (Moncher & Prinz, 1991; Yeaton & Sechrest,
1981); and (c) teachers’ generalized use of effective pro-
gram techniques, which reflects a broader application of
program techniques and strategies reflecting core program
principles to various classroom situations.
In our model, the sustainability process proceeds
through three phases: (a) Preimplementation Phase, the
time period prior to implementation when teachers and
administrators at a particular school are introduced to the
program, implementation plans for the specific school are
developed, etc.; (b) Supported Implementation Phase, the
time period during which teachers are trained in the pro-
gram and receive ongoing in-classroom consultation on
program implementation; and (c) Sustainability Phase,
when supplemental or external support for implementa-
tion (i.e., training, consultation) has been withdrawn. In
each phase, there are factors that may facilitate or impede
the ultimate sustainability of the program.
Preimplementation Phase
Factors that are specific to the school system and its
teachers and that exist prior to the start of the program
define the contextual strengths and potential barriers to
successful implementation (Ikeda et al., 1996; Levenson-
Gingiss & Hamilton, 1989), and can influence program
implementation and long-term sustainability. Such fac-
tors, for instance, can impact on teachers’ intentions to
implement a program; for example, administrative support
for the program, as reflected in principals’ attitudes and
behaviors, communicate how important principals believe
a new program is and sets the stage for teachers’ receptiv-
ity of the program (Rohrbach et al., 1993). Other teacher
factors that may influence their initial motivation to im-
plement a program include efficacy beliefs regarding their
capabilities as teachers to produce desired student out-
comes (Bandura, 1997; Tschannen-Moran & Hoy, 2001),
which have been found to correlate with teacher persis-
tence and willingness to experiment with new methods
(Anderson et al., 1988; Ashton & Webb, 1986; Gibson &
Dembo, 1984); and professional burnout (Maslach et al.,
1996), which correlates with attributions of students’ mis-
675
behavior and negative student-teacher interactions (Bibou
et al., 1999; Lamude et al., 1992). Teachers’ initial moti-
vation to implement a program is also determined by their
preimplementation perceptions of the program, such as
the acceptability of the program (Reimers et al., 1987), the
compatibility between the program’s principles and their
own beliefs (Kealey et al., 2000; Rohrbach et al., 1993),
and the anticipated benefit of the program for their stu-
dents (Clark & Elliott, 1988; Von Brock & Elliott, 1987).
Even for a demonstrably effective program, it is important
to consider preimplementation factors that can affect the
potential success of the program within a particular school
and with a given teacher. Information about teachers’ ini-
tial attributions about the program, the correctness of their
understanding of the program, the degree of compatibility
with their teaching styles, etc. can suggest areas where
program orientation and training procedures may need to
address teachers’ misconceptions or concerns.
Supported Implementation Phase
The supported implementation phase is the time pe-
riod during which supplemental or external resources for
training and implementation support (e.g., consultation)
are provided. The goal of these activities is to maximize
the program’s effectiveness, along with helping teachers
to recognize and correctly attribute positive changes in
students’ behavior to their use of the program. A key
factor in this process is consultant feedback regarding
teachers’ program implementation and attributions about
the program’s impact, with this feedback structured to
(a) increase teachers’ program knowledge and skills, via
direct training as well as corrective feedback and rein-
forcement of correct implementation; (b) help teachers
learn how to adapt the program to the changing needs
of their classrooms; and (c) support teachers’ evolving
attributions about the impact of the program on their
students. Initial training for teachers includes learning
about the program principles and the rationale underly-
ing the principles (i.e., theoretical and empirical bases),
the importance of maintaining fidelity to the core prin-
ciples, classroom lessons and key objectives, implemen-
tation techniques and strategies, and acceptable forms of
flexibility and adaptation within the model. Training may
need to occur over the course of several months or more,
as teachers progress through successive modules of the
program. However, it is crucial that teachers begin imple-
menting the program early in the training process, as these
initial efforts not only make the program more concrete
for teachers but also provide opportunities for consultant
feedback.
676
Consultation is focused on the feedback loop pro-
cesses (see Fig. 1) and has two primary functions,
which are to enhance teachers’ implementation skills and
promote their motivation to implement the program. The
first function of consultation (to help teachers implement
the program accurately and consistently) is achieved by
(a) directly observing teachers’ implementation efforts
and students’ responses to the program, (b) providing
feedback on implementation and collaboratively resolving
implementation issues, and (c) modeling program tech-
niques and strategies. Consultant feedback is invaluable in
helping teachers to understand potential reasons why their
use of a technique did not produce the desired outcome,
thus pinpointing reasons for failure in their implemen-
tation of a technique while at the same time generating
potential solutions. The depth of this training must be suf-
ficient for teachers to be able to differentiate good versus
poor implementation of techniques so that in the future,
when they are no longer receiving consultation, they will
be able to successfully adapt the program to changing
circumstances while still adhering to core principles.
The second function of consultation (to promote
teacher motivation to implement the program) is achieved
by the consultant guiding teachers to (a) focus their atten-
tion on incremental improvements in students’ behavior,
(b) objectively evaluate and interpret the immediate or
short-term effect of a particular program lesson or tech-
nique on their students, and (c) make accurate attributions
of student functioning to their use of the program. The
consultant’s and teacher’s joint attention to even small
increments of “success” is a vital source of positive re-
inforcement for the teacher, especially during the early
weeks of implementation. If the program’s impact is suc-
cessful but teachers do not perceive any positive impact
of the program early on, their use of the program is
likely to diminish (Gingiss, 1992); thus, program adher-
ence can be influenced by consultant feedback about the
impact of program implementation on classroom func-
tioning (Noell et al., 1997). However, although consultant
feedback and encouragement initially serve as external
reinforcement for teachers’ successful implementation,
consultation needs to be designed such that as teachers
become successful and their sense of self-efficacy in re-
gard to implementing the program increases, they become
intrinsically motivated via their sense of responsibility for
their students.
Sustainability Phase
During the previous phase, supplemental or exter-
nal resources to provide training and consultation support
Han and Weiss
were available. It is at the point when this implementation
support is no longer available that it becomes necessary
for the feedback cycle to become self-sustaining. This
requires that (a) teacher motivation be primarily intrinsic
and no longer dependent on external reinforcement from
the consultant (although support from the administration,
colleagues, etc. remains crucial), and that (b) teachers
possess the ability to modify the program and evaluate
the utility of these modifications.
Success during this time period when external project
support for implementation has ceased is dependent on
the skills of the teacher and his/her ability to continue to
effectively implement the program without the additional
resources provided during the supported implementation
phase. Hence, teachers’ level of skills and motivation
demonstrated during this sustainability phase is heavily
dependent on the success experienced during the previous
supported implementation phase. In order for teachers
to be able to continue successful implementation, they
must have achieved a high level of implementation during
the previous phase, as indicated by their degree of pro-
gram delivery, fidelity, and generalized use of program
strategies. As initially developed and refined during the
supported implementation phase, teachers’ skills in pro-
gram implementation will produce continued experiences
of success in achieving desired student outcomes during
the sustainability phase. This observable outcome of im-
proved classroom functioning, which teachers can then
properly attribute to their use of the program, will remain
a central component in maintaining teachers’ motivation
to implement the program.
In addition, the program must be sufficiently flexible
and the teacher sufficiently skilled so that s/he can mod-
ify the program to meet changing circumstances, without
sacrificing the core principles underlying program effec-
tiveness. Prior experience in implementing the program
successfully, as well as belief in the ability of the program
to improve student behavior (based on prior experience of
success during the supported implementation phase), may
“inoculate” teachers from prematurely giving up on the
program when strategies do not show immediate effects
with a new cohort of students. Thus, teachers with the
motivation and skills to implement the program are likely
to experience further success in changing their students’
behavior in the classroom, which will in turn lead to con-
tinued program use—thus continuing an evolving (i.e.,
adaptable to changes in the classroom) and ultimately
self-sustaining cycle. In essence, a teacher who is skilled
in implementing a program with fidelity and motivated
to continue implementing the program beyond the train-
ing and supported phase is vital to long-term program
sustainability.
Teacher Program Implementation
CONCLUSION
As we rely increasingly on schools and teachers to
deliver mental health-related intervention programs to stu-
dents, it is important that research examine the processes
whereby teachers are trained to implement a program ac-
curately and consistently. It is through efficacious pro-
grams that are implemented with fidelity that teachers
and schools can achieve the positive outcomes promised
by evidence-based programs (Botvin et al., 1990; Dane
& Schneider, 1998). In turn, it is through observing the
significant impact of such programs on their students that
teachers and schools are likely to continue to implement
these programs (Datnow & Castellano, 2000; Noell et al.,
1997). This cycle, we believe, is the foundation for the
sustainability of program implementation at the classroom
level by teachers. Although district-level factors in the
form of policies, priorities, and resources undoubtedly
influence the systemic conditions that support or inter-
fere with program sustainability (Coburn, 2003; Elmore,
1996), ultimately it rests upon the teacher to actually de-
liver the program to the classroom with fidelity. Thus, it
is incumbent upon program developers and evaluation re-
searchers to identify effective methods for training teach-
ers on program implementation, so that teachers achieve
program fidelity and also develop an in-depth understand-
ing of the program.
In a recent investigation of a semistructured,
cognitive-behavioral skills training program for
prekindergarten children, we (Han, Catron, Weiss,
& Marciel, 2005) provided intensive consultation on
implementation to teachers as they implemented the
classroom program during a “supported implementation
phase” for one academic year. For teachers who
oftentimes are unfamiliar or uncomfortable with the
demands of mental health curricula that emphasize
interactive skills training methods (e.g., role-playing,
active modeling), implementation support from a
program consultant was beneficial in terms of directly
demonstrating program techniques in the classroom.
Although the results provided preliminary support
for the efficacy of the program on children’s social
skills and behavior problems and for the utility of a
teacher-consultation model for training teachers on
implementation, we were unable to gather data during
what would have been a “sustainability phase” for these
teachers to determine whether consultation resulted in
teachers’ continuing to implement the program with
fidelity after the end of the research project.
Further research incorporating assessments of both
teacher and student outcomes over multiple years that
cover an initial “supported implementation phase” as
677
well an extended “sustainability phase” is needed. More-
over, given the relatively high cost of providing con-
sultation, the role of implementation consultation needs
to be investigated further to determine whether the in-
vestment of intensive in-classroom consultation pro-
vided to teachers during the supported implementa-
tion phase results in enhanced program implementa-
tion and long-term sustainability, compared to provid-
ing teachers with only basic training on implementa-
tion. Lastly, research on sustainability needs to exam-
ine factors that mediate teachers’ program implemen-
tation, such as teachers’ implementation skills, moti-
vation, and attributions about the program’s impact on
students.
ACKNOWLEDGMENTS
This paper was supported in part by a grant from
the National Institute of Mental Health (NIMH R01-
MH58275) and by the Vanderbilt Institute for Public
Policy Studies. The authors thank Annalise Caron, Tom
Catron, Carol Guth, Vicki Harris, and Vicky Ngo for their
suggestions, critique, and encouragement.
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