The study of implementation: Current findings from effective programs that prevent mental disorders in school-aged children

Prevention science is a rapidly advancing field and is at the point where a number of preventive interventions have documented the ability to change developmental trajectories and reduce negative outcomes. Recently, reports sum marizing these "effective" programs have circulated among researchers and practitioners. Surprisingly, many of the highest-quality programs fail to take adequate steps to monitor and verify program integrity. This weakens the conclusions that can be drawn regarding the program outcomes and reduces the likelihood that replications will resemble the original program. The next challenge facing the prevention field is to help consumers who are implementing effective programs in naturalistic settings do so with quality and fidelity to the original program so that they achieve similarly successful outcomes. This article reviews implementation issues in prevention trials and specifically highlights the study of implementation in the 34 programs determined to be effective in a recent review conducted by the Prevention Research Center for the Center for Mental Health Services. Reasons for the lack of attention to implementation and suggestions for way to incorporate implementation measurement into prevention initiatives are discussed.