Practitioner and Site Characteristics That Relate to Fidelity of Implementation: The Early Risers Prevention Program in a Going-to-Scale Intervention Trial Bonnie Klimes-Dougan, Gerald J. August, Chih-Yuan Steven Lee, George M. Realmuto, Michael L. Bloomquist, Jason L. Horowitz, and Todd L. Eisenberg University of Minnesota Despite the increased availability of evidence-based prevention programs targeting serious mental health problems, an ongoing challenge within the field of prevention science is transporting prevention programs into real-world settings where their health impact can be fully realized. As part of a going-to-scale study, we examined how context, namely the characteristics of the practitioners and organizations, promotes or impedes fidelity of implementation of prevention efforts. Practitioners delivered Early Risers, an intensive, multicom- ponent, indicated prevention program across 27 geographically dispersed elementary schools and recorded 3 indexes of fidelity— exposure, adherence, and quality of implementation. As predicted, practitioner charac- teristics, including personality traits (low neuroticism, high extraversion, openness, and conscientiousness), beliefs (pre-implementation beliefs about program success), and use of flexible coping strategies (reappraisal coping) were related to various fidelity indexes. Contrary to predictions, teachers’ negative perceptions of the organizational structure were positively related to fidelity. Follow-up regression analyses suggested that practitioner characteristics differentially predict fidelity for child and family programming. Keywords: targeted or tertiary prevention, going-to-scale, fidelity, practitioner characteristics, organiza- tional culture and climate Despite the increased availability of evidence-based prevention programs targeting serious mental health problems and health compromising behaviors such as substance abuse, an ongoing challenge within the field of prevention science is transporting prevention programs into real-world settings where their health impact can be fully realized. When going-to-scale, there is a host of real-world conditions that result in adaptations and re- inventions that may severely compromise fidelity of implementa- BONNIE KLIMES-DOUGAN received her PhD in clinical psychology from Florida State University. She is currently assistant professor in the Division of Child and Adolescent Psychiatry at the University of Minnesota. She takes a developmental psychopathology approach, examining stress regu- lation systems (experiential, neurocognitive, physiological) that relate to depression as well as critical factors (including psychosocial interventions such as Early Risers) that may potentially alter risk trajectories in children and adolescents. GERALD AUGUST received his PhD in psychology from Purdue University and is currently professor in the Division of Child and Adolescent Psychiatry at the University of Minnesota. His work on early prevention of antisocial and substance abuse has moved from basic science, to intervention development, then to efficacy, and effectiveness trials. His most current studies on preven- tion implementation have examined how prevention services can best be embedded in both traditional and nontraditional community sectors. CHIH-YUAN S. LEE received his PhD in family social science from the University of Minnesota. He is currently assistant professor in the Division of Child and Adolescent Psychiatry, University of Minnesota Medical School. His research areas include prevention intervention program fidel- ity, drug abuse and suicide prevention, mental health and family function- ing, and cross-cultural research on relationship and family dynamics. GEORGE M. REALMUTO received his MD from the State University of New York, Health campus at Brooklyn. He is currently the Medical Director of the State of Minnesota Child and Adolescent Behavioral Health Service and the Attention and Behavior Problems Clinic at the University of Minnesota Med- ical Center Fairview. Major areas of research include prevention of adverse outcomes of early disruptive behavior, community implementation of evi- denced based practice, and service delivery challenges. MICHAEL L. BLOOMQUIST received his PhD in clinical psychology from Illinois Institute of Technology. He is currently associate professor in the Department of Psychiatry at the University of Minnesota. His areas of professional interest include research evaluating the effects of comprehen- sive community-based prevention programs, provision of mental health services to children and families, and forensic psychology consultation. JASON L. HOROWITZ received his PhD in clinical psychology from Vander- bilt University. He currently works as a clinical child psychologist in the Department of Psychiatry at the University of Wisconsin. His research focuses on the prevention of mental health problems in children and adolescents. TODD L. EISENBERG received his MD from the University of Wisconsin and is currently a Child and Adolescent Psychiatry Fellow at the University of Minnesota. His research interests include the study of children’s mental health programs. THIS STUDY was conducted as part of the Early Risers Going-to-Scale Prevention Trial funded by National Institute of Drug Abuse (DA016067). We thank Sarah Coleman, the project manager for her dedication and competence that were largely responsible for making this project a success. The consultations of Sonja Schoenwald and Charles Glisson are appreci- ated. This work relied on the prevention efforts of the Family Advocates across the 27 sites and the support of school principals, collaborative supervisors, and teachers. Finally, we thank the many children and their parents who willingly participated in this research trial. CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Bonnie Klimes-Dougan, Division of Child and Adolescent Psychiatry, University of Minnesota School of Medicine, F256/2B West, 2450 Riverside Avenue, Minneapolis, MN 55454. E-mail: klimes@umn.edu Professional Psychology: Research and Practice © 2009 American Psychological Association 2009, Vol. 40, No. 5, 467– 475 0735-7028/09/$12.00 DOI: 10.1037/a0014623 467