Supporting implementation of universal prevention initiatives in K-12 schools: impacts on fidelity through organizational readiness and team functioning in a cluster-randomized trial.

Background: Rural School Support Strategies (RS3) is a bundle of implementation supports (including training, technical assistance, and a virtual learning collaborative) designed for the scale-up of universal prevention initiatives. This study addresses mechanisms of action, exploring whether positive effects of RS3 on implementation fidelity are attributable to improvements in functioning of school implementation teams, and increases in organizational readiness.

Methods: Data are from a cluster-randomized hybrid Type 3 implementation-effectiveness trial of RS3 among rural Idaho schools implementing Positive Behavioral Interventions and Supports (PBIS). Forty public K-12 schools in Idaho, located in rural areas or townships, were recruited for the trial and were equally randomized to either the basic supports condition, including standard trainings, or to the RS3 condition. Condition was not masked. The mechanistic aims were hypothesized prior to the trial and tested with survey data from individuals on each school's implementation team (n = 205). Surveys were collected in spring 2019 and 2020 regarding organizational readiness and team functioning. The outcome measure was PBIS implementation fidelity, measured by school teams during the summers of 2019 and 2020 using the Tiered Fidelity Inventory. School-level path models tested the effect of RS3 on implementation fidelity, controlling for baseline, school grade level, and school location. Multilevel (2-1-2) mediation models tested the degree to which individual team members' perceptions of organizational readiness and team functioning mediated the relationship between school-level experimental condition and fidelity, controlling for the team members' role.

Results: Schools receiving RS3 reported significantly greater implementation fidelity, although effects were slightly reduced (b = 8.40, p = .056, 95% CI [-0.22,17.01], β = 0.54) after inclusion of baseline and demographic controls. Models indicated a significant indirect effect of RS3 on fidelity through increased team productivity (b = 6.30, SE = 2.63, p = .017, MC 95% CI [0.83,13.86], β = 0.21), and effects through organizational readiness, change commitment, team culture, and team goal setting.

Conclusions: External supports may improve implementation of universal prevention initiatives in rural schools through improvements in readiness and fostering teaming in organizations.

Trial Registration: This research was prospectively registered on ClinicalTrials.gov ( NCT03736395 ), on November 9, 2018.