Exploring Relationships Between CARE Program Fidelity, Quality, Participant Responsiveness, and Uptake of Mindful Practices

As the demand for mindfulness-based interventions grows, so does the need to monitor implementation to ensure effective delivery. Research has shown that the fidelity and quality of program implementation can impact intervention outcomes. This study reports on the development and use of implementation monitoring measures for the Cultivating Awareness and Resilience in Education (CARE) professional development program. Three facilitator-focused observer-rated measures of fidelity and quality of intervention delivery and three participant-focused measures that examined responsiveness and attendance to the program were used. Data were evaluated from six intervention implementations including 166 teachers from 36 schools in New York; 80% of participants provided follow-up data on engagement in mindful practices. We report on regression analyses that examined relationships between implementation monitoring measures and follow-up teacher outcomes related to uptake and sustainment of mindful awareness practices. Results indicated significant positive relationships with an alternative measure of adherence focused on completion of participant objectives and facilitation quality with follow-up teacher reports of continued practice (mindfulness practices used weekly, length of practices, extent that practices helped with stress). Further, participants’ perceived usefulness of the material demonstrated a strong positive relationship with length of practice and whether practices helped to reduce stress. Finally, interactions were found between attendance and adherence, and between facilitation quality and participant knowledge on practice outcomes. We explore the way these measures were used to support program delivery and facilitator training, and discuss the utility of an alternative measure of adherence focused on completion of participant learning objectives.