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Examining the Implementation of Conscious Discipline®: A Qualitative Study Utilizing the I-PARIHS Framework

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Title: Examining the Implementation of Conscious Discipline®: A Qualitative Study Utilizing the I-PARIHS Framework
Language: English
Authors: Wilburn, Elissa (ORCID 0000-0002-8087-6410), John, Sufna (ORCID 0000-0002-7555-6340), Edge, Nicola (ORCID 0000-0001-6832-4384), Sutton, Melissa, Hickman, Karen
Source: Early Childhood Education Journal. Oct 2023 51(7):1131-1143.
Availability: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
Peer Reviewed: Y
Page Count: 13
Publication Date: 2023
Document Type: Journal Articles
Reports - Research
Education Level: Early Childhood Education
Preschool Education
Descriptors: Social Emotional Learning, Classroom Environment, Educational Change, Teaching Methods, Behavior Problems, Early Childhood Education, Young Children, Program Implementation, Evidence Based Practice, Preschool Teachers, Affordances, Barriers, Teacher Attitudes
DOI: 10.1007/s10643-022-01363-w
ISSN: 1082-3301
1573-1707
Abstract: Behavior disorders in early childhood are a major public health concern. A large percentage of young children spend their day in childcare settings, making early childhood educators a relevant population to target for behavior management interventions and training. Conscious Discipline® (CD®) is an evidence-based program targeting social emotional learning that involves helping teachers modify classroom environment and teacher strategies to address children's disruptive behavior. Although CD® has been widely disseminated across the country, very few studies have examined the implementation of the intervention, particularly within early childhood education settings. The current study utilized the promoting action on research implementation in health services framework (i-PARIHS) to assess both facilitators and barriers related to successful implementation among a large cohort of pre-Kindergarten teachers (N = 269). Qualitative methods were utilized to assess teachers' perceived impact of CD®; implementation of structures, rituals, and routines; and both facilitators and barriers to implementation. Results revealed both facilitators and barriers across domains of the innovation; recipients; and local, organizational, and external contexts. Theoretical and practical implications are discussed.
Abstractor: As Provided
Entry Date: 2023
Accession Number: EJ1390088
Database: ERIC
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  Value: <anid>AN0170717117;5mx01oct.23;2023Aug29.05:55;v2.2.500</anid> <title id="AN0170717117-1">Examining the Implementation of Conscious Discipline®: A Qualitative Study Utilizing the I-PARIHS Framework </title> <p>Behavior disorders in early childhood are a major public health concern. A large percentage of young children spend their day in childcare settings, making early childhood educators a relevant population to target for behavior management interventions and training. Conscious Discipline® (CD®) is an evidence-based program targeting social emotional learning that involves helping teachers modify classroom environment and teacher strategies to address children's disruptive behavior. Although CD® has been widely disseminated across the country, very few studies have examined the implementation of the intervention, particularly within early childhood education settings. The current study utilized the promoting action on research implementation in health services framework (i-PARIHS) to assess both facilitators and barriers related to successful implementation among a large cohort of pre-Kindergarten teachers (N = 269). Qualitative methods were utilized to assess teachers' perceived impact of CD®; implementation of structures, rituals, and routines; and both facilitators and barriers to implementation. Results revealed both facilitators and barriers across domains of the innovation; recipients; and local, organizational, and external contexts. Theoretical and practical implications are discussed.</p> <p>Keywords: Implementation; Childhood; Development; Social-emotional; Conscious Discipline®</p> <hd id="AN0170717117-2">Introduction</hd> <p>Behavior disorders are the second most common mental health condition in youth, with up to 20% of children nationally meeting full diagnostic criteria using the Diagnostic and Statistical Manual, 5th edition (DSM-5; Van Hulle et al., [<reflink idref="bib30" id="ref1">30</reflink>]). Behavioral difficulties during the toddler and preschool years (ages 2–5) predict poorer adjustment, including higher levels of depression, deficits in social skills, academic difficulties, and continued externalizing behaviors during middle childhood (Campbell et al., [<reflink idref="bib10" id="ref2">10</reflink>]). This trajectory is often cascading in nature such that continued externalizing behaviors increase the risk of additional problems, such as lower academic achievement, internalizing disorders, substance use, and criminality in adolescence and adulthood (e.g., Burke et al., [<reflink idref="bib7" id="ref3">7</reflink>]). These behaviors are exhibited across settings and tend to persist without effective treatment (Campbell & Ewing, [<reflink idref="bib9" id="ref4">9</reflink>]), thus representing a significant public health concern. In fact, the estimated lifetime cost to society of a single untreated high-risk youth is between 1.7 and 2.3 million dollars (Cohen, [<reflink idref="bib11" id="ref5">11</reflink>]; Cohen & Piquero, [<reflink idref="bib12" id="ref6">12</reflink>]).</p> <p>Fortunately, several evidence-based treatments (EBTs) exist for young children who exhibit behavior difficulties. Early childhood mental health and social-emotional interventions necessitate considerable modifications to caregiver strategies, given that young children develop within the context of caregiver-child relationships (Lieberman & VanHorn, [<reflink idref="bib24" id="ref7">24</reflink>]). Indeed, most EBTs for children focus on the caregiver-child relationship as the vehicle for symptom change and reduced impairment. Given that approximately 62% of young children (i.e., 5 years old and younger) spend much of their day in center-based or non-parental childcare (U.S. Department of Education, National Center for Education Statistics, [<reflink idref="bib29" id="ref8">29</reflink>]), equipping non-parental caregivers, such as early care and education (ECE) teachers, with evidence-based strategies is crucial for managing young child disruptive behaviors. Evidence suggests that many teachers feel ill-equipped and ECE teachers report that managing challenging behaviors is the area in which they most want training (Yoshikawa & Zigler, [<reflink idref="bib33" id="ref9">33</reflink>]).</p> <hd id="AN0170717117-3">Social Emotional Learning Programs</hd> <p>Social-emotional (SE) learning programs began in the 1970s and have become increasingly available across the country. SE learning programs can help address the challenges ECE teachers face with behavior management, as well as help prevent early emerging behavior concerns, improve learning, and increase social and emotional skills (Bierman et al., [<reflink idref="bib5" id="ref10">5</reflink>]; Durlak et al., [<reflink idref="bib17" id="ref11">17</reflink>]). SE learning is considered a developmental process in which children acquire and effectively apply knowledge, attitudes, and skills needed for emotion recognition, self-regulation, problem-solving, and establishing and maintaining positive relationships with others (Collaborative for Academic, Social, and Emotional Learning, [<reflink idref="bib13" id="ref12">13</reflink>]). Young children are undergoing significant and rapid development and require the support of adults to foster and help regulate social and emotional experiences (Bernier et al., [<reflink idref="bib4" id="ref13">4</reflink>]). One of the most widely disseminated classroom-based social emotional programs is called Conscious Discipline® (CD®), which entails modifying the classroom environment and facilitating teacher strategies to reduce child disruptive behaviors and build self-regulation and social skills. Despite the widespread use of CD®, the implementation of this program within early childhood education settings is vastly understudied.</p> <hd id="AN0170717117-4">Conscious Discipline®</hd> <p>Conscious Discipline® (CD®; Bailey, [<reflink idref="bib2" id="ref14">2</reflink>]) is a research-based program that provides adults with a framework to understand the internal brain-body states (e.g., structures, rituals, routines) that are most likely to produce certain behaviors in children and in themselves. Adults learn to consciously manage their own thoughts and emotions so that they can help children learn to do the same. In essence, adults are equipped to stay calm enough to see misbehavior and upset as a signal to teach instead of punish, promoting the use of effective strategies for teaching social-emotional and life skills to children. A primary conceptualization of CD® is that effective learning and self-regulation occurs in safe, loving, and connected environments (Bailey, [<reflink idref="bib2" id="ref15">2</reflink>]). CD® recognizes that children develop within the context of relationships, and thus focuses on building adult capacities as a method for influencing child behavior.</p> <p>CD® is rooted in established social-emotional and trauma-informed theory, and research on the impact of CD® is promising. The program was recognized by the substance abuse and mental health administration's (SAMHSA's) National registry of evidence-based programs and practices (NREPP), and was noted to have particular strengths in emotional process and school climate support in a Harvard analysis of the nation's top 25 SE learning programs (Jones et al., [<reflink idref="bib22" id="ref16">22</reflink>]). Teachers who implement CD® report decreases in children's internalizing and externalizing problems (Hoffman et al., [<reflink idref="bib21" id="ref17">21</reflink>]), increase in teachers' perceptions of a positive school climate, increase in teacher self-efficacy (e.g., Cooper, [<reflink idref="bib14" id="ref18">14</reflink>]) and reduction in discipline referrals and suspensions (Donovan et al., [<reflink idref="bib16" id="ref19">16</reflink>]). Notably, in an unpublished quasi-experimental study of 1396 students and 66 teachers, children in CD® classrooms outperformed students in non-CD® classrooms on social skills and school readiness (Anderson et al., [<reflink idref="bib1" id="ref20">1</reflink>]; Rain, [<reflink idref="bib27" id="ref21">27</reflink>]). In sum, there is evidence that CD® contributes to a variety of positive outcomes across teachers and children within the school environment.</p> <hd id="AN0170717117-5">Dissemination and Implementation of CD®</hd> <p>CD® is widely disseminated, as it is currently practiced in 47 countries and translated into 22 languages (Bailey, [<reflink idref="bib2" id="ref22">2</reflink>]). Within the limited literature focused on implementation, at least one study suggests that teachers generally perceive CD® procedures to be easy to implement on a daily basis and procedures are positively perceived (Caldarella et al., [<reflink idref="bib8" id="ref23">8</reflink>]). Specifically, at least three-quarters of teachers indicated they felt the program was appropriate, should be used consistently, improved outcomes for their students, and was an important part of their teaching interactions with students (Caldarella et al., [<reflink idref="bib8" id="ref24">8</reflink>]). Also, less than 10% of teachers reported that CD® was too time-consuming or challenging to implement (Caldarella et al., [<reflink idref="bib8" id="ref25">8</reflink>]). According to the existing literature on studies that have evaluated the implementation of CD®, results suggest that teachers' positive beliefs about their ability to manage children in their classroom, teachers' positive beliefs about their classroom climate, teacher buy-in, leadership support (Burke, [<reflink idref="bib6" id="ref26">6</reflink>]), and justification for implementation (Friedman & Kass, [<reflink idref="bib19" id="ref27">19</reflink>]) are related to successful implementation. Additionally, the length of time to implement components of the CD® program has been associated with a lack of positive outcomes (Cooper, [<reflink idref="bib14" id="ref28">14</reflink>]). Furthermore, a recent study found that higher fidelity to CD® was associated with improvements in social skills and executive functioning in a sample of preschool children (Anderson et al., [<reflink idref="bib1" id="ref29">1</reflink>]), highlighting the importance of research focused on exploring factors that impede or support implementation with fidelity.</p> <p>Although the widespread use of CD® is established within the literature, the degree to which the model is successfully implemented once disseminated within the school setting (i.e., the degree to which implementation factors such as acceptability, feasibility, fidelity, and sustainability exist within programs using CD®) has rarely been evaluated. These aforementioned results underscore the continued need to examine implementation of the model in larger samples of educators, given the widespread use of CD® among early childhood education teachers. Evaluating the implementation of programs is salient in the context of implementation science, which aids in understanding if and how the CD® program is practiced based on established guidelines and components.</p> <hd id="AN0170717117-6">Implementation Science</hd> <p>Implementation science (IS) is concerned with the way in which clinical innovations (e.g., healthcare policies, clinical practices or treatments) are put into practice (Bauer et al., [<reflink idref="bib3" id="ref30">3</reflink>]). It is clearly established across innovations that implementation is often poor; that is, it is challenging to change established practice to accommodate new innovations (Bauer et al., [<reflink idref="bib3" id="ref31">3</reflink>]). The promoting action on research implementation in health services framework (PARIHS; Kitson et al., [<reflink idref="bib23" id="ref32">23</reflink>]) is widely utilized to allow for the planning, examination, evaluation, and improvement of implementation efforts. It originally posited that successful implementation of an innovation was a function of the strength of the evidence for the innovation, characteristics of the context in which it was being implemented, and how the innovation was introduced and facilitated into practice. The framework was revised in 2016 (i-PARIHS; Harvey & Kitson, [<reflink idref="bib20" id="ref33">20</reflink>]) to also include characteristics of the recipient as an important contributor to successful implementation. Barriers and facilitators to successful implementation exist within each domain of the i-PARIHS framework.</p> <hd id="AN0170717117-7">The Current Study</hd> <p>The goal of the current study was to assess implementation of CD® among a large cohort of pre-Kindergarten teachers (N = 269) employed in state-funded pre-k programs across one southern state, using the i-PARIHS framework to guide the assessment of current implementation. Specifically, the current study explored barriers and facilitators for implementing CD® within the different domains of the i-PARIHS framework (i.e., innovation, recipients, context). Given that CD® is a framework comprised of several different strategies, barriers and facilitators to implementing the most common innovation strategies- structures, rituals and routines were examined.</p> <p>Based on the existing literature regarding program implementation, it is anticipated that innovation-related factors, such as the complexity of CD® and availability of resources, would influence the degree to which teachers report implementation of the model. Moreover, it is anticipated that recipient-related factors, including length of time since teachers participated in CD® training, prior knowledge and experience implementing CD®, and the degree to which teachers are "bought into" the model, will be facilitators to implementing the model. Finally, it is anticipated that context-related factors, such as leadership support, would impact implementation. The current study sought to elucidate facilitators and barriers related to implementation of CD® using a survey approach.</p> <hd id="AN0170717117-8">Methods</hd> <p>The current study was approved as non-human subjects research by the Institutional Review Board. The Arkansas Better Chance program (or ABC) is Arkansas's state-funded pre-kindergarten program. The Arkansas Department of Human Services Division of Child Care and Early Childhood Education (DCCECE) funds CD® training for licensed child care providers in Arkansas, and it is on the list of recommended trainings for the ABC program. CD® training occurs in three, 2 day blocks over about 6 months. Training is provided by Loving Guidance®, LLC (the overarching company dedicated to disseminating the knowledge and skills for implementation of CD®) training team members and facilitated by the staff at Arkansas State University Childhood Services. Coaching was available prior to 2014 upon request, and access to coaching/frequency and intensity of coaching visits varied based on geography and coaching caseloads.</p> <hd id="AN0170717117-9">Participants</hd> <p>The study sample consisted of 269 pre-k teachers who were either newly trained in CD® or who participated in training at least one year prior to the time of the study. Of the 267 teachers who participated and provided responses, a large majority (53.5%) were current trainees of CD® (N = 144), followed by teachers who received training in CD® one year (29.4%; N = 79) or two or more years (16.4%; N = 44) prior to the study. See Table 1 for a summary of teacher demographics.</p> <p>Table 1 Summary of teacher demographics</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" /><th align="left"><p><italic>n</italic></p></th><th align="left"><p>%</p></th></tr></thead><tbody><tr><td align="left" colspan="3"><p>Education level<sup>a</sup></p></td></tr><tr><td align="left"><p> High school diploma-GED</p></td><td align="left"><p>8</p></td><td align="left"><p>3</p></td></tr><tr><td align="left"><p> Some college</p></td><td align="left"><p>14</p></td><td align="left"><p>5.2</p></td></tr><tr><td align="left"><p> Associates degree</p></td><td align="left"><p>14</p></td><td align="left"><p>5.2</p></td></tr><tr><td align="left"><p> Bachelors degree</p></td><td align="left"><p>39</p></td><td align="left"><p>14.6</p></td></tr><tr><td align="left"><p> Some graduate school</p></td><td align="left"><p>16</p></td><td align="left"><p>5.9</p></td></tr><tr><td align="left"><p> Graduate degree</p></td><td align="left"><p>35</p></td><td align="left"><p>13</p></td></tr><tr><td align="left" colspan="3"><p>Child care role<sup>b</sup></p></td></tr><tr><td align="left"><p> Lead teacher</p></td><td align="left"><p>188</p></td><td align="left"><p>69.8</p></td></tr><tr><td align="left" colspan="3"><p>Time Since Training<sup>c</sup></p></td></tr><tr><td align="left"><p> Current trainee</p></td><td align="left"><p>144</p></td><td align="left"><p>53.5</p></td></tr><tr><td align="left"><p> 1 year ago</p></td><td align="left"><p>79</p></td><td align="left"><p>29.4</p></td></tr><tr><td align="left"><p> 2 or more years ago</p></td><td align="left"><p>44</p></td><td align="left"><p>16.4</p></td></tr><tr><td align="left" colspan="3"><p>Training/Certification<sup>d</sup></p></td></tr><tr><td align="left"><p> Child Development</p></td><td align="left"><p>51</p></td><td align="left"><p>42.5</p></td></tr><tr><td align="left"><p> Associate</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p> Certified Teacher</p></td><td align="left"><p>79</p></td><td align="left"><p>65.8</p></td></tr></tbody></table> </ephtml> </p> <p> <sups>a</sups>N = 126 <sups>b</sups>N = 269 <sups>c</sups>N = 269 <sups>d</sups>N = 120</p> <hd id="AN0170717117-10">Context</hd> <p>For this study, multiple methods were utilized to gather information from newly trained teachers and teachers who had the potential to implement CD® for a year or more. To survey teachers newly trained in CD® a convenience sample of pre-k teachers were surveyed at the end of their 6 months of training. These teachers were surveyed 'live' following their last training day and a random subset were invited to contribute to qualitative data collection via a focus group. To survey teachers with longer-term experience with CD® implementation, a web-based survey was emailed to all prior training cohorts. Specifics of these approaches are described below.</p> <hd id="AN0170717117-11">Live Survey</hd> <p>Teachers participated in a live survey on the final day of CD® training to determine the extent to which they had begun to implement the techniques they learned in their first 4 days of training across 6 months as well as their perception of the impact of those techniques on their classroom. In the CD® approach to training, a majority of core concepts, structures, rituals, and routines are introduced in the first 4 days of training, with additional concepts, structures, rituals, and routines introduced in the final 2 days of training. Thus, at the time of the survey teachers had been exposed to all CD® material and had an opportunity for 6 months of practice. The survey was administered electronically using an audience response system which allowed participants to submit their answers to survey questions shown on screens around the room using 'clickers' connected to a computer. On day 1 of the 6 day training, 287 individuals attended. When the survey was administered on day 6, 249 individuals were in attendance, of which 222 (89%) participated in the live survey. Of those, 159 (71%) were employed in state-funded pre-kindergarten systems and 143 (90%) were currently in an active teaching role and were included in study analyses.</p> <hd id="AN0170717117-12">Focus Groups</hd> <p>A focus group was conducted with trainees on the last day of training. Focus group participants were recruited via the placement of 'winning tickets' under randomly located chairs throughout the training rooms. A total of 10 tickets were placed, and eight teachers participated. Of note, teachers were provided the option to 'opt out' or give their ticket to a neighbor if they did not want to participate. The focus group consisted of eight participants from a variety of settings. Several teachers were part of a school district pre-k program and some were from a private setting (consistent with how state-funded pre-k programs operate in the state). The participants represented programs from both urban and rural areas. Most of the participants were teachers, but one participant was a director, who was an individual in a position to provide contributions from a teachers' perspective and not a direct supervisor for any teachers in their focus group. Focus group questions targeted teachers' reasoning for attending CD® training, ways in which teachers began implementation of CD® in their classroom, barriers to implementation, needed supports, and how CD® has impacted their classrooms. Given the limited amount of focus group participants, saturation was not expected and thus the researchers did not use a specific coding approach to these responses. Instead, qualitative data regarding innovation, recipients, and context that influenced implementation of CD® was gathered via a richer discussion. Exemplar quotes are included within the results section, when available, to provide the reader with "teacher voice" to accompany the quantitative survey findings.</p> <hd id="AN0170717117-13">Web Survey</hd> <p>Participants from past training cohorts were recruited for a web-based survey in part through the state pre-k coordinator at the DHS/DCCECE, who sent an introduction letter requesting the ABC pre-k program directors to distribute the survey. The goal of the letter was to ensure participants were aware the state was partnering in this survey for the purposes of evaluating the implementation of CD® among Arkansas teachers. The researchers notified child program directors regarding the letter, which the researchers then distributed directly to teachers via email. Participation was incentivized by providing respondents the option of entering a drawing with the chance to win 1 of 4 $50 Wal-Mart gift cards. Of note, responses to the web-based survey were requested of only those within a teaching role; individuals in an administrative role, for example, were not asked to complete the survey. The intent of the web-based survey was to gather information from pre-k teachers, who were trained a year prior to the current study, regarding both barriers and facilitators that aided in the implementation of CD®. For example, teachers were asked to identify supports using a "Yes/No" response format regarding factors related to directors' training, classroom coaches and mentors, financial resources, center-wide training, size of training, and continuing education and support from their state pre-kindergarten specialist.</p> <p>The web-based survey was distributed to 475 staff in state-funded pre-school centers. Of this group, 143 (30%) responded to the survey, and 126 (88%) responders were currently in teaching roles. Therefore, results from the 126 teachers who participated in the web-based survey were included in study analyses. Notably, for the purposes of this paper, only teachers from Arkansas Better Chance programs were included within analyses, as the sample sizes for teachers from other types of programs were small, limiting the ability to examine the impact of center type on outcomes.</p> <hd id="AN0170717117-14">Measures</hd> <p>Measures utilized in the current study were developed based upon collective input from the training and coaching team.</p> <hd id="AN0170717117-15">Implementation</hd> <p>A series of nine questions were used to determine the extent to which teachers reported using key CD® techniques. Specifically, items selected related to CD® structures, rituals, and routines. Teachers were asked to rate their implementation of three CD® structures (Safe Place®, Ways to be Helpful, We Care Center) and two routines (Brain Smart Start® and Visual Routines) on a three-point scale (not implemented, partially implemented or fully implemented). Additionally, teachers were asked to rate the frequency of their use of three CD® rituals (Absent Child, Wish Well Board, and Safe Keeper) on a four-point scale ranging from 'Never' to 'Always.'</p> <hd id="AN0170717117-16">Perceived Impact</hd> <p>A series of six questions was used to evaluate the extent to which teachers believe they changed the way they interact with the children in their classroom due to learning that occurred as a result of the training. For example, teachers were asked to report on their engagement of strategies focused on managing their own emotions or using assertive and positive commands with children. Teachers answered two additional questions to evaluate their perception of the impact the strategies had on the children in their classroom. For items related to teachers' beliefs regarding changes in their interactions with children in their classroom, the internal reliability was excellent (α = 0.91). Similarly, the items assessing teachers' use of assertive and positive commands with children demonstrated excellent internal consistency reliability (α = 0.90).</p> <hd id="AN0170717117-17">Barriers to Implementation</hd> <p>Teachers trained more than a year prior to the study were provided with specific examples regarding implementation barriers and asked to rate the extent to which each was an identified barrier using a four-point scale ranging from 'Strongly Disagree' to 'Strongly Agree.' The i-PARIHS model describes both internal and external barriers, where internal barriers are factors within and external barriers are factors outside of the implementation setting (Harvey & Kitson, [<reflink idref="bib20" id="ref34">20</reflink>]). More specifically, internal barriers consist of teacher knowledge, understanding, perceptions, and/or beliefs regarding implementation (i.e., feeling that the program is not applicable to the children with whom they work, lack of agreement with program techniques, time constraints, lack of understanding of program material). On the other hand, external barriers are those outside of teachers' individual traits or perspectives (i.e., not having needed materials and lack of support from other teachers or directors). Teachers were also provided the opportunity to note if they discontinued implementation after seeing no benefit.</p> <hd id="AN0170717117-18">Analyses</hd> <p>All statistical analyses were analyzed using IBM SPSS Statistics for Windows, version 25 (IBM Corp, [<reflink idref="bib15" id="ref35">15</reflink>]). Frequency statistics were used to generate the percentage of teachers who implemented particular CD® structures, routines, and rituals. Bivariate correlations were run to evaluate the associations between teacher demographics, perceived facilitators and barriers, and utilization of structures, rituals, and routines. Additionally, regression analyses were conducted to explore factors that support or impede teachers' implementation of CD® structures, rituals, routines, and other teaching strategies.</p> <hd id="AN0170717117-19">Results</hd> <p>A number of significant correlations emerged after conducting bivariate correlation analyses of variables related to teacher demographics, perceived internal and external barriers, and utilization of CD® structures, routines, and rituals. See Table 2 for a summary of correlations.</p> <p>Table 2 Bivariate correlations</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Variable</p></th><th align="left" /><th align="left"><p>1</p></th><th align="left"><p>2</p></th><th align="left"><p>3</p></th><th align="left"><p>4</p></th><th align="left"><p>5</p></th><th align="left"><p>6</p></th><th align="left"><p>7</p></th><th align="left"><p>8</p></th><th align="left"><p>9</p></th><th align="left"><p>10</p></th><th align="left"><p>11</p></th><th align="left"><p>12</p></th><th align="left"><p>13</p></th><th align="left"><p>14</p></th><th align="left"><p>15</p></th><th align="left"><p>16</p></th></tr></thead><tbody><tr><td align="left"><p>1.</p></td><td align="left"><p>School</p></td><td align="left"><p>–</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td char="." align="char" /></tr><tr><td align="left"><p>2.</p></td><td align="left"><p>Experience</p></td><td align="left"><p>−.21*</p></td><td align="left"><p>–</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td char="." align="char" /></tr><tr><td align="left"><p>3.</p></td><td align="left"><p>Training</p></td><td align="left"><p>.14</p></td><td align="left"><p>.07</p></td><td align="left"><p>–</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td char="." align="char" /></tr><tr><td align="left"><p>4.</p></td><td align="left"><p>Lead</p></td><td align="left"><p>.69**</p></td><td align="left"><p>.04</p></td><td align="left"><p>.15**</p></td><td align="left"><p>–</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td char="." align="char" /></tr><tr><td align="left"><p>5.</p></td><td align="left"><p>Director</p></td><td align="left"><p>−.06</p></td><td align="left"><p>.04</p></td><td align="left"><p>.12</p></td><td align="left"><p>−.04</p></td><td align="left"><p>–</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td char="." align="char" /></tr><tr><td align="left"><p>6.</p></td><td align="left"><p>CDA</p></td><td align="left"><p>−.59**</p></td><td align="left"><p>.31**</p></td><td align="left"><p>.05</p></td><td align="left"><p>−.50**</p></td><td align="left"><p>.07</p></td><td align="left"><p>–</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td char="." align="char" /></tr><tr><td align="left"><p>7.</p></td><td align="left"><p>Certified</p></td><td align="left"><p>.67**</p></td><td align="left"><p>−.04</p></td><td align="left"><p>−.07</p></td><td align="left"><p>.71**</p></td><td align="left"><p>−.14</p></td><td align="left"><p>−.71**</p></td><td align="left"><p>–</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td char="." align="char" /></tr><tr><td align="left"><p>8.</p></td><td align="left"><p>Coaching</p></td><td align="left"><p>.07</p></td><td align="left"><p>.10</p></td><td align="left"><p>.13</p></td><td align="left"><p>.09</p></td><td align="left"><p>.07</p></td><td align="left"><p>.07</p></td><td align="left"><p>−.04</p></td><td align="left"><p>–</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td char="." align="char" /></tr><tr><td align="left"><p>9.</p></td><td align="left"><p>External</p></td><td align="left"><p>−.03</p></td><td align="left"><p>−.07</p></td><td align="left"><p>−.15</p></td><td align="left"><p>−.02</p></td><td align="left"><p>−.17</p></td><td align="left"><p>−.06</p></td><td align="left"><p>.02</p></td><td align="left"><p>−.14</p></td><td align="left"><p>–</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td char="." align="char" /></tr><tr><td align="left"><p>10.</p></td><td align="left"><p>Internal</p></td><td align="left"><p>−.03</p></td><td align="left"><p>.01</p></td><td align="left"><p>.01</p></td><td align="left"><p>.04</p></td><td align="left"><p>.03</p></td><td align="left"><p>−.10</p></td><td align="left"><p>.10</p></td><td align="left"><p>−.28**</p></td><td align="left"><p>.55**</p></td><td align="left"><p>–</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td char="." align="char" /></tr><tr><td align="left"><p>11.</p></td><td align="left"><p>Impact-Child</p></td><td align="left"><p>.01</p></td><td align="left"><p>.10</p></td><td align="left"><p>−.04</p></td><td align="left"><p>−.03</p></td><td align="left"><p>−.15</p></td><td align="left"><p>.02</p></td><td align="left"><p>−.07</p></td><td align="left"><p>.08</p></td><td align="left"><p>.06</p></td><td align="left"><p>−.21*</p></td><td align="left"><p>–</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td char="." align="char" /></tr><tr><td align="left"><p>12.</p></td><td align="left"><p>Impact-Teacher</p></td><td align="left"><p>−.06</p></td><td align="left"><p>.07</p></td><td align="left"><p>−.05</p></td><td align="left"><p>−.10</p></td><td align="left"><p>−.15</p></td><td align="left"><p>.16</p></td><td align="left"><p>−.20*</p></td><td align="left"><p>.08</p></td><td align="left"><p>−.02</p></td><td align="left"><p>−.27**</p></td><td align="left"><p>.48**</p></td><td align="left"><p>–</p></td><td align="left" /><td align="left" /><td align="left" /><td char="." align="char" /></tr><tr><td align="left"><p>13.</p></td><td align="left"><p>Structures</p></td><td align="left"><p>−.06</p></td><td align="left"><p>.20*</p></td><td align="left"><p>.27**</p></td><td align="left"><p>−.02</p></td><td align="left"><p>.17</p></td><td align="left"><p>.24**</p></td><td align="left"><p>−.17</p></td><td align="left"><p>.31**</p></td><td align="left"><p>−.32**</p></td><td align="left"><p>−.40**</p></td><td align="left"><p>.36**</p></td><td align="left"><p>.28**</p></td><td align="left"><p>–</p></td><td align="left" /><td align="left" /><td char="." align="char" /></tr><tr><td align="left"><p>14.</p></td><td align="left"><p>Routines</p></td><td align="left"><p>−.14</p></td><td align="left"><p>.06</p></td><td align="left"><p>.12*</p></td><td align="left"><p>−.09</p></td><td align="left"><p>.16</p></td><td align="left"><p>.23**</p></td><td align="left"><p>−.25**</p></td><td align="left"><p>.28**</p></td><td align="left"><p>−.21*</p></td><td align="left"><p>−.33**</p></td><td align="left"><p>.18*</p></td><td align="left"><p>.06</p></td><td align="left"><p>.55**</p></td><td align="left"><p>–</p></td><td align="left" /><td char="." align="char" /></tr><tr><td align="left"><p>15.</p></td><td align="left"><p>Rituals</p></td><td align="left"><p>−.17*</p></td><td align="left"><p>.05</p></td><td align="left"><p>.12*</p></td><td align="left"><p>−.08</p></td><td align="left"><p>.08</p></td><td align="left"><p>.24**</p></td><td align="left"><p>−.25**</p></td><td align="left"><p>.30**</p></td><td align="left"><p>−.12</p></td><td align="left"><p>−.27**</p></td><td align="left"><p>.34**</p></td><td align="left"><p>.37**</p></td><td align="left"><p>.56**</p></td><td align="left"><p>.28**</p></td><td align="left"><p>–</p></td><td char="." align="char" /></tr><tr><td align="left"><p>16.</p></td><td align="left"><p>Strategies</p></td><td align="left"><p>.05</p></td><td align="left"><p>−.12</p></td><td align="left"><p>.02</p></td><td align="left"><p>.05</p></td><td align="left"><p>−.13</p></td><td align="left"><p>−.02</p></td><td align="left"><p>−.07</p></td><td align="left"><p>.29**</p></td><td align="left"><p>−.07</p></td><td align="left"><p>−.31**</p></td><td align="left"><p>.33**</p></td><td align="left"><p>.42**</p></td><td align="left"><p>.42**</p></td><td align="left"><p>.22*</p></td><td align="left"><p>.39**</p></td><td align="left"><p>–</p></td></tr></tbody></table> </ephtml> </p> <p> <emph>School</emph> highest level of school completed, <emph>Experience</emph> years of experience, <emph>Training</emph> trained more than 1 year ago, <emph>Lead</emph> lead teacher, <emph>Director</emph> director attended CD training, <emph>CDA</emph> child development associate credential, <emph>Certified</emph> certified teacher, <emph>Coaching</emph> received coaching, <emph>External</emph> external barriers, <emph>Internal</emph> internal barriers, <emph>Impact-Child</emph> teachers' perceived impact of CD on children, <emph>Impact-Teacher</emph> teachers' perceived impact of CD on teachers, <emph>Structures</emph> combination of all CD structures, <emph>Routines</emph> combination of all CD routines, <emph>Rituals</emph> combination of all CD rituals; <emph>Strategies</emph> teachers' use of CD strategies *<emph>p</emph> <.05, **<emph>p</emph> <.01</p> <hd id="AN0170717117-20">Implementation of CD® Components</hd> <p>Survey results indicated varying degrees of implementation related to specific CD® core techniques (i.e., structures, routines, and rituals). Moreover, degree of implementation within techniques (e.g., activities within structures) also varied.</p> <hd id="AN0170717117-21">Structures</hd> <p>The degree of implementation for three key techniques within the broader category of "structures" was assessed. Within structures, the "Safe Places®" structure was most frequently implemented, with 92% of teachers reporting at least partial implementation. Conversely, the "We Care Center" structure was least frequently implemented, with almost 70% of teachers reporting they had not implemented the technique at all. Of note, less than 20% of teachers reported fully implementing in two of the three structures techniques ("Ways to be Helpful" and the "We Care Center"), suggesting that full implementation was relatively low across most structures (see Table 3). Additionally, regression analyses revealed two factors that significantly predicted stronger implementation of CD® structures. Specifically, teachers who were trained more than one year prior to the study (β = 0.19, <emph>p</emph> < 0.05) as well as teachers who reported lower internal barriers (β = 0.29, <emph>p</emph> < 0.05) were significantly more likely to implement CD® structures.</p> <p>Table 3 Use of CD<sups>®</sups> structures and routines</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" /><th align="left"><p>Not implemented %</p></th><th align="left"><p>Partially implemented %</p></th><th align="left"><p>Fully implemented %</p></th></tr></thead><tbody><tr><td align="left" colspan="4"><p>Structures</p></td></tr><tr><td align="left"><p> Safe places®</p></td><td char="." align="char"><p>9.2</p></td><td char="." align="char"><p>30.6</p></td><td char="." align="char"><p>79.4</p></td></tr><tr><td align="left"><p> Ways to be helpful</p></td><td char="." align="char"><p>53.5</p></td><td char="." align="char"><p>57.5</p></td><td char="." align="char"><p>11.8</p></td></tr><tr><td align="left"><p> We care center</p></td><td char="." align="char"><p>79.4</p></td><td char="." align="char"><p>16.1</p></td><td char="." align="char"><p>4.4</p></td></tr><tr><td align="left" colspan="4"><p>Routines</p></td></tr><tr><td align="left"><p> Brain smart start®</p></td><td char="." align="char"><p>11.9</p></td><td char="." align="char"><p>58.9</p></td><td char="." align="char"><p>29.2</p></td></tr><tr><td align="left"><p> Visual routines</p></td><td char="." align="char"><p>24.6</p></td><td char="." align="char"><p>43.7</p></td><td char="." align="char"><p>31.7</p></td></tr></tbody></table> </ephtml> </p> <p> <emph>Safe Places®</emph> a comfortable place where children practice stress reducing activities, <emph>Ways to be Helpful</emph> method of visually communicating expected positive and specific behaviors within the classroom, <emph>We Care Center</emph> area to express concern and care for others, <emph>Brain Smart Start®</emph> starting each day with activities to unite, reduce stress, and connect, <emph>Visual Routines</emph> visual expectations for routines such as going to the bathroom or coming to circle time</p> <hd id="AN0170717117-22">Routines</hd> <p>The degree of implementation across the two routines surveyed showed similar degrees of implementation, with the majority of teachers reporting at least partial implementation of each technique (88.8% for "Brain Smart Start®" and 71.9% for "Visual Routines;" see Table 3). Additionally, having a trained director was marginally associated with stronger implementation of CD® routines. Greater perceived internal barriers (β = − 0.29, <emph>p</emph> < 0.05) and being a certified teacher (β = − 0.23, <emph>p</emph> < 0.05) were associated with weaker implementation of routines.</p> <hd id="AN0170717117-23">Rituals</hd> <p>The degree of implementation for three key rituals within the broader category of "rituals" was assessed. Approximately two-thirds of teachers agreed that they "often" or "almost always" utilized each of the three rituals. Conversely, less than one-quarter of teachers reported that they never use each strategy, indicating that at least partial implementation of rituals is common. See Table 4 for a summary of the degree of implementation for rituals. Regression analyses revealed that receiving coaching from [state university] staff predicted stronger implementation of CD® rituals (β = 0.19, <emph>p</emph> < 0.05).</p> <p>Table 4 Use of CD<sups>®</sups> rituals</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Ritual</p></th><th align="left"><p>Never %</p></th><th align="left"><p>Occasionally %</p></th><th align="left"><p>Often %</p></th><th align="left"><p>Always %</p></th></tr></thead><tbody><tr><td align="left"><p>Absent child</p></td><td char="." align="char"><p>16.5</p></td><td char="." align="char"><p>24.2</p></td><td char="." align="char"><p>15.4</p></td><td align="left"><p>44</p></td></tr><tr><td align="left"><p>Well wish board</p></td><td char="." align="char"><p>28.3</p></td><td char="." align="char"><p>16.8</p></td><td char="." align="char"><p>14.1</p></td><td align="left"><p>40.8</p></td></tr><tr><td align="left"><p>Safe keeper</p></td><td char="." align="char"><p>10.4</p></td><td char="." align="char"><p>29.0</p></td><td char="." align="char"><p>25.1</p></td><td align="left"><p>35.5</p></td></tr></tbody></table> </ephtml> </p> <p> <emph>Absent Child</emph> teachers and children participate in a welcome back ritual when a child returns from an absence, <emph>Well Wish Board</emph> a board to help the class wish absent children well every day; <emph>Safe Keeper</emph> verbally and nonverbally showing the children that the teachers' job is to keep the classroom safe and that the children's job is to help keep it safe</p> <hd id="AN0170717117-24">Teaching Strategies</hd> <p>Regarding teachers' use of CD strategies, a large majority reported that they either "agree" or "strongly agree" to utilization of calming techniques (88.5%), assertive positive commands (92%), and offering two positive choices (94%). Additionally, prior coaching (β = 0.24, <emph>p</emph> < 0.05) and lower perceived internal barriers (β = − 0.25, <emph>p</emph> < 0.05) were significantly associated with stronger implementation of teaching strategies. See Table 5 for a summary of all regression analyses.</p> <p>Table 5 Regression analyses examining study variables predicting use of CD<sups>®</sups></p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" /><th align="left" colspan="3"><p>Structures</p></th><th align="left" colspan="3"><p>Rituals</p></th><th align="left" colspan="3"><p>Routines</p></th><th align="left" colspan="3"><p>Teaching Strategies</p></th></tr><tr><th align="left"><p>Variable</p></th><th align="left"><p><italic>β</italic></p></th><th align="left"><p><italic>SE (B)</italic></p></th><th align="left"><p><italic>Β</italic></p></th><th align="left"><p><italic>β</italic></p></th><th align="left"><p><italic>SE (B)</italic></p></th><th align="left"><p><italic>Β</italic></p></th><th align="left"><p><italic>β</italic></p></th><th align="left"><p><italic>SE (B)</italic></p></th><th align="left"><p><italic>Β</italic></p></th><th align="left"><p><italic>β</italic></p></th><th align="left"><p><italic>SE (B)</italic></p></th><th align="left"><p><italic>Β</italic></p></th></tr></thead><tbody><tr><td align="left"><p>Certified</p></td><td char="." align="char"><p>−.09</p></td><td char="." align="char"><p>−.07</p></td><td char="." align="char"><p>.07</p></td><td char="." align="char"><p>−.21*</p></td><td char="." align="char"><p>−.30</p></td><td char="." align="char"><p>.13</p></td><td char="." align="char"><p>−.23*</p></td><td char="." align="char"><p>−.28</p></td><td char="." align="char"><p>.10</p></td><td char="." align="char"><p>−.00</p></td><td char="." align="char"><p>−.00</p></td><td char="." align="char"><p>.08</p></td></tr><tr><td align="left"><p>Training</p></td><td char="." align="char"><p>.19*</p></td><td char="." align="char"><p>.16</p></td><td char="." align="char"><p>.07</p></td><td char="." align="char"><p>.10</p></td><td char="." align="char"><p>.15</p></td><td char="." align="char"><p>.13</p></td><td char="." align="char"><p>−.00</p></td><td char="." align="char"><p>−.00</p></td><td char="." align="char"><p>.10</p></td><td char="." align="char"><p>−.03</p></td><td char="." align="char"><p>−.03</p></td><td char="." align="char"><p>.08</p></td></tr><tr><td align="left"><p>Director</p></td><td char="." align="char"><p>.11</p></td><td char="." align="char"><p>.09</p></td><td char="." align="char"><p>.07</p></td><td char="." align="char"><p>.05</p></td><td char="." align="char"><p>.07</p></td><td char="." align="char"><p>.13</p></td><td char="." align="char"><p>.16</p></td><td char="." align="char"><p>.18</p></td><td char="." align="char"><p>.10</p></td><td char="." align="char"><p>−.15</p></td><td char="." align="char"><p>−.13</p></td><td char="." align="char"><p>.07</p></td></tr><tr><td align="left"><p>Coaching</p></td><td char="." align="char"><p>.17</p></td><td char="." align="char"><p>.13</p></td><td char="." align="char"><p>.06</p></td><td char="." align="char"><p>.19*</p></td><td char="." align="char"><p>.25</p></td><td char="." align="char"><p>.12</p></td><td char="." align="char"><p>.12</p></td><td char="." align="char"><p>.13</p></td><td char="." align="char"><p>.10</p></td><td char="." align="char"><p>.24*</p></td><td char="." align="char"><p>.19</p></td><td char="." align="char"><p>.07</p></td></tr><tr><td align="left"><p>External</p></td><td char="." align="char"><p>−.07</p></td><td char="." align="char"><p>−.06</p></td><td char="." align="char"><p>.10</p></td><td char="." align="char"><p>.07</p></td><td char="." align="char"><p>.12</p></td><td char="." align="char"><p>.19</p></td><td char="." align="char"><p>.03</p></td><td char="." align="char"><p>.04</p></td><td char="." align="char"><p>.14</p></td><td char="." align="char"><p>.02</p></td><td char="." align="char"><p>.02</p></td><td char="." align="char"><p>.11</p></td></tr><tr><td align="left"><p>Internal</p></td><td char="." align="char"><p>−.29*</p></td><td char="." align="char"><p>−.35</p></td><td char="." align="char"><p>.13</p></td><td char="." align="char"><p>−.20</p></td><td char="." align="char"><p>−.42</p></td><td char="." align="char"><p>.25</p></td><td char="." align="char"><p>−.29*</p></td><td char="." align="char"><p>−.49</p></td><td char="." align="char"><p>.19</p></td><td char="." align="char"><p>−.25*</p></td><td char="." align="char"><p>−.31</p></td><td char="." align="char"><p>.14</p></td></tr><tr><td align="left"><p><italic>R</italic><sup><italic>2</italic></sup></p></td><td char="." align="char"><p>.23***</p></td><td char="." align="char" /><td char="." align="char" /><td char="." align="char"><p>.11**</p></td><td char="." align="char" /><td char="." align="char" /><td char="." align="char"><p>.17***</p></td><td char="." align="char" /><td char="." align="char" /><td char="." align="char"><p>.13**</p></td><td char="." align="char" /><td char="." align="char" /></tr><tr><td align="left"><p><italic>ΔR2</italic></p></td><td char="." align="char"><p>.27***</p></td><td char="." align="char" /><td char="." align="char" /><td char="." align="char"><p>.16**</p></td><td char="." align="char" /><td char="." align="char" /><td char="." align="char"><p>.22***</p></td><td char="." align="char" /><td char="." align="char" /><td char="." align="char"><p>.17**</p></td><td char="." align="char" /><td char="." align="char" /></tr><tr><td align="left"><p><italic>ΔF</italic></p></td><td char="." align="char"><p>6.23***</p></td><td char="." align="char" /><td char="." align="char" /><td char="." align="char"><p>3.24**</p></td><td char="." align="char" /><td char="." align="char" /><td char="." align="char"><p>4.70***</p></td><td char="." align="char" /><td char="." align="char" /><td char="." align="char"><p>3.65**</p></td><td char="." align="char" /><td char="." align="char" /></tr></tbody></table> </ephtml> </p> <p> <emph>Certified</emph> certified teacher, <emph>Training</emph> trained more than 1 year ago, <emph>Director</emph> director attended CD training, <emph>Coaching</emph> received coaching, <emph>External</emph> external barriers, <emph>Internal</emph> internal barriers *<emph>p</emph> <.05, **<emph>p</emph> <.01, ***<emph>p</emph> <.001</p> <hd id="AN0170717117-25">Facilitators and Barriers to Implementation Associated with I-PARIHS Domains</hd> <p></p> <hd id="AN0170717117-26">Innovation</hd> <p>Survey and focus group results indicated several facilitators and barriers related to characteristics of CD® across areas, including usability, complexity, relative advantage, and evidence from their own experiences implementing CD®. Focus group participant quotes are included below to illustrate "teacher voice" within findings.</p> <hd id="AN0170717117-27">Barriers</hd> <p>Several barriers were noted related to complexity, usability, and perceived advantage of CD®, including a lack of understanding of the innovation (10%) and feeling overwhelmed about ways to implement CD® in the classroom (66%). Also, some teachers noted that they discontinued using CD® after they did not perceive a relative advantage compared to the techniques they were already using (10%).</p> <hd id="AN0170717117-28">Facilitators</hd> <p>Although some teachers reported a lack of perceived advantage, most teachers noted significant improvements that they attributed to CD®. Over 85% of teachers reported a more positive classroom environment, better relationships with their students, and enhanced ability to respond to child disruptive behaviors. Over 85% of teachers also noted that their students were better able to communicate about emotions, control their behavior, and demonstrate appropriate problem-solving abilities. Focus group members echoed these facilitators, with comments such as "my classroom went from chaos to structure," and "[CD® training] was a total transformation for me, it changed the way I talked to myself and my kids."</p> <hd id="AN0170717117-29">Recipient</hd> <p>Survey and focus group results indicated facilitators and barriers related to teacher (recipient) characteristics, including personal motivation, beliefs, skills, and resources. Focus group participant quotes or themes are included below to illustrate "teacher voice" within findings.</p> <hd id="AN0170717117-30">Barriers</hd> <p>With regard to values and beliefs, approximately 15% of teachers reported that they did not agree with CD® techniques as a reason for poor implementation. One focus group member elaborated that "you have to drink the Kool Aid yourself and decide if you like it." They also reported that lacking time to focus on what they had learned (45%) or lack of access to necessary materials (55%) were barriers. Focus group members elaborated that they have a set budget for materials for their classroom, and lack of financial resources limited their ability to purchase CD® equipment or materials. Other members indicated that they could likely make some materials, but that there was no time in which to do this.</p> <hd id="AN0170717117-31">Facilitators</hd> <p>Survey results also indicated that teachers who are certified and had been trained in CD® less recently (2 or more years ago) were more likely to implement CD®.</p> <hd id="AN0170717117-32">Context</hd> <p>Survey results indicated several facilitators and barriers related to characteristics of CD® across the local and systems level regarding implementing CD®. Focus group participant quotes are included below to illustrate "teacher voice" within findings.</p> <hd id="AN0170717117-33">Barriers</hd> <p>With regard to local context, 24% of surveyed teachers reported a lack of support from other teachers within their agency as a significant barrier for implementation. For example, one teacher stated in the focus group that "if all teachers [in the classroom] are not on the same page, it creates a real struggle." Another member added this happens frequently due to the high turn-over of staff within the facility and stated that it would be "too hard to teach [new teachers]" about CD®. Similarly, 21% of teachers reported lack of support for CD® from the director of their agency as a local level barrier. Finally, at the systems level, teachers noted that implementing CD® was challenging within the context of other national requirements for the early childhood education environment (such as handwashing, free play, snack time, nap time).</p> <hd id="AN0170717117-34">Facilitators</hd> <p>Two facilitators to CD® implementation were noted at the local level. Teachers reported more successful implementation when their director was trained in CD® and when there was coaching support provided through learning networks.</p> <hd id="AN0170717117-35">Factors Associated with Overall Impact of CD®</hd> <p>Overall, data suggests the majority of teachers who participated in the current study perceived CD® to have a positive impact on their classroom environments, teacher–child relationships, and student social-emotional skills. Additionally, regression analysis revealed that lower perceived internal barriers (β = − 0.33, <emph>p</emph> < 0.01) significantly predicted positive impact on children overall.</p> <hd id="AN0170717117-36">Discussion</hd> <p>The goal of the current study was to evaluate barriers and facilitators regarding implementation of CD® among a sample of pre-k teachers using the i-PARIHS framework, underscoring the utility of a theory-driven implementation model in predicting implementation success and identifying needed supports.</p> <p>Results indicated that particular components (e.g., structures, rituals, and routines) of CD® differed in the degree of implementation among the study sample. It is possible that the differences in implementation across CD® components reflects teachers' perceptions regarding perceived advantage and relative advantage within their respective classroom and group of students. These results may also reflect the typical progression of CD® implementation over time. Implementing CD® with fidelity requires transformational change, which is different than transitional or traditional change, and requires individuals to commit to both changes in mindset and skill set (Bailey, [<reflink idref="bib2" id="ref36">2</reflink>]). Additionally, CD® suggests a timeline between 3 and 5 years to achieve full implementation of the model, with the first year serving as an "add on" year, the second year conceptualized as a "let go" year, and the third year being one of integration (e.g., Bailey, [<reflink idref="bib2" id="ref37">2</reflink>]). In the current study, more than 80% of teachers were within their first year of implementation, and therefore could be expected to be in the initial "add on" phase of implementation (Bailey, [<reflink idref="bib2" id="ref38">2</reflink>]).</p> <p>In the current study, facilitators of implementation identified in the inner contextual layer included both leadership (e.g., program directors trained in CD®) as well as the realm of structure, systems, and processes (e.g., coaching support through learning networks). This finding, in particular, is consistent with findings from previous literature that suggest coaching support and leadership endorsement are strong factors in successful implementation (Cooper, [<reflink idref="bib14" id="ref39">14</reflink>]). Leadership endorsement and coaching support may provide pragmatic support in implementing interventions for teachers as well as indicate overall organizational support, and potentially resources, ultimately increasing teachers' implementation of and adherence to program components.</p> <p>Organizational priorities, including difficulty incorporating CD® that is consistent with national requirements, emerged as an outer contextual barrier to implementation. This may suggest a need for further examination of educational demands at the macro level and may highlight the importance of evaluating competing expectations. Theoretical conceptualization of contextual layers within the i-PARIHS framework may also suggest larger organizational priorities at the macro level of the educational system may influence and potentially explain barriers identified at the micro and meso levels (e.g., lack of leadership support). National educational requirements and standards that prioritize research-informed practices and consider the quantity of demands of educational settings may have significant bearing on the degree of leadership support, recipient attitudes, and recipient capabilities to implement CD® program components. Further assessment of a school's organizational needs and priorities may be warranted prior to and/or during the course of CD® training to evaluate organizational capacity throughout training. Phases of implementation may enhance success when implementation of the full CD® protocol is not systemically feasible for schools (Finn, [<reflink idref="bib18" id="ref40">18</reflink>]).</p> <p>Regarding the innovation component of the i-PARIHS model, relative advantage was identified as both a facilitator and barrier to implementation of the CD® program. More specifically, some teachers reported lower perceived effectiveness of CD® strategies compared to those already established within the classroom, whereas other teachers reported positive changes in the classroom (e.g., better relationship with students) and observed improvements in their children's social and behavioral skills. Lower perceived effectiveness of CD® strategies may suggest the need to explore a teacher's feelings of self-efficacy in addition to exploring fidelity to CD® strategies, as low self-efficacy has been associated with difficulty managing child behavior within the classroom and does not necessarily indicate low effectiveness of an innovation, like CD® (Cooper, [<reflink idref="bib14" id="ref41">14</reflink>]). Additional barriers related to clarity (e.g., lacking understanding of CD®), novelty (e.g., feeling overwhelmed about implementation), and degree of fit (e.g., CD® described as not appropriate) were identified as barriers to implementation based on teacher responses. Indeed, previously unpublished studies (Finn, [<reflink idref="bib18" id="ref42">18</reflink>]) reported that teachers' beliefs regarding CD® approaches were not consistent with their philosophies regarding social and emotional development in children. Although separate characteristics within the innovation component of the i-PARIHS framework, issues surrounding clarity, novelty, and degree of fit may indicate the need for increased time spent discussing and addressing teacher attitudes towards and comprehension of CD® principles within training and throughout implementation. Exploring teacher attitudes, self-efficacy, and understanding of both the theory and practice behind CD® techniques may absolve additional issues related to relative advantage in implementation and simultaneously help reduce the likelihood of teacher burnout and contribute to a positive school climate more broadly (Freidman & Kass, [<reflink idref="bib19" id="ref43">19</reflink>]).</p> <p>Study findings also elucidated both facilitators and barriers to implementation of CD® within the recipients component of the i-PARIHS model (i.e., teachers who received training in CD®). Specifically, motivation and readiness to change were identified as facilitators to implementation of CD® due to teachers reporting the need for skills and strategies that CD® seemed to fulfill. Simply, these findings highlight the idea that successful implementation of a new innovation is more likely to occur when current practices are perceived to be ineffective. Additionally, teachers who acquired skills and knowledge and participated in CD® training greater than 2 years prior to the study were more likely to implement components of the program. It was beyond the scope of the current study to investigate differences in strategies across classrooms from the sample; however, these data solicit the question as to what factors may influence the perceived and actual effectiveness of strategies utilize (e.g., time, resources, values, beliefs).</p> <hd id="AN0170717117-37">Strengths</hd> <p>Although a substantial amount of research has demonstrated the effectiveness of the CD® program, the current study examined and revealed both important facilitators and barriers related to implementation of CD® within early childhood educational settings using a theory-driven implementation model (i.e., i-PARIHS). Notably, the current study sample targeted preschool providers from some of the highest resource programs in the state (i.e., financial resources, high attendance from teachers and administrators, previous coaching, established certifications and prior attendance to training). Results from this study highlight that even in high resource programs, barriers to implementation exist and further highlight the necessity of program evaluation.</p> <hd id="AN0170717117-38">Limitations</hd> <p>Despite strengths of the study, a few limitations should be considered when interpreting results. Study results are inherently limited to educational settings that would be similar in nature to those included within the current study. Therefore, results may not entirely generalize to school systems that are dissimilar in organizational infrastructure. In addition, most teachers were in the first year of implementation of CD® and additional research is needed to understand patterns of implementation over time.</p> <p>Methodologically, there was a varied survey response rate for the web-based survey. Investigators are unable to determine if teachers who self-selected to complete the web-based survey shared characteristics making them more likely to participate. Additionally, the current study was limited to self-report measurement to aid in feasibility of gathering data. Although this helped to gather a large sample of teachers from across the state, the survey method did not include observational data of implementation as a means of assessing fidelity to the CD® model.</p> <p>Furthermore, Stetler et al., ([<reflink idref="bib28" id="ref44">28</reflink>]) outline limitations specific to the i-PARIHS model. For example, although characteristics of the i-PARIHS components were further defined (Stetler et al., [<reflink idref="bib28" id="ref45">28</reflink>]), the conceptualization of the various facilitators and barriers within the i-PARIHS model may influence how facilitators and barriers are categorized across the framework, potentially shaping the overall understanding of the factors contributing to implementation of CD®; indeed this may lead to differences in interpretations of study results (Stetler et al., [<reflink idref="bib28" id="ref46">28</reflink>]). Measurement intended to deepen understanding of particular facilitators and barriers may elucidate components of the i-PARIHS model that both promote and restrict implementation capabilities.</p> <hd id="AN0170717117-39">Future Directions</hd> <p>CD® is widely disseminated in classrooms across the country. However, there have been very few studies examining factors associated with implementing the program. In light of some methodological limitations in the current study, future studies may consider a multi-informant multi-method approach to evaluating implementation of CD® (i.e., independent structured observations pre- and post-training and ratings of both teacher–child interactions and child behavior). In addition, utilizing CD® fidelity forms will enhance and supplement future work targeted at evaluating factors related to success that are implemented with program fidelity. Additionally, assessment of perceived effectiveness of CD® strategies, attitudes related to social and emotional development in early childhood, teachers' level of burnout, teachers' self-efficacy, and contextual aspects related to school climate (e.g., leadership support and support among teachers) may preemptively address barriers and promote facilitators that were identified in the current study.</p> <p>Furthermore, longitudinal evaluation consisting of multiple data points of CD® would allow for examination of changes in implementation over time, providing a deeper understanding of the factors that contribute to program sustainability. Notably, teacher turnover rates are prevalent in early childhood care settings, with national rates ranging from 13% (Phillips et al., [<reflink idref="bib25" id="ref47">25</reflink>]) to 40% (Wells, [<reflink idref="bib32" id="ref48">32</reflink>]). Future CD® implementation studies may benefit from assessing teacher turnover rates and if, how, and why this may impact implementation at the individual (i.e., teacher) and organizational (i.e., system or administrative) levels. For example, lower teacher turnover rates may be related to higher implementation of CD® components due to consistency in staff and opportunity for utilizing the CD® curriculum. On the other hand, higher teacher turnover may indirectly impact implementation due to increases in organizational stress. More specifically, schools endure costs following teacher turnover (e.g., hiring-related costs and new employee training; Watlington et al., [<reflink idref="bib31" id="ref49">31</reflink>]) and consequently may shift the priorities of other school programming. Additionally, future studies should examine sufficient (or "good enough") implementation, such that developing a better understanding regarding the threshold or degree to which CD® needs to be implemented to produce positive changes. Lastly, the field of IS has proposed The expert recommendations for implementing change (ERIC) program, which contains a list of 73 implementation strategies designed to enhance commitment and application of best practices (Powell et al., [<reflink idref="bib26" id="ref50">26</reflink>]). Future studies may consider utilizing ERIC to identify strategies that match barriers to both the dissemination and implementation of CD®.</p> <hd id="AN0170717117-40">Conclusion</hd> <p>In conclusion, the current study revealed both facilitators and barriers related to the implementation of CD® in a sample of pre-k teachers. Facilitators and barriers identified are consistent with findings from previous studies and specifically highlight factors that promote successful implementation as well as reveal barriers that are pertinent to both novice and experienced teachers implementing CD®. Additional research is warranted to further investigate factors associated with successful implementation and potentially explore the methods in which these findings can aid in strengthening either CD® trainings and/or implementation support within early childhood settings.</p> <hd id="AN0170717117-41">Acknowledgements</hd> <p>Conscious Discipline® training for early care and education professionals in Arkansas is supported by the Arkansas Department of Human Services/Division of Child Care and Early Childhood Education through a contract to Arkansas State University.</p> <hd id="AN0170717117-42">Author Contributions</hd> <p>Project administration: EW; Conceptualization: SJ, NE; Methodology: EW; Formal analysis and investigation: NE, EW; Writing-original draft preparation: SJ, EW; Writing-review and editing: EW, SJ, NE, MS, KH; Supervision: SJ. All authors read and approved the final manuscript.</p> <hd id="AN0170717117-43">Funding</hd> <p>Not applicable.</p> <hd id="AN0170717117-44">Data Availability</hd> <p>The data described within this manuscript are available from the corresponding author on reasonable request.</p> <p>None.</p> <hd id="AN0170717117-45">Declarations</hd> <p></p> <hd id="AN0170717117-46">Conflict of interest</hd> <p>The authors have no relevant financial or non-financial interests to disclose.</p> <hd id="AN0170717117-47">Publisher's Note</hd> <p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p> <ref id="AN0170717117-48"> <title> References </title> <blist> <bibl id="bib1" idref="ref20" type="bt">1</bibl> <bibtext> Anderson KL, Weimer M, Fuhs MW. Teacher fidelity to CD and children's executive function skills. 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  Data: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 13
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2023
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Early+Childhood+Education%22">Early Childhood Education</searchLink><br /><searchLink fieldCode="EL" term="%22Preschool+Education%22">Preschool Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Social+Emotional+Learning%22">Social Emotional Learning</searchLink><br /><searchLink fieldCode="DE" term="%22Classroom+Environment%22">Classroom Environment</searchLink><br /><searchLink fieldCode="DE" term="%22Educational+Change%22">Educational Change</searchLink><br /><searchLink fieldCode="DE" term="%22Teaching+Methods%22">Teaching Methods</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Problems%22">Behavior Problems</searchLink><br /><searchLink fieldCode="DE" term="%22Early+Childhood+Education%22">Early Childhood Education</searchLink><br /><searchLink fieldCode="DE" term="%22Young+Children%22">Young Children</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Implementation%22">Program Implementation</searchLink><br /><searchLink fieldCode="DE" term="%22Evidence+Based+Practice%22">Evidence Based Practice</searchLink><br /><searchLink fieldCode="DE" term="%22Preschool+Teachers%22">Preschool Teachers</searchLink><br /><searchLink fieldCode="DE" term="%22Affordances%22">Affordances</searchLink><br /><searchLink fieldCode="DE" term="%22Barriers%22">Barriers</searchLink><br /><searchLink fieldCode="DE" term="%22Teacher+Attitudes%22">Teacher Attitudes</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1007/s10643-022-01363-w
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1082-3301<br />1573-1707
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Behavior disorders in early childhood are a major public health concern. A large percentage of young children spend their day in childcare settings, making early childhood educators a relevant population to target for behavior management interventions and training. Conscious Discipline® (CD®) is an evidence-based program targeting social emotional learning that involves helping teachers modify classroom environment and teacher strategies to address children's disruptive behavior. Although CD® has been widely disseminated across the country, very few studies have examined the implementation of the intervention, particularly within early childhood education settings. The current study utilized the promoting action on research implementation in health services framework (i-PARIHS) to assess both facilitators and barriers related to successful implementation among a large cohort of pre-Kindergarten teachers (N = 269). Qualitative methods were utilized to assess teachers' perceived impact of CD®; implementation of structures, rituals, and routines; and both facilitators and barriers to implementation. Results revealed both facilitators and barriers across domains of the innovation; recipients; and local, organizational, and external contexts. Theoretical and practical implications are discussed.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2023
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1390088
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1390088
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        Value: 10.1007/s10643-022-01363-w
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 13
        StartPage: 1131
    Subjects:
      – SubjectFull: Social Emotional Learning
        Type: general
      – SubjectFull: Classroom Environment
        Type: general
      – SubjectFull: Educational Change
        Type: general
      – SubjectFull: Teaching Methods
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      – SubjectFull: Behavior Problems
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      – SubjectFull: Early Childhood Education
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      – SubjectFull: Young Children
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      – SubjectFull: Barriers
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      – SubjectFull: Teacher Attitudes
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    Titles:
      – TitleFull: Examining the Implementation of Conscious Discipline®: A Qualitative Study Utilizing the I-PARIHS Framework
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