Date of Graduation


Document Type


Degree Name

Doctor of Philosophy in Psychology (PhD)

Degree Level



Psychological Science


Lauren Quetsch

Committee Member

Tim Cavell

Second Committee Member

Doug Behrend

Third Committee Member

Dustin Sarver


Child Psychology;Cost-Benefit;Cost-effectiveness;Dissemination;Implementation Science


To expand reach of evidence-based strategies for the treatment and prevention of childhood mental health issues, implementation efforts have been focused on educational settings. However, little is known about what facilitates the success of these programs. Implementation determinants provide insight about processes impacting success at the administrative and individual provider level. The current investigation examined data collected from a statewide implementation of Child-Adult Relationship Enhancement (CARE) in early childhood education centers and preschools. Two-hundred, seventeen teachers from 10 early childhood centers and preschools provided ratings of their students’ behavior for several weeks before and after participating in CARE training. Participants also completed measures of their attitudes towards evidence-based practice (EBP) and use of CARE skills. School directors completed ratings of their organization’s readiness to make changes needed to adopt EBP. Results indicated that school directors with lower self-rated efficacy and influence had teachers that felt more supported implementing CARE. Among teachers, openness to EBP before training was related to higher use of CARE after training and at follow-up (all p’s < .01). Higher openness was also related to greater skill knowledge before training. Results of structural equation modeling revealed the effect of teacher attitudes on the change in their students’ behaviors from pre- to post-training. Economic analysis demonstrated the cost-effectiveness of CARE training for reducing students’ disruptive behavior. In general, results indicated that both school directors’ readiness and teachers’ attitudes towards EBP significantly affected teachers’ use of CARE, as well as the potential benefit their students would receive from CARE. Outcomes were considered in the context of enhancing the scientific literacy of teachers to facilitate uptake of prevention and intervention.