Year of Award


Document Type


Degree Type

Doctor of Philosophy (PhD)

Degree Name

Clinical Psychology

Department or School/College

Department of Psychology

Committee Chair

Anisa Goforth

Commitee Members

Christine Fiore, Cameo Stanick, Jacquie Brown, Lindsey Nichols


CFIR, implementation, IOF, rural, schools, trauma


University of Montana


High rates of childhood trauma exposure (65-75%) are concerning given the negative outcomes associated with trauma-related symptoms. Numerous evidence-based practices (EBPs) have been developed to treat posttraumatic stress symptoms; however, schools often experience barriers to implementing these interventions with fidelity. Given the scarcity of service options within rural areas, this qualitative study explored factors that might influence the adoption and implementation of trauma-focused interventions within rural schools using the Consolidated Framework for Implementation Research (CFIR; Damschroder et al., 2009) and the Implementation Outcomes Framework (IOF; Proctor et al., 2011). A semi-structured protocol was used to interview clinicians working in rural schools (N = 12) about their use of trauma-focused interventions. Transcripts were double coded using a deductive content analysis approach and a CFIR- and IOF-based coding manual. Every participant reported adopting a mental health intervention to treat posttraumatic stress symptoms, though only 25% had adopted an EBP to treat trauma-related symptoms. One participant worked in a school that declined an opportunity to adopt trauma-informed care. Thematic analyses revealed that most participants reported the same IOF constructs (i.e., acceptability, appropriateness, feasibility) as both facilitators and barriers to adopting trauma-informed interventions. Implementation constructs across all CFIR domains (i.e., intervention characteristics, outer setting, inner setting, characteristics of individuals, process) were commonly identified as influencing implementation success within rural schools. These results have the capacity to direct the selection of implementation strategies to enhance the adoption and implementation of trauma-focused EBPs within schools, thereby increasing the accessibility of trauma-focused care in rural areas.



© Copyright 2019 Heather Marie Halko