, Volume 7, Issue 1, pp 5–33 | Cite as

Assessing Fidelity of Implementation (FOI) for School-Based Mindfulness and Yoga Interventions: A Systematic Review

  • Laura Feagans Gould
  • Jacinda K. Dariotis
  • Mark T. Greenberg
  • Tamar Mendelson


As school-based mindfulness and yoga programs gain popularity, the systematic study of fidelity of program implementation (FOI) is critical to provide a more robust understanding of the core components of mindfulness and yoga interventions, their potential to improve specified teacher and student outcomes, and our ability to implement these programs consistently and effectively. This paper reviews the current state of the science with respect to inclusion and reporting of FOI in peer-reviewed studies examining the effects of school-based mindfulness and/or yoga programs targeting students and/or teachers implemented in grades kindergarten through twelve (K-12) in North America. Electronic searches in PsychInfo and Web of Science from their inception through May 2014, in addition to hand searches of relevant review articles, identified 312 publications, 48 of which met inclusion criteria. Findings indicated a relative paucity of rigorous FOI. Fewer than 10 % of studies outlined potential core program components or referenced a formal theory of action, and fewer than 20 % assessed any aspect of FOI beyond participant dosage. The emerging nature of the evidence base provides a critical window of opportunity to grapple with key issues relevant to FOI of mindfulness-based and yoga programs, including identifying essential elements of these programs that should be faithfully implemented and how we might develop rigorous measures to accurately capture them. Consideration of these questions and suggested next steps are intended to help advance the emerging field of school-based mindfulness and yoga interventions.


Mindfulness Yoga Fidelity Implementation Review School-based intervention 



This project was supported by and made possible through  a grant from the National Institute on Drug Abuse (R34DA029237). We would like to thank Tony Garofano for his gracious help with graphics and layout.

Conflict of Interest



  1. Anderson, V. L., Levinson, E. M., Barker, W., & Kiewra, K. R. (1999). The effects of meditation on teacher perceived occupational stress, state and trait anxiety, and burnout. School Psychology Quarterly, 14(1), 3–25.CrossRefGoogle Scholar
  2. Barnes, V. A., Taylor, F. A., & Davis, H. (2001). Impact of Transcendental Meditation on cardiovascular function at rest and during acute stress in adolescents with high normal blood pressure. Journal of Psychosomatic Research, 51, 597–605.Google Scholar
  3. Barnes, V. A., Davis, H. C., Murzynowski, J. B., & Treiber, F. A. (2004). Impact of meditation on resting and ambulatory blood pressure and heart rate in youth. Psychosomatic Medicine, 66(6), 909–914.CrossRefPubMedGoogle Scholar
  4. Barnes, V. A., Pendergrast, R. A., Harshfield, G. A., & Treiber, F. A. (2008). Impact of breathing awareness meditation on ambulatory blood pressure and sodium handling in prehypertensive African American adolescents. Ethnicity & Disease, 18(1), 1–5.Google Scholar
  5. Beauchemin, J., Hutchins, T. L., & Patterson, F. (2008). Mindfulness meditation may lessen anxiety, promote social skills, and improve academic performance among adolescents with learning disabilities. Complementary Health Practice Review, 13(1), 34–45.Google Scholar
  6. Benn, R., Akiva, T., Arel, S., & Roeser, R. W. (2012). Mindfulness training effects for parents and educators of children with special needs. Developmental Psychology, 48(5), 1476–1487.CrossRefPubMedGoogle Scholar
  7. Berger, D. L., Silver, E. J., & Stein, R. E. (2009). Effects of yoga on inner-city children’s well-being: a pilot study. Alternative Therapies in Health and Medicine, 15(5), 36–42.Google Scholar
  8. Berkel, C., Mauricio, A. M., Schoenfelder, E., & Sandler, I. N. (2011). Putting the pieces together: An integrated model of program implementation. Prevention Science, 12, 23–33.CrossRefPubMedGoogle Scholar
  9. Black, D. S., & Fernando, R. (2013). Mindfulness training and classroom behavior among lower-income and ethnic minority elementary school children. Journal of Child and Family Studies, 23(7), 1242–1246.Google Scholar
  10. Broderick, P. C., & Metz, S. (2009). Learning to BREATHE: a pilot trial of a mindfulness curriculum for adolescents. Advances in School Mental Health Promotion, 2(1), 35–46.CrossRefGoogle Scholar
  11. Carroll, C., Patterson, M., Wood, S., Booth, A., Rick, J., & Balain, S. (2007). A conceptual framework for implementation fidelity. Implementation Science, 2, 40–48.PubMedCentralCrossRefPubMedGoogle Scholar
  12. Century, J., Rudnick, M., & Freeman, C. (2010). A framework for measuring fidelity of implementation: a foundation for shared language and accumulation of knowledge. American Journal of Evaluation, 31(2), 199–218.CrossRefGoogle Scholar
  13. Coatsworth, J. D., Duncan, L. G., Pantin, H., & Szapocznik, J. (2006). Retaining ethnic minority parents in a preventive intervention: the quality of group process. Journal of Primary Prevention, 27, 367–389.CrossRefPubMedGoogle Scholar
  14. Conboy, L. A., Noggle, J. J., Frey, J. L., Kudesia, R. S., & Khalsa, S. B. S. (2013). Qualitative evaluation of a high school yoga program: feasibility and perceived benefits. Explore: The Journal of Science and Healing, 9(3), 171–180.CrossRefGoogle Scholar
  15. Cook-Cottone, C. (2013). Dosage as a critical variable in yoga therapy research. International Journal of Yoga Therapy, 23(2), 11–12.PubMedGoogle Scholar
  16. Crane, R. S., Kuyken, W., Hastings, R. P., Rothwell, N., & Williams, J. M. G. (2010). Training teachers to deliver mindfulness-based interventions: learning from the UK experience. Mindfulness, 1, 74–86. doi: 10.1007/s12671-010-0010-9.PubMedCentralCrossRefPubMedGoogle Scholar
  17. Crane, R. S., Kuyken, W., Williams, J. M. G., Hastings, R. P., Cooper, L., & Fennell, M. J. V. (2012a). Competence in teaching mindfulness-based courses: concepts, development and assessment. Mindfulness, 3, 76–84.PubMedCentralCrossRefPubMedGoogle Scholar
  18. Crane, R.S., Soulsby, J.G., Kuyken, W., Williams, J.M.G., Eames, C, Bartley, T., et al. (2012b). The Bangor, Exeter & Oxford mindfulness-based interventions teaching assessment criteria (MBI:TAC).
  19. Dane, A. V., & Schneider, B. H. (1998). Program integrity in primary and early secondary prevention: are implementation effects out of control? Clinical Psychology Review, 18(1), 23–45.CrossRefPubMedGoogle Scholar
  20. Davidson, R. J., & Mind and Life Education Research Network. (2012). Contemplative practices and mental training: prospects for American education. Child Development Perspectives, 6(2), 146–153.CrossRefGoogle Scholar
  21. Deming, W. E. (1986). Out of crisis. Cambridge: MIT Press.Google Scholar
  22. Diamond, A., & Lee, K. (2011). Interventions shown to aid executive function development in children 4 to 12 years old. Science, 333(6045), 959–964.PubMedCentralCrossRefPubMedGoogle Scholar
  23. Dobkin, P. L., Hickman, S., & Monshat, K. (2013). Holding the heart of mindfulness-based stress-reduction: balancing fidelity and imagination when adapting MBSR. Mindfulness, 5(6), 710–718.Google Scholar
  24. Domitrovich, C. E., & Greenberg, M. T. (2000). The study of implementation: current findings from effective programs that prevent mental disorders in school-aged children. Journal of Educational and Psychological Consultation, 11, 193–221.CrossRefGoogle Scholar
  25. Durlak, J. A. (1985). School-based prevention programs for children and adolescents. New York: Plenum.Google Scholar
  26. Durlak, J. A. (1998). Why program implementation is important. Journal of Prevention & Intervention in the Community, 17, 5–18.CrossRefGoogle Scholar
  27. Durlak, J. A., & Dupre, E. P. (2008). Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation. American Journal of Community Psychology, 41, 327–350.CrossRefPubMedGoogle Scholar
  28. Dusenbury, L., Brannigan, R., Falco, M., & Hansen, W. B. (2003). A review of research on fidelity of implementation: implications for drug abuse prevention in school settings. Health Education Research Theory & Practice, 18(2), 237–256.CrossRefGoogle Scholar
  29. Elder, C., Nidich, S., Colbert, R., Hagelin, J., Grayshield, L., Oviedo-Lim, D., et al. (2011). Reduced psychological distress in racial and ethnic minority students practicing the transcendental meditation program. Journal of Instructional Psychology, 38(2), 109–116.Google Scholar
  30. Feagans Gould, L., Dariotis, J. K., Mendelson, T., & Greenberg, M. (2012). A school‐based mindfulness intervention for urban youth: exploring moderators of intervention effects. Journal of Community Psychology, 40(8), 968–982.CrossRefGoogle Scholar
  31. Feagans Gould, L., Mendelson, T., Dariotis, J. K., Ancona, M., Smith, A. S. R., Gonzalez, A. A., Smith, A. A., & Greenberg, M. T. (2014). Assessing fidelity of core components in a mindfulness and yoga intervention for urban youth: applying the CORE process. New Directions for Youth Development, 142, 59–81.CrossRefGoogle Scholar
  32. Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M. & Wallace, F. (2005). Implementation research: a synthesis of the literature. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network (FMHI Publication #231).
  33. Fixsen, D. L., Blasé, K. A., Naoom, S. F., & Wallace, F. (2009). Core implementation components. Research on Social Work Practice, 19, 531–540.CrossRefGoogle Scholar
  34. Flook, L., Smalley, S. L., Kitil, M. J., Galla, B. M., Kaiser-Greenland, S., Locke, J., et al. (2010). Effects of mindful awareness practices on executive functions in elementary school children. Journal of Applied School Psychology, 26(1), 70–95.CrossRefGoogle Scholar
  35. Flook, L., Goldberg, S. B., Pinger, L., Bonus, K., & Davidson, R. J. (2013). Mindfulness for teachers: a pilot study to assess effects on stress, burnout, and teaching efficacy. Mind, Brain, and Education, 7(3), 182–195.CrossRefGoogle Scholar
  36. Forgatch, M. S., Patterson, G. R., & DeGarmo, D. S. (2005). Evaluating fidelity: predictive validity for a measure of competent adherence to the Oregon model of parent management training (PMTO). Behavior Therapy, 36, 3–13.PubMedCentralCrossRefPubMedGoogle Scholar
  37. Frank, J. L., Reibel, D., Broderick, P., Cantrell, T., & Metz, S. (2013). The effectiveness of mindfulness-based stress reduction on educator stress and well-being: results from a pilot study. Mindfulness, Advance online publication. doi: 10.1007/s12671-013-0246-2.
  38. Frank, J. L., Bose, B., & Schrobenhauser-Clonan, A. (2014). Effectiveness of a school-based yoga program on adolescent mental health, stress coping strategies, and attitudes toward violence: findings from a high-risk sample. Journal of Applied School Psychology, 30(1), 29–49.CrossRefGoogle Scholar
  39. Gelderloos, P., Lockie, R. J., & Chuttoorgoon, S. (1987). Field independence of students at Maharishi School of the Age of Enlightenment and a Montessori school. Perceptual and Motor Skills, 65(2), 613–614.CrossRefGoogle Scholar
  40. Ghahremani, D. G., Oh, E. Y., Dean, A. C., Mouzakis, K., Wilson, K. D., & London, E. D. (2013). Effects of the Youth Empowerment seminar on impulsive behavior in adolescents. Journal of Adolescent Health, 53(1), 139–141.CrossRefPubMedGoogle Scholar
  41. Greenberg, M. T., & Harris, A. R. (2012). Nurturing mindfulness in children and youth: current state of research. Child Development Perspectives, 6(2), 161–166.CrossRefGoogle Scholar
  42. Gregoski, M. J., Barnes, V. A., Tingen, M. S., Harshfield, G. A., & Treiber, F. A. (2011). Breathing awareness mediation and LifeSkills training programs influence upon ambulatory blood pressure and socium excretion among African American adolescents. Journal of Adolescent Health 48, 59–64.Google Scholar
  43. Hagins, M., Haden, S. C., & Daly, L. A. (2013). A randomized controlled trial on the effects of yoga on stress reactivity in 6th grade students. Evidence-Based Complementary and Alternative Medicine. doi: 10.1155/2013/607134.
  44. Institute of Education Sciences. (2013) Common guidelines for education research and development: a report from the Institute of Education Sciences, U.S. Department of Education and the National Science Foundation. Retrieved from:
  45. Jennings, P. A., Snowberg, K. E., Coccia, M. A., & Greenberg, M. T. (2011). Improving classroom learning environments by cultivating awareness and resilience in education (CARE): results of two pilot studies. Journal of Classroom Interaction, 46(1), 37–48.Google Scholar
  46. Jennings, P. A., Frank, J. L., Snowberg, K. E., Coccia, M. A., & Greenberg, M. T. (2013). Improving classroom learning environments by Cultivating Awareness and Resilience in Education (CARE): results of a randomized controlled trial. School Psychology Quarterly, 28(4), 374–390.CrossRefPubMedGoogle Scholar
  47. Jones, S.M & Bouffard, S.M. (2012). Social and emotional learning in schools: from programs to strategies. Social Policy Report (vol. 26, no. 4). Society for Research in Child Development.
  48. Kabat-Zinn, J. (1990). Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. New York: Bantam Dell.Google Scholar
  49. Kabat-Zinn, J. (2011). Some reflections on the origins of MBSR, skillful means, and the trouble with maps. Contemporary Buddhism, 12(1), 281–306.CrossRefGoogle Scholar
  50. Kemeny, M. E., Foltz, C., Cavanagh, J. F., Cullen, M., Giese-Davis, J., Jennings, P., et al. (2012). Contemplative/emotion training reduces negative emotional behavior and promotes prosocial responses. Emotion, 12(2), 338–350.CrossRefPubMedGoogle Scholar
  51. Khalsa, S. B. S., Hickey-Schultz, L., Cohen, D., Steiner, N., & Cope, S. (2012). Evaluation of the mental health benefits of yoga in a secondary school: a preliminary randomized controlled trial. The Journal of Behavioral Health Services & Research, 39(1), 80–90.CrossRefGoogle Scholar
  52. Klatt, M., Harpster, K., Browne, E., White, S., & Case-Smith, J. (2013). Feasibility and preliminary outcomes for move-into-learning: an arts-based mindfulness classroom intervention. The Journal of Positive Psychology, 8(3), 233–241.CrossRefGoogle Scholar
  53. Koenig, K. P., Buckley-Reen, A., & Garg, S. (2012). Efficacy of the get ready to learn yoga program among children with autism spectrum disorders: a pretest–posttest control group design. American Journal of Occupational Therapy, 66(5), 538–546.CrossRefPubMedGoogle Scholar
  54. Kutash, K., Cross, B., Madias, A., Duchonowski, A. J., & Green, A. L. (2012). Description of a fidelity implementation system: an example from a community-based children’s mental health program. Journal of Child and Family Studies, 21, 1028–1040.CrossRefGoogle Scholar
  55. Kuyken, W., Weare, K., Ukoumunne, O. C., Vicary, R., Motton, N., Burnett, R., Cullen, C., Hennelly, S., & Huppert, F. (2013). Effectiveness of the mindfulness in schools programme: non-randomized controlled feasibility study. The British Journal of Psychiatry, 203(2), 126–131.CrossRefPubMedGoogle Scholar
  56. Lagor, A. F., Williams, D. J., Lerner, J. B., & McClure, K. S. (2013). Lessons learned from a mindfulness-based intervention with chronically ill youth. Clinical Practice in Pediatric Psychology, 1(2), 146–158.CrossRefGoogle Scholar
  57. Lantieri, L., Nagler Kyse, E., Harnett, S., & Malkmus, C. (2011). Building inner resilience in teachers and students. In G.M. Reevy & E. Frydenberg (Eds.), Personality, Stress, and Coping: Implications for Education (pp. 267-292). Charlotte, NC: Information Age Publishing.Google Scholar
  58. Le, T. N., & Gobert, J. M (2013). Translating and implementing a mindfulness-based youth suicide prevention intervention in a native American community. Journal of Child and Family Studies. doi: 10.1007/s10826-013-9809-z.
  59. Liehr, P., & Diaz, N. (2010). A pilot study examining the effect of mindfulness on depression and anxiety for minority children. Archives of Psychiatric Nursing, 24(1), 69–71.CrossRefPubMedGoogle Scholar
  60. Linden, W. (1973). Practicing of meditation by school children and their levels of field dependence-independence, test anxiety, and reading achievement. Journal of Consulting and Clinical Psychology, 41(1), 139–143.CrossRefPubMedGoogle Scholar
  61. Meiklejohn, J., Phillips, C., Freedman, M. L., Griffin, M. L., Biegel, G., Roach, A., et al. (2012). Integrating mindfulness training into K-12 education: fostering the resilience of teachers and students. Mindfulness, 3(4), 291–307.CrossRefGoogle Scholar
  62. Mendelson, T., Greenberg, M. T., Dariotis, J. K., Gould, L. F., Rhoades, B. L., & Leaf, P. J. (2010). Feasibility and preliminary outcomes of a school-based mindfulness intervention for urban youth. Journal of Abnormal Child Psychology, 38(7), 985–994.CrossRefPubMedGoogle Scholar
  63. Mendelson, T., Dariotis, J. K., Feagans Gould, L., Smith, A. S. R., Smith, A. A., Gonzalez, A. A., & Greenberg, M. T. (2013). Implementing mindfulness and yoga in urban schools: a community–academic partnership. Journal of Children’s Services, 8(4), 276–291.CrossRefGoogle Scholar
  64. Metz, S. M., Frank, J. L., Reibel, D., Cantrell, T., Sanders, R., & Broderick, P. C. (2013). The effectiveness of the Learning to BREATHE program on adolescent emotion regulation. Research in Human Development, 10(3), 252–272.CrossRefGoogle Scholar
  65. Napoli, M., Krech, P. R., & Holley, L. C. (2005). Mindfulness training for elementary school students: the attention academy. Journal of Applied School Psychology, 21(1), 99–125.CrossRefGoogle Scholar
  66. Nidich, S. I., Nidich, R. J., & Rainforth, M. (1986). School effectiveness: achievement gains at the Maharishi School of the Age of Enlightenment. Education, 107(1), 49–54.Google Scholar
  67. Noggle, J. J., Steiner, N. J., Minami, T., & Khalsa, S. B. S. (2012). Benefits of yoga for psychosocial well-being in a US high school curriculum: a preliminary randomized controlled trial. Journal of Developmental & Behavioral Pediatrics, 33(3), 193–201.CrossRefGoogle Scholar
  68. O’Donnell, C. L. (2008). Defining, conceptualizing, and measuring fidelity of implementation and its relationship to outcomes in K-12 curriculum intervention research. Review of Educational Research, 78(1), 33–84.CrossRefGoogle Scholar
  69. Peck, H. L., Kehle, T. J., Bray, M. A., & Theodore, L. A. (2005). Yoga as an intervention for children with attention problems. School Psychology Review, 34(3), 415–424.Google Scholar
  70. Reid, E., & Miller, L. (2009). An exploration in mindfulness: classroom of detectives. The Teachers College Record, 111(12), 2775–2785.Google Scholar
  71. Ricard, M., Lutz, A., & Davidson, R. J. (2014). Mind of the mediator. Scientific American, 311(5), 39–45.CrossRefGoogle Scholar
  72. Roeser, R. W., & Pinela, C. (2014). Mindfulness and compassion training in adolescence: a developmental contemplative science perspective. New Directions for Youth Development, 142, 9–30.CrossRefGoogle Scholar
  73. Roeser, R. W., Schonert-Reichl, K. A., Jha, A., Cullen, M., Wallace, L., Wilensky, R., et al. (2013). Mindfulness training and reductions in teacher stress and burnout: results from two randomized, waitlist-control field trials. Journal of Educational Psychology, 105(3), 787–804.CrossRefGoogle Scholar
  74. Rohrback, L. A., Gunning, M., Sun, P., & Sussman, S. (2010). The project towards no drug abuse (TND) dissemination trail: implementation fidelity and immediate outcomes. Prevention Science, 11, 77–88.CrossRefGoogle Scholar
  75. Rosaen, C., & Benn, R. (2006). The experience of transcendental meditation in middle school students: a qualitative report. Explore: The Journal of Science and Healing, 2(5), 422–425.CrossRefGoogle Scholar
  76. Ross, A., Friedman, E., Bevans, M., & Thomas, S. (2012). Frequency of yoga practice predicts health: results from a national survey of yoga practice. Evidence-based Complementary and Alternative Medicine.
  77. Ruiz-Primo, M.A. (2005). A multi-method and multi-score approach for studying fidelity of implementation. Unpublished manuscript.Google Scholar
  78. Schonert-Reichl, K. A., & Lawlor, M. S. (2010). The effects of a mindfulness-based education program on pre-and early adolescents’ well-being and social and emotional competence. Mindfulness, 1(3), 137–151.CrossRefGoogle Scholar
  79. Semple, R. J., Reid, E. F. G., & Miller, L. F. (2005). Treating anxiety with mindfulness: an open trial of mindfulness training for anxious children. Journal of Cognitive Psychotherapy: An International Quarterly, 19, 379–392.CrossRefGoogle Scholar
  80. Serwacki, M. L., & Cook-Cottone, C. (2012). Yoga in the schools: a systematic review of the literature. International Journal of Yoga Therapy, 22, 101–109.PubMedGoogle Scholar
  81. Sibinga, E., Perry-Parrish, C., Chung, S. E., Johnson, S. B., Smith, M., & Ellen, J. M. (2013). School-based mindfulness instruction for urban male youth: a small randomized controlled trial. Preventive Medicine, 57(6), 799–801.CrossRefPubMedGoogle Scholar
  82. Steiner, N. J., Sidhu, T. K., Pop, P. G., Frenette, E. C., & Perrin, E. C. (2013). Yoga in an urban school for children with emotional and behavioral disorders: a feasibility study. Journal of Child and Family Studies, 22(6), 815–826.CrossRefGoogle Scholar
  83. Wall, R. B. (2005). Tai chi and mindfulness-based stress reduction in a Boston public middle school. Journal of Pediatric Health Care, 19(4), 230–237.CrossRefPubMedGoogle Scholar
  84. Weare, K. (2013). Developing mindfulness with children and young people: a review of the evidence and policy context. Journal of Children’s Services, 8(2), 141–153.CrossRefGoogle Scholar
  85. White, L. S. (2012). Reducing stress in school-age girls through mindful yoga. Journal of Pediatric Health Care, 26(1), 45–56.CrossRefPubMedGoogle Scholar
  86. Winzelberg, A. J., & Luskin, F. M. (1999). The effect of a meditation training in stress levels in secondary school teachers. Stress and Health, 15(2), 69–77.Google Scholar
  87. Wisner, B. L. (2013). An exploratory study of mindfulness meditation for alternative school students: perceived benefits for improving school climate and student functioning. Mindfulness. doi: 10.1007/s12671-013-0215-9.
  88. Wisner, B. L., & Norton, C. L. (2013). Capitalizing on behavioral and emotional strengths of alternative high school students through group counseling to promote mindfulness skills. The Journal for Specialists in Group Work, 38(3), 207–224.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Laura Feagans Gould
    • 1
  • Jacinda K. Dariotis
    • 2
  • Mark T. Greenberg
    • 3
  • Tamar Mendelson
    • 4
  1. 1.Minds IncorporatedWashingtonUSA
  2. 2.College of Education, Criminal Justice, and Human Services and Evaluation Services CenterUniversity of CincinnatiCincinnatiUSA
  3. 3.Prevention Research CenterPennsylvania State UniversityState CollegeUSA
  4. 4.Department of Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA

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