Despite availability of empirically supported school-based substance abuse prevention programs, adoption and implementation fidelity of such programs appear to be low. A replicated case study was conducted to investigate school adoption and implementation processes of the EXSELS model (Project ALERT delivered by program leaders through Cooperative Extension). Interviews with school personnel revealed: (1) schools were not aware of evidence-based programs until Extension approached them; (2) schools dared not eliminate DARE; (3) teachers are unlikely to implement with fidelity; (4) implementation of theory-based prevention is not consistent with school views of curriculum delivery; and (5) schools believed Project ALERT via EXSELS was an advantage over teacher delivery, but only three of the eight schools sustained the model. Discussed are potential for Extension as a national implementation system, the value of qualitative inquiry to study processes of adoption, and issues related to the selection and implementation of evidence-based programs.
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