Treatment integrity has always had a presence in research, but now more than ever must become a priority owing to the changes in Special Education Law. The present study intends to explore the relationship between factors of implementation, treatment integrity of intervention implementation, and reading fluency. Participants included students in grades 2 through 5 and their teachers enrolled in an urban elementary school in the southwest area of the United States. Participants were chosen for possible inclusion on the basis of their fall performance relative to oral reading fluency on a universal screening measure used as part of the district's Response to Intervention (RTI) plan. Classroom teachers were observed implementing reading interventions and asked to respond to surveys aimed at summarizing their opinions regarding factors related to choice of intervention and implementation. Path analysis was conducted to explore the relationship between two factors of implementation (intervention complexity and acceptability), treatment integrity (adherence to intervention protocol) and student outcomes (oral reading fluency scores). It was hypothesized that low scores for intervention complexity would be inversely related to levels of treatment integrity, which would subsequently be positively related to reading fluency. Moreover, it was hypothesized that intervention acceptability and treatment integrity would be positively related, which would subsequently be positively related to reading fluency. Lastly, it was hypothesized that there would be an inverse relationship between intervention complexity and reading fluency, and a positive relationship between intervention acceptability and reading fluency. Results indicated an inverse relationship between intervention complexity and treatment integrity, suggesting that when complexity was low, treatment integrity was high. A positive relationship was found between intervention acceptability and treatment integrity, suggesting that when acceptability was high, treatment integrity was high. Furthermore, when treatment integrity was high, reading fluency scores were found to be high. An inverse relationship was found between complexity and reading fluency, suggesting that when complexity was low, reading fluency scores were high. Lastly, a positive relationship was found between acceptability and reading fluency, suggesting that when acceptability was high, reading fluency scores were high.