The Importance of Contextual Fit when Implementing Evidence-Based Interventions. Addressing Skills/Competencies: It’s Your Game Project in South Carolina Schools


The U.S. Department of Health and Human Services’ Office of Adolescent Health (OAH) Teen Pregnancy Prevention (TPP) Program works to preven teen pregnancy by supporting the replication of evidence-based interventions and the implementation of demonstration programs to develop and test new models and innovative strategies. In September 2010, OAH provided funding to 75 grantees to replicate medically accurate age-appropriate, evidence-based TPP interventions that have been proven through rigorous evaluation to prevent teen pregnancy and/or associated sexual risk behaviors. The South Carolina (SC) Campaign to Prevent Teen Pregnancy (SC Campaign) received funding from OAH to replicate It’s Your Game, Keep it Real (IYG), a 2-year, middle school, evidence-based intervention shown to delay the initiation of sex, increase positive beliefs about abstinence, and decrease unprotected sex at last intercourse. The curriculum consists of 12 lessons in seventh grade and 12 lessons in eighth grade. The SC Campaign partnered with 10 SC school districts representing 24 middle schools to participate in the project, most of which selected physical education teachers or coaches to implement the IYG curriculum at school. As a condition of the agreement between the SC Campaign and participating schools, IYG facilitators were required to be trained by a certified trainer before implementing the intervention. Implementation began in 12 schools during the 2011–2012 school year and has expanded to 25 schools across the state in the current school yea (2013–2014).

The SC Campaign has held a 3-day training of facilitators each year since 2011 for rising IYG facilitators. The training included a review of the curriculum’s logic model, core components, and theoretical foundation. To ensure fidelity, a lesson-by-lesson review of the curriculum also was conducted and teach-back sessions were used to build educators’ implementation skills. Moreover, the SC Campaign included instruction on values clarification and opportunities for participants to practice answering sensitive questions to better prepare them for implementing a reproductive health curriculum. The literature has shown that training is necessary but not sufficient for quality implementation; instead, training should be supplemented with site-specific, customized technical assistance (TA). As a result, SC Campaign staff provide IYG facilitators with continuous, customized TA to address site-specific needs that is informed by data on fidelity and implementation quality collected from facilitators and independent observations of the intervention. The ability to identify facilitator needs through fidelity data is important because facilitators with lower capacity levels are less likely to request TA or assistance. Because of data-informed TA, SC Campaign staff could provide strategies to address issues in real time so that further threats to implementation were prevented. Long-term responses to challenges to implementation fidelity, such as trainings and webinars, were also developed based on site needs as derived from data collected from facilitators and independent observers (For further information on how the SC Campaign used real-time fidelity data to inform TA, see Kershner et al., 2014).

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