The Importance of Quality Implementation for Research, Practice, and Policy. Adaptation: Can a Program be Changed or Does it Always have to be Conducted "As Is"?

02/01/2013

Adaptation refers to changes made in a program when it is implemented in a new setting. Whenever programs are conducted, there is the issue of the extent to which they should be delivered as originally developed, or adapted in some way. This is a very important issue because, when others consider using a program, there is often a question in their minds that goes something like: "Yes, I know that program X has been effective elsewhere, but our situation here seems different. If we change the original program so it is a better fit for our circumstances, will it still be successful?" As the science of implementation has advanced, clarity regarding this issue has emerged.

There is now agreement in implementation science that whenever the core components of a program are known (i.e., the active ingredients of a program that are primarily associated with its effectiveness), these elements should be implemented without adaptation (see accompanying ASPE Research Brief by Blase and Fixsen entitled Core Intervention Components: Identifying and Operationalizing What Makes Programs Work). If all the core components are not administered, then the program either will not work or will not work as well as it could. Decisions as to what constitutes core components are challenging as research has seldom isolated these components. Although some program designers may identify core components based upon theory alone, these assumptions are not always correct and could lead to an omission that is, in fact, an active ingredient of the program. Decisions regarding core components should be based upon empirical findings.

Beyond its core components, other aspects of the program can be modified to suit the setting or the population served, and this often offers possibilities for some adaptation to occur. In other words, fidelity and adaptation are not necessarily mutually exclusive, either-or considerations, and programs can be a blend of both fidelity and adaptation.

There are many different aspects to developing a program for children or youth (e.g., home visitation, teen pregnancy prevention) that might be adapted. For example, exercises or activities within a lesson may be modified to suit the cultural background of the participants as long as they fulfill the objective of the original lesson or the teaching point. Other modifications might include changing the time at which the program is offered or providing repeat sessions to better fit the needs of the clients. Depending on the circumstances, some of these elements can be adapted to fit the new setting, as long as the core components are delivered.

Decisions regarding adaptation should be made collaboratively by the original program designer, or others who know the theory and central operational features of the intervention, and those hosting the new program who know their setting, the target population, and the local culture. Otherwise, ineffective or even harmful adaptations might be made.

Collaborative working relationships are crucial for making wise decisions regarding fidelity and adaptation (Durlak & DuPre, 2008). Depending on each unique circumstance, some changes that do not compromise the core elements of the program can be made, but improving the organization's ability to help its clients should always be of central importance. In other words, an organization's primary motive for its actions should be to improve its services by offering the most effective assistance to its clientele. Extrinsic reasons for adapting programs such as political pressure, administrative fiat, and grabbing available money are not associated with quality implementation. Similarly, changing a program merely to save time, effort, or money is not wise. Under these conditions, the intended outcomes may be compromised because the program's active ingredients are either omitted or not well-implemented (Damshroder et al. 2009; Mihalic et al. 2008).

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