Adaptations in a Community-Based Family Intervention: Replication of Two Coding Schemes

Abstract

Although program adaptation is a reality in community-based implementations of evidence-based programs, much of the discussion about adaptation remains theoretical. The primary aim of this study was to replicate two coding systems to examine adaptations in large-scale, community-based disseminations of the Strengthening Families Program for Parents and Youth 10-14, a family-based substance use prevention program. Our second aim was to explore intersections between various dimensions of facilitator-reported adaptations from these two coding systems. Our results indicate that only a few types of adaptations and a few reasons accounted for a majority (over 70 %) of all reported adaptations. We also found that most adaptations were logistical, reactive, and not aligned with program's goals. In many ways, our findings replicate those of the original studies, suggesting the two coding systems are robust even when applied to self-reported data collected from community-based implementations. Our findings on the associations between adaptation dimensions can inform future studies assessing the relationship between adaptations and program outcomes. Studies of local adaptations, like the present one, should help researchers, program developers, and policymakers better understand the issues faced by implementers and guide efforts related to program development, transferability, and sustainability.

Therapist report of adaptations to delivery of evidence-based practices within a system-driven reform of publicly funded children’s mental health services.

“…This supports past qualitative findings that community therapists frequently tailor the terminology or language used to meet the needs of their clients and improve client engagement (Gibbs, Krieger, Cutbush, Clinton-Sherrod, & Miller, 2016; Stirman et al, 2013). However, in past studies of community implementation of EBPs, therapists also commonly reported omitting core components from practices or making other adaptations that might represent drift from fidelity (Cooper, Shrestha, Hyman, & Hill, 2015; Stirman et al, 2013; Stirman et al, 2015). Whether such adaptations have an impact on clinical outcomes is an important question for further study.…”

Using stakeholder perspectives to guide systematic adaptation of an autism mental health intervention for Latinx families: A qualitative study

“…There are increased efforts to implement evidence‐based interventions (EBIs) in routine mental health services. Within these efforts, there is a strong emphasis on delivering EBIs with fidelity to reproduce effective intervention outcomes; however, the need to maintain intervention integrity must be balanced with the need to adapt interventions to respond to local settings and client preferences to increase intervention sustainment (August, Gewirtz, & Realmuto, ; Cooper, Shrestha, Hyman, & Hill, ). Indeed, a number of key implementation outcomes (Proctor et al, ) are important to understanding and informing adaptations.…”

“…Examination of EBIs in mental health settings indicates that therapists utilize a high rate of adaptations when implementing interventions (Aarons et al, ; Cooper et al, ; Lau et al, ; Stirman, Miller, Toder, & Calloway, ). Stirman et al () argued that classifying adaptations is crucial for accurate measurement of the impact of different types of adaptations on clinical (e.g., effectiveness) and implementation (e.g., engagement and sustainment) outcomes and initially classified adaptations as fidelity‐consistent (adaptations that do not change the core elements of the EBI) versus fidelity‐inconsistent (adaptations that change core EBI components; Stirman et al, ).…”

“…Adaptations in mental health are often made to meet a client's clinical or cultural needs (Aarons et al, ; Cooper et al, ; Lau et al, ; Stirman et al, ). Cultural adaptation is defined by Bernal, Jiménez‐Chafey, and Domenech Rodríguez (, p. 362) as “the systematic modification of an evidence‐based treatment or intervention protocol to consider language, cultural, and the context in such a way that it is compatible with the client's cultural patterns, meanings, and values.” Indeed, multiple frameworks have emerged to guide researchers in the cultural adaptation process.…”

How can evidence-based interventions give the best value for users in social services? Balance between adherence and adaptations: a study protocol

“…Studies from other areas show that adaptation is the rule rather than the exception [18]. An accumulation of findings has shown that between 44 and 88% of users adapt the procedure, dosage, content, format, and/or target group when using EBIs (e.g., [19][20][21][22]).…”