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EBP Fidelity and Adaptations

All evidence-based programs (EBPs) have been evaluated and found to be effective in changing risky sexual behaviors among adolescents. However, while every program contains many parts, each program has been evaluated as a whole. This means that we don't know specifically which content, teaching strategies, and implementation factors make the program effective. If we want to see positive outcomes, we can't improvise, because we might be tampering with the "recipe" that makes the program work. That is why it is important to deliver the program as developed, staying true to its core components.

Planned Adaptations

At the same time, we have learned that some adaptations are unavoidable or necessary for a number of reasons. For example, rapidly changing youth culture may make some content seem dated and hard for participants to relate to. Programs may also need adaptations that make them more inclusive of specific populations.

Core Component Adaptation Examples
What is being communicated?
Adaptations might include changing the language and scenarios of role plays, updating health information, or using local statistics.
How is the content being taught?
Pedagogy refers to teaching strategies. Adaptations may involve structuring activities differently. Replacing a short lecture with a game that covers the same content, for example, is a change in teaching strategy.
How is the program being delivered?
The recommended group size may be from 6-12 participants. In school settings, however, group size may vary from 15-25 participants.

These adaptations can (and should) be planned in advance, working with ACT for Youth. Recognizing the need for certain adaptations, program developers have made recommendations for changes that are consistent with the learning theories that governed each program's development.

Implementation Guidelines

Recognizing the need for certain adaptations, program developers have made recommendations for changes that are consistent with the learning theories that governed each program's development. Developers' guidance is summarized in the documents below. Developers' guidance is summarized in the documents below.

Adaptation Master Lists

PREP providers are required to submit any planned adaptations to ACT for Youth for pre-approval. We recommend that supervisors create a master list of adaptations when an EBP will be used repeatedly in a particular setting. Master lists:

  • Give all educators the same guidance, reducing ad-hoc adaptations
  • Help educators be better prepared, which improves the quality of program delivery
  • Streamline the adaptation pre-approval process
  • Simplify reporting in the online system (see below)
  • Can be used repeatedly in a given setting

Adaptations that are approved for one setting may not be appropriate in another. When using the EBP at a new site, work with your TA contact to create a new master list.

Planning Tools for Creating Master Lists

To help you plan, implement, and report adaptations systematically, ACT for Youth has developed planning tools for master lists of adaptations for each EBP. Health Educator Supervisors can use these tools to draft a master list. Your TA contact will work with you to finalize the list.

Recording Adaptations in the Online Reporting System

Are you recording a modification to content, teaching strategies, and/or implementation? Use the guidelines below when you are 1) using a planning tool to create a master list, or 2) entering adaptations into the online reporting system.

Pre-approved Adaptations: Reporting is Short and Sweet!

Ideally, nearly all adaptations will be pre-approved by ACT for Youth. Once you and your TA contact have finalized your adaptations using a master list, you need only describe them very briefly in the online reporting system (ORS). For a pre-approved adaptation, all you need to record is a short reference to the full description ACT for Youth will have on file plus "ML" (for master list).

For example, if you have modified a myth/fact activity to change the language of some of the statements, the exact modifications will be on record in your pre-approved master list. When you implement the session that includes the adapted activity, you would indicate in the ORS that the activity was implemented "with modifications" and select "content was modified." When asked to provide detail about this activity's modification, you would simply enter "statement language change - ML" in the description box — no additional detail is needed for a pre-approved adaptation.

Not Pre-approved: Detailed Description and Justification Needed

If an adaptation is NOT pre-approved, you will need to supply a full description of the adaptation and the reason you made the change in the online reporting system. Remember that it is a requirement of the grant that all planned adaptations be pre-approved by ACT for Youth.