Issue No. 24

Welcome to the Blueprints Bulletin

Adaptation 

We at Blueprints are frequently asked to provide guidance on maintaining fidelity in adaptations of evidence-based interventions. The Blueprints registry currently lists 106 preventive interventions that have been evaluated using rigorous scientific standards and demonstrated to improve youth behavioral outcomes.  
 
Implementing Blueprints-certified interventions with fidelity (or as intended) is important to yield these positive outcomes, as poor implementation fidelity can compromise program mechanisms and undermine their effectiveness.
 
Adhering to fidelity guidelines, however, is challenging when interventions are adapted to the realities of the environment. Some adjustments or adaptations are necessary when interventions are implemented in natural settings.
 
Fidelity and adaptation are often at odds; simultaneously adhering to fidelity guidelines while adapting to realities of the implementation context is a delicate balance. So how do we specify that balance between flexibility and fidelity? This is a topic of much debate.

Advantages and Disadvantages of Adaptation
 
Thoughtful and deliberate adaptation to the delivery of a Blueprints-certified intervention to improve its fit in each context can lead to better engagement, acceptability, and outcomes.
 
However, modifications that remove key elements – or core components – of an intervention may be less effective. An evidence-based program’s core components are the essential activities deemed necessary to produce desired outcomes. The core components are the features that define an effective program.
 
Similarly, reactive adaptations can lead to program drift, resulting in lower impact on outcomes and rendering an evidence-based intervention ineffective.
 
Adaptations, especially untested, threaten to weaken evidence-based interventions, undermine results, and thereby erode confidence in scientific claims that Blueprints-certified interventions work.

Research-Informed Adaptation Strategies

What are “best practices” for making adaptations to a Blueprints-certified program?
 
Using a traffic light as an analogy, Balis and colleagues (2021) assign a color for making changes to an evidence-based intervention:

• Tailoring language or pictures (green light/low risk).
• Adding/substituting activities or session sequence (yellow light/medium risk).
• Deleting lessons and decreasing session length (red light/high risk).

The National Institutes of Health developed a series of Practice Tools to understand, plan for, and implement evidence-based interventions into routine health care and public health settings.
 
Included in this series is a workbook, titled Implementation Science at a Glance. The picture below can be found on page 12 of this guide – it offers some concrete guidance on how to use the “traffic light” analogy to balance fidelity and adaptation.

Video Trainings on Best Practices for Adaptation of Evidence-Based Programs
 
Below are a series of pre-recorded workshops developed by the Prevention Research Center (PRC) at Colorado State University (CSU). Click on each title to view the workshop.
 
Learning Workshop I: Orientation to the PRC’s Implementation Toolbox
 
Join CSU’s PRC Research-to-Practice team to learn about their new Implementation Toolbox website. During this interactive tutorial, we will walk you through the website, introduce you to new tools and resources for program implementation and adaptation, and describe different navigation methods.
 
Learning Workshop II: Roadblocks, Potholes, & Solutions for High-Impact EBP Implementation
 
Join CSU’s PRC Research to Practice team as we delve into the topic of maintaining fidelity to evidence-based program (EBP) implementation. This workshop will describe what implementation fidelity is, best practice methods for maintaining fidelity to EBPs, and discuss common implementation barriers and potential solutions for overcoming them. Additionally, available resources through the PRC’s Implementation Toolbox will be described.
 
Learning Workshop III – Adaptations Part I: Best Practices for Adapting EBPs
 
Join the PRC’s Research to Practice Team as we dive into best practices for modifying programs in part one of a two-part Learning Workshop series on program adaptations. In this video you will learn what adaptations are, common causes that lead to them, and best practices for deciding upon and implementing program changes. Specifically, the Traffic Light Model for Adaptations is discussed and considered through a series of activities provided throughout the presentation.
 
Learning Workshop IV – Adaptations Part II: Challenges in Adapting for Culture
 
Join the PRC’s Research to Practice Team as we dive into best practices for culturally adapting evidence-based programs in part two of a two-part Learning Workshop series. In this video, you will learn what cultural adaptations are, important definitions to keep in mind, and best practices to follow as you adapt your programs to meet your local community’s needs and strengths.

Conclusion

Please send us research-informed strategies you have used to balance fidelity with adaptation to a Blueprints-certified program. We can be reached at: blueprints@colorado.edu.
 
And as always, thank you for your continued interest in and support of Blueprints.
 
Sincerely,

Pamela Buckley, PhD
PI, Blueprints Initiative
Pamela.Buckley@Colorado.edu

Karl G. Hill, PhD
Board Chair and Co-PI
Karl.Hill@Colorado.edu

Blueprints for Healthy Youth Development is developed and managed by the University of Colorado Boulder, Institute of Behavioral Science, with current support from Arnold Ventures and former funding from the Annie E. Casey Foundation. Each intervention included in the Blueprints database has been reviewed carefully by an independent advisory panel that looked at research on the intervention’s impact, practical focus and potential for implementation in public systems.

Featured Model Program
Blues Program

Blueprints Certified: 2015

Ages Served: Late Adolescence (15-18) – High School

Program Outcomes: Alcohol, Depression, Illicit Drugs, Marijuana/Cannabis

Goal and Target Population: A school-based group intervention that aims to reduce negative cognition and increase engagement in pleasant activities to prevent the onset and persistence of depression in high school students exhibiting depressive symptoms.

Learn more about Blues Program

Featured Promising Program
RealTeen

Blueprints Certified: 2022

Ages Served: Early Adolescence (12-14) – Middle School

Program Outcomes: Illicit Drugs, Marijuana/Cannabis, Tobacco

Goal and Target Population: An internet-based, gender-specific drug abuse prevention program intended to reduce substance use among early adolescent girls through improving personal, social, and drug refusal skills.

Learn more about RealTeen

© 2023 Blueprints for Healthy Youth Development, Regents of the University of Colorado. All rights reserved. 

Our mailing address is:
University of Colorado Boulder | Institute of Behavioral Science
483 UCB, Boulder, CO 80309