G ENERAL A DAPTATION G UIDELINES Regina Firpo-Triplett, MPH, MCHES Center for Sexual and Reproductive Health Promotion 1

A DAPTATION G UIDANCE P ROJECTS CDC’s Division of Reproductive Health (DRH) o a framework to guide program adaptation o EBI-specific guidance for informed adaptations o general guidance for informed adaptations Office of Adolescent Health (OAH) o EBI-specific guidance for informed adaptations

O BJECTIVES o Define common adaptation and fidelity terms o Explain the difference between green, yellow and red light adaptations o Present and apply general green/yellow/red light guidelines to common adaptation challenges

E VIDENCE -B ASED I NTERVENTIONS (EBI S ) Sexual health programs that have been rigorously evaluated and found to effectively reduce sexual risk taking behavior among youth.

F IDELITY IS … … the faithfulness with which a practitioner implements a program. Maintaining fidelity to a program means implementing it without compromising its core components.

F IDELITY C HILI

I S IT STILL C HILI ?

C ORE C OMPONENTS Core Components are the key elements or defining characteristics of a program. To maintain a program’s effectiveness, its core components must be kept intact when it is replicated or adapted. Core components relate to: Content Pedagogy Implementation

T YPES OF C ORE C OMPONENTS o Content : WHAT is being taught (knowledge, attitudes, skills, etc.). o Pedagogy: HOW the content is taught. o Implementation: The LOGISTICS that are responsible for a conducive learning environment.

A DAPTATION IS … …making o Changes o Additions o Deletions o Substitutions to an EBI to make it more suitable for a particular population and/or an organization’s capacity.

I NFORMED A DAPTATIONS … ….are adaptations that do not compromise or delete the program’s core components.

o Meet the Needs of the Population o Stay within Organizational Capability R EASONS FOR ADAPTATIONS

G REEN / Y ELLOW / R ED A DAPTATION F RAMEWORK GOCaution STOP

G REEN Y ELLOW R ED L IGHT A DAPTATIONS Provides guidance on whether a particular adaptation is … …safe (green) …should be made cautiously (yellow) …should be avoided (red)

G REEN L IGHT A DAPTATIONS o Updating and/or customizing statistics and other reproductive health information o Customizing role play scenarios (e.g., names, setting, language, terms) o Making activities more interactive, appealing to different learning styles o Tailoring learning activities to youth culture, developmental stage, gender, sexual orientation

G REEN L IGHT A DAPTATIONS – C LOSE U P o Updating and/or customizing statistics and other reproductive health information.

G REEN L IGHT A DAPTATIONS – C LOSE U P o Customizing role play scenarios (e.g., names, setting, language, terms)

G REEN L IGHT A DAPTATIONS – C LOSE U P o Making activities more interactive, appealing to different learning styles

G REEN L IGHT A DAPTATIONS – C LOSE U P o Tailoring learning activities to youth culture, developmental stage, gender, sexual orientation

G REEN L IGHT A DAPTATIONS o Updating and/or customizing statistics and other reproductive health information o Customizing role play scenarios (e.g., names, setting, language, terms) o Making activities more interactive, appealing to different learning styles o Tailoring learning activities to youth culture, developmental stage, gender, sexual orientation

Y ELLOW L IGHT A DAPTATIONS o Changing the order of sessions or sequence of activities o Adding activities to reinforce learning o Adding activities to address additional risk and protective factors o Modifying condom activities o Replacing or supplementing videos or activities with other videos o Implementing the program with a different population o Implementing the program in a different setting

Y ELLOW L IGHT A DAPTATIONS – C LOSE U P o Changing the order of sessions or sequence of activities

Y ELLOW L IGHT A DAPTATIONS – C LOSE U P o Adding activities to reinforce learning

Y ELLOW L IGHT A DAPTATIONS – C LOSE U P o Adding activities to address additional risk and protective factors

Y ELLOW L IGHT A DAPTATIONS – C LOSE U P o Modifying condom activities

Y ELLOW L IGHT A DAPTATIONS – C LOSE U P o Replacing or supplementing videos with other videos and o Replacing or supplementing activities with videos

Y ELLOW L IGHT A DAPTATIONS – C LOSE U P o Implementing the program with a different population

Y ELLOW L IGHT A DAPTATIONS – C LOSE U P o Implementing the program in a different setting

Y ELLOW L IGHT A DAPTATIONS o Changing the order of sessions or sequence of activities o Adding activities to reinforce learning o Adding activities to address additional risk and protective factors o Modifying condom activities o Replacing or supplementing videos or activities with other videos o Implementing the program with a different population o Implementing the program in a different setting

R ED L IGHT A DAPTATIONS o Shortening a program o Reducing or eliminating activities that allow youth to personalize risk o Reducing or eliminating opportunities for skill practice o Removing condom activities o Contradicting, competing with, or diluting the program’s goals o Replacing interactive activities with lectures or individual work

o Shortening a program R ED L IGHT A DAPTATIONS - C LOSE U P

o Reducing or eliminating activities that allow youth to personalize risk R ED L IGHT A DAPTATIONS - C LOSE U P

o Reducing or eliminating opportunities for skill practice

o Removing condom activities R ED L IGHT A DAPTATIONS - C LOSE U P

o Contradicting, competing with, or diluting the program’s goals R ED L IGHT A DAPTATIONS - C LOSE U P

o Replacing interactive activities with lectures or individual work

R ED L IGHT A DAPTATIONS o Shortening a program o Reducing or eliminating activities that allow youth to personalize risk o Reducing or eliminating opportunities for skill practice o Removing condom activities o Contradicting, competing with, or diluting the program’s goals o Replacing interactive activities with lectures or individual work

A PPLYING THE G UIDELINES

P ATRICIA ’ S C HALLENGE 1. Replace videos with TV clips? 2. Add lesson about alcohol and sexual decision-making? 3. Change names in role plays? 4. Add info on HPV vaccine? 39 ‹#›

1. Replace videos with TV clips? Yellow Light 2. Add lesson on alcohol & sexual decision- making? Yellow Light 3. Change names in role plays? Green Light 4. Add info on HPV vaccine? Green Light P ATRICIA ’ S C HALLENGE 40 ‹#›

E DDIE ’ S C HALLENGE Single sex groups? 2. Addressing local prevalent myths? 3. Show video instead of doing the condom demonstration? 4. Teach two lessons back-to- back in block schedule?

E DDIE ’ S C HALLENGE Single sex groups? 2. Addressing local prevalent myths? 3. Show video instead of doing the condom demonstration? 4. Teach two lessons back-to-back in block schedule? Yellow Green Yellow Red

E DDIE AND P ATRICIA ARE R EADY TO G O N OW

EBI-S PECIFIC A DAPTATION K IT 1. Logic Model 2. Core Components 3. Green, Yellow and Red Light Adaptations 4. Fidelity Monitoring Logs

EBI-S PECIFIC A DAPTATION K ITS ETR’s ReCAPP website o Becoming a Responsible Teen o Reducing the Risk o Safer Choices o SIHLE (in process) o Draw the Line/Respect the Line (in process) o All 4 You (in process) o Safer Sex intervention (in process)

O THER R ESOURCES FOR M AKING A DAPTATIONS US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration Center of Substance Abuse Prevention. (2002). Finding the Balance: Program Fidelity and Adaptation in Substance Abuse Prevention: Executive Summary of a State-of-the-Art Review. Kirby, D. & LePore, G. (2007). Sexual Risk and Protective Factors: Factors Affecting Teen Sexual Behavior, Pregnancy, Childbearing, and Sexually Transmitted Disease: Which are Important? Which can You Change? Scotts Valley, CA: ETR Associates. McKleroy, V. S., Galbraith, J. S., Cummings, B., Jones, P., Harshbarger, C., Collins, C., Gelaude, D., Carey, J. W., & the ADAPT Team. (2006). Adapting evidence-based behavioral interventions for new settings and target populations. AIDS Education and Prevention, 18, Supplement A, Solomon, J., Card, J. J., & Malow, R. M. (2006). Adapting efficacious interventions: Advancing translational research in HIV prevention. Evaluation & Health Professions, 29 (2), Tortolero, S. R., Markham C. M., Parcel, G. S., Peters, R. J., Escobar-Chaves, L., Basen-Enquist K., & Lewis, H. L. (2005). Using Intervention Mapping to Adapt an Effective HIV, Sexuality Transmitted Disease, and Pregnancy Prevention Program for High-Risk Minority Youth. Health Promotion Practice, 6, 286. Wingood, G. M., DiClemente, R. J. (2008). The ADAPT-ITT model: A novel method of adapting evidence-based HIV interventions. Acquired Immune Deficiency Syndrome, 47, Supplement 1.

A CT FOR Y OUTH C ENTER FOR E XCELLENCE o Youth development and adolescent sexual health resources: o Youth site with resources on sexual health, leadership, rights and more: Please give us your feedback on this presentation at:

C ONTACT I NFORMATION Regina Firpo-Triplett, MPH, MCHES ETR Associates Check out the Resource Center for Adolescent Pregnancy Prevention