1. FINDING THE OPTIMAL BALANCE BETWEEN FIDELITY AND FIT: LOCAL ADAPTATIONS OF CRIME PREVENTION PROGRAMS
Melanie Bania Benjamin Roebuck Beth O’Halloran Vanessa Chase
2017
Prepared for Public Safety Canada

2. Overview of Project Components
Finding the Optimal Balance Between Fidelity and Fit: Local Adaptations of Crime Prevention Programs
Literature Review
Recommendations, Framework & Practical Tools
Key Effective Elements of Crime Prevention Programming
Illustrative Case Examples
Summary Toolkit
Overview of Project Components

3. Overview & Key Findings
Literature Review
Overview & Key Findings

4. How can evidence-based crime prevention initiatives be adapted from one successful program into new contexts with different people, cultures, and geographies, while remaining effective?
Research Question

5. Literature Review Outline
Situating the Concept of Program Adaptation
Scaling Effective Initiatives
Replication, Fidelity, & Implementation Science
Program Adaptation: Balancing Fidelity & Fit
Specific Frameworks for Program Adaptation
Types of Program Modifications
Green Light, Yellow Light, & Red Light adaptations
Dynamic Process Adaptation (DAP)
ADAPT-ITT
Community-Based Participatory Research (CBPR)
Empowerment Implementation
Cultural Adaptation
Literature Review Outline

6. Methodology Extensive search of multiple databases and libraries:
Mendeley
National Implementation Research Network
uOttawa Library, including databases of online journals
Google.com
Retained 257 publications for reading
Retained 96 publications for inclusion in the review
Methodology

7. Scaling Effective Interventions
Program replication and program adaptation are both forms of ‘scaling out’ – trying to expand the reach of an evidence-based program to other individuals in other settings
Program replication is an exact copy (Stith et. al., 2006)
Program adaptation modifies an evidence-based program to meet the unique needs of a specific population (Child & Family Research Institute)
Scaling Effective Interventions

8. Replication, Fidelity, & Implementation Science
Implementation fidelity
The degree to which the implementation of an evidence-based program adheres to the exact elements, components, activities and tools developed and tested by its original developers (Stith et al., 2006)
Better fidelity generally suggests better outcomes (Metz, 2016)
Implementation drivers (Metz, 2016):
Leadership Drivers – effective leadership
Competency Drivers – competent and well-trained staff
Organization Drivers – organizational support, project management, data monitoring, and ongoing improvement
Enabling contexts (Fixsen et al., 2005; Metz, 2016; Moore et al., 2013):
Dynamic environments open and amenable to change
Site capacity and readiness (Bory & Franks, 2016)
Replication, Fidelity, & Implementation Science

9. Program Adaptation: Balancing Fidelity & Fit
Tension Between (Castro, Barrera, & Martinez, 2004):
Fidelity: scientific, universally applicable, empirically-supported programs replicated with high implementation fidelity
Fit: responding adequately to local contexts and needs
Potential conflict between those who prioritize fidelity by focusing on empirical aspects, and those who prioritize fit by emphasizing community knowledge and processes that seek to engage local people in meaningful ways (Bania, 2012)
Program Adaptation: Balancing Fidelity & Fit

10. Fidelity & Fit: Evidence-Based Decision Making
Components of Evidence-Based Decision Making (CDC, nd)
Fidelity & Fit: Evidence-Based Decision Making

11. Program Adaptation: Balancing Fidelity & Fit
Ad Hoc Adaption: Leads to program ‘drift’ and a loss of benefits to participants (Aarons et al., 2012).
Program adaptation must be a carefully planned and intentional process where modifications are made through a series of assessments and decisions amongst program developers, researchers, funders and services providers. Balance of fidelity and fit is best addressed through a planned, organized , and systematic approach (Castro, Barrera, & Martinez, 2004; Solomon, Card & Malow, 2006).
Benefits of program adaptation (Solomon, Card & Malow, 2006):
Enhances community support
Enhances client participation
Enhances program satisfaction
Enhances outcomes
Promotes sustainability
Program Adaptation: Balancing Fidelity & Fit

12. Program Adaptation on the Ground
Types of Program Modification (adapted from Stirman et al., 2013):
By whom is the modification made?
What is modified?
How is it modified?
Green Light, Yellow Light, & Red Light Adaptations (adapted from O’Conner et al., 2007; & U.S. Department of Health and Human Services, 2012, p.4-5).
Green Light Adaptations: Go for it!
Yellow Light Adaptations: Proceed with caution!
Red Light Adaptations: Stop!
Program Adaptation on the Ground

13. List of Adaptations to Consider or Avoid

14. Specific Frameworks for Program Adaptation
Dynamic Process Adaptation (DAP)
ADAPT-ITT
Community-Based Participatory Research (CBPR)
Empowerment Implementation
Cultural Adaptation
Specific Frameworks for Program Adaptation

15. Dynamic Adaptation Process (DAP)
Six stages of implementation for the replication of an evidence- based program (Aarons et al., 2012; Savignac & Dunbar, 2014).
Exploration and adoption of an evidence-based program
Preparation and installation in the site
Initial implementation in the site
Full implementation in the site
Sustainability / continuity
Innovation (adjustments)
Also includes (Aarons et al., 2012):
Multi-level assessment of ‘fit’ at the exploration phase
Implementation resource team
Formal feedback loops between stages of implementation
Dynamic Adaptation Process (DAP)

16. ADAPT-ITT Phase Consideration Assessment
Who is the new target population and what are the risk and protective factors?
Decision
What evidence-based program is going to be selected and is it going to be adopted or adapted?
Administration
What in the original evidence-based program needs to be adapted, and how should it be done?
Production
How do you produce draft 1 and document adaptations?
5. Topical Experts
Who can help adapt the evidence-based program?
Integration
What will be included in the pilot adaptation?
Training
Who needs to be trained?
Testing
Was the adaptation successful, and did it enhance sort-term outcomes?
ADAPT-ITT
(adapted from Wingood & DiClemente 2008, Table 1, p.542).

17. Community-Based Participatory Research (CBPR)
A Continuum of Participatory Research in Practice (Lee, 2008)
Community-Based Participatory Research (CBPR)
Research ON communities
Research FOR communities
Research WITH communities
Less Community Involvement More

18. Community-Based Participatory Research (CBPR)
Cyclical Process of Community-Based Participatory Research
Community-Based Participatory Research (CBPR)
Engagement
Research Questions/ Needs Assessment
Research Plan/
Action Plan
Implementation
Analysis, Interpretation, Dissemination

19. Empowerment Implementation
Four Steps (Rabin, 2016; Van Daele, 2012):
Develop theoretically sound core program components, test them in a controlled setting, identify elements that are key to efficiency.
Select skilled partners to be responsible for implementation.
Adapt program by involving partners to assess the fidelity/adaptation concerns, decide on logistics and practical applications, and work on content adaptations with partners and researchers as equal contributors.
Develop implementation plan with the role of partners outlined. Researchers monitor variations to essential program elements and work with partners to address deviations and avoid future issues.
Empowerment Implementation

20. Cultural Adaptation Considerations for Cultural Adaptation
Integrating cultural variables in community initiatives
Multilevel cultural framework / Cultural sensitivity model (surface culture and deep culture adaptations)
Dimensions of culturally sensitive interventions / Ecological validity model
Guiding principles for cultural adaptation
Cultural Adaptation

21. Recommendations, Framework & Tools
Planning for Success

22. Recommendations For Funders & Policy Makers
Invest in systematic development and implementation of adaptations
Support rigorous mixed methods evaluation of adaptations
For Local Adaptations of Crime Prevention Programming on the Ground
Support key leadership, competency, and organization drivers
Balance empirical evidence with context and experience
Rely on acceptable motives
Avoid fundamental change to key elements of intervention
Respect and reflect the surface structure and deep structure of culture
Use a strengths-based and capacity-building lens
Use mixed methods and community based participatory research to guide assessment and evaluation
Use an intentional and systematic approach to balance fidelity & fit
Recommendations

23. Build a strong foundation through strong leadership and effective partnership building
Conduct program exploration and participatory assessment to select an appropriate evidence-based intervention and decide on its necessary adaptations; create adaptation plan
Conduct training and pilot testing of adaptation
Refine program adaptation and begin implementation
Evaluate and maximize program quality (process)
Evaluate and maximize program impact (outcomes)
Disseminate information about your program and its results ~ Ensure continuous learning and improvement ~
Framework Phases

24. Tools Provided The VSP Tool (Values, Structure, Processes)
The Community Toolbox
Hexagon Exploration Tool
Pentagon Tool
Green Light, Yellow Light, & Red Light Adaptations
Program Fidelity & Adaptation Plan Template
Experiential Learning Tips & Tools
Intelligent Failure & Learning Loops Worksheet
Tools Provided

25. Framework Phases & Steps to Follow

27. Key Effective Elements of Crime Prevention Programming
A Review of 31 Evidence-Based Programs

28. Review of 31 Evidence-Based Programs
Programs in Indigenous Communities (N=3)
Programs for Children Ages 6 to 11 (N=13)
Programs for Youth Ages 12 to 17 (N=12)
Programs for Addressing Youth Gang Involvement (N=3)
Programs for Offenders (N=1)
Review of 31 Evidence-Based Programs

29. Coding Framework 1 Main objectives of the intervention 2
Target risk and protective factors 3
Definition & description 4
Universal vs. targeted program 5
Target population 6
Setting 7
Level of intervention 8
Components 9
Specifics of delivery 10
Dosage 11
Duration 12
Evaluations methods and findings 13
References 14
Existing adaptations
Coding Framework

30. Key Effective Elements
Review of findings are presented - a comprehensive table of each evidence-based program reviewed is provided
Broader themes in crime prevention literature are highlighted – importance of target population (the right audience), dosage (the right amount), duration (for the right period of time)
Recent trends are discussed: from prevention science to strength-based approaches and trauma-informed services
Key Effective Elements

31. Case Studies
Applying the Model

32. Case Example 1:  Local Adaptation of the OJJDP Comprehensive Gang Model (Spergel Model) in a Canadian City
Case Example 2:  Local Adaptation of Multisystemic Therapy (MST) for Indigenous Youth
Case Studies

33. Putting Knowledge into Practice
Final Toolkit
Putting Knowledge into Practice

35. Melanie Bania, PhD
Community-Engaged Consulting
Contact Information