1. SPF PLANNING 1

2. 2 SAMHSA’s Strategic Prevention Framework Supports Accountability, Capacity, and Effectiveness Assessment Profile population needs, resources, and readiness to address needs and gaps Evaluation Monitor, evaluate, sustain, and improve or replace those that fail Implementation Implement evidence-based prevention programs and activities Planning Develop a Comprehensive Strategic Plan Capacity Mobilize and/or build capacity to address needs

3. 3 SAMHSA’s Strategic Prevention Framework Supports Accountability, Capacity, and Effectiveness Assessment Profile population needs, resources, and readiness to address needs and gaps Evaluation Monitor, evaluate, sustain, and improve or replace those that fail Implementation Implement evidence-based prevention programs and activities Planning Develop a Comprehensive Strategic Plan Capacity Mobilize and/or build capacity to address needs

4. Training Objectives Explain Pre-Requisites to Successful Planning Define Purpose of Planning Provide Guidance for Writing a Strategic Plan Distinguish Logic Models & Action Planning Overview Environmental Strategies Link Steps to Cultural Competency & Sustainability Explain Evidence-Based Selection/Implementation Provide Guidance for Monitoring 4 4

5. Key Pre-Requisites to Planning Public Health Approach Population Based Change Data Informs Decisions Outcome-Based Assessment of Problems, Resources, Gaps, Readiness Stakeholders Engagement 5

6. Pre-Requisite Questions What is going on in my community? How big & what kinds of problems? Is there consequence data? How useful is data? What resources exist? How ready is community? 6

7. 7 But Why? Problem But Why Here? 7

8. Why Strategic Planning? Communities are expected to develop and implement strategies that have a good chance of reducing county-level indicators of ATOD and attendant problems. 8

9. What is a Strategic Plan? Roadmap that Guides: Data collection/sharing Capacity Expansion Logical identification of goals/objectives Selection of evidence-based programs, policies Evaluation plan 9 9

10. Failure to Plan Lack of understanding of problem Limited understanding of solutions Overlooking important details Failure to create shared responsibility Poor evaluation Non Sustained procedures/programs/policies 10

11. The Planning Team Start with Team Comprised from 12 Sectors Team Collaborates Around Logic Model Group Determines Need for Other Partners Note: Convene team before you start writing plan 11

12. Logic Model: Outcomes-Based Prevention 12 Substance- related problems Intervening Variables Strategies/ Programs 12

13. The Logic Model Clearly States the Problem Surfaces the Root Causes Identifies Why These Root Causes Exist in Your Community 13

14. Why Use a Logic Model? Insures clarity on precisely how the group intends to make a difference Establishes a common language for how things will improve Keeps the focus on outcomes Integrates planning, implementation and evaluation 14

15. 15 High rate of alcohol- related crash mortality Among 15 to 24 year olds Low or discount PRICING of alcohol Easy RETAIL ACCESS to Alcohol for youth Easy SOCIAL ACCESS to Alcohol Media Advocacy to Increase Community Concern about Underage Drinking Restrictions on alcohol advertising in youth markets SOCIAL NORMS accepting and/or encouraging youth drinking PROMOTION of alcohol use (advertising, movies, music, etc) Low ENFORCEMENT of alcohol laws Young Adult DRINKING AND DRIVING Social Event Monitoring and Enforcement Bans on alcohol price promotions and happy hours Enforce underage retail sales laws Causal Factors (Intervening Variables) Strategies (Examples) Substance- Related Consequences Substance Use (consumption) Logic Model Components: Reducing Alcohol-Related Youth Traffic Fatalities Low PERCEIVED RISK of alcohol use Underage BINGE DRINKING Young Adult BINGE DRINKING Underage DRINKING AND DRIVING

16. 16 The Care and Feeding of a Winning Plan 16

17. Components of Strategic Plan Vision Mission Objectives Strategies Action Plan 17

18. Planning – Key Questions What do we want to do about the identified problem? What programs and practices have other communities used to solve this problem? What will work in our community? 18

19. Implementation – Key Questions 1. How will we know if we are successful in solving the problem (what measures)? 2. What are some of the potential road blocks to successful implementation? 3. How can we improve existing strategies and/or processes to solve this problem? 19

20. Substance-related Consumption Patterns Overall consumption Acute heavy consumption Consumption in risky situations ◦ Drinking and driving ◦ Smoking around young children Consumption by populations/groups ◦ Youth, college students, older adults ◦ Pregnant women ◦ Other? 20

21. Vision Statement A vision statement is a statement of what a community is trying to become; the desired end state or the ultimate goal. 21 It answers the question “why do it.” It should read in the present tense. If you were to accomplish what you want, what would it look like.

22. Sample Vision Statements “Alcohol and drug free community” “Healthier, safer community” Other http://www.cadca.org/files/PlanningPrimer-06-2009.pdf 22

23. Mission Statement A mission statement expresses HOW the coalition will work to achieve this shared vision 23

24. Sample Mission Statement “To develop an alcohol and drug- free community through consensus planning, community action and policy advocacy.” Other? 24

25. Not So Fast... Though succinct, a vision for prevention is based on: ◦ Documented needs ◦ Identified resources and strengths ◦ Measurable objectives and performance measures ◦ Baseline data Include a long-term strategy to sustain policies, programs, and practices Adjust plans as the result of ongoing needs assessment and monitoring 25

26. Defining and Writing Goals Think of goals as targets that are to be reached or “hit”. Goals are broad, general statements describing what the project or group wants to accomplish and/or achieve They are not specific activities or action steps! 26

27. Goals Should... Specify end result or desired ultimate accomplishment Reflect perceived present and future needs Be capable of being effectively pursued Source: http://www.for.gov.bc.ca/hfd/library/documents/glossary/G.htm 27

28. Examples of UAD Goals Reduce underage drinking by enforcing underage drinking laws and regulations Educate youth and adults on the serious consequences of underage drinking Improve communication and collaboration among organizations involved in UAD prevention 28

29. Guiding Points About Objectives Foundation for program development and evaluation Must be clear and “actionable” Objectives are not action steps (Who/What not How) They should be realistic... Unrealistic expectations may lead to failure In most cases, it is impossible to achieve a goal of 100%. 29

30. Measurable Objectives Articulate what program is intended to do Should be measurable to assess progress toward the goal Specific, attainable, timely, and lead to observable behaviors Tools you use to make sure you reach your goals Should not restrict or constrain vision; but ensure that actions are clearly focused and communicated so that all parties know what is going on You can shoot your arrows many ways, but they reach and score the bulls eye!! 30

31. Tips for Writing Objectives 1. Audience – Who is this being aimed at? 2. Behavior – What do you expect them to be able to do? 3. Condition – How? Under what circumstances will the impact or learning occur? 4. Degree – How much? Must a specific set of criteria be met? Do you want total mastery (100%) of the task(s), 80%, 50%, etc.? 31

32. Examples of Objectives If the goal is to reduce underage drinking by enforcing underage drinking laws and regulations, objectives might include: By October 2014 increase by 10% the number of citations given to youth that violate the state’s liquor laws. By October 2014, decrease by 10% the number of retailers that sell alcohol to minors (as determined by compliance checks. See Community How To Guide on Underage Drinking Enforcement). Hint: When assigning percentages to an objective, go back to the needs assessment and determine how much improvement can be realistically achieved over a given period of time. 32

33. Prioritizing Intervening Variables Before the strategic plan can be developed, Intervening Variables must be prioritized. Prioritization will be based on: ◦ Severity ◦ Capacity ◦ Ability to Implement Strategies 33

34. 34 Promotion Social Norms Social Access Easy Retail Access Low Perceived Risk Low Enforcement Low Prices Substance Use 15-24 year olds involved in alcohol-related vehicle crashes and crash fatalities 34

35. 35 Low Enforcement Lack of Sobriety Check Points Sales to Intoxicated People DWI convictions result in Minimum consequence Youth are able To Purchase Alcohol At various stores No Law Enforcement Currently Involved No Judicial officials Experts involved Low Priority for small Police Force Low Priority for small Police Force 35

36. 36 Strategizing how things will be accomplished Strategizing how things will be accomplished

37. Strategic Planning Objectives Prioritize Intervening Variables according to severity and existing capacity. Define priorities and objectives and organize those objectives into a strategy Address the needs that have been documented 37

38. Merchant Education Low Enforcement Retailers ID compliance checks Sobriety Check Points Rewards for not Selling to intoxicated patrons Media Campaign Behavior Changes Behavior Changes Decrease 15-24 year olds Alcohol related classes Community Action group Sheriff's office Inputs Outputs Short Term Outcomes Long Term Outcomes Community Change

39. Strategic Planning Objectives Build on identified resources, strengths and capacity Address multiple causes of identified problems in multiple community sectors Identify benchmarks, recruitment strategies, and action steps for capacity in each Intervening Variable 39

40. 40 Strategic Planning Objectives Include measurable objectives, the performance measures and baseline data against which progress will be monitored. Identify goal(s) for Intervening Variable(s) and determine objectives that address contributing factors Identify strategies that are population appropriate 40

41. Strategic Planning Objectives Consider community readiness Identify evidence-based programs, practices, and policies (strategies) for each contributing factor Identify action steps for continual assessment of each Intervening Variable 41

42. Reducing Risks & Increasing Protective Factors 42 Identify evidence-based programs, practices, and policies (strategies). Strategies should meet one of the following: 1. Evidence-based 2. Limited evidence 3. Logic Driven 42

43. 43 What We Know So Far (Planning) Goal: Create an environment where alcohol is not illegally or inappropriately available to adolescents and young adults in social settings. Objective: Reduce the percentage of parents reported to provide alcohol to their minor children by 20% by May 30, 2012. Strategy: Increase parental knowledge of underage drinking laws by disseminating “Parents Who Host Lose the Most” information cards to 4,000 APS High School Parents. 43

44. The Devil is in Details Identify action steps for continual assessment Develop action and capacity plan Ensure Cultural Competence and Sustainability 44

45. Strategic Plan Details Plans will continuously need to be monitored and reviewed. Why? ◦ Evaluate progress ◦ Accountability ◦ Make necessary changes ◦ Account for new data ◦ Management 45

46. Strategic Plan Details Ensure cultural competence and sustainability throughout the strategic planning process. Identify a process to review progress towards benchmarks and action steps included in the strategic plan. 46

47. Other 5-Step Considerations How will Data Driven Decision-making continue? Mutually Reinforcing Strategies: When and how should strategies work together to impact consequence/consumption identified (ecological model) 47

48. To Consider Target multiple domains or contexts across the lifespan Consider questions of reach when selecting strategies: How many people will your interventions impact? Which sectors of the community will be impacted by your efforts? What dosage of the interventions will target audience experience? 48

49. Ecological Model 49

50. 50 Action Planning Why create a plan for action? An action plan allows us to create an objective profile of community, identify how to focus resources and efforts, and to implement more effective strategies. Moves us from strategizing to Implementation

51. 51 Action Plan Before and After Questions How will we know if we are successful in solving the problem (what measures)? What are some of the potential road blocks to successful implementation? How can we improve existing strategies and/or processes to solve this problem?

52. The Action Plan Describes:  What specific community/system changes to be sought in accomplishment of goals  Which objectives will be employed (EBPs/Activities)  Who is going to do what  When measurable results will occur (in conjunction with evaluation) 52

53. Evaluate Appropriateness of Action Plan Completeness Clarity Sufficiency (can it realistically effect change?) Resources Currency Flexibility 53

54. Double Check Your Process Is plan truly comprehensive? Have you looked at all appropriate data? Were all appropriate people involved? Built upon theory of change? Have you considered all the angles? Does plan, as written, make sense to someone who had no input? 54

55. Monitor the Strategic Plan Develop a protocol – What do you want to know? Who should be interviewed? What does action plan say you will do? Develop a schedule – How often should you review? Adjust plans as the result of ongoing needs assessment and monitoring 55

56. Phases of Implementation Pre-Conditions – Need, target decisions, possible interventions and trouble-shooting Pre-Implementation - Community input, internal brainstorming, pilot test, prep for implementation Implementation – Deliver best fit EBP, staff and key leader training, fidelity, evaluation Maintenance - Organizational or financial changes to sustain, customizing, TA 56

57. Cultural Competency Considerations Is the strategy culturally appropriate and responsive? Will the strategy be delivered in a culturally appropriate manner? What other thoughts might be added to this conversation? 57

58. Next Step After careful planning, it is time to consider what evidence –based prevention will be used. 58

59. THANK YOU FOR PARTICIPATING IN THIS TRAINING MODULE. 59

60. 60 PART 2 Evidence-Based Prevention

61. 61 State Level Implementation AssessmentMobilizing Capacity State and Community Implementation PlanningImplementEvaluate Implement infrastructure development activities state and local level Community Level Implement evidence-based prevention strategies and infrastructure development activities

62. Identifying and Selecting Evidence-Based Interventions (EBIs) 62

63. 63 Effective intervention planning should address both risk and protective factors.

64. Evidence Based Prevention Definition: A prevention service (program, policy or practice) that has been proven to positively change the problem you are trying to impact. Examples: ◦ Program: Strengthening Families Program ◦ Policy: Increased tax on cigarettes ◦ Practice: Consistent enforcement of YTA

65. Using Research to Make Decisions Putting the scientific method to work for prevention: ◦ Start with an observation ◦ Make a hypothesis (a guess), ◦ Conduct trials and tests to test the hypothesis ◦ Examine the data, develop newer ideas which leads to more tests and refinement of hypotheses. Research is used to test out theories Often the theory being examined is whether an intervention is effective

66. 66 Why be concerned about Evidenced Based Prevention? Why be concerned about Evidenced Based Prevention? Federal and state agencies, as well as private funders are asking for it Public accountability The desire to improve programs We want to be effective Limited resources used wisely

67. History of Terms Then: ◦ Best Practice Principles - When certain principles are incorporated into prevention programming the effort is more likely to be effective. ◦ Research/Science Based - A pre-existing validated model program (eg. Botvin’s life skills) OR based on a validated theory relevant to substance abuse (eg. risk/protective factor, Bandura’s social learning theory) Now: ◦ Evidence-Based Prevention - There is evidence that the activity has shown to achieve the desired outcomes.

68. 68 Paradigm Shift Anecdotal  bean counting  trend profiles From picking off lists to thinking critically about needs From categorical labels to ratings along a continuum From relying on strength of evidence alone to assessing the relative importance of strength of evidence in a broader context From stand-alone intervention selections to comprehensive community plans

69. 69 Comprehensive Approach: Any priority problem will have multiple contributing conditions Each contributing condition will require multiple interventions An effective community plan requires a comprehensive approach ◦ made up of multiple strategies/interventions, and ◦ each strategy/intervention requires evidence

70. Comprehensive Plans Prevention interventions require ‘evidence’ throughout the SPF steps: ◦ Evidence that your addressed priority is a need ◦ Evidence that you’re addressing the stuff that makes the bad thing happen (intervening variables) ◦ Evidence that your selected strategies work to fix the stuff that makes the bad thing happen ◦ Evidence that the intervention is working (evaluate) 70

71. Consequence and consumption: High-risk drinking 18–25 year olds Low-price alcohol specials in bars Servers not checking IDs Policy to limit drink specials Responsible server education Evidence required that this is really a problem for your community Evidence required that these are contributing conditions in your community Evidence required that these strategies reduce low-price alcohol specials and increase servers checking ID’s

72. Evidence-Based Interventions Strength of Evidence ≠ strength of effect Strength of evidence is determined by the answers to the following: ◦ How thorough and rigorous was the research/evaluation? ◦ How well were the evaluation results documented, disseminated? ◦ Is there consensus among the experts?

73. Evidence-Based Interventions Strength of Evidence The nature of evidence is continuous Will fall along a continuum from weak to strong The strength of evidence is assessed using scientific standards and criteria for applying these standards

74. “Three Bears” EB Rigor 1. Logic driven - have not been widely researched, but derived from logic or theory 2. Limited evidence - supported by evidence or individual studies, but not as rigorous as meta- analysis studies 3. Evidence-based - sufficient research and evidence to demonstrate effectiveness as identified by a meta-analysis or expert peer panel 74

75. Current EBP Categories Identified by CSAP No evidence Strong evidence Innovative program unlike any other effort previously evaluated for effectiveness Documented effectiveness supported by other sources of info and expert consensus Reported with positive results in peer reviewed journal Listed on a Federal registry of effective programs Continuum Evidence-Based interventionNot Evidence-based Evaluated but was found to be ineffective

76. 76 CSAP Categories of Evidence-Based

77. SPF Evidence-Based Categories According to latest CSAP guidance published in the document, “Identifying and Selecting Evidence-Based interventions” there are three categories of EBP: 1. Included on federal registries of evidence-based interventions 2. Reported (with positive effects on the primary targeted outcome) in peer-reviewed journals 3. Documented effectiveness supported by other sources of information, the consensus judgment of informed experts, and meeting 4 specific guidelines

78. Federal Registries Many federal agencies have developed a review process to look at the evaluation of specific programs Typically review programs that: ◦ Are discrete in scope ◦ Use a curricula or manual ◦ Defined and tangible settings ◦ Focus on primarily individuals or families Level of evidence required varies considerably Still have to think critically and make reasoned judgments

79. Federal Registries Advantages: Easy to find Easy to replicate Federal agency reviews the research One-stop shopping Funders Challenges: Limited number of interventions Very few population-based interventions Misleading ‘global effectiveness labels’ Often over generalize outcomes

80. Federal Registries OJJDP Model Programs Guide http://www.dsgonline.com/mpg2.5/mpg_index.htm Exemplary and Promising Safe, Disciplined and Drug-Free Schools Programs Sponsored by the U.S. Department of Education http://www.ed.gov/admins/lead/safety/exemplary01/exemplary01.pdf http://www.dsgonline.com/mpg2.5/mpg_index.htm http://www.ed.gov/admins/lead/safety/exemplary01/exemplary01.pdf Guide to Clinical Preventive Services Sponsored by the Agency for Healthcare Research and Quality [AHRQ] http://www.ahrq.gov/clinic/cps3dix.htm http://www.ahrq.gov/clinic/cps3dix.htm Guide to Community Preventive Services Sponsored by the Centers for Disease Control and Prevention [CDC] http://www.thecommunityguide.orghttp://www.thecommunityguide.org A list of other registries may be found at SAMHSA’S website: http: //www.samhsa.gov/ebpWebguide/appendixB.asp. http: //www.samhsa.gov/ebpWebguide/appendixB.asp SAMHSA National Registry of Evidence-Based Programs and Practices (NREPP) http://www.nrepp.samhsa.govhttp://www.nrepp.samhsa.gov

81. Federal Registries National Registry of Evidence-Based Programs and Practices (NREPP) History: ‘Model’ program endorsement Current: ◦ Inclusion does not constitute endorsement of an intervention by SAMHSA. ◦ NREPP inclusion does indicate effectiveness ◦ Provides information to support a critical review of research within the broader context of your community.  quality of the research supporting outcomes  Strength of the outcomes  quality and availability of training and implementation materials

82. Peer-Reviewed Journals (with positive effects on the primary targeted outcome) Peer review is the process of subjecting research to the scrutiny of other experts in the same field. The purpose is very different than of a federal registry. For scholarly purposes and to further a field of research. To be published an article must: ◦ meet the accepted standards for research methodology (rigors) AND ◦ Ensure appropriate interpretations of the research conducted.

83. 83 Glossy, often color pictures Target = general public General interest or current events Many ads, often in color Writers typically journalists or reporters Author sometimes “unsigned” Chosen by editor or edit board No formal citations Newsstand, subscription Corporation/popular press Popular

84. 84 Often bland, with few colors Targets field professionals Research reports or professional concerns Usually few or no ads Writers = Practitioners/ Scholars/ researchers Author "signed articles" Selected by field experts “Peer-Reviewed" Article bibliographies Subscription Professional association or scholarly publisher Scholarly

85. 85 Sample Journal Titles Available from Libraries Addictive Behaviors Alcohol Health and Research World Contemporary Drug Problems Journal of Ethnicity in Substance Abuse Journal of Child & Adolescent Substance Abuse Journal of Drug Education Natl. Institute on Alcohol Abuse and Alcoholism www.niaaa.nih.gov Western North Carolina Library Network (WNCLN)

86. Using Peer-Reviewed Journal Research Advantages: Detailed findings and analysis that document whether the intervention works. Contact info Meta-analysis articles Challenges: Often don’t give enough detail to replicate Onus of determination of SOE on the reader Access to journals is limited Where to find: University libraries Michigan E-journals

87. Peer Reviewed Journals Structure of a PRJ: Abstract: a summary of the key points in the article and the hypothesis being tested Introduction: context for the study. What prompted the research, what research does study build on Methods: Explains how the researchers set about testing their hypothesis Results: detailed findings of the research conducted Discussion: a summary of the results and what they mean Bibliography: a listing of all the sources cited in the article, as well as relevant articles or books that were not cited 87

88. Peer-Reviewed Journal: Critical Review Quality of PRJ information: How rigorous was the evaluation? Are the findings and outcomes clearly described? Is there enough info about the intervention to replicate it? Are there multiple articles with consistently positive results for the intervention? Local Fit: Does the intervention address your identified problem and relating contributing conditions? Has the intervention been effective in a community like yours? Has the intervention been effective with a population similar to yours?

89. Documented Effectiveness… Documented effectiveness supported by other sources of information and the consensus judgment of informed experts. Guidelines: (Must meet all 4 guidelines to qualify) 1.Based on solid theory of change that is documented in a clear logic or conceptual model; 2.Similar in content and structure to interventions that appear in registries and/or peer-reviewed literature; 3.Supported by documentation that it has been effectively implemented in the past, multiple times, in a manner attentive to scientific standards of evidence and with results that show a consistent pattern of credible and positive results. 4.Reviewed and deemed appropriate by a panel of informed prevention experts

90. Documented Effectiveness… It may be necessary to rely on this weaker strength of evidence when no appropriate interventions are available in categories with stronger evidence. Keep in mind that your intervention must be appropriate for the: ◦ Identified problem and contributing condition, ◦ population to be served/reached, and ◦ cultural and community context in which the intervention will be implemented

91. Documented Effectiveness… Advantages Increases the possible strategies to use as a part of a comprehensive plan; Flexibility for those making programming decisions; Empowers planners to select or develop innovative, complex interventions to meet the needs of individual communities; Creates the ability to include culturally based evidence as well as traditional evidence to support local decisions; and Authorizes planners to exercise professional judgment in deciding the potential contribution of unique intervention components in the comprehensive plan.

92. Documented Effectiveness… Challenges: Places substantial responsibility on prevention planners for intervention selection decisions The burden of proof for documented effectiveness lies with the program planners and practitioners making the selection decisions Require prevention planners to think critically about the evidence to support the inclusion of a particular intervention in the community’s comprehensive plan.

93. Must prove all four guidelines 1.Based on solid theory of change that is documented in a clear logic or conceptual model 2.Similar in content and structure to interventions that appear in registries and/or peer-reviewed literature 3.Supported by documentation that it has been effectively implemented in the past, multiple times, in a manner attentive to scientific standards of evidence and with results that show a consistent pattern of credible and positive results. 4.Reviewed and deemed appropriate by a panel of informed prevention experts

94. Selecting Best-Fit Interventions

95. 95 Selecting Best-Fit Prevention Interventions Select Specific Programs, Practices, & Policies Ensure Effectiveness Identify Types of Strategies Best-Fit Prevention Interventions Demonstrate Conceptual Fit Demonstrate Evidence of Effectiveness Demonstrate Practical Fit Relevant?Practical?Effective?

96. Questions to ask yourself? Does it fit into community logic model? Does it address the identified contributing conditions? Has it been tested for the target population? Does it respond to the specific needs of your targeted population? Does the intervention contribute to a comprehensive community plan? Conceptual Fit Does it do what you need to accomplish?

97. Practical Fit for Community Can you actually do it? Questions to ask yourself and your coalition: Do you have the manpower and funding needed? Do you have the necessary community contacts needed (police, leaders, etc.)? Will the community support this strategy? Does this strategy reflect your community’s culture? Could this strategy be sustained? Could this strategy be evaluated?

98. Effectiveness Is there evidence that the strategy works? Questions to ask: How effective is the strategy at impacting desired outcome? How strong is the evidence? Would the reach be large enough to impact the desired outcome?

99. 99 Cultural Considerations Can the intervention be adapted to serve diverse groups? Has targeted community been consulted regarding design, etc. Is the intervention responsive to targeted group? How do you know? Do implementers understand the group culture? Do organization(s) have the resources to deliver culturally appropriate strategies? Are there any language/literacy barriers

100. Fidelity and Adaptation

101. Fidelity and Adaptation Considerations Fidelity: the degree of fit between the developer-defined components of a substance abuse prevention program and its actual implementation in a given organizational or community setting. Program Adaptation: deliberate or accidental modification of the program, including the following: ◦ deletions or additions; ◦ modifications in the nature of the components that are included; ◦ changes in the manner or intensity of administration of program components called for in the program manual, curriculum, or core components analysis; or ◦ cultural and other modifications required by local circumstances.

102. Fidelity/Adaptation Balance A dynamic process, often evolving over time, by which those involved with implementing a evidence-based interventions address both the need for fidelity to the original intervention and the need for local adaptation. ◦ There is evidence that many evidence-based prevention programs still produce positive results despite significant adaptation. Some adaptations are, in fact, necessary for program success, given widely varying circumstances in different organizations or communities. ◦ There is significant evidence that the greatest impact from evidence- based programs occurs when there is program fidelity with respect to certain key elements. And some adaptations are undesirable, whether deliberate or accidental.

103. Fidelity/Adaptation – Be Strategic 1. What are the theoretical underpinnings of the program? 2. Identify the core components: Those elements of a program that fundamentally define its nature, and that analysis shows are most likely to account for its main effects 3. Identify fidelity/adaptation concerns for local implementation 4. If possible, consult as needed with the program developer to review proposed adaptations 5. Consult with the organization and/or community in which the implementation will take place 6. Develop an overall implementation plan based on these results 7. Continually assess fidelity and adaptations during implementation

104. 104 QUESTIONS? If you have any questions or desire technical assistance on this topic please contact: MDCH Bureau of Substance Abuse & Addiction Svcs Larry Scott, Prevention Section Manager 320 S. Walnut Street Lansing, MI 48913 517-335-0174 scottl11@michigan.gov

105. Thank you for participating in this training module! 105