SPF PLANNING
1
SAMHSA’s
Strategic Prevention Framework
Supports Accountability, Capacity, and Effectiveness
Assessment
Profile population needs, resources, and
readiness to address needs and gaps
Capacity
Mobilize and/or build capacity to address
needs
Planning
Develop a Comprehensive Strategic Plan
Implementation
Implement evidence-based prevention
programs and activities
Evaluation
Monitor, evaluate, sustain, and improve or
replace those that fail
2
SAMHSA’s
Strategic Prevention Framework
Supports Accountability, Capacity, and Effectiveness
Assessment
Profile population needs, resources, and
readiness to address needs and gaps
Capacity
Mobilize and/or build capacity to address
needs
Planning
Develop a Comprehensive Strategic Plan
Implementation
Implement evidence-based prevention
programs and activities
Evaluation
Monitor, evaluate, sustain, and improve or
replace those that fail
3
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
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
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
But Why
Here?
But Why?
Problem
7
7
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
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
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
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
11
Logic Model:
Outcomes-Based Prevention
Substancerelated
problems
Intervening
Variables
Strategies/
Programs
12
12
The Logic Model

Clearly States the Problem

Surfaces the Root Causes

Identifies Why These Root Causes
Exist in Your Community
13
13
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
14
Logic Model Components:
Reducing Alcohol-Related Youth Traffic Fatalities
SubstanceRelated
Consequences
Substance
Use
(consumption)
(Intervening
Variables)
Underage
BINGE
DRINKING
Easy RETAIL ACCESS to
Alcohol for youth
Young Adult
High rate of
alcoholrelated crash
mortality
Among 15 to
24 year olds
Causal
Factors
BINGE
DRINKING
Young Adult
DRINKING AND
DRIVING
Underage
DRINKING AND
DRIVING
Low ENFORCEMENT of
alcohol laws
Easy SOCIAL ACCESS to
Alcohol
Low PERCEIVED RISK of
alcohol use
SOCIAL NORMS accepting
and/or encouraging
youth drinking
Strategies
(Examples)
Enforce underage
retail sales laws
Social Event
Monitoring and
Enforcement
Media Advocacy to
Increase Community
Concern about
Underage Drinking
PROMOTION of alcohol
use (advertising, movies,
music, etc)
Restrictions on
alcohol advertising in
youth markets
Low or discount PRICING
of alcohol
Bans on alcohol price
promotions and
happy hours
15
The Care and Feeding
of a Winning Plan
16
16
Components of Strategic Plan
 Vision
 Mission
 Objectives
 Strategies
 Action
Plan
17
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
18
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
19
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
20
Vision Statement
A vision statement is a statement of
what a community is trying to
become; the desired end state or
the ultimate goal.
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.
21
21
Sample Vision Statements
 “Alcohol
and drug free
community”
 “Healthier, safer
community”
 Other
http://www.cadca.org/files/PlanningPrimer-06-2009.pdf
22
Mission Statement
A mission statement expresses
HOW the coalition will work to
achieve this shared vision
23
Sample Mission Statement
 “To
develop an alcohol and drugfree community through consensus
planning, community action and
policy advocacy.”
 Other?
24
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
25
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
26
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
27
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
28
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
29
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
30
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
31
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
32
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
33
Easy Retail
Access
Promotion
Low Perceived
Risk
Low Prices
Low
Enforcement
Social Norms
Social Access
Substance Use
15-24 year olds involved in alcohol-related vehicle crashes
and crash fatalities
34
34
Lack of Sobriety
Check
Points
Youth are able
To Purchase Alcohol
At various stores
Low Priority for small
Police Force
No Law Enforcement
Currently Involved
Low
Enforcement
Low Priority for small
Police Force
Sales to Intoxicated
People
No Judicial officials
Experts involved
DWI convictions result in
Minimum consequence
35
35
Strategizing how things
will be accomplished
36
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
37
Low Enforcement
Inputs
Sheriff's
office
Outputs
Sobriety
Check Points
ID
compliance
checks
Short Term
Outcomes
Long Term
Outcomes
Behavior
Changes
Decrease
15-24 year olds
Alcohol related
classes
Merchant
Education
Retailers
Community
Action
group
Rewards for not
Selling to intoxicated
patrons
Media
Campaign
Community
Change
Behavior
Changes
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
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
40
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
41
Reducing Risks &
Increasing Protective Factors
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
42
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
43
The Devil is in Details
• Identify action steps for continual
assessment
• Develop action and capacity plan
• Ensure Cultural Competence and
Sustainability
44
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
45
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
46
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
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
Ecological Model
49
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
50
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?
51
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
Evaluate Appropriateness of
Action Plan

Completeness

Clarity

Sufficiency (can it realistically effect change?)

Resources

Currency

Flexibility
53
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
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
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
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
Next Step

After careful planning, it is time to
consider what evidence –based
prevention will be used.
58
THANK YOU FOR
PARTICIPATING IN THIS
TRAINING MODULE.
59
PART 2
Evidence-Based
Prevention
60
State and Community
Implementation
State Level
Implementation
Implement infrastructure
development activities
state and local level
Community Level
Assessment
Mobilizing
Capacity
Planning
Implement
Evaluate
Implement evidence-based
prevention strategies and
infrastructure development
activities
61
Identifying and Selecting
Evidence-Based
Interventions (EBIs)
62
Effective intervention
planning should address
both risk and protective
factors.
63
63
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
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
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

66
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.
Paradigm Shift





Anecdotal c bean counting c 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
68
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
69
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
Consequence
and
consumption:
Low-price
alcohol
specials in
bars
Policy to
limit drink
specials
High-risk
drinking
18–25 year olds
Servers not
checking
IDs
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
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?
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
“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 metaanalysis studies
3.
Evidence-based - sufficient research and
evidence to demonstrate effectiveness as
identified by a meta-analysis or expert peer
panel
74
Current EBP Categories
Identified by CSAP
Not Evidence-based
Evaluated
but was
found to
be
ineffective
Innovative
program
unlike any
other effort
previously
evaluated for
effectiveness
Evidence-Based intervention
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
No
evidence
Strong
evidence
CSAP Categories of
Evidence-Based
76
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
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
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
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

Guide to Clinical Preventive Services Sponsored by the Agency for
Healthcare Research and Quality [AHRQ]
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.org

A list of other registries may be found at SAMHSA’S website:
http://www.samhsa.gov/ebpWebguide/appendixB.asp.

SAMHSA National Registry of Evidence-Based Programs and Practices
(NREPP) http://www.nrepp.samhsa.gov
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
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.

Glossy, often color pictures
Popular
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
83
Often bland, with few colors
Scholarly
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
84
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)
85
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
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
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?
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
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
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.
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.
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
Selecting Best-Fit Interventions
Selecting Best-Fit
Prevention Interventions
Identify
Types of
Strategies
Demonstrate
Conceptual Fit
Relevant?
Select Specific
Programs,
Practices,
& Policies
Demonstrate
Practical Fit
Practical?
Ensure
Effectiveness
Best-Fit
Prevention
Interventions
Demonstrate
Evidence of
Effectiveness
Effective?
95
Conceptual Fit
Does it do what you need to accomplish?
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?
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?
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?

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
99
Fidelity and Adaptation
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.
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 evidencebased programs occurs when there is program fidelity with respect to
certain key elements. And some adaptations are undesirable, whether
deliberate or accidental.
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.
4.
5.
6.
7.
Identify fidelity/adaptation concerns for local implementation
If possible, consult as needed with the program developer to
review proposed adaptations
Consult with the organization and/or community in which the
implementation will take place
Develop an overall implementation plan based on these results
Continually assess fidelity and adaptations during implementation
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
10
4
Thank you for participating in
this training module!
10
5