Real-World Replication of Strengthening Families Program: Exploring Links Between Adaptations & Outcomes

Despite a growing body of evidence that fidelity is associated with improved outcomes (Durlak & Dupre, 2008), adaptations inevitably occur when programs are transported into the real-world (e.g., Dusenbury et al., 2005). Debate abounds about whether programs should be flexibly adapted to fit local contexts or rather should be delivered with strict fidelity to the original program model. Some researchers propose a middle ground, arguing that it is possible for fidelity and adaptation to co-occur without negatively influencing outcomes and in some cases may improve them. Thus far, this discussion has been primarily theoretical, however, with little empirical evidence to support either side of the argument. In particular, there is a dearth of evidence from adaptations made under non-research conditions.

Using data from a large-scale replication of Strengthening Families Program (SFP; a 7-week substance use prevention program with youth 10-14 years old and their parents), we will apply and extend two multidimensional coding systems that were previously applied to analysis of SFP and were designed to determine the nature of adaptations, why they took place, and whether they were aligned with program goals and theory (Hill, Maucione, & Hood, 2007; Moore, Bumbarger, & Cooper, in press).  In previous studies, the coding systems were applied to observational data to describe the types of adaptation made by facilitators.  In the present study, we will apply them to self-reports of adaptations from facilitators in 100 sites in WA and OR, and examine the relation of adaptations to program outcomes. Specifically, we will explore how various dimensions of adaptations are linked to parent and youth outcomes using multilevel models with gender, race, and pretest scores as covariates. 

Results will extend previous research in two important ways. First, by examining the degree to which self-report findings match observational findings using the same coding scheme, we will be able to determine the utility of this coding system as a tool communities can use in real-world replications for quality improvement.  Second, as previous research has focused mainly on associations between program fidelity and outcomes within the context of highly-controlled research trials, this study extends our knowledge of these associations to the context of large-scale, real-world implementation.

Ultimately, this study provides a multidimensional perspective on adaptations under natural conditions and empirically demonstrates how adaptations are linked with program outcomes, thus informing how best to support real-world replications of prevention programs.