Testing the Implementation of Ebi's within an Urban, Culturally Diverse Population

The District of Columbia’s Addiction Prevention and Recovery Administration (APRA) has taken a novel approach to the implementation of CSAP’s Strategic Prevention Framework State Incentive Grant (SPF SIG).  Instead of allowing sub-grantees to select evidence-based interventions (EBIs) from an array of available strategies, APRA prevention staff selected a smaller subset which appeared most appropriate for implementation to reduce alcohol and marijuana use in the District’s youth populations. APRA then funded sub-grantees to pilot test these EBIs to better understand the challenges and successes associated with implementing them in an urban and culturally diverse community. APRA placed equal importance on understanding implementation fidelity/adaptation and assessing behavioral impact.  APRA also examined novel implementation settings to determine the utility of the interventions within these environments with the intention of encouraging more extensive dissemination.  These environments included using community organizations to implement a mixture of individual and environmental strategies; implementing a brief intervention approach designed for selected and indicated populations; and implementing of a family intervention within an adolescent treatment environment to prevent use by the treated adolescent’s siblings. 

This mixed-methods evaluation examined implementation fidelity and adaptation through observation and implementer interviews. Participant surveys examined the direct impact of the intervention on individuals while archival and national survey data allowed for an evaluation of the effectiveness of the interventions in the District overall.

The District’s culturally diverse population faces a unique mix of socioeconomic risk factors, with some Wards demonstrating exceptionally high rates of unemployment, poverty, single parent households and low levels of education. Program implementers exhibited high fidelity to the interventions, rating an average of 14 out of 15 points on the Fidelity Rubrics Instrument.  However they noted a number of program adaptations needed to better reflect their target populations.  These included changes in the language used to reflect the more urban setting, changes in scenarios (for e.g. changing a golfing example to one focused on basketball), and swapping outdated, suburban set program videos with a more relevant role play.  Even with the adaptations implementers still viewed some of the programs as not appropriate for the District, for two programs because the program activities focused on intact nuclear families and appeared to exclude single-parent families.  The interventions demonstrated some positive impacts with participating youth showing improvements in their perceived risks of substance use and with parents reducing their acceptance of youth alcohol use and reporting more monitoring of alcohol in their homes.