Adaptations and Lessons Learned from the Pilot Implementation of the “Communities That Care” Prevention System in Three Chilean Communities

Introduction: “Communities that Care” (CTC) is an evidence-based preventive system that seeks to promote youth wellbeing and prevent drug use and other adolescent problem behaviors. We have been working to adapt the model, developed in the U.S., for use in Chile, with a pilot study that began in 2014 in three low-income communities. This poster presents results of a study that collected qualitative data, from the perspective of different key actors in the adaptation process, on the main adaptations and lessons learned. The goal of the study was to organize the information on adaptations in order to incorporate them when replicating the adapted model in other local Chilean communities.

Methods: Qualitative data were collected through (1) self-administered interviews with three local community coordinators, and (2) in-person, in-depth key informant interviews with the same three coordinators and three additional foundation staff in charge of coordinating the project, who were selected because of their knowledge of the project. The data were analyzed using an inductive qualitative approach. Interview transcripts were coded and data were classified into four dimensions, based on saturation (e.g., information appeared in at least two interviewee transcripts): (1) bonding process with the community, (2) milestones and benchmarks (tasks and goals) for each CTC phase, (3) implementation roles, and (4) implementation procedures.

Results: The main themes that emerged regarding CTC system adaptation were: (1) linguistic translation and cultural adaptation for implementation in Spanish and in the Chilean context; (2) modification of the structure and mode of CTC trainings for the community board; (3) incorporating an additional technical assistance provider (link between CTC coach and community coordinator); (4) developing a specific training for the youth involvement workgroup; (5) operationalizing the Social Development Strategy though local approaches; (6) systematizing a series of organizational and outreach activities that were performed prior to Phase 1; and (7) identifying the need for a Chilean registry of locally available and Spanish-language evidence-based programs.

Conclusions: Although a complete language translation was necessary, cultural adaptations were overall quite minimal and superficial, with most elements of the system “working” well in the new country and context. The biggest exception was the dearth of evidence-based programs already available in Chile, which affects the fidelity of CTC implementation. In light of this, key focus areas for the project in the upcoming years include fostering program development and adaptation, promoting program evaluation and developing a local registry of tested preventive programs.