GENERAL
ADAPTATION
GUIDELINES
Regina Firpo-Triplett, MPH, MCHES
Center for Sexual and Reproductive Health Promotion
1
ADAPTATION GUIDANCE PROJECTS
CDC’s Division of Reproductive Health (DRH)
o a framework to guide program adaptation
o EBI-specific guidance for informed
adaptations
o general guidance for informed adaptations
Office of Adolescent Health (OAH)
o EBI-specific guidance for informed
adaptations
OBJECTIVES
o Define common adaptation and fidelity terms
o Explain the difference between green, yellow
and red light adaptations
o Present and apply general green/yellow/red
light guidelines to common adaptation
challenges
EVIDENCE-BASED INTERVENTIONS
(EBIS)
Sexual health programs that have been
rigorously evaluated and found to effectively
reduce sexual risk taking behavior among
youth.
FIDELITY IS…
… the faithfulness with which a practitioner
implements a program.
Maintaining fidelity to a program means
implementing it without compromising its
core components.
FIDELITY CHILI
IS IT STILL CHILI?
CORE COMPONENTS
Core Components are the key elements or
defining characteristics of a program.
To maintain a program’s effectiveness, its core
components must be kept intact when it is
replicated or adapted.
Core components relate to:
• Content
• Pedagogy
• Implementation
TYPES OF CORE COMPONENTS
o Content: WHAT is being taught (knowledge,
attitudes, skills, etc.).
o Pedagogy: HOW the content is taught.
o Implementation: The LOGISTICS that are
responsible for a conducive learning
environment.
ADAPTATION IS…
…making
o Changes
o Additions
o Deletions
o Substitutions
to an EBI to make it more suitable for a
particular population and/or an organization’s
capacity.
INFORMED ADAPTATIONS…
….are adaptations that do not
compromise or delete the
program’s core components.
REASONS FOR ADAPTATIONS
o Meet the Needs of the Population
o Stay within Organizational Capability
GREEN / YELLOW / RED ADAPTATION
FRAMEWORK
GO Caution STOP
GREEN YELLOW RED
LIGHT ADAPTATIONS
Provides guidance on
whether a particular
adaptation is …
…safe (green)
…should be made
cautiously (yellow)
…should be avoided (red)
GREEN LIGHT ADAPTATIONS
o Updating and/or customizing
statistics and other reproductive
health information
o Customizing role play scenarios (e.g.,
names, setting, language, terms)
o Making activities more interactive,
appealing to different learning styles
o Tailoring learning activities to youth
culture, developmental stage, gender,
sexual orientation
GREEN LIGHT ADAPTATIONS
– CLOSE UP
o Updating and/or
customizing statistics and
other reproductive health
information.
GREEN LIGHT ADAPTATIONS
– CLOSE UP
o Customizing role play
scenarios (e.g., names,
setting, language, terms)
GREEN LIGHT ADAPTATIONS
– CLOSE UP
o Making activities more
interactive, appealing to
different learning styles
GREEN LIGHT ADAPTATIONS
– CLOSE UP
o Tailoring learning
activities to youth culture,
developmental stage,
gender, sexual orientation
GREEN LIGHT ADAPTATIONS
o Updating and/or customizing
statistics and other reproductive
health information
o Customizing role play scenarios (e.g.,
names, setting, language, terms)
o Making activities more interactive,
appealing to different learning styles
o Tailoring learning activities to youth
culture, developmental stage, gender,
sexual orientation
YELLOW LIGHT
ADAPTATIONS
o Changing the order of sessions or
sequence of activities
o Adding activities to reinforce
learning
o Adding activities to address
additional risk and protective factors
o Modifying condom activities
o Replacing or supplementing videos
or activities with other videos
o Implementing the program with a
different population
o Implementing the program in a
different setting
YELLOW LIGHT
ADAPTATIONS – CLOSE UP
oChanging the order of
sessions or sequence
of activities
YELLOW LIGHT
ADAPTATIONS – CLOSE UP
oAdding activities to
reinforce learning
YELLOW LIGHT
ADAPTATIONS – CLOSE UP
oAdding activities to
address additional
risk and protective
factors
YELLOW LIGHT
ADAPTATIONS – CLOSE UP
oModifying condom
activities
YELLOW LIGHT
ADAPTATIONS – CLOSE UP
o Replacing or
supplementing videos
with other videos
and
o Replacing or
supplementing activities
with videos
YELLOW LIGHT
ADAPTATIONS – CLOSE UP
oImplementing the
program with a
different population
YELLOW LIGHT
ADAPTATIONS – CLOSE UP
oImplementing the
program in a different
setting
YELLOW LIGHT
ADAPTATIONS
o Changing the order of sessions or
sequence of activities
o Adding activities to reinforce
learning
o Adding activities to address
additional risk and protective factors
o Modifying condom activities
o Replacing or supplementing videos
or activities with other videos
o Implementing the program with a
different population
o Implementing the program in a
different setting
RED LIGHT ADAPTATIONS
o Shortening a program
o Reducing or eliminating activities
that allow youth to personalize risk
o Reducing or eliminating
opportunities for skill practice
o Removing condom activities
o Contradicting, competing with, or
diluting the program’s goals
o Replacing interactive activities with
lectures or individual work
RED LIGHT ADAPTATIONS -
CLOSE UP
oShortening a
program
RED LIGHT ADAPTATIONS -
CLOSE UP
oReducing or
eliminating
activities that allow
youth to personalize
risk
RED LIGHT ADAPTATIONS -
CLOSE UP
oReducing or
eliminating
opportunities for
skill practice
RED LIGHT ADAPTATIONS -
CLOSE UP
oRemoving condom
activities
RED LIGHT ADAPTATIONS -
CLOSE UP
oContradicting,
competing with, or
diluting the
program’s goals
RED LIGHT ADAPTATIONS -
CLOSE UP
oReplacing
interactive activities
with lectures or
individual work
RED LIGHT ADAPTATIONS
o Shortening a program
o Reducing or eliminating activities
that allow youth to personalize risk
o Reducing or eliminating
opportunities for skill practice
o Removing condom activities
o Contradicting, competing with, or
diluting the program’s goals
o Replacing interactive activities with
lectures or individual work
APPLYING THE GUIDELINES
PATRICIA’S CHALLENGE
1. Replace videos with TV
clips?
2. Add lesson about
alcohol and sexual
decision-making?
3. Change names in role
plays?
4. Add info on HPV
vaccine?
39
‹#›
PATRICIA’S CHALLENGE
1. Replace videos with TV
clips? Yellow Light
2. Add lesson on alcohol
& sexual decision-
making? Yellow Light
3. Change names in role
plays? Green Light
4. Add info on HPV
vaccine? Green Light
40
‹#›
EDDIE’S
CHALLENGE
1. Single sex
groups?
2. Addressing local
prevalent myths?
3. Show video
instead of doing
the condom
demonstration?
4. Teach two
lessons back-to-
back in block
schedule?
41
EDDIE’S CHALLENGE
1. Single sex groups?
Green Yellow Red
2. Addressing local
prevalent myths?
Green
3. Show video
instead of doing
the condom
demonstration?
Yellow
4. Teach two lessons
back-to-back in
block schedule?
Yellow 42
EDDIE AND PATRICIA ARE READY TO GO NOW
EBI-SPECIFIC ADAPTATION KIT
1. Logic Model
2. Core Components
3. Green, Yellow and Red Light
Adaptations
4. Fidelity Monitoring Logs
EBI-SPECIFIC ADAPTATION KITS
ETR’s ReCAPP website
www.etr.org/recapp
o Becoming a Responsible Teen
o Reducing the Risk
o Safer Choices
o SIHLE (in process)
o Draw the Line/Respect the Line (in process)
o All 4 You (in process)
o Safer Sex intervention (in process)
OTHER RESOURCES FOR MAKING
ADAPTATIONS
US Department of Health and Human Services, Substance Abuse and Mental
Health Services Administration Center of Substance Abuse Prevention. (2002).
Finding the Balance: Program Fidelity and Adaptation in Substance Abuse
Prevention: Executive Summary of a State-of-the-Art Review.
Kirby, D. & LePore, G. (2007). Sexual Risk and Protective Factors: Factors
Affecting Teen Sexual Behavior, Pregnancy, Childbearing, and Sexually
Transmitted Disease: Which are Important? Which can You Change? Scotts
Valley, CA: ETR Associates.
McKleroy, V. S., Galbraith, J. S., Cummings, B., Jones, P., Harshbarger, C.,
Collins, C., Gelaude, D., Carey, J. W., & the ADAPT Team. (2006). Adapting
evidence-based behavioral interventions for new settings and target
populations. AIDS Education and Prevention, 18, Supplement A, 59-73.
Solomon, J., Card, J. J., & Malow, R. M. (2006). Adapting efficacious
interventions: Advancing translational research in HIV prevention.
Evaluation & Health Professions, 29(2), 162-194.
Tortolero, S. R., Markham C. M., Parcel, G. S., Peters, R. J., Escobar-Chaves,
L., Basen-Enquist K., & Lewis, H. L. (2005). Using Intervention Mapping to
Adapt an Effective HIV, Sexuality Transmitted Disease, and Pregnancy
Prevention Program for High-Risk Minority Youth. Health Promotion Practice,
6, 286.
Wingood, G. M., DiClemente, R. J. (2008). The ADAPT-ITT model: A novel
method of adapting evidence-based HIV interventions. Acquired Immune
Deficiency Syndrome, 47, Supplement 1.
ACT FOR YOUTH
CENTER FOR EXCELLENCE
o Youth development and adolescent sexual
health resources: www.actforyouth.net
o Youth site with resources on sexual health,
leadership, rights and more:
www.nysyouth.net
Please give us your feedback on this presentation at:
http://www.zoomerang.com/Survey/WEB22AEZWMYJH3
CONTACT INFORMATION
Regina Firpo-Triplett, MPH, MCHES
ETR Associates
reginaf@etr.org
Check out the Resource Center for Adolescent
Pregnancy Prevention
www.etr.org/recapp