Background:
Adaptations are often made to evidence-based practices (EBPs) by systems, organizations,and/or service providers in the implementation process. The degree to which core elements ofan EBP can be maintained while allowing for local adaptation is unclear. In addition,adaptations may also be needed at the system, policy, or organizational levels to facilitateEBP implementation and sustainment. This paper describes a study of the feasibility andacceptability of an implementation approach, the Dynamic Adaptation Process (DAP),designed to allow for EBP adaptation and system and organizational adaptations in a plannedand considered, rather than ad hoc, way. The DAP involves identifying core elements andadaptable characteristics of an EBP, then supporting implementation with specific training onallowable adaptations to the model, fidelity monitoring and support, and identifying the needfor and solutions to system and organizational adaptations. In addition, this study addresses asecondary concern, that of improving EBP model fidelity assessment and feedback in realworldsettings.
Methods:
This project examines the feasibility, acceptability, and utility of the DAP; tests the degree towhich fidelity can be maintained using the DAP compared to implementation as usual (IAU);and examines the feasibility of using automated phone or internet-enabled, computer-basedtechnology to assess intervention fidelity and client satisfaction. The study designincorporates mixed methods in order to describe processes and factors associated withvariations in both how the DAP itself is implemented and how the DAP impacts fidelity,drift, and adaptation. The DAP model is to be examined by assigning six regions inCalifornia (USA) to either the DAP (n = 3) or IAU (n = 3) to implement an EBP to preventchild neglect.DiscussionThe DAP represents a data-informed, collaborative, multiple stakeholder approach tomaintain intervention fidelity during the implementation of EBPs in the field by providingsupport for intervention, system, and organizational adaptation and intervention fidelity tomeet local needs. This study is designed to address the real-world implications of EBPimplementation in public sector service systems and is relevant for national, state, and localservice systems and organizations.