As organizations try to implement evidence-based programs and practices during the COVID-19 pandemic, they face new implementation challenges. One of the common issues is how to adapt evidence-based programs/practices and implementation strategies to accommodate for changes to the way we work and live during the pandemic. Just as we want our implementation efforts to be based on evidence and the use of implementation science theories, models, and frameworks, we want our adaptation efforts to also be guided by evidence, theories, models, and frameworks.
If you are facing the need to adapt, there are 4 key questions that can guide you to better plan for and address adaptations.
1) Why are you adapting? What is the reason for your adaptation?
Before the pandemic, common reasons to adapt included implementing in a new setting or with a new population. Currently, the most common reason is because of changes that are a result of the pandemic. No matter the reason, it is good to ask the question and make sure that everyone involved understands why you are making adaptations.
2) What is the purpose of adapting? What is your goal in making an adaptation?
Before the pandemic, people adapted for a host of reasons, for example to increase recruitment or retention. Now, one of the main goals is to fit the intervention into the new way of work (e.g., providing services virtually).
3) What is the nature of the adaptation? Provide a clear description of the adaptation and how it is different than the original intervention.
We have found that people often think about why they are adapting and the purpose of the adaptation, but then jump into the adaptation without clearly describing the nature of the adaptation and how it is different than the original intervention. Just like people need clear guidance on what success looks like (e.g., in the form of a practice profile), we need the same level of rigor to describe what the adaptations look like. This is essential for both the people implementing and delivering interventions and for the people evaluating those efforts. Stirman's FRAME is a great framework to help you think through the different types of adaptations.
4) What is the potential impact of the adaptation? Will it change the effectiveness of the intervention?
Although we do not know the impact of adaptations until we evaluate them, if we truly understand the underlying mechanism of change/the theory of change, we can hypothesize the potential impact of different adaptations. Ideally, we should be making adaptations that do not change the underlying function/mechanism of change of the interaction. However, some adaptations are clearly likely to be detrimental to the effectiveness of an intervention. Given the current context, we have seen situations where people were required to make adaptations hypothesized to be detrimental because no alternative exists at this moment. When that happens, we should be very aware of the potential impact of those adaptations and make sure that our evaluation efforts help us understand whether or not we have adversely impacted the effectiveness of the intervention.
As we seek to provide timely and responsive implementation support to public service systems and organizations during the COVID-19 pandemic, we will inevitably find ourselves planning for potential adaptations to implementation strategies and intervention components due to constraints on how we can deliver interventions and the shifting needs of the people and communities we hope benefit from these interventions. Planning for adaptations should be informed by key principles that guide our implementation practice including curiosity, empathy, and being methodical.
We need to remain curious during the pandemic by continually asking questions, tolerating uncertainty, and engaging with different forms of evidence to make informed decisions about adaptations. We also need to enter into conversations with empathy, understanding that different perspectives related to adaptations may emerge during the crisis. For example, public child welfare systems are currently grappling with how to make adaptations to implementation strategies and intervention components during the pandemic. Adaptations to implementation strategies such as shifting staff training to virtual platforms may be easily agreed upon by different stakeholder groups such as service providers, model developers and public agencies. However, other adaptations that involve changing core interventions components, such as family engagement, may be less easily agreed upon as stakeholders consider how to balance model fidelity with real world challenges to service delivery in the COVID environment. This type of planning also requires a methodical approach, where we collaborate with different stakeholders to share data and use evidence to make informed decisions about adaptations that will be both feasible and beneficial.
We invite you to listen to this recording of our conversation where we discuss how to plan for adaptations during a pandemic and beyond. More information regarding principles to guide implementation practice can be found here.
Julia Moore is Senior Director of the Center for Implementation. She has worked on over 100 implementation projects and is most passionate about supporting professionals to use implementation science in practical and useful ways. The Center for Implementation provides online learning opportunities in implementation science at https://thecenterforimplementation.teachable.com.
Allison Metz is Director of the National Implementation Research Network (NIRN), a Senior Research Scientist at the Frank Porter Graham Child Development Institute, Research Professor at the School of Social Work, and Adjunct Professor at the School of Global Public Health at The University of North Carolina at Chapel Hill.